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When electrolyte disorders cause seizures, the symptoms and signs often progress rapidly, and emergency treatment is needed.Generally, seizure control and neurologic recovery depend on correcting specific metabolic defects; long-term recovery depends on correcting the underlying condition.

A person's water homeostasis and electrolyte imbalance, especially sodium, are interrelated.

Their osmolalities are expressed in milliosmoles (mOsm) per kilogram of water in terms of their particle concentrations (osmoles).Each compartment of the ECF's osmolality equilibrates due to water flowing along osmolality gradients as well as having the ability to pass through cell membranes freely.A second point is that the osmolality of the ECF and the ICF are equal.The volume of the ECF compartment is larger than that of the ICF compartment after osmotic equilibrium has been reached, so the ECF osmolality determines the ICF volume.

It is true that water crosses cell membranes freely, but some solutes may not due to active transporters or pumps that maintain different solute concentrations between the inside and outside of cells.Effective osmolality (also known as tonicity) of a compartment is determined by these solutes.Sodium is mainly located in the ECF, and thus, the amount of sodium in the ECF is a key factor in determining the osmolality of the ECF (and, eventually, the volume of the ICF).Therefore, hyponatremia is the main cause of serum hypoosmolality.

It is normal for plasma osmolality to range between 275 and 290 mOsm/kg, which is maintained as long as the volume of water consumed equals the volume of water excreted.Excretion of water occurs primarily through the kidneys, but also through insensible water loss (e.g., sweat, respiration) and stool.ADH, also known as arginine vasopressin, is responsible for controlling the kidney's water excretion.Healthy subjects secrete ADH in response to serum osmolality or tonicity, which is sensed through hypothalamic osmoreceptors as a function of cell volume.

When subjects drink more water, their plasma osmolality falls.ADH is suppressed, resulting in rapid excretion of water from the kidneys through dilute urine.On the other hand, ADH secretion is lowered by circulatory volume loss caused by bleeding, vomiting, diarrhea, or by using diuretics, or by existing conditions that cause edema (e.g., nephrotic syndrome, congestive heart failure).Water is absorbed from the kidneys more readily, and the urine becomes more concentrated.

The metabolic disorders has been adapted from Schachter SC and Lopez MR.In: Ettinger AB and Devinsky O, editors.Manage curiouslyravenous.com and co-existing disorders.It has been published by Butterworth-Heinemann; 2002;195–208. Also available from Elsevier (www.elsevier.com).

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