A dyshomeostasis of electrolytes and trace elements in acute stressor states

Impact on the heart

Anthony D. Whitted, John W. Stanifer, Preeti Dube, Brian J. Borkowski, Jawwad Yusuf, Babatunde O. Komolafe, Richard C. Davis, Judith E. Soberman, Karl Weber

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Acute stressor states are associated with a homeostatic activation of the hypothalamic-pituitary-adrenal axis. A hyperadrenergic state follows and leads to a dyshomeostasis of several intra- and extracellular cations, including K+, Mg2+, and Ca2+. Prolongation of myocardial repolarization and corrected QT interval (QTc) of the ECG are useful biomarkers of hypokalemia and/or hypomagnesemia and should be monitored to address the adequacy of cation replacement. A dyshomeostasis of several trace elements, including Zn2+ and Se2+, are also found in critically-ill patients to compromise metalloenzyme-based antioxidant defenses. Collectively, dyshomeostasis of these electrolytes and trace elements have deleterious consequences on the myocardium: atrial and ventricular arrhythmias; induction of oxidative stress with reduced antioxidant defenses; and adverse myocardial remodeling, including cardiomyocytes lost to necrosis and replaced by fibrous tissue. To minimize such consequences during hyperadrenergic states, systematic surveillance of electrolytes and trace elements, together with QTc, are warranted. Plasma K+ and Mg2+ should be maintained at ≥4.0 mEq/L and ≥2.0 mg/dL, respectively (the 4 and 2 rule).

Original languageEnglish (US)
Pages (from-to)48-53
Number of pages6
JournalAmerican Journal of the Medical Sciences
Volume340
Issue number1
DOIs
StatePublished - Jul 1 2010

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Trace Elements
Electrolytes
Cations
Antioxidants
Hypokalemia
Cardiac Myocytes
Critical Illness
Cardiac Arrhythmias
Myocardium
Electrocardiography
Oxidative Stress
Necrosis
Biomarkers

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

A dyshomeostasis of electrolytes and trace elements in acute stressor states : Impact on the heart. / Whitted, Anthony D.; Stanifer, John W.; Dube, Preeti; Borkowski, Brian J.; Yusuf, Jawwad; Komolafe, Babatunde O.; Davis, Richard C.; Soberman, Judith E.; Weber, Karl.

In: American Journal of the Medical Sciences, Vol. 340, No. 1, 01.07.2010, p. 48-53.

Research output: Contribution to journalArticle

Whitted, AD, Stanifer, JW, Dube, P, Borkowski, BJ, Yusuf, J, Komolafe, BO, Davis, RC, Soberman, JE & Weber, K 2010, 'A dyshomeostasis of electrolytes and trace elements in acute stressor states: Impact on the heart', American Journal of the Medical Sciences, vol. 340, no. 1, pp. 48-53. https://doi.org/10.1097/MAJ.0b013e3181e5945b
Whitted, Anthony D. ; Stanifer, John W. ; Dube, Preeti ; Borkowski, Brian J. ; Yusuf, Jawwad ; Komolafe, Babatunde O. ; Davis, Richard C. ; Soberman, Judith E. ; Weber, Karl. / A dyshomeostasis of electrolytes and trace elements in acute stressor states : Impact on the heart. In: American Journal of the Medical Sciences. 2010 ; Vol. 340, No. 1. pp. 48-53.
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