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Health Benefits, Risks of Alcohol. Avoid the Flu. The Truth About Toxins. You've probably seen those ads for sports drinks that claim to offer better hydration than water during or after an intense workout. The reason, they say, is that sports drinks replenish electrolytes; water does not. Are these claims valid, or are sports drink companies just trying to sell you their products? What, exactly, are electrolytes? And is it really so important to replace them? It turns out, there is some truth in advertising.

You're probably familiar with most or all of the electrolytes, even if you didn't necessarily know they were electrolytes:. These electrically-charged minerals help regulate everything from hydration the amount of water in your body , to your nervous system to muscle function — including the most important muscle of all: the heart.

Electrolytes enable the electrical impulses to be generated normally within the heart, so your heart can contract and relax at a normal rate. If you think of the heart as a lamp, electrolytes are like the electrical circuit, generating the current that keeps the light burning steady and strong," Braun says. If you unplug the lamp, it won't work at all. Similarly, your body can't function without electrolytes.

And if the level of one or more electrolytes becomes too low or too high, it creates an imbalance that can cause everything from mild, temporary symptoms to serious long-term health problems. Exactly how the imbalance affects your health — and how quickly symptoms appear — depends on which electrolytes are affected, and how high or low the levels are. For instance, over time, calcium deficiency will weaken bones and, possibly, cause osteoporosis.

Very high calcium, on the other hand, can lead to kidney failure, abnormal heart rhythm arrhythmia , mental confusion and even coma. Arrhythmias can also result from low magnesium, as well as high or low potassium levels, especially in people who already have a heart condition.

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The good news: Most of the time, healthy people don't have to worry about electrolytes. The key to preventing health-threatening imbalances is to be aware of these instances when electrolytes are more likely to become depleted or build up. And, if need be, get advice from your doctor or another health care provider on how to maintain or restore the balance.

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While some situations, such as health conditions, are beyond your control, Braun says there are steps you can take to avoid severe electrolyte spikes or dips:. Edema, which occurs when the body retains too much fluid, commonly causes swelling and pain in the face, arms, legs, hands and feet. Dehydration, which happens when the body loses more fluids than it consumes, can cause a range of symptoms including thirst, weakness, light headedness, fainting and decreases in urine output or increases in its concentration darker colored urine. Appointments can be made directly by calling Physician referrals can be made by calling M-Line at For details on prescribing for routine maintenance see section Intravenous fluid therapy for fluid resuscitation.

The unnecessary use of IV fluids should be avoided.

Fluids and Sodium Imbalance: Clinical Implications

When they are needed, they should be stopped as soon as possible. Assessment must be informed by all information available including a focussed history and examination along with results of clinical monitoring e. NEWS, fluid balance and body weight and laboratory results. For details on assessment and monitoring, see section Assessment and monitoring of patients receiving intravenous fluid therapy.

For details on prescribing for routine maintenance see section Intravenous fluid therapy for routine maintenance. Recommendations and more details on fluid prescription for replacement are covered in the section Intravenous fluid therapy for replacement and redistribution. IV fluid prescriptions must aim to account for both non-specific responses to illness or injury described in Section 5. Recommendations and more details on these issues are also covered in the section Intravenous fluid therapy for replacement and redistribution.

Consideration of all questions above allows estimates of the total volume of IV fluid and amounts of electrolytes that should be given, before deciding on the best rate at which to administer the fluids. Often, that rate needs to be slow in order not to overload the circulation or to cause acute electrolyte problems, since time is needed for transmembrane i. The best IV fluid or mix of fluids to use can then be chosen although, before completing the prescription, allowance must be made for any fluid and electrolytes intake from other sources.

These include any food and drinks, enteral tube provision and other IV therapies. Blood or blood products, in particular, contain large amounts of electrolytes as do some IV drugs, especially those given in larger volume diluents, several times a day. Patients on artificial parenteral or enteral nutrition usually receive adequate fluid and electrolytes from their feed to meet at least routine maintenance needs and prescription of unnecessary additional IV fluids in such patients is a common mistake.

