Electrolytes and alcohol abuse
Effects of alcohol on electrolytes and minerals
Alcohol Health & Research World, Summer, 1989 by Luis Marsano, Craig J. McClain
Electrolytes and minerals are involved in most cellular activities and assume a major role in metabolism.
They have multiple functions such as holding fluids in compartments of the body and maintaining normal acid-base balance.
Electrolytes as sodium, potassium, and chloride can dissociate into positively and negatively charged particles capable of conveying electrical impulses.
Thus, dissolving sodium chloride, commonly known as table salt, in water separates the electrolyte into sodium (positively charged) and chloride (negatively charged). Positively charged (metallic) elements in the diet often are referred to as minerals. With the exception of phosphate, all of the nutrients cited in this article bear a positive charge.
Alcohol consumption, both chronic and acute, has major effects on the absorption, elimination, and serum concentrations of many physiologically important electrolytes and minerals, including sodium, potassium, phosphorus, calcium, magnesium, iron, zinc, and selenium (Beard et al. 1979; Harris et al. 1979; Arieff and Papadakis 1988; Knochel 1988; and McClain et al. 1986).
Electrolyte disturbances may lead to severe and even life-threatening metabolic abnormalities. This article provides a clinical overview of the effects of acute and chronic alcohol intake, as well as of liver disease, on these electrolytes.
Sodium and Water Balance
A close relationship exists between the metabolism of water and that of sodium. Sodium is the primary electrolyte present in body fluids outside the cells, with only about 5 percent of the sodium concentration of the body occurring intracellularly.
This electrolyte, together with potassium, assists in the maintenance of the body's electrolyte and water balance. In addition, potassium and sodium play an important role in nerve conduction, muscle contraction, and the transport of substances across membranes.
Only one-third of the body's water, however, is outside the cells (Levinsky 1987).
The presence of water in the body is essential for the performance of many physiological functions.
Water helps to equilibrate and maintain body temperature; provides moisture to the surfaces of the lungs; furnishes a medium for digestion, absorption, and metabolism; and acts as a solvent for the other materials in the cell.
Because a close relationship exists between the metabolism of water and sodium, changes in the fluid volume inside vessels and around the cells--fluid that consists mainly of water and sodium salts--may have a major impact on serum sodium concentrations.
Alcohol consumption can have pharmacological effects on water and sodium metabolism. The effects of alcohol on sodium and water balance may differ with acute alcohol intake, chronic alcohol intake, or acute withdrawal from chronic alcohol abuse.
As the blood alcohol level rises with acute alcohol intake, a transitory increase in the elimination of "free water" (water without salts) by the kidney occurs (Rubini et al. 1955), resulting from inhibition of the release of antidiuretic hormone (ADH). As the plasma alcohol level decreases, urinary flow is reduced (Nicholson and Taylor 1938).
Concomitant stimulation of water intake (Sargent et al. 1978) causes significant water gain. This water retention occurs together with sodium retention (Nicholson and Taylor 1938; Sargent et al. 1978) due to increases in the reabsorption of sodium by the kidney.
Animal studies involving chronic alcohol intake have shown significant retention of water, sodium, potassium, and chloride after the first week of daily alcohol ingestion (Beard and Knott 1968). Urine output does not decrease, but fluid ingestion is stimulated.
During acute withdrawal following chronic alcohol abuse, urinary elimination of sodium, chloride, and water increases (Beard and Knott 1968). The augmented urinary flow eliminates the fluid and electrolytes that were retained in excess during alcohol abuse.
Low Serum Sodium (Hyponatremia)
Factors other than the direct pharmacological effects of alcohol can alter sodium and water balance, modifying the final serum sodium concentration. Disorders that diminish the volume of fluid in vessels and other extracellular spaces occur frequently in alcoholics, and can produce low serum sodium.
Among these disorders are diarrhea, due to alcohol ingestion; vomiting, attributable to stomach irritation; excessive urination, due to poor control of glucose (in alcoholics with diabetes); and excessive perspiration, because of alcohol withdrawal or fever.
Alcoholics with liver disease frequently have abnormal sodium serum concentrations, with hyponatremia (low plasma sodium concentration) as the most common alteration. In this condition, the low sodium concentration results from "dilution" (Edelman et al. 1958), with normal or increased amounts of sodium offset by greater increases in the total volume of water.
The increase in the volume of water and sodium in the body finally is expressed as edema or ascites (fluid accumulation in the abdomen).
Electrolyte Disturbance in Acute Alcoholism
With Particular Reference to Magnesium
HELEN EASTMAN MARTIN M.D.1, CHARLES MCCUSKEY JR. M.D.1, and NATALIA TUPIKOVA 1
1 From the Department of Medicine of the University of Southern California School of Medicine and Los Angeles County Hospital, Los Angeles, California
Serum electrolyte determinations were made in 30 patients with acute, severe alcoholism before any therapy was given. Sixty per cent of the serum magnesium levels, 30 per cent of the serum potassium levels, and 20 per cent of the serum calcium levels were below the normal range.
Approximately one-third of the patients showed hypernatremia and hyperchloremia.
There was little correlation in most patients between serum magnesium levels and such clinical findings as hallucinations, tremor, and tremulous handwriting. All but one of the patients with completely illegible handwriting had low serum magnesium levels.
Possible mechanisms suggested for the alterations in the serum electrolytes included poor food and electrolyte intake, poor gastrointestinal absorption, and accelerated urinary loss of electrolytes due to effects of starvation and dehydration.
Water diuresis, a demonstrated effect of alcohol, might explain the occurrence of hypernatremia and hyperchloremia in some patients.
The need for adequate fluid and electrolyte therapy in the treatment of the acute alcoholic was stressed in view of the deleterious effects of altered body electrolytes.
lcohol and Nutrition
Alcohol Alert From NIAAA
Nutrition is a process that serves two purposes: to provide energy and to maintain body structure and function. Food supplies energy and provides the building blocks needed to replace worn or damaged cells and the nutritional components needed for body function. Alcoholics often eat poorly, limiting their supply of essential nutrients and affecting both energy supply and structure maintenance. Furthermore, alcohol interferes with the nutritional process by affecting digestion, storage, utilization, and excretion of nutrients.
Impairment of Nutrient Digestion and Utilization
Once ingested, food must be digested (broken down into small components) so it is available for energy and maintenance of body structure and function. Digestion begins in the mouth and continues in the stomach and intestines, with help from the pancreas. The nutrients from digested food are absorbed from the intestines into the blood and carried to the liver. The liver prepares nutrients either for immediate use or for storage and future use.