⚡ Electrolyte Disorder [Neurosurgery Wiki]

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====== ⚡ Electrolyte Disorder ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1rE397IRBYU0-pjJtBc9rgf9TTG0KPEe52_cMJ8IQiGPSKPcTW/?limit=15&utm_campaign=pubmed-2&fc=20250616122429}}

===== Definition =====

An electrolyte disorder is any disturbance—whether in concentration, distribution, or function—of key electrically charged minerals (electrolytes) in the body, such as sodium (Na⁺), potassium (K⁺), calcium (Ca²⁺), magnesium (Mg²⁺), chloride (Cl⁻), and phosphate (PO₄³⁻).

These disorders may result from:

Fluid shifts (e.g., dehydration, fluid overload)

Renal dysfunction

Medications (e.g., diuretics, chemotherapy)

Hormonal imbalances (e.g., SIADH, hyperaldosteronism)

Critical illness or neurological injury

===== Clinical relevance =====

Electrolyte imbalances can:

Disrupt neuronal excitability

Alter cardiac conduction

Lead to seizures, encephalopathy, paralysis, or respiratory failure

Examples:

Hyponatraemia → cerebral edema, confusion, seizures

Hyperkalaemia → arrhythmias, muscle weakness

Hypocalcaemia → tetany, perioral numbness

Hypophosphataemia → diaphragmatic weakness, failure to wean from ventilation

Hypomagnesaemia → refractory seizures, torsades de pointes

Mnemonic: “Sick CNS? Check the ions first.”

===== Narrative reviews =====

Howard et al.
((Howard RS, Baheerathan A, Brown R, Spillane J, Waraich M. Neurological aspects of electrolyte disorders. Pract Neurol. 2025 Jun 15:pn-2023-003801. doi: 10.1136/pn-2023-003801. Epub ahead of print. PMID: 40518262.))
provide a narrative overview of the neurological manifestations associated with electrolyte disorders (Na⁺, K⁺, Ca²⁺, PO₄³⁻, Mg²⁺), especially in [[critical care]] and neurology settings.
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No original data. Lacks systematic methodology or evidence hierarchy.

===== 🧨 Critical Review =====

=== 1. Academic Repackaging Disguised as Novel Insight ===
This article re-sells basic textbook knowledge in a polished format, offering no original synthesis, no diagnostic algorithms, and no decision trees that a clinician might actually use. It reads like a long consultant’s memo, not a cutting-edge update for neurologists.

=== 2. Absence of Evidence-Based Prioritization ===
Despite discussing life-threatening imbalances (e.g., acute hyponatraemia, hypokalemia-induced paralysis), there is no grading of urgency, no evidence tables, no clinical decision thresholds. This lack of structure renders the article practically useless in an emergency or ICU setting.

=== 3. Didactic Tone without Clinical Sophistication ===
Statements like “calcium derangement can give neurological manifestations” border on vacuous generality. There's no [[granularity]] (e.g., when to order ionized [[calcium]] vs total calcium, or how to interpret [[magnesium]] in the context of [[renal failure]]). In an era of [[precision medicine]], this is nebulous and disappointingly low-yield.

=== 4. Neglect of Emerging Concepts and Guidelines ===
There is no discussion of recent guideline changes, such as:

When to use [[vaptan]]s vs [[hypertonic saline]] in [[hyponatraemia]].

Role of continuous electrolyte monitoring in neurocritical care.

Integration of AI-driven electrolyte prediction tools in EHR systems.

In short, the review feels pre-[[ChatGPT]] era—blind to digital transformation and modern clinical decision-making.



===== 🧠 Bottom Line for the Neurosurgeon =====
This review is a glossy reminder of what we already know, wrapped in academic language but hollow in utility. It adds no value to daily [[practice]], especially in [[neurocritical care]] or emergency neurology. For practical decision-making, better sources include:

[[UpToDate]] for actionable protocols.

Neurocritical Care Society guidelines.

[[Cochrane]] reviews for therapeutic thresholds.

Verdict: 📄 Educational filler with zero clinical edge.
Recommendation: ❌ Not worth citing, let alone reading twice.