Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital

Shahin Ibn Rahman; Milton Barua; Nausher Azimul Huq; Bimol Kumar Agarwala; Muhbubunnesa Sadia

doi:doi:10.11648/j.ijde.20200504.14

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Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital

Shahin Ibn Rahman, Milton Barua, Nausher Azimul Huq, Bimol Kumar Agarwala, Muhbubunnesa Sadia

Published in International Journal of Diabetes and Endocrinology (Volume 5, Issue 4)

Received: 10 November 2020 Accepted: 25 November 2020 Published: 22 December 2020

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Abstract

Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison’s disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn’s syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn’s syndrome and don’t forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.

Published in	International Journal of Diabetes and Endocrinology (Volume 5, Issue 4)
DOI	10.11648/j.ijde.20200504.14
Page(s)	71-76
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2020. Published by Science Publishing Group

Keywords

Electrolytes, Diabetes Mellitus, Addison’s Disease, Hyperparathyroidism

References

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[2]	Bockenkamp, B. and Vyas, H. (2003) ‘Understanding and managing acute fluid and electrolyte disturbances’, Current Paediatrics. 2003 13: pp. 520–528.
[3]	Goldberg, A. Hammerman, H. Petcherski, S. Nassar, M. Zdorovyak, A. Yalonetsky, S. et al. (2006) ‘Hyponatremia and long-term mortality in survivors of acute ST-elevation myocardial infarction’, Arch Intern Med. 166: pp. 781–786.
[4]	Sharkawy, A. M. Sahota, O. Maughan, R. J. and Lobo, D. N. (2014) ‘The pathophysiology of fluid and electrolyte balance in the older adult surgical patient’, Clinical Nutrition. 33: pp. 6-13.
[5]	Zaman, M. M. Choudhury, S. R. Ahmed, J. Numan, S. M. Islam, S. M. and Yoshiike, N. (2004) ‘Non biochemical risk factors for cardiovascular disease in general clinic-based rural population of Bangladesh’, Journal of Epidemiology. 14: pp. 63-68.
[6]	Ahmed, S (2014) ‘Electrolyte Imbalance in Admitted Diabetic Patients: Patterns and Factors Responsible- A Cross Sectional Study’, KYAMC Journal, 5 (1), pp. 458–466.
[7]	Haque, H. et al. (2012) ‘Pattern of Electrolyte Imbalance in Hospitalized Diabetic Patients: Experience in a Tertiary Care Hospital’, BIRDEM Medical Journal, 2 (1), pp. 14–18.
[8]	Siragy, H. M. (2006) ‘Hyponatremia, fluid-electrolyte disorders, and the syndrome of inappropriate antidiuretic hormone secretion: diagnosis and treatment options’, Endocrine practice, 12 (4), pp. 446–57.
[9]	Clayton, J. A., Le Jeune, I. R. and Hall, I. P. (2006) ‘Severe hyponatraemia in medical in-patients: Aetiology, assessment and outcome’, Qjm, 99 (8), pp. 505–51.
[10]	Boysen, S. R. (2008) ‘Fluid and Electrolyte Therapy in Endocrine Disorders: Diabetes Mellitus and Hypoadrenocorticism’, Veterinary Clinics of North America - Small Animal Practice, 38 (3), pp. 699–717.
[11]	Vryonidou, A. et al. (2018) ‘Hypokalemia: a clinical update’, Endocrine Connections, 7 (4), pp. 135–146.
[12]	Fraser, R. (1984) ‘Disorders of the adrenal cortex: their effects on electrolyte metabolism’, Clinics in Endocrinology and Metabolism, 13 (2), pp. 413–430.
[13]	Kumar, V. (2018) ‘Case Report A Case of Diabetic Ketoacidosis Presenting with Hypernatremia, Hyperosmolarity, and Altered Sensorium’, Case Reports in Endocrinology, 2018, pp. 1–4.
[14]	Das gupta, A., Saikia, U. and Sarma, D. (2012) ‘Hypomagnesemia in type 2 diabetes mellitus’, Indian Journal of Endocrinology and Metabolism, 16 (6), p. 1000.
[15]	Sales, C. H. and Pedrosa, L. de F. C. (2006) ‘Magnesium and diabetes mellitus: Their relation’, Clinical Nutrition, 25 (4), pp. 554–562.
[16]	Qureshi, S. et al. (2015) ‘A severe case of ectopic ACTH presenting with Cushing’s syndrome with hypokalaemia, hypomagnesemia, hypophosphatemia, hyponatraemia and hypocalcaemia’, Endocrine Abstracts. BioScientifica.

