Correction of Electrolyte Abnormalities in Critically Ill Patients

Abstract

The majority of patients in the intensive care unit (ICU) are at risk for at least one electrolyte abnormality and critically ill patients are the most vulnerable population to the effects of suboptimal electrolyte levels. These patients have unique characteristics impacting implications of the electrolyte disturbances and management. In the ICU, magnesium, potassium, calcium, phosphorous, and sodium are the most commonly encountered electrolytes that can be abnormal in the critically ill. Critical illness both is affected by and affects disturbances of these electrolytes which can result in more severe illness, longer duration of mechanical ventilation, increased dialysis support, longer length of stay, and increased mortality. Often, patients have multiple imbalances that require correction. Removal or mitigation of the cause should be undertaken whenever possible and should be concurrent with any therapeutic management used to correct the electrolyte imbalance. Selection of medication to correct electrolyte imbalances should be undertaken according to available evidence and drug-specific characteristics that impact medication delivery in the critically ill. Electrolyte disturbances, measurements, and corrections are ubiquitous in the ICU. Published literature on the management of electrolytes in the critically ill is limited. Management should consider factors unique to the critically ill when selecting optimal treatment approach and it is essential to individualize treatment to a patient’s unique needs and adapt management to the patient’s chancing clinical situation.