Opthalmologist Visit--Finally

I went to see the ophthalmologist on the 26th of January.  I was scared.
the news was mixed, but no one ever told me. .  My eyes had improve a 
great deal--but I had toget my Blood Pressure down--and keep it down.
Each time my BP went above 200 systolic, I was getting hemorrhages in my
eyes--which could permanently damage my eyes--notto mention the
possibility of a stroke.

So I got home and that night I took a pill that I was prescribed a year ago,
but I didn't take probably in fear that it would react in a paradoxical
fashion--my BP would go up, not down.  The next morning I took the
full dose of Clonidine--0.1 mg.  Crossed my fingers and prayed.  An hour
later I checked my BP again.  It was 119/60.  I could not recall when
it had been that low.  But the true test was would it stay that way.
Meanwhile I was still taking Lasix--yes, it was presribed, but as a prn
med, not an everyday med.  I was also taking Potassium 20 because
Lasix is a wonderful drug but makes you lose Potassium.  Potassium in
conjunction with Calcium, sodium, and magnesium is responsible for
for making your heart beat.

So not having enough Potassium is dangerous.  It can kill you.

Here is a blurb on electolytes and their importance:

Electrolyte Disorders 

Definition

An electrolyte disorder is an imbalance of certain ionized salts (i.e.,

bicarbonate, calcium, chloride, magnesium, phosphate, potassium, and 

sodium) in the blood.

Description

Electrolytes are ionized molecules found throughout the blood, tissues,

and cells of the body. These molecules, which are either positive (cations) 

or negative (anions), conduct an electric current and help to balance pH 

and acid-base levels in the body. Electrolytes also facilitate the passage 

of fluid between and within cells through a process known as osmosis and 

play a part in regulating the function of the neuromuscular, endocrine, and 

excretory systems. The serum electrolytes include:

• Sodium (Na). A positively charged electrolyte that helps to balance 
•  fluid levels in the body and facilitates neuromuscular functioning.
•  
• Potassium (K). A main component of cellular fluid, this positive 
•  electrolyte helps to regulate neuromuscular function and osmotic
•  pressure.
•  
• Calcium (Ca). A cation, or positive electrolyte, that affects 
• neuromuscular performance and contributes to skeletal growth 
• and blood coagulation.
•  
• Magnesium (Mg). Influences muscle contractions and intracellular 
• activity. A cation.
•  
• Chloride (CI). An anion, or negative electrolyte, that regulates blood 
• pressure.
•  
• Phosphate (HPO4). Negative electrolyte that impacts metabolism 
• and regulates acid-base balance and calcium levels
• .
• Bicarbonate (HCO3). A negatively charged electrolyte that assists 
• in the regulation of blood pH levels. Bicarbonate insufficiencies and 
• elevations cause acid-base disorders (i.e., acidosis, alkalosis).

Medications, chronic diseases, and trauma (for example, burns, or 

fractures etc.) may cause the concentration of certain electrolytes in 

the body to become too high (hyper-) or too low (hypo-). When this

happens, an electrolyte imbalance, or disorder, results.

Causes and symptoms

Sodium

HYPERNATREMIA. Sodium helps the kidneys to regulate the amount of

water the body retains or excretes. Consequently, individuals with elevated 

serum sodium levels also suffer from a loss of fluids, or dehydration.  

Hypernatremia can be caused by inadequate water intake, excessive fluid loss 

(i.e., diabetes insipidus, kidney disease, severe burns, and prolonged vomiting 

or diarrhea), or sodium retention (caused by excessive sodium intake or 

 aldosteronism). In addition, certain drugs, including loop diuretics, corticosteroids, 

and antihypertensive medications may cause elevated sodium levels.