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Shahin Ibn Rahman, Milton Barua, Nausher Azimul Huq, Bimol Kumar Agarwala, Muhbubunnesa Sadia. (2020). Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital. International Journal of Diabetes and Endocrinology, 5(4), 71-76. https://doi.org/10.11648/j.ijde.20200504.14

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Shahin Ibn Rahman; Milton Barua; Nausher Azimul Huq; Bimol Kumar Agarwala; Muhbubunnesa Sadia. Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital. Int. J. Diabetes Endocrinol. 2020, 5(4), 71-76. doi: 10.11648/j.ijde.20200504.14

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Shahin Ibn Rahman, Milton Barua, Nausher Azimul Huq, Bimol Kumar Agarwala, Muhbubunnesa Sadia. Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital. Int J Diabetes Endocrinol. 2020;5(4):71-76. doi: 10.11648/j.ijde.20200504.14

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@article{10.11648/j.ijde.20200504.14,
  author = {Shahin Ibn Rahman and Milton Barua and Nausher Azimul Huq and Bimol Kumar Agarwala and Muhbubunnesa Sadia},
  title = {Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital},
  journal = {International Journal of Diabetes and Endocrinology},
  volume = {5},
  number = {4},
  pages = {71-76},
  doi = {10.11648/j.ijde.20200504.14},
  url = {https://doi.org/10.11648/j.ijde.20200504.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20200504.14},
  abstract = {Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison’s disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn’s syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn’s syndrome and don’t forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.},
 year = {2020}
}

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TY  - JOUR
T1  - Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital
AU  - Shahin Ibn Rahman
AU  - Milton Barua
AU  - Nausher Azimul Huq
AU  - Bimol Kumar Agarwala
AU  - Muhbubunnesa Sadia
Y1  - 2020/12/22
PY  - 2020
N1  - https://doi.org/10.11648/j.ijde.20200504.14
DO  - 10.11648/j.ijde.20200504.14
T2  - International Journal of Diabetes and Endocrinology
JF  - International Journal of Diabetes and Endocrinology
JO  - International Journal of Diabetes and Endocrinology
SP  - 71
EP  - 76
PB  - Science Publishing Group
SN  - 2640-1371
UR  - https://doi.org/10.11648/j.ijde.20200504.14
AB  - Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison’s disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn’s syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn’s syndrome and don’t forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.
VL  - 5
IS  - 4
ER  -

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Author Information

Shahin Ibn Rahman

Department of Endocrinology, Dhaka National Medical Institute Hospital, Dhaka
Milton Barua

Department of Medicine, Sadar Hospital, Khagrachari
Nausher Azimul Huq

Department of Endocrinology, Dhaka National Medical College, Dhaka
Bimol Kumar Agarwala

Department of Endocrinology, Dhaka National Medical College, Dhaka
Muhbubunnesa Sadia

Department of Endocrinology, Dhaka National Medical Institute Hospital, Dhaka

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APA Style

Shahin Ibn Rahman, Milton Barua, Nausher Azimul Huq, Bimol Kumar Agarwala, Muhbubunnesa Sadia. (2020). Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital. International Journal of Diabetes and Endocrinology, 5(4), 71-76. https://doi.org/10.11648/j.ijde.20200504.14

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ACS Style

Shahin Ibn Rahman; Milton Barua; Nausher Azimul Huq; Bimol Kumar Agarwala; Muhbubunnesa Sadia. Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital. Int. J. Diabetes Endocrinol. 2020, 5(4), 71-76. doi: 10.11648/j.ijde.20200504.14

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AMA Style

Shahin Ibn Rahman, Milton Barua, Nausher Azimul Huq, Bimol Kumar Agarwala, Muhbubunnesa Sadia. Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital. Int J Diabetes Endocrinol. 2020;5(4):71-76. doi: 10.11648/j.ijde.20200504.14