Many different crystalloids, artificial colloids and albumin solutions are available for IV fluid therapy. The aim is to meet estimates of total fluid and electrolyte requirements. There are theoretical advantages to giving a colloid instead of a crystalloid when resuscitating the hypovolaemic patient because colloid-based fluids generally remain for longer in the circulation. Crystalloids are distributed throughout the ECF and traditional teaching is that their infusion has relatively limited and transient effects on plasma volume.

However, such considerations are based on data derived from studies undertaken in euvolaemic human volunteers who have no illness-induced abnormalities in fluid distribution and capillary permeability, and in hypovolaemic patients, crystalloids have much better intravascular retention than these studies have suggested.

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The actual benefits, if any, of colloids over crystalloids when intravascular volume expansion is required are therefore unclear. A review of all the available IV fluids in the UK is beyond the remit of this guidance but understanding the composition and properties of some of those more commonly used provides much of the understanding needed to prescribe any fluid appropriately. Furthermore, it helps understanding of the issues in fluid prescribing which are of debate in current practice.


See Appendices P. A brief description of some of the available fluids highlighting their properties and potential pros and cons of their usage is detailed below. Sodium chloride 0. However, questions have been raised in relation to its appropriate use. As with all crystalloids, sodium chloride 0. Traditionally sodium chloride 0. Theoretically, use of sodium chloride 0. In addition, it is also possible that a significant albeit lesser degree of unnecessary sodium and water retention, is a problem when sodium chloride 0.

The normal daily requirements of sodium are only 70—mmol but one litre of normal saline contains mmol, so it is easy to give an excess. This will then need to be excreted but the ability to clear a solute load is limited even in health and may be further impaired during illness or injury. Another issue that raises questions about the widespread usage of sodium chloride 0. This in turn could lead to significant reductions in renal blood flow and glomerular filtration 18 as well as hyperchloraemic acidosis, gastrointestinal mucosal acidosis and ileus.

Some GI fluid losses and occasionally renal losses are very high in sodium chloride and hence sodium chloride 0. It is important to recognize, however, that many of these losses will be high in potassium, calcium and magnesium and so a balanced crystalloid might have advantages over sodium chloride 0.

Balanced crystalloids are also distributed throughout the ECF and are therefore of similar efficacy to sodium chloride 0. However, they do have theoretical advantages in that they contain somewhat less sodium and significantly less chloride, and they may already have some potassium, calcium and magnesium content. The use of balanced crystalloids could therefore have advantages over sodium chloride 0.

Balanced solutions containing lactate or other buffers might also grant advantages in situations of significant acidosis which is often seen when resuscitation is needed. They are however, useful means of providing free water for, once the glucose is metabolised, they are largely distributed through total body water with very limited and transient effects on blood volume.


Electrolyte Imbalance: Care Instructions

They should therefore be useful in correcting or preventing simple dehydration, and the administration of appropriate glucose saline with potassium solutions may provide a good means of meeting routine maintenance needs. However, the use of these fluids will increase risks of significant hyponatraemia, especially if too much fluid is given or the infusion is given too rapidly.

Fluid, Electrolyte, and Acid Base Balance

Such risks are particularly high in children, the elderly, patients on diuretics and those with SIADH problems which are seen quite frequently in hospitalized patients. Synthetic colloids contain non-crystalline large molecules or ultramicroscopic particles dispersed through a fluid which is usually a crystalloid.

The colloidal particles are large enough that they should be retained within the circulation and so exert an oncotic pressure across capillary membranes. The actual advantages of colloids over crystalloids when used for either intravascular volume expansion in patients requiring fluids for resuscitation or to help with the resolution of oedematous redistribution problems are therefore uncertain and with some preparations, there have been concerns that any potential advantages may be offset by problems including renal dysfunction or disturbed coagulation. It is important to note, that older preparations of hydroxyethyl starch are suspended in sodium chloride 0.

Nevertheless, all currently available semi-synthetic colloids contain — mmol sodium which could contribute to positive sodium balance in sicker patients in the same way as for sodium chloride 0.

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