Electrolyte and Fluid Disorders

The kidneys play an important role in the regulation of fluids and electrolytes, and when they malfunction it often leads to an electrolyte imbalance. Electrolytes are charged particles involved in the transmission of impulses in the nerve and muscles. When imbalances occur, this can lead to serious complications and even death.

Loss of normal renal function may lead to major changes in the fluid and sodium balance. Loss of renal function leads to retention of potassium and magnesium with serious systemic and cardiovascular consequences, including cardio-respiratory compromise and collapse, as well as cardiac dysrhythmias. While treating cases with renal or kidney dysfunction, it is necessary to identify the fluid and electrolyte disorders so as to manage the clinically significant changes effectively. The treatments for kidney dysfunction may themselves cause a disturbance in the fluid and electrolyte homeostasis, particularly the use of diuretics and renal replacement therapy.

Causes and Symptoms

There are several different causes of electrolyte disorders, including medications, chronic diseases and trauma. Symptoms vary according to the type of electrolyte disorder, but some of the most common ones are dehydration, concentrated urine, loss of skin elasticity, irregular heartbeat, irritability, fatigue, difficulty in breathing, muscle twitching or seizures, nausea, headache, swelling, paralysis, disorientation, coma, diarrhea, muscle pain, cardiac arrest, tingling in hands/fingers, convulsions, weight loss and bone deformities.

Diagnosis and Treatment

A simple blood test can measure the levels of the electrolytes in your body. Your doctor may want to perform a physical exam or order extra tests to confirm a suspected electrolyte disorder.

Treatment depends upon the underlying cause of the problem and the type of electrolyte involved. If the disorder is caused by poor diet or improper fluid intake, nutritional changes may be prescribed. If medications trigger the imbalance, they may be discontinued or adjusted. Fluid and electrolyte replacement therapy – either orally or intravenously – can reverse the depletion.

The most effective way to treat electrolyte disorders in a patient who has renal failure is by careful management of fluid balance, which involves thoughtful assessment of hydration, a fluid treatment plan personalized for the specific patient, repeated and frequent reassessment of the fluid and electrolyte balance, and appropriate changes in the treatment plan in response to the rapidly changing clinical situation. Disorders of sodium, chloride, potassium, calcium and phosphorus are commonly encountered in renal failure and may be life threatening. Treatment of metabolic acidosis and nutritional support are recommended and necessary.