What electrolyte imbalances are commonly seen in patients with chronic diarrhea?

1.

Greenbaum, Larry A. (2025). In Nelson Textbook of Pediatrics (pp. 525). DOI: 10.1016/B978-0-323-88305-4.00074-2

The gastrointestinal (GI) tract is potentially a source of considerable water loss. GI water losses are accompanied by electrolytes and thus may cause disturbances in intravascular volume and electrolyte concentrations. GI losses are often associated with loss of potassium, leading to hypokalemia. Because of the high bicarbonate concentration in stool, children with diarrhea usually have ametabolic acidosis, which may be accentuated if volume depletion causes hypoperfusion and a concurrent lactic acidosis. Emesis or losses from an NG tube can cause ametabolic alkalosis(seeChapter 73). In the absence of vomiting, diarrhea, or NG drainage, GI losses of water and electrolytes are usually quite small. All GI losses are considered excessive, and the increase in the water requirement is equal to the volume of fluid losses. Because GI water and electrolyte losses can be precisely measured, an appropriate replacement solution can be used. It is impossible to predict the losses for the next 24 hours; it is better to replace excessive GI losses as they occur. The child should receive an appropriate maintenance fluid that does not consider the GI losses. The losses should then be replaced after they occur, with use of a solution with a similar electrolyte concentration as the GI fluid. The losses are usually replaced every 1-6 hours, depending on the rate of loss, with very rapid losses being replaced more frequently. Diarrheais a common cause of fluid loss in children and can result in dehydration and electrolyte disorders. In the unusual patient with significant diarrhea and a limited ability to take oral fluid, it is important to have a plan for replacing excessive stool losses. The volume of stool should be measured, and an equal volume of replacement solution should be given. Data are available on the average electrolyte composition of diarrhea in children (seeTable 74.7). With this information, an appropriate replacement solution can be designed. The solution shown inTable 74.7replaces stool losses of Na+, K+, chloride (Cl−), and bicarbonate. Each 1 mL of stool should be replaced by 1 mL of this solution. The average electrolyte composition of diarrhea is just an average, and there may be considerable variation.

2.

Seifter, Julian Lawrence (2024). In Goldman-Cecil Medicine (pp. 745). DOI: 10.1016/B978-0-323-93038-3.00103-9

Normally, no more than 10 to 20% of total potassium excretion is accomplished by the gastrointestinal tract, but colonic excretion is increased in renal failure, primarily through potassium-induced increases in epithelial Na+, K+-ATPase activity and aldosterone. In renal failure, the normal mechanisms to distribute potassium acquire increased importance. Some conditions that cause the greatest losses of gastrointestinal potassium include secretory diarrheas of the colon, the result of infection or laxative abuse. Disorders of the small intestine, which may lead to large quantities of liquid stool with a low potassium concentration, engender favorable gradients for marked potassium secretion by the colon. A syndrome of watery diarrhea and hypokalemia is associated with neuroendocrine tumors (Chapter 213) that secrete vasoactive intestinal peptide. Rectosigmoid secretion of potassium may result in particularly high potassium losses, and potassium deficiency is seen in patients who have ureterosigmoidostomies. Potassium can be lost from a variety of other sources, including excess sweat or salivation. Potassium can also be depleted by vomiting or diarrhea. In gastric alkalosis, the loss of potassium is in the urine. In renal tubular disorders, urinary losses may exceed intake when excessive quantities of osmotic or anionic products are excreted in the urine, or in patients who take diuretics. Patients with pernicious anemia who receive vitamin B12to stimulate erythropoiesis may deplete extracellular potassium and suffer from hypokalemia as a cost of producing new red blood cells. Leukemias with rapid growth rates (Chapter 168) also may cause a drop in the serum potassium level, and some forms of myelogenous leukemia are associated with a high level of lysozyme, which leads to urinary potassium loss. It is unusual for hyperkalemia to be caused by excessive potassium intake unless the patient has renal dysfunction.

3.

Food and Drug Administration (DailyMed).

Publish date: June 1, 2023.

Warnings And Cautions Severe diarrhea was reported in one Linzess (linaclotide)-treated patient [see Adverse Reactions ( 6.1 )]. In post-marketing experience, severe diarrhea associated with dizziness, syncope, hypotension and electrolyte abnormalities (hypokalemia and hyponatremia) requiring hospitalization or intravenous fluid administration have been reported in patients treated with Linzess (linaclotide). If severe diarrhea occurs, suspend dosing and rehydrate the patient.

4.

Elsevier ClinicalKey Drug Monograph

Content last updated: May 5, 2024.

Contraindications And Precautions Correct any electrolyte imbalance including hypokalemia, hypomagnesemia, or hypocalcemia prior to initiation of cordarone. Give special attention to electrolyte and acid-base balance in patients experiencing severe or prolonged diarrhea or in patients receiving concomitant diuretics, laxatives, systemic corticosteroids, intravenous amphotericin B, or other drugs affecting electrolyte levels. Electrolyte imbalance may predispose the patient to the development of proarrhythmias as well as potentially decrease the efficacy of cordarone.