Sodium and potassium: What we need to know about the signs and risks of their imbalance


53-year-old Susheela Sinha was rushed to the hospital when she suddenly got delusional. The family panicked and rushed her to the emergency, where it was found that her sodium levels had dropped. While we often talk about nutrients like calcium, iron, Vitamin B12, Vitamin K and more, two electrolytes that seem to get ignored are sodium and potassium. Dr. Atul Bhasin, Director, Internal Medicine, BLK Max Super Speciality Hospital shares, “Both the electrolytes are important for the human body. Any imbalance needs to be diagnosed early and treated aggressively. Patients of cardiac disease, diabetes, renal failure, and elderly on hypertension medicine need to be very vigilant to these symptoms.”
According to Dr. Veenu Gupta, Senior Consultant, Department of Internal Medicine, Amrita Hospital, Faridabad, “Sodium and Potassium are two of the very important minerals in the body, the other being calcium, magnesium, chloride, bicarbonate and phosphate. An electrolyte imbalance occurs due to alterations in the body’s water content. Several factors like excessive sweating, not eating or drinking enough, medications, heart or kidney diseases, vomiting or diarrhea, can affect our fluid and electrolyte balance in the body. Any drop or increase in the electrolyte levels below/above the normal range can have deleterious effects on the body depending upon how acute and how severe the changes are.”
What are the normal levels?
The normal sodium levels in the adult human body are—136-145 meq/l. The maximum recommended daily intake for sodium is 2,300 mg.
The normal potassium levels in the adult human body are—3.5-5.2 meq/l. Maximum of 2,600 mg for adult females and 3,400 mg for adult males per day.
Risks of low levels of sodium
Sodium regulates fluid balance and supports healthy neuron and muscle function. Dr. Atul explains, “Low levels of sodium are called hyponatremia. Hyponatremia can be due to excessive water retention in the body causing dilution of sodium in blood or less intake of sodium. It needs to be corrected under medical supervision. Patients develop nausea, headache, fatigue, muscle weakness, spasms. If not treated, it progresses to lethargy, disorientation, confusion and unconsciousness.”
Low sodium levels are frequently discovered by accident during normal blood tests. Signs and symptoms of hyponatremia are generally related to the underlying cause, and degree of fluid loss or dehydration, the degree of hyponatremia and the rate at which it develops. Typically, the indications and manifestations of mild hyponatremia are vague, such as feelings of nausea and fatigue. People with mild, long-term hyponatremia are often asymptomatic. The occurrence of severe or rapid-onset hyponatremia may result in disorientation, agitation, unsteadiness, seizures, coma, and even death due to cerebral edema.
Hypernatremia (high sodium levels) is much less commonly encountered in general practice than hyponatremia but when it does occur it is associated with a high mortality rates. The signs and symptoms of hypernatremia are primarily neurological and can include lethargy, weakness and irritability. In cases of more severe hypernatremia or a sudden increase in sodium levels, there is a risk of developing muscle twitches, seizures, coma, and even death.
Risks of low levels of potassium
Hypokalemia can be due to drugs, renal diseases. Symptoms are weakness, muscle cramps, constipation and abnormal heart rhythm or feeling of skipped heartbeats or irregular heartbeat. This is easily diagnosed with Electrocardiogram abnormalities.
Treatment involves correction of imbalance by stopping the offending drugs, oral or intravenous supplementation under strict medical supervision, adds Dr Bhasin.
The occurrence of serum potassium imbalance is higher among the elderly population and individuals with co-existing medical conditions such as renal impairment and congestive heart failure. Patients may experience irregular, fast or slow heartbeats, fatigue, tremors, muscle spasms, tetany, constipation, respiratory distress, confusion, paralysis, or memory loss.
Hyperkalemia (raised serum potassium level) is most commonly caused as an adverse effect of a medicine or secondary to a disease process. Hyperkalemia is often asymptomatic. The presence of symptoms is often characterized by non-specific indications such as nausea, vomiting, and less frequently by muscle pain, weakness, paresthesia, or flaccid paralysis. Patients may also complain of palpitations and moderate to severe hyperkalemia can result in cardiac disturbances and fatal arrhythmias, adds Dr Veenu.
Signs and symptoms to know
Dr Veenu shares the common symptoms of electrolyte imbalance which a common person should know:
Paresthesias i.e. Experiencing numbness or tingling sensations in the hands or feet.
Nausea and vomiting.
Confusion and irritability.
Diarrhea or constipation.
Fast or irregular heart beat .
Muscle cramps or weakness.
Seizures, coma or sudden cardiac arrest in case of sudden or significant changes in electrolytes
How to ensure optimum levels
Everyone needs to ensure that people consume their recommended daily amount of electrolytes.
One of the important steps is to ensure proper hydration. So drink at least 7-8 glasses of water per day. Along with water, people should have fruit juices, milk, coconut water, buttermilk, lemon water etc.
Dr Veenu adds, “People with diabetes, heart disease, kidney disease or other comorbidities should take precautions regarding oral intake of adequate recommended fluid intake. Appropriate medications, and timely treatment of infections are essential. People should also avoid self-medication as many drugs can lead to electrolyte imbalances.”


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