Electrolyte Imbalances mean what?

Our pathology results may include electrolyte results. They are the 'E' in 'UEC' test request. What are they and what do imbalances in the results mean?

Electrolytes are minerals in our body that carry an electric charge. They help regulate many of our body systems including heart rhythms, nerves, and muscles. They are also involved in helping maintain the amount of fluid and the acid-base balance in our bodies. The kidneys control electrolyte concentrations in the blood so the most common cause of electrolyte imbalance is kidney dysfunction.

What do Electrolyte Imbalances Mean?

Electrolyte tests are used along with other tests to assess how well the following are working:

• Kidneys

• Liver

• Hormones

Your kidneys work to keep electrolyte concentrations in the blood at a constant level no matter what changes take place in the body. They do this through the reabsorption of electrolytes back into the blood or by elimination into the urine. Therefore, the most common cause of electrolyte imbalance is when our kidneys aren't working properly. This is known as kidney dysfunction.

Kidneys work to keep electrolyte concentrations at a constant level.

Image source

In addition, electrolytes can give you an early heads up warning that things are not optimal. This is discussed with each of the individual electrolytes below.

Individual Electrolytes Discussed

The biochemical symbol for Sodium is Na+

Sodium Interpretation

Reference Ranges for Optimal Health

Female Adults: 136 - 140 mmol/L (138)

Male Adults: 137 - 143 mmol/L (140)

LOW SODIUM

• Low sodium from lost fluid - from chronic diarrhoea, vomiting, inflammatory bowel disease, excess sweating, diuretics, eating disorders, kidney disease. Hypocortisolism, Adrenal disorders - including chronic stress & Addison's disease, aldosterone deficiency.

• Low sodium from excess fluid intake or retention. Examples: Over-hydration in competitive athletes, pregnancy, congestive heart failure, cirrhosis, acute and chronic kidney disease, malnutrition, Nephrotic Syndrome, and oedema.

• Medications like diuretics, and SSRI's can lower blood sodium levels.

• Low sodium occurs in chronic mild metabolic acidosis. It follows a low bicarbonate reading and above normal anion gap reading.

ELEVATED SODIUM

• The most common cause of elevated Sodium is dehydration. Presentation will be dry mouth, thirst, dry mucous membranes, and dry eyes. Blood Pressure may be also elevated.

• Renal dysfunction

• Higher androgens in females e.g. Polycystic Ovarian Syndrome (PCOS)

• Sympathetic Nervous System (SNS) over activation e.g. excess liquorice consumption

• Altered regulation (medications)

The biochemical symbol for Potassium is K+

Potassium Interpretation

Reference Range for Optimal Health

Female Adults: 3.6 - 4.55 mmol/L (4.1)

Male Adults: 3.8 - 4.55 mmol/L (4.2)

LOW POTASSIUM

• Low potassium from lost fluid - from diarrhoea, vomiting, excess sweating, diuretics,laxatives, PPI's.

• As an aside, magnesium deficiency impairs Vitamin D metabolism and lowers calcium and potassium levels eventually leading to osteoclastic behaviour, or bone breakdown.

ELEVATED POTASSIUM

• Metabolic acidosis.

• Hyperglycaemia, diabetes, kidney disease, infection, injury to tissues may all result in elevated potassium.

• Potassium levels may rise with dehydration. Presentation will be dry mouth, dry mucous membranes, and dry eyes.

• Altered regulation by medications - antihypertensive drugs, non-steroidal anti-inflammatories, potassium sparing diuretics.

• Hyperglycaemia as in uncontrolled diabetes

• Injury to tissue, exercise, Addison's disease, Kidney disease.

• The blood sample could be haemolysed - an increase in LDH will support this finding, and the laboratory should report it.

  
  

The biochemical symbol for Chloride is Cl-

Chloride Interpretation

Reference Range for Optimal Health Female Adults: 106-107 mmol/L

Male Adults: 106-107 mmol/L

CHLORIDE IS GENERALLY STABLE

• One time that chloride levels may dip is if blood sample is collected immediately after eating, as chloride is sequestered for HCl (stomach acid) usage to assist the breakdown of food. As most samples are fasting samples, this should rarely be a factor.

