6 institutions jointly remind: In these situations, attention should be paid to electrolyte balance

On December 16, a seminar on electrolyte balance and health was held jointly by the Drinking Water and Health Branch of the Chinese Nutrition Society, the Digestive Physician Branch of the Chinese Medical Association, and other institutions. Six professional institutions jointly issued the "Joint Tips on Electrolyte Balance and Health" to remind the public to pay attention to electrolyte balance and replenish electrolytes correctly and reasonably.

Professor Ma Guansheng, Chairman of the Drinking Water and Health Branch of the Chinese Nutrition Society, Standing Committee Member of the Health Communication Branch of the Chinese Preventive Medicine Association, and Director of the Department of Nutrition and Food Hygiene at the School of Public Health of Peking University, said that water and electrolyte balance is an important basis for the stability of the human body's internal environment and is crucial to maintaining health. Under normal circumstances, under self-regulation, the body's internal environment, including water, ion concentration, pH, and osmotic pressure, maintains a dynamic balance. If the water, electrolyte, and acid-base balance are disturbed, the function of cells will be affected, causing disease and even endangering life.

In order to help the public understand the importance of maintaining water and electrolyte balance in the human body and to supplement electrolytes correctly and reasonably, the Drinking Water and Health Branch of the Chinese Nutrition Society, the Digestive Physicians Branch of the Chinese Medical Association, the Physical Fitness and Health Branch of the Chinese Society of Sports Science, the Health Communication Branch of the Chinese Preventive Medicine Association, the China Food and Health Information Exchange Center and the Health Communication and Promotion Special Fund of the China Health Promotion Foundation jointly issued the "Joint Tips on Electrolyte Balance and Health".

Importance of water and electrolyte balance

Water is an important substance that constitutes the human body, accounting for 60-70% of the body weight of a normal adult. It plays a vital physiological role in maintaining cell morphology, forming the internal environment of the human body, maintaining body fluid osmotic pressure, pH and electrolyte balance, regulating body temperature, etc. The intake and discharge of water in the human body maintain a dynamic balance to maintain appropriate hydration and normal physiological functions. Drinking too little or too much water will lead to the destruction of water balance and osmotic pressure balance, which will affect the health of the body and even endanger life.

The main component of body fluids in the human body is water, followed by electrolytes. Body fluids are widely distributed in various parts of the human body and are divided into extracellular fluid and intracellular fluid according to the distribution area. There are large differences in the electrolyte composition and concentration of extracellular fluid and intracellular fluid. The cations of extracellular fluid are mainly sodium ions, and the anions are mainly chloride ions, followed by bicarbonate ions; the cations of intracellular fluid are mainly potassium ions, and the anions are bicarbonate ions and proteins. Maintaining the electrolyte balance and osmotic pressure balance of intracellular fluid and extracellular fluid is crucial to maintaining the normal morphology and function of cells and maintaining the normal physiological function and health of the body.

Electrolyte imbalance is harmful to the health of the body. If the electrolyte concentration in the extracellular fluid is lower than that in the intracellular fluid, the cell will continue to absorb water, exceeding the expansion and contraction limit of the cell membrane, and the cell will rupture. If the electrolyte concentration in the extracellular fluid is higher than that in the intracellular fluid, the cell will lose water, shrink, and even die. Sodium metabolism disorders can cause symptoms such as fatigue, irritability, and muscle aches[1]; potassium metabolism disorders can cause symptoms such as apathy, muscle pain and weakness, thirst, and nausea[2]; calcium metabolism disorders can cause symptoms such as slow reaction, emotional indifference, increased muscle tension, and tetany[3]; magnesium metabolism disorders can cause symptoms such as dizziness, muscle cramps, and movement disorders[4]. Severe electrolyte imbalances can be life-threatening.

When do we need to supplement electrolytes in daily life?

1. Long-term or high-intensity physical activities, or working in a high-temperature environment

During long-term or high-intensity physical activities, or when working in a high-temperature environment, the body regulates its temperature mainly by dissipating a large amount of sweat. As sweat evaporates, water and electrolytes are lost. In this case, not only water but also electrolytes need to be replenished. In a high-temperature environment, it is also necessary to leave the high-temperature environment in time for physical cooling. If you simply replenish a large amount of water without replenishing electrolytes, electrolyte disorders may occur, and in severe cases, even water poisoning may occur, which is life-threatening.

Studies have shown that replenishing water and electrolytes by drinking appropriate amounts of electrolyte water before, during, and after prolonged exercise can improve the body's hydration status and maintain electrolyte balance, which helps improve athletic performance and recovery from fatigue[5],[6].

2. Fever, vomiting, diarrhea, etc.

When you have a persistent or high fever, you may suffer from electrolyte imbalance due to excessive sweating, most commonly low sodium, low potassium, and low calcium. In this case, you should supplement electrolytes appropriately under the guidance of a doctor or according to your physical condition.

Morning sickness: Pregnant women may experience nausea, vomiting and other early pregnancy reactions. If vomiting is severe, or even if they cannot eat normally, it will cause insufficient intake of inorganic salts such as potassium and sodium, leading to electrolyte imbalance. Studies have found that for women in labor, proper intake of energy electrolyte fluids can reduce the incidence of ketosis and vomiting in pregnant women [7].

If you experience severe morning sickness, inability to eat, etc. during pregnancy, you should seek medical attention promptly and replenish electrolytes under the evaluation and guidance of a professional.

Vomiting after drinking: Vomiting after drinking causes the body to lose electrolytes, which can aggravate the effects of alcohol on myocardial function. Excessive drinking can also indirectly cause kidney disease and electrolyte and acid-base imbalances[8]. Electrolytes need to be replenished in a timely manner.

