---
title: Electrolyte Imbalance Correction
description: A comprehensive clinical reference on the diagnosis and management of electrolyte imbalances.
keywords: [electrolytes, hyponatremia, hyperkalemia, hypokalemia, fluid balance, acid-base]
category: clinical
---

## Introduction

Electrolyte imbalances are common clinical conditions that can have significant impacts on patient health and outcomes if not properly recognized and managed. Prompt identification and correction of electrolyte disturbances is essential to prevent potentially life-threatening complications. This document provides a comprehensive overview of the diagnostic criteria, treatment approaches, and monitoring parameters for the most common electrolyte imbalances.

## Hyponatremia

### Diagnostic Criteria
Hyponatremia is defined as a serum sodium concentration less than 135 mmol/L. It is further classified as mild (130-134 mmol/L), moderate (125-129 mmol/L), or severe (<125 mmol/L) based on the degree of sodium depletion. Diagnostic evaluation should include assessment of volume status, osmolality, and urine sodium concentration to determine the underlying etiology.

### Treatment
The management of hyponatremia depends on the acuity, severity, and underlying cause. For acute, symptomatic hyponatremia (e.g. seizures, coma), rapid correction with hypertonic saline (3% NaCl) is indicated, with a target sodium increase of 4-6 mmol/L over the first 4-6 hours. For chronic, asymptomatic hyponatremia, more gradual correction with fluid restriction, loop diuretics, and/or oral sodium supplementation (e.g. sodium chloride tablets) is appropriate, aiming for a sodium increase of no more than 8-12 mmol/L per day. Specific treatment algorithms are outlined in the SCCM/ESICM/ACCP/ATS/SIS International Sepsis Guidelines.

### Monitoring
Serum sodium should be monitored closely during treatment, with more frequent monitoring (e.g. every 2-4 hours) for acute, severe cases. Overcorrection of hyponatremia must be avoided to prevent the development of osmotic demyelination syndrome. Other parameters to monitor include fluid balance, urine output, and mental status.

## Hyperkalemia

### Diagnostic Criteria
Hyperkalemia is defined as a serum potassium concentration greater than 5.5 mmol/L. It is further classified as mild (5.5-6.0 mmol/L), moderate (6.1-6.5 mmol/L), or severe (>6.5 mmol/L) based on the degree of potassium elevation. Diagnostic evaluation should include assessment of renal function, acid-base status, and medications that may be contributing to the hyperkalemia.

### Treatment
The management of hyperkalemia depends on the acuity, severity, and underlying cause. For severe, acute hyperkalemia (e.g. ECG changes, arrhythmias), immediate treatment with calcium gluconate, insulin/glucose, and/or sodium bicarbonate is indicated to stabilize the myocardium and shift potassium intracellularly. For less severe cases, oral or intravenous potassium binders (e.g. sodium polystyrene sulfonate, patiromer, or calcium polystyrene sulfonate) may be used to facilitate potassium excretion. Diuretics, such as loop or thiazide agents, can also be employed to promote urinary potassium wasting. Specific treatment algorithms are outlined in the KDIGO Clinical Practice Guideline for the Management of Blood Pressure in CKD.

### Monitoring
Serum potassium should be monitored closely during treatment, with more frequent monitoring (e.g. every 2-4 hours) for acute, severe cases. Other parameters to monitor include renal function, acid-base status, and cardiac rhythm.

## Hypokalemia

### Diagnostic Criteria
Hypokalemia is defined as a serum potassium concentration less than 3.5 mmol/L. It is further classified as mild (3.0-3.4 mmol/L), moderate (2.5-2.9 mmol/L), or severe (<2.5 mmol/L) based on the degree of potassium depletion. Diagnostic evaluation should include assessment of gastrointestinal or renal losses, as well as potential contributing factors such as diuretic use or acid-base disturbances.

### Treatment
The management of hypokalemia depends on the acuity, severity, and underlying cause. For severe, symptomatic hypokalemia (e.g. muscle weakness, paralysis, cardiac arrhythmias), immediate treatment with intravenous potassium chloride or potassium phosphate is indicated, with close monitoring of serum potassium and cardiac rhythm. For less severe cases, oral potassium supplementation (e.g. potassium chloride tablets or solution) may be sufficient, with the dose and frequency adjusted based on the degree of depletion and ongoing losses. Specific treatment algorithms are outlined in the AHA/ACC/HRS Guideline for the Management of Patients with Atrial Fibrillation.

### Monitoring
Serum potassium should be monitored closely during treatment, with more frequent monitoring (e.g. every 2-4 hours) for acute, severe cases. Other parameters to monitor include renal function, acid-base status, and cardiac rhythm.

## Metabolic Acidosis

### Diagnostic Criteria
Metabolic acidosis is defined as a decreased blood pH (<7.35) and decreased serum bicarbonate concentration (<22 mmol/L). It can be further classified based on the underlying cause, such as diabetic ketoacidosis, lactic acidosis, or renal tubular acidosis. Diagnostic evaluation should include assessment of anion gap, osmolal gap, and potential contributing factors.

### Treatment
The management of metabolic acidosis depends on the underlying cause and severity. For severe, life-threatening acidosis (e.g. pH <7.1, bicarbonate <10 mmol/L), immediate treatment with intravenous sodium bicarbonate may be indicated to improve tissue perfusion and correct the acidemia. For less severe cases, treatment should focus on addressing the underlying cause, such as insulin administration for diabetic ketoacidosis or fluid resuscitation for lactic acidosis. Specific treatment algorithms are outlined in the GOLD Guidelines for the Diagnosis and Management of COPD.

### Monitoring
Arterial blood gas, serum electrolytes, and anion gap should be monitored closely during treatment, with more frequent monitoring (e.g. every 2-4 hours) for acute, severe cases. Other parameters to monitor include fluid balance, urine output, and mental status.

## Conclusion

Electrolyte imbalances are common clinical conditions that require prompt recognition and management to prevent potentially life-threatening complications. Diagnostic evaluation should focus on identifying the underlying etiology, and treatment should be tailored to the specific imbalance, severity, and clinical context. Close monitoring of serum electrolytes, fluid balance, and other relevant parameters is essential to ensure safe and effective correction of electrolyte disturbances.