title: Acid-base and electrolyte abnormalities in heart failure: pathophysiology and implications.
abstract: Electrolyte and acid-base abnormalities are a frequent and potentially dangerous complication in subjects with congestive heart failure. This may be due either to the pathophysiological alterations present in the heart failure state leading to neurohumoral activation (stimulation of the renin-angiotensin-aldosterone system, sympathoadrenergic stimulation), or to the adverse events of therapy with diuretics, cardiac glycosides, and ACE inhibitors. Subjects with heart failure may show hyponatremia, magnesium, and potassium deficiencies; the latter two play a pivotal role in the development of cardiac arrhythmias. The early identification of these alterations and the knowledge of the pathophysiological mechanisms are very useful for the management of these patients.
authors.affiliation: Dipartimento Biomedico di Medicina Interna e Specialistica, Universitá di Palermo, 90127, Palermo, Italy, ursocat@gmail.com.
authors.forename: Caterina
authors.initials: C
authors.lastname: Urso
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brucculeri
authors.forename: Gregorio
authors.initials: G
authors.lastname: Caimi
mesh_terms: D000137:Acid-Base Imbalance / Q000503:physiopathology*; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology*; D006801:Humans; D014883:Water-Electrolyte Imbalance / Q000503:physiopathology*
references.citation: Kidney Int. 2004 Oct;66(4):1387-92
references.pmid: 15458431
references.citation: Vnitr Lek. 1990 Apr;36(4):330-41
references.pmid: 2192496
references.citation: Kidney Int. 1992 Sep;42(3):727-34
references.pmid: 1405350
references.citation: Eur J Intern Med. 2002 Aug;13(5):304-310
references.pmid: 12144909
references.citation: Congest Heart Fail. 2005 Sep-Oct;11(5):274-7
references.pmid: 16230871
references.citation: Kidney Int. 1987 Jun;31(6):1402-15
references.pmid: 2956452
references.citation: J Clin Invest. 1984 Feb;73(2):507-15
references.pmid: 6699174
references.citation: J Card Fail. 1995 Jun;1(3):195-200
references.pmid: 9420651
references.citation: Am Heart J. 1996 Sep;132(3):664-71
references.pmid: 8800040
references.citation: Nihon Rinsho. 1992 Sep;50(9):2173-7
references.pmid: 1434008
references.citation: Cardiology. 2003;100(3):136-42
references.pmid: 14631134
references.citation: J Pharmacol Exp Ther. 1982 Jun;221(3):815-9
references.pmid: 7086689
references.citation: Am J Physiol. 1995 Apr;268(4 Pt 2):R825-37
references.pmid: 7733391
references.citation: BMC Med. 2012;10:7
references.pmid: 22264220
references.citation: Am J Med. 2005 Oct;118(10):1094-101
references.pmid: 16194637
references.citation: Eur Respir J. 1993 Sep;6(8):1197-201
references.pmid: 8224136
references.citation: Eur J Clin Invest. 2012 Jun;42(6):649-56
references.pmid: 22150123
references.citation: Circ J. 2013;77(8):2157-201
references.pmid: 23759659
references.citation: Med J Aust. 2002 Mar 4;176(5):219-21
references.pmid: 11999238
references.citation: Am J Manag Care. 1999 Jun;5(6):715-23
references.pmid: 10538451
references.citation: Rev Med Chir Soc Med Nat Iasi. 2014 Apr-Jun;118(2):315-9
references.pmid: 25076693
references.citation: Br Heart J. 1989 Mar;61(3):274-9
references.pmid: 2467681
references.citation: Magnesium. 1986;5(3-4):134-43
references.pmid: 3523055
