KETIDAKSEIMBANGAN ELEKTROLIT http://www.healthline.

com/galecontent/electrolyte-disorders#2 LATAR BELAKANG

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 (i.e., burns, 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. (Healthline.com) Electrolytes are vital to health, and act as chemical messengers in the body carrying electrical impulses from the nerves to control all tissue function and movement. An imbalance of any of the electrolytes can lead to serious disruptions in physiologic function. Many bodily processes are highly dependent on them, primarily heart and nerve function, muscle coordination and control, and maintenance of the bodys fluid levels.

Electrolytes are found throughout body tissues. Blood, plasma (the acellular portion of blood) and the fluid that bathes the cells are high in sodium (Na+) and chloride (Cl-), which is similar to common table salt, otherwise known as sodium chloride (Na+Cl-). In other areas of the body (cells that make up organs), the electrolytes potassium (K+), chloride (Cl-), calcium (Ca+), and magnesium (Mg2+) are prevalent. Electrolyte levels are tightly controlled by several hormones and by the kidneys, which are primarily responsible for retaining and removing electrolytes when necessary and keeping them in a constant state of balance. An electrolyte imbalance can lead to serious health issues, including eventual death if not corrected. (http://www.gleukos.com/science/pdf/Electrolytes&Hydration.pdf ) Pokok Bahasan Kalsium

Natrium Sodium is highly important for the regulation of fluid levels outside of the cells in the body. It is an essential factor in hydration as it holds water in the cells. While sodium is highly important as an electrolyte, it is found at excessively high levels in many foods and drinks. The minimum physiological requirement for sodium is 500 milligrams per day. In the meantime, the average American diet contains roughly 3000 to 5000 milligrams of sodium per day, far exceeding the minimal requirement. For optimal health, it is recommended that one consume less than 2400 milligrams per day. Excessive intake of sodium is associated with hypertension (high blood pressure) and swelling in the tissues.1 Additionally, high sodium levels are associated with osteoporosis (thinning of the bones) due to sodiums effect on increasing urinary loss of calcium.2 Despite the widespread prevalence of sodium in the diet, many sports drinks continue to add high amounts of sodium into their formulation. This is done primarily for flavor enhancement, rather than for the claim that people need extra amounts of sodium, which is incorrect. Hypernatremia Defined as excessive blood levels of sodium, hypernatremia is a common occurrence due to the high amounts of sodium found in foods and beverages. Too much sodium may lead to increased thirst, leading to the intake of more water resulting in swelling in the hands, feet and face. Hypernatremia also contributes to high blood pressure (the sodium pulls more water into the bloodstream, raising the pressure in the cardiovascular system). Hyponatremia Low blood sodium levels, known as hyponatremia, occurs when the blood volume is diluted with excessive water. This can occur when an athlete replaces lost fluid with plain water. Hyponatremia has become a widespread concern, as the message to drink plenty of fluids is prevalent in the athletic community. Hyponatremia can cause swelling, wheezing, nausea and vomiting, dizziness, and coma or death if untreated. Consumption of a sodium-containing beverage rather than plain water will prevent this condition (http://www.gleukos.com/science/pdf/Electrolytes&Hydration.pdf )

Kalium Potassium is integral to maintaining the bodys fluid balance with sodium. Along with sodium, it is one of the main electrolytes that are consistently lost in sweat. Potassium is the most abundant electrolyte found inside the cells of the body, and is essential for many physiologic processes including nerve impulse transmission, heart and skeletal muscle contraction, and processing of carbohydrates (energy production).3 The daily recommended allowance of potassium is roughly 3.5 grams per day. Potassium is found in many fresh fruits and vegetables. The potassium found in vegetables is often lost in steaming and other forms of processing The standard American diet contains roughly 2000 to 6000 milligrams of potassium per day; levels tend to be lower in people who sweat heavily, take certain prescription drugs, drink coffee and/or alcohol and consume a high-salt diet. Also, people that follow low-calorie or fad diets, off-again, on-again dieting regimens or those that consume diet pills, diuretics (blood pressure medications) or laxatives may be susceptible to low levels of potassium. Potassium is typically found in low levels in many sports beverages, and has a taste similar to sodium. Levels of potassium that are either very high (hyperkalemia) or very low (hypokalemia) can be life threatening. Hypokalemia Low levels of potassium may occur for a number of reasons; those listed above are typical causes. The most common symptoms of hypokalemia are fatigue and weakness. Other signs are low blood pressure and decreased heart rate. Advanced cases of hypokalemia can result in irregular heart rhythms (dysrhythmia) and if untreated, death. Hyperkalemia Elevated potassium levels occur more rarely; typically this happens in people who have reduced kidney function, protein-breakdown diseases, or severe infections. Some medications may predispose a person to hyperkalemia as well. (http://www.gleukos.com/science/pdf/Electrolytes&Hydration.pdf ) Magnesium http://www.mgwater.com/hypomagnesemia.shtml

