International Journal of Health & Allied Sciences

ORIGINAL ARTICLE
Year
: 2021  |  Volume : 10  |  Issue : 1  |  Page : 17--22

Electrolytes imbalance and their clinical outcomes in the intensive care unit: A prospective, observational study


Sravanthi Gunturi1, Mohammad Jaffar Sadiq Mantargi2, Easwaran Vigneshwaran3, Moataz Mohamed Farid Ahmed4, BV Dileep Krishna1, Tajmulla Ahmed5,  
1 Raghavendra Institute of Pharmaceutical Education and Research, Anantapur, Andhra Pradesh, India
2 Department of Pharmacology, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
3 Department of Clinical Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia
4 Department of Pharmaceutics, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia
5 Department of Prosthodontics, Batterjee Medical College, Jeddah, Kingdom of Saudi Arabia

Correspondence Address:
Mohammad Jaffar Sadiq Mantargi
Department of Pharmacology, Batterjee Medical College, North - Obhur, Jeddah - 21442
Kingdom of Saudi Arabia

Abstract

BACKGROUND: Various researchers have concluded in their work focusing on the essentiality of electrolyte imbalance admitting even under good medication conditions the prognosis of the patients with poor electrolyte imbalance was found challenging. METHODS: This is a current prospective study. The medical information of the patients was obtained from the medical history chart and the reasonable study outcomes were justified. RESULTS: The educational levels and lack of interest of the participants were identified to be negligible which also impacts the good maintenance of the electrolyte balance in the patients. CONCLUSION: Electrolyte imbalance causes notable changes in the physiology of the body. A high quality of life ensures the proper maintenance of the electrolyte balance may prove to be essential.



How to cite this article:
Gunturi S, Sadiq Mantargi MJ, Vigneshwaran E, Farid Ahmed MM, Dileep Krishna B V, Ahmed T. Electrolytes imbalance and their clinical outcomes in the intensive care unit: A prospective, observational study.Int J Health Allied Sci 2021;10:17-22


How to cite this URL:
Gunturi S, Sadiq Mantargi MJ, Vigneshwaran E, Farid Ahmed MM, Dileep Krishna B V, Ahmed T. Electrolytes imbalance and their clinical outcomes in the intensive care unit: A prospective, observational study. Int J Health Allied Sci [serial online] 2021 [cited 2021 Mar 2 ];10:17-22
Available from: https://www.ijhas.in/text.asp?2021/10/1/17/308576


Full Text



 Introduction



Electrolytes imbalance is among the most common clinical complications met in the setting of intensive care and is associated with the poor prognosis. Critical disorders such as severe burns, trauma, sepsis, brain damage, and heart failure as well as many other diseases lead to disturbances in fluid and electrolyte homeostasis. Electrolytes are essential for sustaining with good health in individuals. The major functions of electrolytes are to control osmosis of water between the different compartments of the body, as co-factors for optimal activity of enzymes and maintain acid-base balance. Their imbalance in the body definitely results in electrolyte disorder ranging from osmotic imbalance, edema, hypertension, hormonal changes, confusion, and loss of consciousness.[1] Feasible mechanisms of the imbalance may include reduced perfusion to the kidney due to hypovolemia or hypotension, stimulation of hormonal systems such as renin-angiotensin-aldosterone system and vasopressin, and also tubular damage due to ischemic or renal damage, including insult caused by a myriad of medications used in the intensive care. The main electrolytes necessary to perform several functions are as follows: Sodium (Na+), Potassium (K+), Calcium (Ca2+), Magnesium (Mg2+), and Phosphates. Electrolytes are present in both extracellular (sodium and chloride) and intracellular (potassium, calcium, and phosphate, etc.) matrix in and around the cells and their concentration is mainly regulated by kidneys. Furthermore, there are some hormones that are involved in the regulation of water and electrolyte balance such as: aldosterone, ADH (antidiuretic hormone), and renin-angiotensin.[2]

Sodium is the major cation with the normal serum concentration of sodium is 135–148 mmol/L, and the daily requirement of sodium is 5–10 g/day.[1],[3],[4]

Potassium is an intracellular electrolyte, and the normal serum concentration of potassium is 3.5–5.0 mEq/L, and the daily requirement of potassium is 3–4 g/day.[2],[3],[4]

Chloride ions (Cl) are the most prevalent anion with the normal serum concentrations of chloride is 93–105 mmol/L, concentration is more in CSF, and the daily requirement of chloride as sodium chloride is 5–10 g.[1],[2],[4]

Calcium (Ca2+) is the abundant among minerals in the body. The total content of the calcium in an adult human is 1–1.5 kg, and the normal concentrations of calcium are 4.5–5.5 mEq/L.[1],[2]

