I.
Introduction to Electrolytes
Definition:
Electrolytes are charged minerals (ions) in body fluids that are essential for many
physiological functions, including nerve conduction, muscle contraction, hydration, pH
balance, and enzyme activity.
II. Major Electrolytes and Normal Ranges
Electrolyte Symbol Normal Main
Range Function
(Serum)
Sodium Na⁺ 135–145 Osmotic
mEq/L balance,
nerve/muscl
e function
Potassium K⁺ 3.5–5.0 Heart
mEq/L rhythm,
muscle
contraction
Chloride Cl⁻ 98–106 Acid-base
mEq/L balance,
osmotic
pressure
Bicarbonate HCO₃⁻ 22–28 mEq/L Buffer
system (pH
balance)
Calcium Ca²⁺ 8.5–10.5 Muscle
(total) mg/dL function,
nerve
transmission
, bone
Ionized Ca²⁺ 4.5–5.6 Active form
Calcium mg/dL used in
physiology
Magnesium Mg²⁺ 1.5–2.5 Enzyme
mEq/L cofactor,
neuromuscu
lar function
Phosphate PO₄³⁻ 2.5–4.5 ATP
mg/dL production,
bone
metabolism
III. Sodium (Na⁺)
Main extracellular cation
Regulated by aldosterone, ADH, and kidneys
Disorders:
Hyponatremia (<135 mEq/L):
Causes: SIADH, diuretics, heart failure
Symptoms: Confusion, seizures, coma
Hypernatremia (>145 mEq/L):
Causes: Dehydration, diabetes insipidus
Symptoms: Thirst, restlessness, weakness
IV. Potassium (K⁺)
Main intracellular cation
Maintains membrane potential and cardiac function
Disorders:
Hypokalemia (<3.5 mEq/L):
Causes: Vomiting, diarrhea, diuretics
Symptoms: Muscle weakness, arrhythmias, ECG changes (U waves)
Hyperkalemia (>5.0 mEq/L):
Causes: Renal failure, tissue damage
Symptoms: Palpitations, paralysis, peaked T waves on ECG
V. Chloride (Cl⁻)
Works with sodium to maintain osmotic pressure
Involved in acid-base balance
Disorders:
Hypochloremia: Seen in vomiting, metabolic alkalosis
Hyperchloremia: Seen in dehydration, metabolic acidosis
VI. Bicarbonate (HCO₃⁻)
Primary buffer for maintaining blood pH
Regulated by lungs (CO₂) and kidneys
Used in:
Arterial Blood Gas (ABG) interpretation
Diagnosing metabolic acidosis/alkalosis
VII. Calcium (Ca²⁺)
99% stored in bones, 1% in blood
Exists as bound (to albumin) and ionized (active)
Controlled by PTH, vitamin D, calcitonin
Disorders:
Hypocalcemia (<8.5 mg/dL):
Causes: Hypoparathyroidism, renal failure
Symptoms: Tetany, Chvostek’s & Trousseau’s signs
Hypercalcemia (>10.5 mg/dL):
Causes: Hyperparathyroidism, malignancy
Symptoms: Stones, bones, groans, and psychiatric overtones
VIII. Magnesium (Mg²⁺)
Intracellular cation, cofactor in >300 enzymes
Regulated by kidneys
Disorders:
Hypomagnesemia (<1.5 mEq/L):
Causes: Alcoholism, malabsorption
Symptoms: Neuromuscular irritability, arrhythmias
Hypermagnesemia (>2.5 mEq/L):
Causes: Renal failure, excessive antacids
Symptoms: Muscle weakness, hypotension, bradycardia
IX. Phosphate (PO₄³⁻)
Component of ATP, nucleic acids, bones
Inversely related to calcium
Disorders:
Hypophosphatemia:
Causes: Malnutrition, alcoholism, refeeding syndrome
Symptoms: Weakness, confusion, bone pain
Hyperphosphatemia:
Causes: Renal failure, hypoparathyroidism
Symptoms: Often asymptomatic, possible calcification
X. Electrolyte Panel Interpretation
Common Patterns:
Condition Na⁺ K⁺ HCO₃⁻ Cl⁻
Dehydrati ↑ Normal ↑ ↑
on
Renal ↓/↑ ↑ ↓ ↑
failure
Vomiting ↓ ↓ ↑ ↓
Diarrhea ↓ ↓ ↓ ↓
DKA ↓/normal ↑/↓ ↓ ↑
(diabetic
ketoacido
sis)
XI. Regulation of Electrolytes
Hormonal Control:
Aldosterone – ↑ Na⁺ retention, ↓ K⁺
ADH (vasopressin) – Water retention, affects Na⁺ concentration
PTH – ↑ blood calcium
Calcitonin – ↓ blood calcium
Vitamin D – ↑ absorption of Ca²⁺ and phosphate
XII. Clinical Relevance
Electrolyte imbalances can lead to:
Cardiac arrhythmias
Seizures
Acid-base disturbances
Neuromuscular symptoms
Routine tests: BMP (Basic Metabolic Panel), CMP (Comprehensive Metabolic Panel), ABG
(for HCO₃⁻ and pH)
