Electrolytes are compounds that break down into electrically charged particles when dissolved in a fluid. These minerals in our blood and other body fluids play a major role in numerous basic cell functions, such as sending nerve signals to muscles. The management of electrolyte is not a problem for healthy people since their kidneys regulate its levels. Healthy kidneys keep electrolyte in balance. However, this balance is disturbed in chronic kidney disease. At most, fluid replacement may be enough if a healthy person sweats heavily after an intense workout. Unfortunately, that’s not the case for kidney patients. An impaired kidney can no longer perform its vital regulatory function. The management of electrolytes is a very important part of helping patients who need hemodialysis. Every dialysis technician should be aware of this. Electrolytes in the blood may come in the form of sodium, potassium, calcium, magnesium and bicarbonate. When the level of an electrolyte in the blood is very high (hyper) or very low (hypo), the results can be catastrophic.
The Basic Types of Electrolytes Every Dialysis Technician Should Know
- Sodium (Na+) – This electrolyte helps regulate the body’s water content and fluid balance. Sodium also keeps acids and alkaline substances in balance in the body, and helps transmit nerve signals to the body’s different muscles. Normal Level: 135 – 147 mEq/L
- Hypernatremia – When too much sodium is present in the blood, the patient may experience intense thirst, flushed skin, high fever, seizures, and death. Appropriate amounts of water, juices and other fluids consumed during treatment day may help prevent high sodium levels. When confirmed, the dialysis technician should offer the patient something to drink and inform the registered nurse.
- Hyponatremia – The sodium levels can be too low in the patient’s blood. This often results when the dialysis technician doesn’t infuse enough sodium in the dialysate. As a result of this abnormal level, the patient may have low blood pressure, muscle cramping, restlessness, anxiety, pain in the access site, headache, and nausea. Treatment for hyponatremia is aimed at resolving the underlying condition. With the confirmation of the physician, the dialysis technician may simply ask the patient to cut back on how much he drinks.
- Potassium (K+) – Potassium shares many attributes with the more prominent electrolyte, sodium. Potassium helps control the nerves and muscles, including that of the heart. Along with potassium ions, potassium cells also contain calcium ions. The electrical impulses they produce help maintain the body’s water balance and aid glucose metabolism. Normal Level: 3.5 – 5.2 mEq/L
- Hyperkalemia – An abnormally-high level of potassium in the blood can cause very serious, even deadly, changes in the heart rhythm. When patients eat too many high-potassium foods, such as sweet potatoes or bananas, hyperkalemia may result since their kidneys can no longer remove potassium. Other causes of hyperkalemia include bleeding, trauma, breakdown of red blood cells, and missed treatments. This condition can cause major symptoms. When the patient has muscle weakness, abdominal cramps, and abnormal heart rhythms, the dialysis technician should immediately report these to the nurse. Consequently, if potassium levels are unregulated for an extended amount of time, the patient may have sudden cardiac arrest with no early warning symptoms. Once confirmed by the dialysis technician, the physician may ask the patient to discontinue medications that increase blood potassium levels. Intravenous administration of glucose and insulin, which promotes movement of potassium from the extracellular space back into the cells, may also be prescribed.
- Hypokalemia – Potassium in the blood may diminish significantly when the patient is vomiting and has diarrhea. Having a diet that does not include enough potassium can cause a lower-than-normal blood potassium level. While this is not common in people on dialysis, the treatment itself can remove too much potassium from the blood. Hypokalemia can be very dangerous unless treated immediately. This condition can cause fatigue, muscle weakness, and abnormal heart rhythms.
- Calcium (Ca++) – This electrolyte is mainly found in the bones and teeth. Only small, regular levels of calcium are needed by the body at all times. Calcium helps in blood clotting, enzyme regulation, hormone action, and nerve and muscle function. Normal Level: 8.8 – 10.3 mg/dL
- Hypercalcemia – High blood calcium levels can usually be caused by high doses of vitamin D or calcium. Hypercalcemia can cause vomiting, weakness, confusion, and coma.
- Hypocalcemia – Hypocalcemia is most often caused by problems with the metabolism and absorption of calcium. It may also occur with hyperphosphatemia. When phosphate levels are high in the blood, calcium levels are lowered due to precipitation of phosphate with the calcium in tissues. Hypocalcemia causes numbness, seizures, and tetany. Tetany is a medical symptom that causes involuntary contraction of muscles.
- Phosphorus (P) – Highly similar to calcium, phosphorus is mainly found in the bones and teeth. This electrolyte plays a major role in the body’s use of energy. Normal Level: 2.5 – 4.5 mg/dL
- Hyperphosphatemia – People who have malfunctioning kidneys can’t effectively excrete phosphorus. Because of this, phosphorus builds up and elevates in their blood. This condition is quite common for dialysis patients. Dialysis technicians must always watch out for its signs and symptoms. In acute cases, hyperphosphatemia can cause severe itching. Chronically, it contributes to debilitating bone diseases. Patients who are treated in dialysis centers should take binders to remove some phosphorus from the blood. They should also strictly follow a diet that limits phosphorus. The most significant problems associated with hyperphosphatemia are hypocalcemia and metastatic calcification. Metastatic calcification is a condition characterized by calcium phosphate deposition that develops in the skin, eyes, heart, lungs, joints, and blood vessels. The dialysis technician may educate the patient about the importance of limiting the intake of high-phosphate foods, such as milk, pudding or yogurt.
- Hypophosphatemia – Poor diet or taking high doses of phosphate binders can cause a low phosphorus level. In most cases, hypophosphatemia does not cause any symptoms unless phosphorus levels go above 1mg/dL. Severe hypophosphatemia causes muscle weakness, paralysis, and problems with the function of red blood cells. Oral replacement therapy may be initiated. To raise phosphate levels in the blood, the dialysis technician may suggest a diet consisting of high phosphate foods, such as cheese and shellfish, as needed.
- Magnesium (Mg++) – Magnesium is an electrolyte found in tissues, muscles, and bones. It helps break down carbohydrates and protein. Normal Level: 1.6 – 2.4 mEq/L
- Hypermagnesemia – Magnesium levels in the blood may elevate when its excretion is impaired. Since dialysis patients have impaired kidney functions, heavy magnesium intake in the diet causes magnesium levels to rise. Symptoms of hypermagnesemia may include heart rhythm disturbances, muscle weakness, nausea and vomiting, and breathing difficulties. Foods high in magnesium must be avoided at all costs. The dialysis technician may suggest a diet of low magnesium foods like lean roast pork or grilled lamb.
- Hypomagnesemia – Common causes of hypomagnesemia include alcoholism and its associated malnutrition, chronic diarrhea, and medications used to control high blood pressure. Since magnesium also helps neutralize stomach acid and move stools through the intestine, low levels can cause chronic constipation, and problems with digestion. Dark leafy greens and almonds are foods high in magnesium that may be recommended by the dialysis technician.