Although magnesium (Mg) is predominantly an intracellular cation, participating in many membrane-enzymatic functions, technical difficulties in determining the cellular content of this cation in different tissues have mandated reliance on the blood levels of Mg as the index of deficiency. However, Mg deficiency may exist with normal or elevated levels of Mg in blood [Fitzgerald and Fourman, 1965, Lim et al. 1969]. The body of the adult human contains about 2000 mEq of Mg with half of this amount in the skeleton and the other half in soft tissues [Wacker and Parisi 1968]. The normal concentration of Mg in blood is maintained within narrow limits and ranges between 1.5-2.0 mEq/l. About 2030% of Mg in blood is bound to proteins and the rest (75 9%, (SD)) is present in a diffusible form. The major part of the diffusible fraction is made of free ionized Mg [Walser 1967]. The kidney plays an important role in maintaining blood Mg within the normal range. Oral or intravenous loads are rapidly excreted [Chesly and Tepper 1958, Heaton and Parson 1961], and in the magnesium deficient state or with rigid dietary restriction, Mg almost disappears from the urine [Barnes et al. 1958, Fitzgerald and Fourman 1965].

Klorida Phospat

Hypophosphatemia is an electrolyte disturbance in which there is an abnormally low level of phosphate in the blood. The condition has many causes, but is most commonly seen when malnourished patients (especially chronic alcoholics) are given large amounts of carbohydrates, which creates a high phosphorus demand by cells, removing phosphate from the blood (refeeding syndrome). Because a decrease in phosphate in the blood is sometimes associated with an increase in phosphate in the urine, the terms hypophosphatemia and "phosphaturia" are occasionally used interchangeably; however, this is improper since there exist many causes of hypophosphatemia besides overexcretion and phosphaturia, and in fact the most common causes of hypophosphatemia are not associated with phosphaturia.

Common causes of hypophosphatemia

Refeeding syndrome This causes a demand for phosphate in cells due to the action of phosphofructokinase, an enzyme that attaches phosphate to glucose to begin metabolism of this. Also, production of ATP when cells are fed and recharge their energy supplies, requires phosphate. Respiratory alkalosis Any alkalemic condition moves phosphate out of the blood into cells. This includes most common respiratory alkalemia (a higher than normal blood pH from low carbon dioxide levels in the blood), which in turn is caused by any hyperventilation (such as may result from sepsis, fever, pain, anxiety, drug withdrawal, and many other causes). This phenomenon is seen because in respiratory alkalosis carbon dioxide (CO2) decreases in the extracellular space, causing intracellular CO2 to freely diffuse out of the cell. This drop in intracellular CO2 causes a rise in cellular pH which has a stimulating effect on glycolysis. Since the process of glycolysis requires phosphate (the end product is adenosine triphosphate), the result is a massive uptake of phosphate into metabolically active tissue (such as muscle) from the serum. It is interesting to note, however, that this effect is not seen in metabolic alkalosis, for in such cases the cause of the alkalosis is increased bicarbonate rather than decreased CO2. Bicarbonate, unlike CO2, has poor diffusion across the cellular membrane and therefore there is little change in intracellular pH. [1] Alcohol abuse Alcohol impairs phosphate absorption. Alcoholics are usually also malnourished with regard to minerals. In addition, alcohol treatment is associated with refeeding, and the stress of alcohol withdrawal may create respiratory alkalosis, which exacerbates hypophosphatemia (see above). Malabsorption This includes GI damage, and also failure to absorb phosphate due to lack of vitamin D, or chronic use of phosphate binders such as sucralfate, aluminumcontaining antacids, and (more rarely) calcium-containing antacids.

Primary hypophosphatemia is the most common cause of nonnutritional rickets. Laboratory findings include low-normal serum calcium, moderately low serum phosphate, elevated serum

alkaline phosphatase, and low serum 1,25 dihydroxy-vitamin D levels, hyperphosphaturia, and no evidence of hyperparathyroidism.[2] Other rarer causes include

Certain blood cancers such as lymphoma or leukemia Hereditary causes Hepatic failure Tumor-induced osteomalacia
Hyperphosphatemia is an electrolyte disturbance in which there is an abnormally elevated level of phosphate in the blood.[1] Often, calcium levels are lowered (hypocalcemia) due to precipitation of phosphate with the calcium in tissues.

Hypoparathyroidism: In this situation, there are low levels of Parathyroid hormone (PTH). PTH normally inhibits renal reabsorption of phosphate, and so without enough PTH there is more reabsorption of the phosphate. Chronic renal failure: When the kidneys aren't working well, there will be increased phosphate retention. Osteomalacia, which may be caused by the insufficient content of vitamin D in the diet, the lack of sunlight, malabsorption or renal disorders. Drugs: hyperphosphatemia can also be caused by taking oral sodium phosphate solutions prescribed for bowel preparation for colonoscopy in children.