Diarrhea: When you have diarrhea, you lose a lot of water and electrolytes, which may lead to dehydration and electrolyte imbalance, so you need to replenish electrolytes appropriately. Severe diarrhea may cause hyponatremia, hyperchloremia, hypocalcemia, and hypokalemia, so you should seek medical attention in time. Therefore, patients with diarrhea should not only receive treatment for the cause, but also pay attention to maintaining electrolyte balance[9].

3. In certain diseases, electrolyte supplementation should be cautious

In the case of chronic renal failure, acute and chronic heart failure, endocrine diseases and other related diseases, patients may suffer from electrolyte imbalance due to impaired body functions. Patients with the above diseases should seek medical attention in a timely manner and reasonably correct the electrolyte imbalance under the evaluation and guidance of the doctor.

How to replenish water and electrolytes scientifically

Regarding water supplementation, adult males should drink 1700 mL of water per day, and women should drink 1500 mL of water per day. The appropriate daily water intake for pregnant women is 1700 mL, and the appropriate daily water intake for nursing mothers is 2100 mL. When engaging in physical activities, pay attention to the intake of water before, during, and after physical activities. You can replenish 100 to 200 mL of water every 15-20 minutes; when the amount of physical activity increases, you can consume 300 to 500 mL more water per day; when the weather is hot or the amount of physical activity increases, you should increase the amount of water you drink appropriately according to the amount of sweating, and supplement electrolytes as appropriate.

Regarding electrolyte supplementation, if the above-mentioned situation requires electrolyte supplementation, it can be done in the following ways:

• Supplementation through food

Under normal circumstances, it is recommended to supplement electrolytes through food. Many foods are rich in vitamins and minerals, which can effectively supplement electrolytes. For example, eating bananas, spinach and other foods can increase potassium ion intake; eating milk, soy products, fish and shrimp can increase calcium ion intake; dark green leafy vegetables, nuts and other foods can supplement magnesium ions.

• Choose electrolyte water or electrolyte drinks

Electrolyte water or electrolyte drink is a beverage made by dissolving a group of compounds in water according to relevant standards, which can replenish water and electrolytes.

After sweating profusely due to high temperatures, exercise, etc., drinking an appropriate amount of electrolyte water or electrolyte beverages can replenish lost electrolytes[10]. Drinking electrolyte beverages after exercise dehydration is beneficial for replenishing body water and improving hydration status[11].

People who experience morning sickness, fever, diarrhea or vomiting should seek medical attention as directed and, under the doctor's evaluation and guidance, drink appropriate amounts of electrolyte water or electrolyte beverages to replenish lost electrolytes.

People who work in special environments such as high temperatures can choose electrolyte water or electrolyte drinks to replenish water and electrolytes in time.

• Drugs and other clinical approaches

Patients who have lost excessive electrolytes due to illness need to seek medical treatment in a standardized manner and replenish electrolytes under the evaluation and guidance of a doctor.

At the same time, the reporter noticed that in the recommendations for prevention of new coronavirus infection issued by relevant departments, there are also clear reminders to "pay attention to water and electrolyte balance" or "appropriately supplement drinking water containing a certain amount of electrolytes."

Experts at the meeting said that water and electrolyte balance is an important basis for the stability of the human body's internal environment and is crucial to maintaining health. They hope that the public can better understand relevant health knowledge and protect their own and their family's health.

[1] Jiang Zhuming. Clinical Water and Electrolyte Balance (3rd Edition)[M]. Beijing: People's Medical Publishing House, 2013.

[2] Zhu Lei. Balance and disorder of body fluid metabolism[M]. Beijing: People's Medical Publishing House, 2011.

[3] Luo Mingsheng, Gao Tianhui. Modern Clinical Drug Dictionary[M]. Sichuan: Sichuan Science and Technology Press, 2001.

[4] Wang Tinghuai. Physiology (9th edition) [M]. Beijing: People's Medical Publishing House, 2018.

[5] Sawka MN, Burke LM, Eichner ER, Maughan RJ, Montain SJ, Stachenfeld NS: American College of Sports Medicine position stand. Exercise and fluid replacement. Med Sci Sports Exerc 2007, 39(2):377-390.

[6] Peacock OJ, Thompson D, Stokes KA: Impact of a carbohydrate-electrolyte drink on ingestive behavior, affect and self-selected intensity during recreational exercise after 24-h fluid restriction. Appetite 2013, 60(1):5-12.

[7] Li Qi, Xu Yajun, An Lin, Zhao Yangyu, Fan Ling, Cai Yan, Liu Caixia, Wu Fangyin, Yang Hailan, Sun Lizhou, He Jing, Ma Yanyan, Pang Ruyan. A multicenter prospective study on the effects of energy, electrolyte and fluid intake during labor in pregnant women[J]. Chinese Research Hospital. 2021, 8(4):5.

[8] Zhang Daoyou, Jin Ming. New progress in the study of the effects of alcohol abuse on kidney and water and electrolyte metabolism [J]. Medical Review. 1999, (11): 499-500.

[9] Zhong Kewen, Mai Zhizhou, Zhang Yinghua. Correlation between electrolyte imbalance and the etiology of infectious diarrhea in children. Medical Laboratory and Clinical. 2007, 18(3): 779-780.

[10] Liang Chunyu, Shi Xiaocai, Yan Yi. Fluid replacement scheme and exercise capacity of athletes[J]. Chinese Journal of Sports Medicine, 2020, 39(6):9.

[11] Wu Yifan, Huang Xianren, Yu Yingxiang, et al. Effects of seasonal adaptation on the effect of sugar-electrolyte beverage on fluid recovery after exercise in healthy young men[J]. Journal of Chinese Academy of Medical Sciences, 2021, 43(5):11.