Copy | Download

@article{10.11648/j.ijde.20200504.14,
  author = {Shahin Ibn Rahman and Milton Barua and Nausher Azimul Huq and Bimol Kumar Agarwala and Muhbubunnesa Sadia},
  title = {Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital},
  journal = {International Journal of Diabetes and Endocrinology},
  volume = {5},
  number = {4},
  pages = {71-76},
  doi = {10.11648/j.ijde.20200504.14},
  url = {https://doi.org/10.11648/j.ijde.20200504.14},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20200504.14},
  abstract = {Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison’s disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn’s syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn’s syndrome and don’t forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.},
 year = {2020}
}

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TY  - JOUR
T1  - Pattern of Electrolytes Including Calcium and Magnesium Imbalance with Etiology Assessment in Patients Admitted in Endocrine Department of a Tertiary Care Hospital
AU  - Shahin Ibn Rahman
AU  - Milton Barua
AU  - Nausher Azimul Huq
AU  - Bimol Kumar Agarwala
AU  - Muhbubunnesa Sadia
Y1  - 2020/12/22
PY  - 2020
N1  - https://doi.org/10.11648/j.ijde.20200504.14
DO  - 10.11648/j.ijde.20200504.14
T2  - International Journal of Diabetes and Endocrinology
JF  - International Journal of Diabetes and Endocrinology
JO  - International Journal of Diabetes and Endocrinology
SP  - 71
EP  - 76
PB  - Science Publishing Group
SN  - 2640-1371
UR  - https://doi.org/10.11648/j.ijde.20200504.14
AB  - Objectives: Several endocrine disorders have marked effects on fluid, electrolyte, and acid-base homeostasis including diabetic ketoacidosis, hyperglycemic hyperosmolar state, and acute adrenal crisis etc. An understanding of the etiology behind the development of these electrolytes along with calcium and magnesium imbalance helps to guide therapy and improves the clinical outcome. The aim of this study to see the pattern of electrolytes, calcium and magnesium imbalance with etiology assessment in patients admitted in endocrine department of a tertiary care hospital. Study design and methods: This cross sectional observational study was carried out from January 2018 to December 2018, at in-patient department of Endocrinology, BIRDEM General Hospital, Dhaka. Diagnosed (old and new) cases of diabetic and other endocrine disorders having electrolytes, calcium and magnesium imbalance were approached for sinclusion of the study. Sampling technique was purposively selected focusing on demographic profile and diagnosis of the disease. Results: Among the 100 participants, mean age of the study population was 46.26±16.97 years, ranging from 14 to 75 years. There were 50%-male and 50%-female. In result the most common electrolyte imbalance was hyponatremia (36%) that was more in type-2 DM patients (n=25) then in Addison’s disease (n=4) and rest are in other specific form of DM (n=3), type-1 DM (n=2), DM with hypoparathyroidism (n=1) and hypoparathyroidism (n=1) which may be due to SIADH. Followed by hypokalemia (14%) which mostly encountered in type-2 DM patient (n=6) due to diuretics and in Conn’s syndrome (n=4), hyperkalemia (10%) which mostly observed in type-1 DM patient (n=4) due to DKA, and hypercalcemia (8%) was found in non-diabetic endocrine disorders. Hypernatremia, hypocalcemia and hypomagnesemia were present in 7%, in 6%, and 6% cases, respectively. The most common precipitating cause of these electrolyte imbalances was vomiting (30%) due to different causes like urinary tract infection; acute gastritis and pancreatitis. Diuretic (Loop & Thiazide) therapy (10%) and HHS (8%) were the second and third most common cause behind these electrolytes imbalance Conclusion: In conclusion data obtained in this study showed hyponatremia was the most common findings which more observed in diabetic patients. As vomiting is the most common cause behind this so any diabetic patients either present with vomiting or any other illness should routinely advice electrolytes along with magnesium as hypomagnesemia also more observed in this group. To find out the cause of hypokalemia in non-diabetic patients should evaluate the Conn’s syndrome and don’t forget to measure the parathyroid hormone in hypercalcemic patient. Further study is needed to find out the causes of vomiting.
VL  - 5
IS  - 4
ER  -

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