references.citation: Hypertension. 1993 Sep;22(3):315-22
references.pmid: 8349324
references.citation: Eur J Heart Fail. 2002 Mar;4(2):167-73
references.pmid: 11959045
references.citation: Am J Cardiol. 2005 May 2;95(9A):2B-7B
references.pmid: 15847851
references.citation: Clin Exp Hypertens. 1995 Aug;17(6):989-1008
references.pmid: 7581265
references.citation: J Am Coll Cardiol. 2003 Jun 18;41(12):2164-71
references.pmid: 12821241
references.citation: Anesthesiology. 1969 Jul;31(1):28-34
references.pmid: 4306819
references.citation: J Am Coll Cardiol. 1984 Apr;3(4):1035-43
references.pmid: 6323565
references.citation: Thromb Diath Haemorrh. 1970 May 31;23(2):299-305
references.pmid: 5426212
references.citation: N Engl J Med. 2003 Apr 3;348(14):1309-21
references.pmid: 12668699
references.citation: J Am Coll Cardiol. 2008 Nov 4;52(19):1527-39
references.pmid: 19007588
references.citation: Circulation. 2005 Oct 25;112(17):2627-33
references.pmid: 16246962
references.citation: Br Heart J. 1987 Sep;58(3):230-8
references.pmid: 3311097
references.citation: Am J Kidney Dis. 2013 May;61(5):822-7
references.pmid: 23481366
references.citation: J Am Coll Cardiol. 2004 Jan 21;43(2):155-61
references.pmid: 14736430
references.citation: Eur Heart J. 2012 Jul;33(14):1787-847
references.pmid: 22611136
references.citation: Circulation. 2005 May 17;111(19):2454-60
references.pmid: 15867182
references.citation: Zhonghua Zheng Xing Shao Shang Wai Ke Za Zhi. 1996 May;12(3):177-9
references.pmid: 9206127
references.citation: Arch Intern Med. 2007 Oct 8;167(18):1998-2005
references.pmid: 17923601
references.citation: Arch Intern Med. 1996 Sep 9;156(16):1814-20
references.pmid: 8790075
references.citation: Int J Cardiol. 2012 Jun 28;158(1):12-7
references.pmid: 21775000
references.citation: Heart Fail Rev. 2005 Jan;10(1):5-6
references.pmid: 15947885
references.citation: Ann N Y Acad Sci. 1980;355:165-80
references.pmid: 6940473
references.citation: Ann Intern Med. 1990 Jul 15;113(2):155-9
references.pmid: 2193561
references.citation: N Engl J Med. 2001 Dec 6;345(23):1689-97
references.pmid: 11759649
references.citation: J Physiol. 2008 Sep 1;586(17):4193-208
references.pmid: 18617566
references.citation: Br Heart J. 1987 Dec;58(6):572-82
references.pmid: 2447925
references.citation: Ann Intern Med. 1978 Dec;89(6):867-70
references.pmid: 363007
references.citation: J Am Soc Nephrol. 2000 Feb;11(2):369-75
references.pmid: 10665945
references.citation: Arch Intern Med. 1990 Apr;150(4):769-73
references.pmid: 2327838
references.citation: Neth J Med. 1999 Mar;54(3):108-13
references.pmid: 10189785
references.citation: Cardiovasc Res. 1994 Dec;28(12):1854-62
references.pmid: 7867039
references.citation: Semin Nephrol. 1994 Sep;14(5):485-505
references.pmid: 7997653
references.citation: Am J Cardiol. 1986 Aug 1;58(3):295-9
references.pmid: 3739918
references.citation: N Engl J Med. 1975 Jan 9;292(2):81-8
references.pmid: 234006
references.citation: Heart. 2004 Oct;90(10):1137-43
references.pmid: 15367507
references.citation: Clin Sci (Lond). 2005 Jan;108(1):23-36
references.pmid: 15476436
references.citation: Circulation. 1999 Sep 21;100(12):1311-5
references.pmid: 10491376
references.citation: Arch Biochem Biophys. 1971 Jul;145(1):121-5
references.pmid: 4256440
references.citation: J Am Coll Cardiol. 1990 Oct;16(4):827-31