Phosphate (PO42−) is the mineral which plays a main role in the body. Around 85% of the phosphate is present as calcium phosphate in adults, and the remaining 15% is ionized. The normal serum concentrations of phosphate are 1.7–2.6 mEq/L, and the dietary requirement of phosphate is 800 mg/day.[1],[3],[4]

Magnesium (Mg2+) is the mineral present in our body mostly (54%) in the bone. The normal serum concentrations of magnesium are 1.3–2.1 mEq/L, and the daily requirement of magnesium is 300 mg/day and 350 mg/day (women and men). Magnesium levels may rise or fall due to disease, drugs, or other clinical-related conditions.[1],[4],[5]

The present study is conducted to determine the diseases and the medications associated with fluid and electrolyte disorders. The electrolyte imbalance in critically ill patients admitted in the intensive care unit (ICU) in a secondary care hospital situated in resource-challenged settings in India.

 Materials and Methods



Study design

It is a prospective, observational, uni-center study, which was performed at the ICU of a secondary care referral hospital located in a resource-challenged settings of South India for a period of 6 months. The patients above the age of 18 years and keen to participate in the study were included in the study after taking the inform consent of acceptance to be part of the study. Whereas patients below 18 years of age and unwilling to join the study were excluded from the study for good.

Data collection and procedure

Demographic details and biochemical data regarding the electrolytes concentration of the study participants were collected from the medication history chart of patients. Participants were counseled to maintain better health and hygiene for good.

Ethical clearance for the study

Before the beginning of the study, a detailed protocol regarding the study was prepared and submitted to the Institutional Review Board (IRB) for obtaining the ethical clearance for the study. After detailed study and evaluation the protocol through the presentation, the IRB approved the protocol with highlighted points being that the study is non-interventional, observational, uni-centered, prospective study and allotted the approval number as– RIPER/IRB/2014/01. A document of the approval letter was preserved in the department of quality assurance of IRB of the institute.

Inform consent

As per the review board guidance, an informed consent form was prepared and validated for its authenticity. As the people around the study are native Telugu speakers, the consent form was prepared in Telugu for the easy of understanding for the participants or the guardians of the study participants. Forms were distributed to all the participants before the beginning of the study, only after getting the signed consent form from the participants, the patients are taken up as participants.

Statistical analysis

The data were put to test through ANOVA, followed by unpaired t-test as posttest by using Instat – GraphPad Software, Inc. “GraphPad Software, InStat guide to choosing and interpreting statistical tests, 1998, GraphPad Software, Inc., San Diego California USA, www.graphpad.com”, and the results obtained were expressed basing up on the significance.[18],[19]

 Results



A total of 41 patients were included in the study, with a mean age of 46.34 (standard deviation = 18.38) years, with 21 (51%) males and 20 (49%) females. The gender distribution of the participants shall be considered approximately equal in the study.

[Table 1] shows that, from the total study population (41), 41% (17) were of the age group of 20–40 years, 32% (13) were of the age group of 41–60 years, and 27% (11) were of the age group of 61–80 years.{Table 1}

[Table 2] shows the associated comorbid conditions such as respiratory diseases (chronic obstructive pulmonary disease) etc., in the study population and the respiratory diseases (32%) are more common in ICU patients and the associated comorbid conditions are metabolic disorders (such as DM and DKA), poisoning cases (OP poisoning), neurological diseases (such as seizures), renal diseases (such as renal failure and acute kidney injury), cardiac diseases such as (cardiomyopathy), and cancers (right ovarian cyst).{Table 2}

[Table 3] represents the percentage of drugs prescribed in the study sample and majority of drugs prescribed are anti-microbials, and other drugs are CNS drugs (12%), steroids (5%) such as prednisolone, and respiratory drugs (9%) such as salbutamol and ipratropium bromide, cardiovascular acting drugs (14%), analgesics (8%), anesthetics (5%), hematological drugs (4%), and miscellaneous drugs (19%).{Table 3}

 Discussion



In objective of the current study was to evaluate the electrolytes imbalance and their implications on the patients who are admitted in the ICU of a secondary care referral hospital situated in resource-challenged settings of South India. The data regarding the electrolytes concentration were obtained by maintaining the normal level of communication with the patients through the patient's case history chart after obtaining the inform consent from the study participants. The data related to the demographics, diagnosis, past medical history, and present medications prescribed were obtained along with the electrolyte test results [Table 1] and [Table 4].{Table 4}

