Electrolytes such as sodium, potassium, calcium and bicarbonate keep your nerves, muscles and heart working properly, and the kidneys keep them in balance. When these levels become too high or too low, symptoms can range from mild tiredness to serious heart rhythm problems. Dr. Satarupa Deb evaluates and treats electrolyte and acid-base disorders at Bombay Hospital, South Mumbai.
What Are Electrolyte and Acid-Base Disorders?
Electrolytes are minerals dissolved in body fluids that carry an electrical charge. The kidneys fine-tune their levels by deciding how much to keep and how much to pass in the urine. They also help maintain the body's acid-base balance, keeping blood pH within a narrow healthy range.
An electrolyte disorder occurs when a level falls outside the normal range. An acid-base disorder occurs when the blood becomes too acidic (acidosis) or too alkaline (alkalosis).
Common Disorders and Causes
These imbalances may result from kidney disease, other illnesses, medicines or fluid losses.
- Low sodium (hyponatraemia): heart, liver or kidney disease, some diuretics and antidepressants, excess water intake or hormonal conditions
- High or low potassium: kidney disease, certain blood pressure medicines, diuretics, vomiting or diarrhoea
- Calcium, phosphate and magnesium imbalances: kidney disease, parathyroid or vitamin D problems
- Metabolic acidosis: chronic kidney disease, diarrhoea, uncontrolled diabetes or renal tubular acidosis
- Metabolic alkalosis: prolonged vomiting or diuretic use
Symptoms
Mild imbalances often cause no symptoms and are found on routine blood tests. More significant disturbances may cause:
- Weakness, fatigue or muscle cramps
- Confusion, headache, drowsiness or seizures, particularly with sodium problems
- Palpitations or irregular heartbeat, particularly with potassium problems
- Nausea, vomiting or loss of appetite
- Rapid or deep breathing in severe acidosis
Diagnosis
Finding the underlying cause is as important as correcting the number itself. Your nephrologist will review your medical history, medicines and fluid status.
- Blood electrolytes, creatinine, glucose and venous or arterial blood gas
- Urine sodium, potassium and osmolality
- Serum osmolality, thyroid and cortisol tests where relevant
- ECG when potassium or calcium is abnormal
- Kidney ultrasound and further tests for tubular disorders if needed
Treatment
Treatment depends on the type, severity and speed of onset of the imbalance, and on its cause. It may involve adjusting or stopping medicines, changing fluid intake, dietary advice, oral or intravenous replacement, or medicines that help remove excess potassium or correct acidosis.
Some disorders, especially low sodium, must be corrected gradually under close monitoring, since correcting too quickly can itself be harmful. Severe cases are treated in hospital, and occasionally dialysis is needed.
Once the imbalance has been corrected, follow-up blood tests help confirm that levels remain stable. People with chronic kidney disease, heart failure or those taking diuretics often need regular monitoring, as their electrolyte levels can change with illness, diet or medicine adjustments.
When to See a Nephrologist
See a nephrologist if you have repeated or unexplained abnormalities in sodium, potassium, calcium or bicarbonate, electrolyte problems linked to kidney disease, or imbalances that keep returning despite treatment. Seek emergency care for confusion, seizures or palpitations.
Frequently Asked Questions
Can drinking too much water be harmful?
In some people, especially those with heart, liver or kidney problems or on certain medicines, drinking very large amounts of water can lower sodium levels. Follow the fluid advice your doctor gives you.
Why is high potassium dangerous?
High potassium can affect the electrical activity of the heart and may cause dangerous rhythm problems, sometimes without warning symptoms. It needs prompt evaluation, especially in people with kidney disease.
Should I avoid fruits if my potassium is high?
Some fruits, vegetables and coconut water are high in potassium. If your potassium is high, your doctor or dietitian can advise which foods to limit, rather than cutting out all fruit.
Can my regular medicines affect electrolytes?
Yes. Diuretics, some blood pressure medicines, painkillers and certain antidepressants can affect sodium or potassium. Bring a list of all your medicines, including supplements, to your appointment.
Consult Dr. Satarupa Deb
If your blood tests show an electrolyte or acid-base imbalance, book a consultation with Dr. Satarupa Deb at Bombay Hospital, South Mumbai, to find and treat the cause.
This page is for general information only and is not a substitute for a medical consultation. Please consult a qualified doctor for diagnosis and treatment.