references.pmid: 2212365
references.citation: Arch Intern Med. 2000 Sep 11;160(16):2429-36
references.pmid: 10979053
references.citation: Hypertension. 1990 May;15(5):451-8
references.pmid: 2185149
references.citation: Am J Med Sci. 1997 Jul;314(1):37-40
references.pmid: 9216439
references.citation: Am J Cardiol. 1989 Apr 18;63(14):31G-34G
references.pmid: 2650512
references.citation: Ann Intern Med. 1990 Dec 1;113(11):841-6
references.pmid: 2240899
references.citation: Circulation. 1998 Oct 13;98(15):1510-6
references.pmid: 9769304
references.citation: J Intensive Care Med. 2009 Nov-Dec;24(6):347-51
references.pmid: 19850560
references.citation: Am J Cardiol. 1990 Mar 6;65(10):45E-51E; discussion 52E
references.pmid: 2178378
references.citation: N Engl J Med. 1999 Aug 19;341(8):577-85
references.pmid: 10451464
references.citation: N Engl J Med. 1983 Dec 8;309(23):1414-9
references.pmid: 6314140
references.citation: Am J Nephrol. 2002 Jul-Aug;22(4):332-7
references.pmid: 12169864
references.citation: World J Cardiol. 2014 Nov 26;6(11):1175-91
references.pmid: 25429330
references.citation: Am J Cardiol. 1989 Apr 18;63(14):39G-42G
references.pmid: 2650514
references.citation: J Cardiol. 2012 Oct;60(4):288-94
references.pmid: 22819039
references.citation: Endocrinology. 1978 Dec;103(6):2098-104
references.pmid: 748034
references.citation: Am J Med. 1970 Sep;49(3):306-15
references.pmid: 5455562
references.citation: Kidney Int. 1972 May;1(5):306-21
references.pmid: 4600132
references.citation: Am Heart J. 1994 Sep;128(3):564-74
references.pmid: 8074021
references.citation: Am J Med. 2006 Jul;119(7 Suppl 1):S47-53
references.pmid: 16843085
references.citation: Am J Cardiol. 1992 Oct 8;70(10):44C-49C
references.pmid: 1414894
references.citation: Am J Cardiol. 1990 Mar 6;65(10):33E-44E; discussion 52E
references.pmid: 2178376
references.citation: Semin Nephrol. 1987 Sep;7(3):253-62
references.pmid: 3317639
references.citation: Cardiovasc Res. 1984 May;18(5):257-63
references.pmid: 6329516
references.citation: QJM. 2003 Dec;96(12):911-7
references.pmid: 14631057
references.citation: Am J Cardiol. 1987 Jan 1;59(1):84-8
references.pmid: 3812257
references.citation: Anadolu Kardiyol Derg. 2008 Aug;8(4):255-9
references.pmid: 18676300
references.citation: Arch Intern Med. 1983 Mar;143(3):429-33
references.pmid: 6830378
references.citation: Am J Physiol. 1946 Sep;147:138-54
references.pmid: 21000731
references.citation: Eur Heart J. 1995 Jul;16 Suppl F:4-6
references.pmid: 8521884
references.citation: Hypertension. 1994 Apr;23(4):485-90
references.pmid: 8144217
references.citation: N Engl J Med. 2000 May 25;342(21):1581-9
references.pmid: 10824078
references.citation: Am J Physiol. 1997 Mar;272(3 Pt 2):H1333-41
references.pmid: 9087609
references.citation: Am J Cardiol. 2005 Dec 19;96(12A):19L-23L
references.pmid: 16399089
references.citation: Am J Cardiol. 1990 Mar 6;65(10):28E-32E; discussion 52E
references.pmid: 2178375
references.citation: Am J Med. 1985 Jun;78(6 Pt 1):1033-5
references.pmid: 4014262
references.citation: Am Heart J. 1985 Mar;109(3 Pt 1):611-3
references.pmid: 2983522
references.citation: Am Heart J. 1970 Sep;80(3):329-42
references.pmid: 5452310
references.citation: Methods Find Exp Clin Pharmacol. 1992 May;14(4):315-25
references.pmid: 1507935