Symptoms of hypernatremia include:

• thirst
• orthostatic hypotension
• dry mouth and mucous membranes
• dark, concentrated urine
• loss of elasticity in the skin
• irregular heartbeat (tachycardia)
• irritability
• fatigue
• lethargy
• heavy, labored breathing
• muscle twitching and/or seizures

HYPONATREMIA. Up to 1% of all hospitalized patients and as many as 

18% of nursing home patients develop hyponatremia, making it one of the

 most common electrolyte disorders. A 2004 study questioned the routine 

make-up of fluids prescribed for children and delivered intravenously 

(through a needle into a vein) in hospitals today. The authors recommended 

only using IV fluids when necessary and then using isotonic saline.  

 

Diuretics, certain psychoactive drugs (i.e., fluoxetine, sertraline, haloperidol), 

 specific antipsychotics (lithium), vasopressin, chlorpropamide, the illicit drug 

"ecstasy," and other pharmaceuticals can cause decreased sodium levels, 

or hyponatremia. Low sodium levels may also be triggered by inadequate 

dietary intake of sodium, excessive perspiration, water intoxication, and 

impairment of adrenal gland or kidney function.

Symptoms of hyponatremia include:

• nausea, abdominal cramping, and/or vomiting
• headache
• edema (swelling)
• muscle weakness and/or tremor
• paralysis
• disorientation
• slowed breathing
• seizures
• coma

Potassium

HYPERKALEMIA. Hyperkalemia may be caused by ketoacidosis (diabetic coma),

 myocardial infarction (heart attack), severe burns, kidney failure, fasting, bulimia 

nervosa, gastrointestinal bleeding, adrenal insufficiency, or Addison's disease. Diuretic 

drugs, cyclosporin, lithium, heparin, ACE inhibitors, beta blockers, and trimethoprim 

can increase serum potassium levels, as can heavy exercise. The condition may also 

be secondary to hypernatremia (low serum concentrations of sodium). Symptoms 

may include:

• weakness
• nausea and/or abdominal pain

• irregular heartbeat (arrhythmia)
• diarrhea
• muscle pain

HYPOKALEMIA. Severe dehydration, aldosteronism, Cushing's syndrome, 

kidney disease, long-term diuretic therapy, certain penicillins, laxative abuse, 

congestive heart failure, and adrenal gland impairments can all cause depletion 

of potassium levels in the bloodstream. A substance known as glycyrrhetinic 

acid, which is found in licorice and chewing tobacco, can also deplete potassium 

serum levels. Symptoms of hypokalemia include:

• weakness
• paralysis
• increased urination
• irregular heartbeat (arrhythmia)
• orthostatic hypotension
• muscle pain
• tetany

Calcium

HYPERCALCEMIA. Blood calcium levels may be elevated in cases of thyroid 

disorder, multiple myeloma, metastatic cancer, multiple bone fractures, milk-alkali 

syndrome, and Paget's disease. Excessive use of calcium-containing supplements 

and certain over-the-counter medications (i.e., antacids) may also cause hypercalcemia. 

In infants, lesser known causes may include blue diaper syndrome, Williams syndrome,

 secondary hyperparathyroidism from maternal hypocalcemia, and dietary phosphat

e deficiency. Symptoms include:

• fatigue
• constipation
• depression
• confusion
• muscle pain
• nausea and vomiting
• dehydration
• increased urination
• irregular heartbeat (arrhythmia)

HYPOCALCEMIA. Thyroid disorders, kidney failure, severe burns, sepsis,

 vitamin D deficiency, and medications such as heparin and glucogan can deplete 

 blood calcium levels. Lowered levels cause:

• muscle cramps and spasms
• tetany and/or convulsions
• mood changes (depression, irritability)
• dry skin
• brittle nails
• facial twitching

Magnesium

HYPERMAGNESEMIA. Excessive magnesium levels may occur with end-stage 

renal disease, Addison's disease, or an overdose of magnesium salts. Hypermagnesemia 

is characterized by:

• lethargy
• hypotension
• decreased heart and respiratory rate
• muscle weakness
• diminished tendon reflexes

HYPOMAGNESEMIA. Inadequate dietary intake of magnesium, often caused 

by chronic alcoholism or malnutrition, is a common cause of hypomagnesemia. 

