Unexplained Electrolyte Imbalance

[JennKay]

Hi guys -

I've had a fun weekend. I woke-up yesterday feeling funky - nauseated, achy, chills, elevated heart rate, ectopics. Basically similar to how I felt when I had covid19 in January. Then, when I just resting trying to figure out how to feel better, my heart rate jumped up to 135bpm and my BP went up to 145/85, which is super high for me. That's when I thought it was time to go to the ER b/c I was feeling so crappy and my HR and BP were off. Got there, my EKG showed prolonged QT, my Mg was low, my potassium was low, and my phosphorus was low. So, they decided to admit me to monitor my EKG. My heart rate finally came down after being at like 120bpm for 5hrs, but it took 2 bags of saline, 2 bags of potassium, and a bag of Mg. QT interval is normal again and cardiologist thinks the electrolytes caused the issue. They are keeping me one more night for testing on Monday: an echo (last one was June 2021 which was normal) and stress test (last one was just a few weeks ago and was normal). Oh, and I tested positive for covid19 again! They aren't sure if this is a new infection or lingering virus particles from my previous infection. One internist said might be new infection, another said probably old viral particles. Unfortunately, they really can't tell with the PCR test, but the symptoms I had yesterday were similar to my January infection.

Question to the group - has anyone had their electrolyte levels randomly tank like this before and what explanation, if anything, were you given? I've been taking a daily Mg supplement so I'm very confused as to how my level of Mg were below normal.

I guess if this is a new covid19 infection then the virus could have thrown my electrolytes out of whack - but I am vaxxed and had omicron in January, so if this is the case then I am super unlucky! Mainly just looking for support. Am tired of feeling so brittle!! And, I'm missing my kiddos so I'm a bit sad too.

[Jyoti]

Hi @JennKay--So sorry to hear about Covid!  That is so unlucky.  And such a drag.  

I did have a similar experience a number of years ago.  Before I had gotten any kind of diagnosis (was still in the 'why don't you try meditation' from the medical profession phase).   I had had a bad month, really.   New GI symptoms and I was struggling to eat well, but not starving or anything.  Then one night (it just happened to be Christmas night) my heart rate went nuts, my blood pressure went up to 180 over something (can't recall now) and I highed myself to the ER.  There, it was learnt that my QT interval was off and my potassium very low.  

I felt a lot better after saline and IV potassium (2 bags as well) but the cause of the tank was never identified.  I find that my electrolytes go out of whack from time to time and now that I recognize the symptoms, I can respond.  At first, I was in the ER every week for a while, but ultimately saw that all they would do was give me IV potassium and saline--which was nice but certainly not worth the horror of having to hang out in an ER all day or night.  I did get my doctor to write a standing order for electrolyte assays each week so I could monitor what was happening.  As you know I am sure, too much is as dangerous as too little in this arena; I did not want to over-supplement.  

In recent weeks I have been struggling with electrolyte imbalances again and have begun to look at MCAS as a potential key to this pattern in my body.  I have not gotten to a place of clarity yet, but having been well-tested (in both senses) since that initial incident without anything definitive emerging as a cause, I mostly keep an eye open for explanation and try to stay on top of symptoms when they arise.

I imagine you will be home with your kids soon, which will be much better than being in the hospital.  I hope you recover from whatever is going on soon!

 

[JennKay]

@Jyoti- thanks for sharing your story. Sorry that you have had the same experience, but it's nice to know that I'm not alone. It is just so puzzling and weird to me. It all feels random and scary. I am very deliberate with eating and staying hydrated, so I can't explain what happened. Maybe it is from covid19 since this is the first time it has happened to me and I tested positive...a second time...within two months. Am hoping it doesn't happen again!

Have also learned that my BP in the morning, after a full bag of saline overnight, is only 95/55. Not sure how to explain that either! I'm as plump as a brined chicken and still my BP is low.

[MomtoGiuliana]

My electrolytes go low when I am in a flare.  I've gone to ER feeling really badly--weak, a lot of ectopic heart beats, etc., and my Mg and/or K are low.  I will feel a little better after fluids and supplement/s.  

No one has ever really explained to me why this happens.  Drs ask me if I was vomiting or had diarrhea.  

