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Electrolyte Imbalance

The human body is composed of up to 60 % water. Adequate fluid and electrolyte levels are essential for healthy functioning of all organs and body systems. Electrolytes are found in the blood, urine, tissues and body fluids. Sodium, calcium, potassium, chlorine, phosphate and magnesium play an important role conducting electric charge within the body. These minerals must be maintained in the appropriate ratio for proper functioning of the muscles, nerves, brain and heart. If there is any imbalance in their ratio, which usually occurs due to change in water levels in the body, electrolyte imbalance will occur. The kidneys work as major regulators of the electrolyte balance. Kidney malfunction results in excessive electrolyte retention or excretion resulting in an imbalance.


Symptoms of electrolyte imbalance vary with the electrolyte. Typical symptoms of electrolyte imbalance include fatigue, dizziness, excessive sweating, cold extremities and trembling. Swelling in the feet, ankles, legs, and hands might also be due to a fluid and electrolyte imbalance. There might be nausea, reduced urine output, dark urine, dry skin, aching joints and dry mouth. In cases of severe electrolyte imbalance, there might be convulsions and seizures.

Urine test and blood tests are done to evaluate the electrolyte imbalance. Often kidney ultrasound or EKG might be ordered. Based on the electrolyte that is out of balance, treatment includes dietary changes, fluid intake restrictions and medications to correct the imbalance. Often medication like corticosteroids, laxatives, cough medicines, diuretics and oral contraceptives can cause changes in the electrolyte balance.

Hyponatremia: Imbalance in sodium concentration in the plasma.

Hypokalemiaa: Deficiency of potassium in the bloodstream.

Hypercalcemia: Elevated calcium level in the blood.

Dehydration

Water forms a large part of our bodies and plays no small role in vital functions such as eliminating waste, transporting and absorbing nutrients and formation of body fluids. Dehydration occurs when a body loses more fluids than normal and the body faces shortage of water for normal functioning. While this condition can happen at any age, it can be very dangerous in babies and young children. Untreated severe dehydration can lead to seizures, permanent brain damage or death.


1. Gastrointestinal illness leading to diarrhea and vomiting can lead to dehydration. If a person does not replenish the water levels in the body with timely fluids, tremendous loss of water and electrolytes in a short amount of time is noticed. This can be life threatening in small babies and older persons.

2. Athletes, wrestlers and those engaging in sports may sweat and lose body water. Saunas and steam baths also have a dehydrating effect on the body. It can lead to electrolyte imbalance.

3. Fad diets, laxatives and diuretics can lead to dehydration.

4. Going out on a warm day and excessive sweating can cause the body to become dehydrated.

5. Aerated drinks, tea and coffee add to dehydrating effect

6. A person who is ill and running fever is more likely to become dehydrated.


Some of the symptoms of dehydration are dizziness and dry or sticky mouth. The dehydrated person produces less urine of a darker color. Low blood pressure and poor skin turgor are noticed. Dehydration can lead to dizziness and listlessness. In an infant it is imperative to recognize the symptoms of dehydration. The infant may become lethargic and have a marked sunken fontanelle (soft spot on the top of the head). The child may pass blood in the stools.


Drinking plenty of water and electrolytes can help in tackling dehydration. For severe cases of dehydration, intravenous fluids and hospitalization will be needed.


Delirium Tremens

Delirium Tremens or DT is a serious condition of alcohol withdrawal syndrome. DT leads to sudden and severe mental and nervous system changes.


Causes of Delirium Tremens

When a person suddenly stops drinking alcohol after a period of heavy consumption, and does not eat enough food, delirium tremens occurs. This means, a person consuming 4-5 pints of wine or 7-8 pints of beer of a pint of hard alcohol every day for several months. This could happen to people with more than a decade of drinking alcohol.

One important reason is that in long term drinkers, alcohol interferes with body's ability to regulate a neurotransmitter called GABA. In chronic alcohol abuse, the body mistakes alcohol for GABA and reacts to this by reducing its production of the neurotransmitter. As alcohol levels falls too low, it means there is not enough GABA for proper functioning. This can also occur due to infection, injury and illness in people with a history of heavy alcohol use and abuse.


Signs and symptoms of Delirium Tremens

Symptoms normally occur within 72 hours of the last drink, but they can also occur up to 10 days after the last drink. Common symptoms include:


  • Body tremors
  • Functional changes
  • Agitation
  • Anger and irritability
  • Confusion and loss of focus
  • Reduced attention span
  • Deep sleep that lasts for a day or longer
  • Excitement and fear
  • Hallucination
  • Hyperactivity
  • Quick mood reversals
  • Restlessness
  • Sensitivity to light, sound and touch
  • Sleeplessness and fatigue.

There could be seizures, most commonly in the first 12-48 hours after the last drink. As DT can temporarily reduce the amount of blood flow to the brain, symptoms as confusion, disorientation, stupor and loss of consciousness and hallucinations occur. There are other medical complications that can arise due to alcohol abuse. These include:


  • Alcoholic liver disease
  • Cardiomyopathy
  • Neuropathy
  • Blood clotting disorders
  • Wernicke Korsakoff's syndrome, a brain disorder due to thiamine deficiency
  • Injury from fall during seizures
  • Irregular heartbeat which can be life threatening
  • Delirium and injury to self/others in a state of confusion

The body goes through change due to withdrawal of alcohol when a person suddenly stops drinking after prolonged use. Alcohol has a slowing and sedating effect on the brain and the brain of a long term drinker is conditionally exposed to the depressant effect of alcohol. The brain starts producing naturally stimulating chemicals to compensate for the effect of alcohol. Hence, if the alcohol is withdrawn suddenly, the brain is lost. This dangerous condition of delirium tremens occurs in almost 1 out of every 20 persons. In this condition the brain is unable to read the chemistry after alcohol is stopped and therefore creates a temporary confusion leading to dangerous changes in the way the brain regulates body circulation and breathing. This creates risk of heart attack, stroke and death.


Diagnosis of DT

Blood tests can be done to assess blood magnesium and blood phosphate levels. Comprehensive metabolic panel and toxicology tests are also conducted. A stay in hospital in required for treatment. Regular checks of blood chemistry levels, such as electrolytes, body fluids level and vital signs such as temperature, pulse, breathing rate and blood pressure are monitored. Medications such as anticonvulsants, central nervous system depressants and sedatives are administered for symptoms such as seizures and irregular heartbeat. Sometimes the patient is put in a state of sedation for a week until withdrawal is complete. Benzodiazepine medications are given to treat seizures, anxiety and tremors. Only after the patient recovers from immediate symptoms is long term preventive treatment given. The doctor allows a ‘drying out' period in which no alcohol is consumed.

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Collection of Pages - Last revised Date: March 20, 2019