  
  

The biochemical symbol for Bicarbonate

Bicarbonate Interpretation

Reference Range for Optimal Health Female Adults: 23-27 mmol/L (>26)

Male Adults: 23-27 mmol/L (>26)

LOW BICARBONATE

• Reflects the acidic burden in your body from overconsumption of meat, carbohydrates, sugars etc. The lower the HCO3- result will be, reflects it has been consumed to bind to the acidic load in the body for elimination via kidneys and lungs. e.g.diabetes.

• Bicarbonate can be likened to the fire retardant spray used on fires. If there is too much of a fire, we likely have lower levels of the retardant left to fight the fire.

• Fasting blood collections should be performed after 8-10 hours. Should the testing occur after a longer fasting time, the bicarbonate levels may be decreased.

ELEVATED BICARBONATE

• Reflects a healthy diet full of green, leafy vegetables (alkaline foods) that will provide less of an acidic burden for the body so HCO3- levels will remain high as they haven't consumed to reduce the acidic burden.

  
  

Anion Gap

Anion Gap Interpretation

Reference Range for Optimal Health Female Adults: 10-12 (<14)

Male Adults: 10-12 (<14)

Anion Gap = (Na + K) - (Cl + HCO3)

ELEVATED ANION GAP

• Elevation in Fasting Anion Gap as per the formula above, reflects inflammation, and a very high result (>16) can reflect insulin resistance.

  
  

Biochemical symbol for Magnesium is Mg++

Magnesium Interpretation

Reference Range for Optimal Health Female Adults: 0.7-0.85 mmol/L (>0.85)

Male Adults: 0.7-0.85 mmol/L (>0.85)

LOW MAGNESIUM

• Low Magnesium can be form a low magnesium diet. Magnesium is prevalent in leafy, green vegetables so a diet high in those will help magnesium levels. However, harvesting soils are relatively deficient in magnesium as our soils are often overworked now, so supplementation is often required especially as chronic disease increases.

• Loss of magnesium can occur from the gut, intestines may not absorb nutrients, or our kidneys may excrete too much magnesium. Elderly, or malnourished individuals, those with GIT issues, diabetes, prolonged diarrhoea, on diuretics, may suffer.

ELEVATED MAGNESIUM

• Laxatives containing magnesium

• Impaired kidneys

• Hypothyroidism

HOW IMPORTANT IS MAGNESIUM?

Magnesium deficiency blocks calcium regulation. A reduction in Calcium leads to an up-regulation of PTH which requires magnesium to convert to Vitamin D.

Without magnesium, people can become Vitamin D & calcium deficient, as well as the original magnesium deficiency.

Magnesium deficiency often coincides with reduced bicarbonate, as magnesium deficiency (not enough green, leafy vegetables) often coincides with a diet high in ultra-processed foods.

Biochemical symbol for Calcium is Ca++

Calcium Interpretation

Reference Range for Optimal Health Female Adults: 2.1-2.3 mmol/L (<2.3)

Male Adults: 2.1-2.4 mmol/L (<2.3)

EXPLANATORY NOTES ON CALCIUM

• 99% of calcium is found in our bones, with only 1% in blood. The total calcium we measure in blood is 50% active or free (measured as ionised calcium), and the other 50% is inactive and bound to albumin. It does not reflect the Calcium we eat.

• The ionised calcium result (free or active Calcium) is the preferable measurement.

LOW CALCIUM

• Hypoparathyroidism

• Low Vitamin D Magnesium deficiency

• Increased phosphate levels

• Alcoholism, malnutrition, pancreatitis, renal failure.

ELEVATED CALCIUM

• Hyperparathyroidism

• Hyperthyroidism

• Excess Vitamin D

• Cancer

If you would like to discuss your own pathology results in line with your own personal circumstances, feel free to make a booking with me on the bookings tab on my website.

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References:

Electrolytes

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