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Hypokalemia

Low potassium level in the blood is referred to as hypokalemia. Potassium is an electrolyte that is essential to ensure the proper functioning of muscle and nerve cells, in particular the heart muscle cells. Potassium is a vital mineral in the body as it helps the muscles contract when required. Almost 98% of the potassium found in our body is present within the cells. The small levels present outside have a major influence in the functioning of the heart, muscles and nerves.


Normal potassium level in the blood is 3.6 to 5.2 millimoles per liter. Anything less than 2.5 millimoles per liter could indicate low level potassium in the blood. The condition may arise from reduced intake of potassium or from increased loss of potassium from the body.


Blood tests can confirm this condition in a person. Oral supplements or in severe cases, intravenous medication helps. In many cases oral supplements would do the needful; however this could lower the thyroid hormone levels and raise the potassium levels thus leading to paralysis of the body. A few patients may also experience irregular heartbeat which may turn fatal. The condition is more common in men and in women and occurs more often in elderly people.

Consuming a potassium rich diet by including food items like banana, carrots, bran, avocados, oranges, milk, spinach, wheat germ, peas and beans may help prevent the condition. Common causes include:


  • Chronic kidney failure, as kidney plays a vital role in removing excess potassium into the urine and maintaining proper balance of this mineral in the body.
  • Eating disorders like bulimia
  • Magnesium deficiency
  • Sweating excessively
  • Diarrhea
  • Excessive use of laxatives
  • Vomiting
  • Alcoholism
  • Use of insulin

Hypokalemia symptoms include nausea, abdominal pain, cramps, dehydration, frequent urination, palpitations and confusion.

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.


Nocturia

When deep slumber at night is regularly disrupted by an urgent feeling of urination, it is a condition called nocturia. It is common in older adults, both men and women, usually in the age group of 55 and 84 years. Nocturia is different from enuresis or bed-wetting wherein the person does not wake up from sleep but involuntarily empties the bladder. Nocturia affected person experiences sleep loss due to an urgent need to urinate. Mild nocturia is characterized by a need to urinate two to three times and in severe cases it can be anywhere between five to six times on a particular night, occasionally or daily.

Nocturia types and causes

Besides the normal aging process, nocturia is also linked to other causes. In women, besides age, childbirth or pelvic organ prolapse and menopause are often contributing factors to nocturia.

Nocturnal Polyuria

There is an overproduction of urine at night. In a 24-hour cycle the urine volume may be greater than 40 ml/kg or if the volume of urine passed at night exceeds one-third of the total daily urine output. The main feature of nocturnal polyuria is that more urine is produced during sleep which in turn induces more nighttime urination.

All fluids or even certain foods like salads, vegetables, fruits, rice and pasta with high water content can cause nocturnal polyuria. Diuretics, cardiac glycosides, demeclocycline, lithium, methoxyflurane, phenytoin, propoxyphene and excessive Vitamin D medication can lead to frequent urination. Ankle swelling is another common cause of nocturnal polyuria. Congestive heart failure, venous stasis, hypoalbuminemia or excessive salt intake are other causes for fluid retention.


Polyuria

In adults, the normal urine production is 1 to 2 liters. Polyuria is characterized by urine output that exceeds 2500 ml/24 hours during the day as well as at night. Polyuria is common in people with diabetes mellitus and diabetes insipidus. Other conditions causing polyuria are Polycystic kidney disease, Sickle cell disease, Pyelonephritis, Amyloidosis, Sjogren syndrome and Myeloma. Vascular disease, restless leg syndrome, thyroid disorder and congestive heart failure are some causes for increased urinary output at night by the kidneys. Polydispisia or excessive thirst that compels drinking lots of water can cause polyuria. The thirst center or hypothalamus is affected due to anxiety, stress or psychiatric illness and leads to excessive thirst. Intravenous saline drip excessively administered can lead to polyuria. Hypercalcemia and hypokalemia lead to abnormal levels of electrolytes that can result in excessive urination.


Inadequate bladder storage

The urinary bladder has the capacity to hold as much as 600 ml of urine. But the desire to urinate is experienced when the level reaches about 150 ml. There are various reasons and conditions that lead to inadequate bladder storage. Bladder obstruction, bladder infection or recurrent urinary tract infection, bladder inflammation, pain in the bladder, bladder cancer can reduce bladder storage capacity. Stroke and Parkinson's disease can also lead to reduction in its storage capacity thus inducing an urgent need to empty the bladder.


Mixed Nocturia

A combination of nocturnal polyuria with reduced bladder capacity is termed as mixed nocturia.

Diagnosis of Nocturia

Basic diagnostic procedure is to record the frequency, volume and timing both daytime and nighttime for a minimum of 1-3 days. Certain diagnostic tests like urine analysis, urine culture or an ultrasound are done. Accordingly, the treatment procedure is determined. Treatment options include making dietary changes, behavioral changes with a combination of medications.

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Bibliography / Reference

Collection of Pages - Last revised Date: November 19, 2019