Other causes include malabsorption syndromes, pancreatitis, aldosteronism, 

burns, hyperparathyroidism, digestive system disorders, and diuretic use. Symptoms

of low serum magnesium levels include:

• leg and foot cramps
• weight loss
• vomiting
• muscle spasms, twitching, and tremors
• seizures
• muscle weakness
• arrthymia

Chloride

HYPERCHLOREMIA. Severe dehydration, kidney failure, hemodialysis, traumatic 

brain injury, and aldosteronism can also cause hyperchloremia. Drugs such as boric 

acid and ammonium chloride and the intravenous (IV) infusion of sodium chloride 

can also boost chloride levels, resulting in hyperchloremic metabolic acidosis. 

Symptoms include:

• weakness
• headache
• nausea
• cardiac arrest

HYPOCHLOREMIA. Hypochloremia usually occurs as a result of sodium and 

potassium depletion (i.e., hyponatremia, hypokalemia). Severe depletion of

serum chloride levels causes metabolic alkalosis. This alkalization of the 

bloodstream is characterized by:

• mental confusion
• slowed breathing
• paralysis
• muscle tension or spasm

Phosphate

HYPERPHOSPHATEMIA. Skeletal fractures or disease, kidney failure, 

hypoparathyroidism, hemodialysis, diabetic ketoacidosis, acromegaly, 

systemic infection, and intestinal obstruction can all cause phosphate 

retention and build-up in the blood. The disorder occurs concurrently

with hypocalcemia. Individuals with mild hyperphosphatemia are

typically asymptomatic, but signs of severe hyperphosphatemia include:

• tingling in hands and fingers
• muscle spasms and cramps
• convulsions
• cardiac arrest

HYPOPHOSPHATEMIA. Serum phosphate levels of 2 mg/dL or 

below may be caused by hypomagnesemia and hypokalemia. Severe 

burns, alcoholism, diabetic ketoacidosis, kidney disease, hyperparathyroidism,

hypothyroidism, Cushing's syndrome, malnutrition, hemodialysis,  

vitamin D deficiency, and prolonged diuretic therapy can also diminish blood 

phosphate levels. There are typically few physical signs of mild phosphate depletion. 

Symptoms of severe hypophosphatemia include:

• muscle weakness
• weight loss
• bone deformities (osteomalacia)

Diagnosis

Diagnosis is performed by a physician or other qualified healthcare provider 

who will take a medical history, discuss symptoms, perform a complete

 physical examination, and prescribe appropriate laboratory tests. Because 

electrolyte disorders commonly affect the neuromuscular system, the provider 

will test reflexes. If a calcium imbalance is suspected, the physician will also 

check for Chvostek's sign, a reflex test that triggers an involuntary facial twitch, 

and Trousseau's sign, a muscle spasm that occurs in response to pressure on the 

upper arm. Serum electrolyte imbalances can be detected through blood tests. 

Blood is drawn from a vein on the back of the hand or inside of the elbow by a 

medical technician, or phlebotomist, and analyzed at a lab.

Normal levels of electrolytes are:

• Sodium. 135-145 mEq/L (serum)
• Potassium. 3.5-5.5 mEq/L (serum)
• Calcium. 8.8-10.4 mg/dL (total Ca; serum); 4.7-5.2 mg/dL (unbound Ca; serum)
• Magnesium. 1.4-2.1 mEq/L (plasma)
• Chloride. 100-108 mEq/L (serum)
• Phosphate. 2.5-4.5 mg/dL (plasma; adults)

Standard ranges for test results may vary due to differing laboratory standards and 

physiological variances (gender, age, and other factors). Other blood tests that 

determine pH levels and acid-base balance may also be performed.

