What electrolyte disturbances are associated with seizures?

From the Guidelines

Electrolyte disturbances that commonly trigger seizures include hyponatremia, hypocalcemia, hypomagnesemia, and hypoglycemia, with hyponatremia being the most frequent electrolyte abnormality causing seizures, especially when sodium levels fall below 120 mEq/L or drop rapidly 1.

Key Electrolyte Disturbances

• Hyponatremia: especially when sodium levels fall below 120 mEq/L or drop rapidly
• Hypocalcemia: becomes concerning when ionized calcium falls below 1.1 mmol/L
• Hypomagnesemia: can directly cause seizures and also worsens hypocalcemia by impairing parathyroid hormone function
• Hypernatremia and severe hypophosphatemia: can occasionally trigger seizures as well

Treatment and Management

• Correction of the underlying electrolyte abnormality while providing appropriate seizure management
• For acute symptomatic seizures, correction of sodium should be carefully controlled at 6-8 mEq/L per day to avoid osmotic demyelination syndrome
• Calcium gluconate 1-2g IV or calcium chloride 1g IV can be given for severe hypocalcemia
• Magnesium sulfate 2g IV over 10 minutes followed by infusion may be needed for hypomagnesemia, as supported by the most recent guidelines 1

Importance of Prompt Identification and Correction

• These electrolytes are critical for neuronal membrane stability and action potential generation, with disturbances altering the electrical activity threshold required for seizure development
• Prompt identification and correction of these abnormalities is essential for effective seizure management, as emphasized in recent studies 1

From the Research

Electrolyte Disturbances Associated with Seizures

• Sodium disorders, including hyponatremia and hypernatremia, are associated with increased rates of morbidity and mortality, and can cause seizures 2
• Severe hyponatremia can lead to altered mental status, seizures, and other neurological symptoms, and requires urgent treatment with hypertonic saline administration 2
• Hypernatremia can also cause seizures, as well as vomiting, somnolence, and coma, and requires management with oral or intravenous hypotonic fluids and addressing the underlying cause 3
• Other electrolyte disturbances, such as hypokalemia, hyperkalemia, hypocalcemia, and hypercalcemia, can also cause neurological symptoms, including seizures, and require prompt identification and treatment 4, 5
• Dysnatremias, including hyponatremia and hypernatremia, can affect the central nervous system and cause epileptic encephalopathies, and require careful management to prevent permanent nervous system injury 5

Specific Electrolyte Disturbances and Seizures

• Hyponatremia is a common electrolyte disorder that can cause seizures, and requires urgent treatment with hypertonic saline administration 2, 3
• Hypernatremia can cause seizures, and requires management with oral or intravenous hypotonic fluids and addressing the underlying cause 3
• Hypokalemia and hyperkalemia can also cause neurological symptoms, including seizures, and require prompt identification and treatment 4, 3
• Hypocalcemia and hypercalcemia can affect the central nervous system and cause neurological symptoms, including seizures, and require careful management to prevent permanent nervous system injury 5