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Electrolyte imbalance in alcoholics

A review discusses the association between chronic alcohol use in alcoholics and electrolyte imbalance or deficiency; in addition to the therapies that could be adopted to address these issues.

Chronic alcohol use, or alcoholism, affects roughly 4% of Canadians1 and roughly 12.5% of Americans.2

Alcohol consumption is known to increase the risk of several types of cancer, diabetes, cardiovascular disease, and liver disease in a dose-dependent manner.

Additionally, chronic alcohol use is associated with acid-base and electrolyte imbalance.

A review published in The New England Journal of Medicine discusses these disorders, as well as the therapeutic approaches that can be adopted to treat these disorders.4

Acid-Base Disturbances

A variety of acid-base disturbances are observed in roughly 78% of the patients with chronic alcohol use.

One of these is alcoholic ketoacidosis, which manifests as abdominal pain and vomiting.

These symptoms are caused by gastritis and pancreatitis that follow chronic alcohol use.

Clinically, alcoholic ketoacidosis is characterized by high ketone levels in the blood, a high anion gap (or an increased concentration of anions), and normal to slightly elevated glucose levels.

Alcoholic ketoacidosis is a consequence of ethanol metabolism and prolonged starvation with the depletion of glycogen stores in the liver.

The authors recommend that initial treatment in such patients should involve terminating the ketogenic process by intravenous administration of dextrose.

Additionally, they recommend administering thiamine but not insulin or bicarbonate.

Phosphorus Disturbances

Acute hypophosphatemia, or phosphorus deficiency, is seen in up to 50% of patients over the first 2-3 days after they are hospitalized for alcohol overuse.

Hypophosphatemia is manifested as rhabdomyolysis (muscle breakdown) and weakness of the skeletal muscles.

Magnesium and Calcium Disturbances

Magnesium deficiency, or hypomagnesemia, is seen in approximately a third of patients who chronically abuse alcohol and is manifested as weakness, tremors, and a positive Trousseau’s sign (occurrence of carpal spasm when the upper arm is compressed).

Hypomagnesemia could be a consequence of insufficient intake, poor gastrointestinal absorption, and increased excretion.

Hypomagnesemia is often accompanied by hypocalcemia, or lowered calcium levels, which may be aggravated by a deficiency of vitamin D.

Potassium Disturbances

Potassium deficiency, or hypokalemia, is seen in approximately 50% of patients who chronically use alcohol.

It results from inadequate dietary intake, gastrointestinal losses from diarrhea, and increased urinary loss. Hypokalemia may manifest in the form of muscle weakness, changes in the ECG, and/or arrhythmias.

Sodium Disturbances

Acute consumption of alcohol, or binge drinking, can result in dehydration as water is excreted in the form of urine, which may increase sodium levels (hypernatremia).

However, with chronic alcohol use, decreased water clearance and hyponatremia (reduced sodium levels) are observed.

Such patients need to be assessed for plasma osmolality, kidney function, and intravascular volume (or blood volume).

Hyponatremia may be corrected by administering sodium chloride in intravenous fluids or refeeding accompanied by restricted fluid intake.

There are a number of acid-base and electrolyte disturbances that accompany chronic alcohol use or abuse.

These disturbances can be experienced in any alcoholic, not only those who are obviously malnourished.

Overall, this review offers a comprehensive overview of the electrolyte imbalance that can be seen in alcoholics and is an excellent guide for clinicians in diagnosing and treating these electrolyte imbalances.


1) Alcoholism in Canada. Accessed: October 14, 2017.

2) Grant BF, Chou SP, Saha TD, Pickering RP, Kerridge BT, Ruan WJ, Huang B, Jung J, Zhang H, Fan A, Hasin DS. Prevalence of 12-Month Alcohol Use, High-Risk Drinking, and DSM-IV Alcohol Use Disorder in the United States, 2001-2002 to 2012-2013: Results From the National Epidemiologic Survey on Alcohol and Related  Conditions. JAMA Psychiatry. 2017 Sep 1;74(9):911-923. doi: 10.1001/jamapsychiatry.2017.2161. PubMed PMID: 28793133.

3) The Chief Public Health Officer’s Report on the State of Public Health in Canada 2015. Alcohol Consumption In Canada. Accessed: October 08, 2017.

4) Palmer BF, Clegg DJ. Electrolyte Disturbances in Patients with Chronic Alcohol-Use Disorder. N Engl J Med. 2017 Oct 5;377(14):1368-1377. doi: 10.1056/NEJMra1704724. PubMed PMID: 28976856.



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