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

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.

A nonspecific clinical picture and the course of Conn syndrome — current findings in the screening program for hypertensive patients

“…In a single center study, the prevalence of Conn syndrome was reported to be 2.6% of patients in primary care [3]. Patients with CS may account for as many as half of the patients admitted to the endocrinology department due to hypokalemia [4]. Primary hyperaldosteronism (PHa) appears to be the most common endocrine cause of secondary hypertension.…”