ELECtrolYTE disOrDERS

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 phosphate 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 recommended 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.

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.

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.

Addison's disease

A disease characterized by a deficiency in adrenocortical hormones due to destruction of the adrenal gland.

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.

INTERior desIGning, DEcorating, FUrniture

TEMPERATURE SENSITIVE GLASS TILES

is an innovative technology which takes glass tiles to new heights in terms of interior design. These are temperature sensitive textured glass tiles which change color with the ambient, body or water temperature. So when someone touches them or if warm water from a shower hits them, the tiles then literally “bloom with color”! How neat is that?

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How much is this going to cost? It’s approximately $17 per standard size 4″ x 4″ x 3/8″ tile or $149/ft with reductions for volume discounts. It’s not cheap because the tiles are all individually hand made from recycled glass but you have to admit, they are “cool” when hot! -

No matter which part of the room you are decorating and how you wish to improve the beauty of your home, you will always find decorators telling you that lighting makes or breaks the entire effort. Creating the perfect lighting conditions is the difference between an attractive home and dull interiors that are pale and lack any luster.

DAZZLING DELIGHTS:HOW LIGHT UP A ROOM BEAUTIFULLY

But lighting is far harder than just putting up bright lights in one of the corners of the room with even often experts struggling to create the perfect look. Here are some ways of lighting up your room beautifully, which will offer you a direction in your efforts to create a better space around.

#1 Mix direct lighting with plenty of ambient lighting

Many rooms use just one lighting source. This creates an uneven distribution of light as everything is concentrated in only one spot. It is a good idea to mix the standard lighting solutions with ambient light options to create a tranquil, laidback and soothing environment in the room. It will work great on majority of occasions.

#2 Utilize a simple combination of dim lights to eliminate dark corners

Shelves in the living room or decorative closets are perfect to be pimped with simple dim lights that can be switched on only when needed. Apart from adding to the beauty of the room, this also helps eliminate the ark corners that are formed from uneven lighting. Beautifully lit corners make any room look simply stunning.

#3 Use a mix of chandeliers and scones with simple table lamps

If the room is tall enough and grand enough to sport a giant scone or even a chandelier, then bring one in without any hesitation. But go a bit beyond. Have you considered using corner lights and table lamps that create a separate area that can be easily altered? It’s both a practical and sensuous solution to the lighting needs of the room.

#4 Focal lighting to highlight the significance of a special collectible

If you have a rare art piece or even an expensive collectible that you would like to display proudly, give its own special spot in the room and highlight it appropriately. Of course, take good care of the effects of such lighting on particular pieces of art before you put it under the spotlight. Your exquisite painting could sensitive. That means you’ll need a more dim-lighted atmosphere.

#5 Use under-counter lighting with intensity-adjustable options

These lights can be used in rooms with counters, in kitchens or even in your bedroom. Because they create a more romantic atmosphere. Make sure that you can adjust the intensity of the lights as you desire and the room effect will be magical.

Ensure that natural lighting merges well with artificial lighting

The best form of lighting one can use during the day is natural light. Hence, provide for options like skylights wherever possible and allow for maximum natural ventilation. And only try to merge this natural light with any artificial lighting options to create a wonderful and flowing look to the entire room.

Lighting is a matter of aesthetics at its very best and it takes plenty of time, effort and right approach to get it right. So, do not get disheartened if you do not get it right straight away as sometimes even the experts are challenged endlessly in an attempt to strike the perfect balance.

HORCHOW MIRRORED FURNITURE

Mirrors do help give a living area the illusion of space. They also help brighten up a room by reflecting light. But if mirrored tiles on walls seem dated and even tacky to you, consider the selection of stylish mirrored furniture from HORCHOW. They are even better in some ways than stainless steel fixtures which give very muted reflections. The dramatic focal pieces are best in the hallway or in other prominent spots. The furniture has been imported from various sources so the construction materials vary but they all use mirror veneers. These are luxury priced items so be warned!

Feeling a little holier than thou lately? Then you should get the Jesus floor lamp by Mexican designer, RICARDO GARZA MARCOS. You can place the halo style lamp behind where you sit either at home or at the office. Not only will it illuminate your work or reading area but it will make you look positively angelic! This design is not just simply beautiful but it does carry a saintly message, perhaps along the lines of “Who, me?”

SHELVING KNOWLEDGE :HOW TO DECORATE YOUR OWN HOME LIBRARY

A home library is not something for everyone, but if you do have an inclination towards books or even love collecting the rare ones, then this can really add immensely both to the look of your home and how people view you when they come for a visit. A home library talks about your personality, shouts about what kind of a person you are and it also ensures that those who walk in, leave with something added to their wisdom. It can make for a great topic of conversation and earn you some great new buddies.

Of course, a whole library at home looks hard to put together, but with these tips, you will find that it is not that hard as you thought.

#1 Pick the perfect room and devote the required space

The most significant aspect towards building a grand home library is to pick the right room. Obviously, preferable it should have a high ceiling along with space for racks and other accessories. You can of course, devote just a part of a certain room for this purpose, but an entire room that is totally dedicated makes it a lot more wonderful. Also make sure it’s large enough to accommodate your entire book collection and maybe the ones you are going to add in the future.

#2 Choose the type of shelves that you feel would be apt

You can either go for built-in shelves, racks that are made of wood, separate standings sshelves that occupy more space or the ones that hang from the ceiling. No matter which variety you pick ensure that they all go well with the furnishings you have in the room and are all crafted from wood. Wooden racks give your home library an authentic and original feel that cannot be achieved by other modern materials.

#3 Colors, shades and usage of materials

Dark and Victorian styled colors are often used in libraries to give them a more antique feeling. The same can be done for your home library. Once again the use of woodwork grained in darker textures helps a great deal in capturing this essence. This will go well with any collection or theme you chose. Such as the French, Spanish or Italian collection. The appeal for such interiors is almost universal.

#4 Accessorize with rugs, lamps, tables and chairs

Use tables and chairs inside your home library according to the space available and the comfort factor. You can get a bit unconventional and even go for a couch so that you feel more at home. A small television that is put in a closed cabin, a fine rug and an antique lamp will do wonders to the interiors. This though is a matter of individual choice and you can go the way you chose with accessories.

#5 Use lighting to add to your book collection

Use lighting smartly so that it brings the beauty out of your rare and specially bounded books while it hides those rugged looking old copies of the paperbacks. Your home library can be altered and changed by using lighting in various different patterns. The lighting must be most often soft, ambient and must reflect the studious mood inside.

Apart from all those, one can also add a dash of class with sculptures and plants which will bring life to the home library. Since the walls are already full, it will be such standing decorative that will bring added beauty to your home library. If you are willing to spend a tad bit extra, then you can create your very own favorite library in your own home.