The results reveal that out of all the patients who were admitted into the ICU and ended up being dead because of complicated illness shows 25% hypernatremia, 37.5% hyperkalemia, 18.75% hypokalemia, 56% hyperchloremia, 70% hyperkalcemia, 37.5% hypomagnesemia, 100% hyperphosphotemia, and those who were treated successfully and ended up being alive were 4% hyponatremia and no cases of hypernatremia, 12% hypokalemia and no cases of hyperkalemia, 32% hyperchloremia and 8% hypochloremia, 64% hyperkalcemia and no cases of hypokalcemia, 8% hypermagnesemia and 24% hypomagnesemia, and 8% hyperphosphotemia [Table 5] and [Table 6].{Table 5}{Table 6}

As the results indicate clearly that the patients with hypernatremia and hyperkalaemia its improper management were at high risk of death. There are various studies published earlier which can be related to the current study which explains that in 1968, a study conducted by Owen and Campbell[6] in which they compared healthy outpatients with hospitalized patients where the serum sodium concentration was found to be 5–6 meq/L in hospitalized participants, in a similar study conducted by Anderson et al.[7] in 1985, found the incidence and prevalence in patients who are admitted in the various departments such as medical, surgical, psychiatric hospital, and they reported that the daily incidence of hyponatremia was 1% and prevalence was 2.5%. Polder man et al.[8] conducted a 1-year retrospective study to determine the hypernatremia in patients and reported that hypernatremia was found in 9% of the patients who are admitted to ICU and also found that some of the patients subjected to hypernatremia during their stay in ICU. A similar study by Lindner et al.[9] conducted a study to determine the incidence of hyponatremia in critically ill patients, and they reported that there is high mortality rate in patients with hypernatremia and another similar, in a 5-year retrospective study of 2,188 patients, Bennani[10] and associates found the incidence of hyponatremia (serum sodium <130 meq/L) to be 14% at the time of admission to the ICU. In a recent study by Crop et al., from 1,178 patients in whom serum potassium level was measured, 140 patients (12%) with hypokalemia were identified and also 23 patients (16%) developed hyperkalemia.

The levels difference of sodium and potassium in the current study among the patients who successfully obliged to the treatment and those did not were significant. In one of the case studied during the study, gestational eclampsia was well managed by maintaining the optimal levels of sodium, potassium, and magnesium. Whereas, in another case where the patient was suffering with gestational eclampsia was identified to be suffering with increased chlorine, calcium and phosphates levels, which has finally resulted in loss of precious life in the 25th week of gestation.

In case of diabetic ketoacidosis,[11] the parameters shows that the patient was suffering with increased levels of sodium which mirrors the final results of the study where there is a significant difference between the levels of the sodium and potassium in the study participants of both the groups. In the patients with peritonitis, bowel obstruction with acute kidney injury, lower limb cellulites, and epilepsy with diabetic nephropathy were identified to be suffering with increased levels of potassium and diabetic ketoacidosis, epilepsy with diabetic nephropathy, ketoacidosis with brain tumor, and increased levels of sodium were identified. Hence, increased levels of sodium and potassium have shown serious implications in the therapeutic outcomes in the patients admitted in the ICU.

However, the increased levels of chlorine, calcium, magnesium, and phosphate do not shows significant differences between the two study groups. However, from the point of view of management of the electrolytes imbalance chlorine, calcium, magnesium, and phosphates are easy to be managed with less serious outcomes, and sodium and potassium are challenging to be managed with serious outcomes.

This increase in the levels of electrolytes may be attributed to the various reasons ranging from, perception and attitude toward unhealthy lifestyle,[12],[13],[14],[15] usage of drugs without proper monitoring[14],[15],[16],[17] (NSAIDS, ARBs, ACEI, and narcotics) unidentified diseased conditions (autoimmune diseases), and genetic disorders. Hence, counseling the general population for the proper lifestyle modifications shall be recommended, proper use of the medications by the patients, for example, the prescription of anticoagulants must be based on the INR of the patients, diuretic must be based on the GFR of the patient, dose of the drug must be based on the age of the patient, excessive antibiotic usage must be restricted and must be dispensed on prescription, narcotics dispensing must be strictly controlled by the law and pharmacist, NSAIDS must be avoided from taking unnecessary, antihistaminics must be avoided for all allergic manifestations, lot more knowledge of pharmacology must be put in while prescribing the drugs in pregnancy and lactation, usage of metformin must be restricted in renal failure patients. And to achieve this said recommendations, the services of the qualified pharmacist may prove handy.

 Conclusion



Electrolyte imbalance in critically ill patients can lead to lethal consequences. Additional caution to electrolyte disturbances should be paid in ICUs because it is often hard to effectively assess the symptoms and signs of critically ill patients. The health-care staff should be well educated about fluid and electrolyte homeostasis and the underlying medications and diseases associated with.

Acknowledgment

All the authors express their gratitude toward the hospitals situated in the Anantapur district of South India.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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