I think overdrinking water CAN cause this--in extreme cases.  My cardiologist (who diagnosed me w POTS) has cautioned against "too much salt" that can unbalance electrolytes by causing the kidneys to over excrete K--if I remember correctly.  I'm not really convinced too much salt or water led to my imbalances in the past.  But now when I am in flares I make sure to eat or drink high potassium foods and I take a moderate Mg supplement (although my gp cautioned against taking Mg supplement bc she is concerned it will cause GI issues).  It's hard to know what to do sometimes.

[Pistol]

@JennKay I had COVID last fall and had to go to ER several times before being admitted with respiratory failure. When In ER my potassium was very low as well - and that is strange because I get IV fluids with electrolytes twice a week for POTS! I wonder if it could have something to do with COVID, but I am just wondering. 

I really hope you feel better soon. I am glad they are giving you a thorough work-up!

[JennKay]

@MomtoGiuliana - Thanks for your reply. That was the weird thing, I didn't feel different leading up to the episode. I didn't feel like I was in a flare. I actually felt pretty good. But, I am super intrigued by your comment about taking too much sodium. I had just seen my cardiologist and my BP was low at my appointment so she reminded me about increasing my salt intake to help with it. So I did, then this happens! They released me yesterday and I have been super focused on high potassium foods and drinks since coming home - coconut water, potatoes, bananas, etc. Will see if this helps. I guess I prefer low BP and normal electrolytes over tachycardia and prolonged QT intervals! Geeze, the things we get to worry about....

@Pistol - Thanks for your response as well. There was a consensus yesterday that my positive test is from my January infection and not a new infection, which they wanted to come to an agreement on since this determined if I needed to isolate or not. Whatever virus this is activated my sympathetic nervous system like crazy. It is just strange b/c the only other time this happened was with covid19. I've had other colds before and after covid19 without this type of sympathetic activity. Interestingly, my daughter woke-up with upper and lower GI symptoms this morning, so there is definitely a bug in my house. I guess whatever bug this is, covid19 or something else, is likely what triggered my episode. They did an echo and ran me on the treadmill before leaving the hospital yesterday and all looked good so hopefully this is only temporary. I have a headache and fatigue today, but maybe this is my body dealing with the virus...without all the IV fluids helping too.

[MomtoGiuliana]

This information might be helpful

https://uniontestprep.com/nclex-rn-exam/blog/electrolyte-relationships-sodium-and-potassium

 

[MikeO]

^^^^ Interesting read. I would like to see how my increased salt intake has affected my potassium level. I will be going in for blood tests next week. Can't wait to get the results.

[Jyoti]

2 hours ago, MikeO said:

I would like to see how my increased salt intake has affected my potassium level. I will be going in for blood tests next week. Can't wait to get the results.

I take Vitassium (though there are plenty of other good options that feature the same combo) because it pairs sodium and potassium.  I feel better and safer because I am getting a small bump on the potassium in conjunction with all the sodium I am taking in.

Also--it is possible to have a potassium level within laboratory-defined range but to still have low intracellular potassium levels.  Most doctors don't seem eager to measure this (Potassium blood test, RBC), but it is something to keep in mind if you have any hypokalemic symptoms and come up normal on the blood test.  The standard blood test measures potassium circulating in the blood.  About 5%--as I recall--of total body potassium is in the blood, while the remainder is in the cells as noted in the article @MikeO linked above.  While measuring the amount of potassium in the blood is a good way to estimate how much is in the cells (based on the assumption that percentage-wise they are in balance) it is not always the case.

One final thought--I have found over time that I get symptoms of hypokalemia at the lower end of the reference range.  In other words, my test comes back normal, but I am definitely experiencing symptoms of low potassium.  It is good to keep in mind that reference ranges in general refer to an average of what a healthy person will show, but are not foolproof in terms of defining one's own personal requirements and deficits.

[MikeO]

1 hour ago, Jyoti said:

 Most doctors don't seem eager to measure this (Potassium blood test, RBC),

I did look back at my previous tests. Not sure if a potassium serum test is the same as a RBC. but both times that i was in the ICU i was given a potassium drip even though the results were in the normal range. BTW for me the potassium drips hurt.

I hope you fared better with it. I will ask my Doc if any additional blood work is warranted

Glad to hear you are back at home and doing better..