Treatment

Treatment of electrolyte disorders depends on the underlying cause of the 

problem and the type of electrolyte involved. If the disorder is caused by 

poor diet or improper fluid intake, nutritional changes may be prescribed. 

If medications such as diuretics triggered the imbalance, discontinuing or 

adjusting the drug therapy may effectively treat the condition. Fluid and electrolyte replacement therapy, either intravenously or by mouth, can reverse electrolyte depletion.

 

Hemodialysis treatment may be required to reduce serum potassium levels

 in hyperkalemic patients with impaired kidney function. It may also be 

ecommended for renal patients suffering from severe hypermagnesemia.

Prognosis

A patient's long-term prognosis depends upon the root cause of the electrolyte 

disorder. However, when treated quickly and appropriately, electrolyte imbalances

 in and of themselves are usually effectively reversed.

 

When they are mild, some electrolyte imbalances have few to no symptoms and 

may pass unnoticed. For example, transient hyperphosphatemia is usually fairly benign. 

However, long-term elevations of blood phosphate levels can lead to potentially 

fatal soft tissue and vascular calcifications and bone disease, and severe serum 

phosphate deficiencies (hypophosphatemia) can cause encephalopathy, coma, and death.

Severe hypernatremia has a mortality rate of 40-60%. Death is commonly due 

to cerebrovascular damage and hemorrhage resulting from dehydration and 

shrinkage of the brain cells.

Prevention

Physicians should use caution when prescribing drugs known to affect electrolyte 

levels and acid-base balance. Individuals with kidney disease, thyroid problems, 

and other conditions that may place them at risk for developing an electrolyte 

disorder should be educated on the signs and symptoms.

Resources

Books

Post, Theodore, and Burton Rose. Clinical Physiology of Acid-Base 

and Electrolyte Disorders. 5th ed. New York: McGraw-Hill Professional, 2001.

Periodicals

Cohn, Jay N., et al. "New Guidelines for Potassium Replacement in 

Clinical Practice: A Contemporary Review by the National Council 

on Potassium in Clinical Practice." Archives of Internal Medicine 160,

 no.16 (September 11, 2000): 2429-36.

 

Goh, Kian Ping. "Management of Hyponatremia." American Family 

Physician May 15, 2004: 2387.

 

Moritz, Michael L., Juan Carlos Ayus. "Hospital-acquired Hyponatremia: 

Why are There Still Deaths?" Pediatrics May 2004: 1395-1397.

 

Springate, James E., Mary F. Carroll. "HAdditional Causes of Hypercalcemia

 in Infants." American Family Physician June 15, 2004: 2766.

Key terms

Acid-base balance — A balance of acidity and alkalinity of fluids in the 

body that keeps the pH level of blood around 7.35-7.45.

 

Addison's disease — A disease characterized by a deficiency in adrenocortical 

hormones due to destruction of the adrenal gland.

 

Aldosteronism — A condition defined by high serum levels of aldosterone, a 

hormone secreted by the adrenal gland that is responsible for increasing sodium 

 reabsorption in the kidneys.

 

Bulimia nervosa — An eating disorder characterized by binging and purging 

(self-induced vomiting) behaviors.

 

Milk-alkali syndrome — Elevated blood calcium levels and alkalosis caused 

by excessive intake of milk and alkalis. Usually occurs in the treatment of peptic ulcer.

 

Orthostatic hypotension — A drop in blood pressure that causes faintness or

 dizziness and occurs when one rises to a standing position. Also known as 

postural hypotension.

Osmotic pressure — Pressure that occurs when two solutions of differing 

concentrations are separated by a semipermeable membrane, such as a

cellular wall, and the lower concentration solute is drawn across the membrane 

into the higher concentration solute (osmosis)

.

Tetany — A disorder of the nervous system characterized by muscle cramps, 

 spasms of the arms and legs, and numbness of the extremities.

Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. 

All rights reserved.

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OK--enough about electolytes.


All for now

Kate Thorn