Electrolyte Imbalances from Prolonged Watery Diarrhea

Primary Electrolyte Disturbances

The World Health Organization recommends that the WHO-ORS contains 30 mmol/L of base to address bicarbonate loss in stool, which is the predominant acid-base disorder in watery diarrhea 1, 2
Serum sodium concentrations relate more to hydration status than to the amount of sodium lost, as water loss typically exceeds proportional sodium loss 3

Water loss is the most immediate life-threatening consequence, with stool losses more pronounced in secretory diarrheas than other causes, according to the Centers for Disease Control and Prevention 1, 4
Severe dehydration (≥10% fluid deficit) requires immediate IV intervention to prevent shock and acute renal failure, as recommended by the American College of Emergency Physicians 4, 5
Dry mucous membranes, tachycardia, and weakness are cardinal signs of volume depletion from fluid and salt loss, as noted by the American Heart Association 4, 5

The standard WHO-ORS contains only 20 mmol/L of potassium, which may be inadequate for prolonged watery diarrhea with ongoing losses, according to the World Health Organization 1, 2
Many clinicians use "clear liquids" instead of properly formulated ORS, which can cause osmotic diarrhea and worsen electrolyte imbalance due to inadequate sodium bicarbonate and excess sugar, as warned by the American Gastroenterological Association 1, 2