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Table 1 Investigation at first consultation

From: Electrolyte outpatient clinic at a local hospital – experience from diagnostics, treatment and follow-up

A thorough medical history was taken since electrolyte imbalances can cause nonspecific symptoms (such as nausea, headaches, drowsiness, etc.), in addition to dietary history and fluid intakes per day, as well as urination and defecation. A clinical examination was performed, including an orthostatic blood pressure test (to assess volume status), and a thorough drug history (including natural remedies) was performed, as many drugs may lead to electrolyte imbalances. Patients were weighed, and their respective heights were given.

Patients with hyponatremia were asked about antidiuretic hormone (ADH) stimuli: pain, nausea, stress and anxiety.

General blood samples were taken for all patients: hemoglobin, C-reactive protein, leukocytes, sodium, potassium, albumin, glucose, creatinine, urea and eGFR in addition to urine electrolytes (depending on the electrolyte imbalance).

The following additional tests were taken depending on the electrolyte imbalance

Hyponatremia

Blood tests: effective osmolality, thyroid-stimulating hormone (TSH), free T4, adrenocorticotropic hormone (ACTH), cortisol, aldosterone, renin activity. None of the patients had hyperglycemia, thus there was no need for glucose correction of serum sodium.

Urine tests: sodium, potassium, creatinine, uric acid and osmolality.

Hyperkalemia

Serum and plasma potassium in addition to blood gas and platelets.

Hypomagnesaemia

Blood tests: magnesium, phosphate, free calcium, TSH, free T4.

Urine tests: magnesium and creatinine. Fractional excretion of magnesium (FEMg) was calculated.

Hypophosphatemia

Blood tests: phosphate, magnesium, free calcium, blood gas, parathyroid hormone (PTH), and 25-OH vitamin D if suspicion of vitamin D deficiency.

Urine tests: phosphate and creatinine. Fractional excretion of phosphate (FEPO4) was calculated.

Calcium disturbances

Blood tests: free calcium, PTH, 25-OH vitamin D, and blood gas.

Urine tests: calcium and creatinine. Urine calcium/urine creatinine ratio.