Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Older adults may not get enough to eat or drink due to disability or lack of appetite or thirst or because they do not have regular access to food and drink. Classes & Events The most reported imbalances are those involving sodium and potassium, and these are the electrolytes that will be specified and addressed in the present work. Nephrol Nurs J. Ruth Jessen Hickman, MD, is a freelance medical and health writer and published book author. Customized approach to neurology treatment for a wide range of conditions. Hyponatremia signs and symptoms may include: Seek emergency care for anyone who develops severe signs and symptoms of hyponatremia, such as nausea and vomiting, confusion, seizures, or lost consciousness. Hypomagnesemia. Treatment of electrolyte imbalances will depend on the underlying medical problem. Electrolyte imbalances can cause serious or life threatening symptoms. These include: Intravenous (IV) fluids, typically containing sodium chloride, can help rehydrate the body. Sodium, potassium, and chloride are the significant electrolytes along with magnesium, calcium, phosphate, and bicarbonates. Mild electrolyte imbalance may not cause any symptoms. Comparison of sports drink versus oral rehydration solution during exercise in the heat. Dark-colored urine and thirst are classic signs that someone is dehydrated. (8) Without enough water present in your body, dehydration and deficits can cause cardiovascular complications (changes to heartbeats), muscle cramping, fatigue, dizziness and confusion. In Conversation: Is the ketogenic diet right for autoimmune conditions? This article takes a detailed look at electrolytes, their, Traditional sports drinks provide easy-to-digest carbohydrates to help athletes to fuel longer-duration exercises and replace electrolyte lost in, Low blood sodium, or hyponatremia, occurs when water and sodium are out of balance in your body. Hyperchloremia occurs when theres too much chloride in the body. Other risk factors include having a high fever and taking medications that increase urination. Murdeshwar HN, et al. A normal blood sodium level is between 135 and 145 milliequivalents per liter (mEq/L). These might include illness affecting organs like: Your electrolytes might need to be regularly tested if you are taking a medication that might change your electrolyte levels, like a diuretic. It can cause weakness, headache, nausea, and muscle, Hypercalcemia is a condition in which you have too much calcium in your blood. Same-day convenient care right around the corner. For example, if you are sweating or vomiting too much, it can lower the levels of some electrolytes in the body., In fact, when you're sweating, you lose 2% to 6% of your body weight. Practical hydration solutions for sports. You can also eat certain foods to increase electrolyte levels in the body, such as potatoes, avocados, oranges, bananas, strawberries, turkey, and spinach., Dont rehydrate with carbonated or energy drinks. If you work out for less than 75 minutes, standard water should work fine. Surgical treatment for parathyroid adenoma: a case report, Behavioural patterns of electrolyte repletion in intensive care units: lessons from a large electronic dataset, Abnormalities in potassium (hypokalemia or, Abnormalities in calcium (hypercalcemia or hypocalcemia), Imbalances in magnesium (hypermagnesemia or hypomagnesemia). All rights reserved. Especially in someone with a relatively mild imbalance, this might be the only intervention needed. These tests can tell you whether you have an electrolyte imbalance in a specific electrolyte, like sodium. How much water is the right amount for you? Hypomagnesemia means having too little magnesium in the body. This can happen after prolonged vomiting, diarrhea, or sweating, due to an illness, for example. Conditions caused by electrolyte level imbalances include: Calcium is a vital mineral that your body uses to stabilize blood pressure and control skeletal muscle contraction. As another example, sometimes people can also get an electrolyte imbalance if they drink very large amounts of water. When this happens, your body's water levels rise, and your cells begin to swell. "Staying hydrated is key to proper body function," says Dr. Jones. Maintaining an electrolyte balance is vital for your body to function smoothly. These minerals are dissolved in your bodys fluids. If you can identify with the descriptions of electrolyte imbalance symptoms below, its best to talk visit a health care provider to talk about how to reverse the problem and prevent it from happening again. View and register online for upcoming community events and classes. Medications or supplements to replace lost electrolytes. Electrolyte imbalances can develop when the amount of water in your body changes, either causing dehydration (not enough water compared to certain elevated electrolytes) or overhydration (too much water). (2022). Chloride functions to balance cations in the ECF, maintaining the electrical neutrality of this fluid. Replenishing electrolytes has been a well-known recommendation for years and is why sports drinks and enhanced waters are popular among people who are very active. Monitoring how much sodium you consume helps keep symptoms at bay, including bloating, lethargy, dehydration, weakness, irritability and muscle twitching. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Certain diuretics are considered potassium-sparing, meaning they can cause potassium levels to stay very high while other electrolytes like sodium, calcium and magnesium can fall very low. A nationally recognized heart center providing comprehensive heart and vascular health services. Visit your doctor if youre experiencing common symptoms of an electrolyte imbalance. For example, someone might have an electrolyte imbalance because of untreated type 1 diabetes. All rights reserved. Your doctor will look for any noticeable changes in optimal electrolyte levels, including very high or low potassium, magnesium or sodium levels. Balance your body's acid/base (pH) level. Call your doctor if you know you are at risk of hyponatremia and are experiencing nausea, headaches, cramping or weakness. (2022). These blood tests check for electrolytes, as well as other substances in blood. They should therefore consult a doctor. Thats why its so important to protect yourself from dehydration. Sodium is an electrolyte, and it helps regulate the amount of water that's in and around your cells. Last medically reviewed on December 14, 2022. Electrolytes are essential for basic life functioning, such as maintaining electrical neutrality in cells, generating and conducting action potentials in the nerves and muscles. 2019;11(7):1550. doi:10.3390/nu11071550. This article is based on scientific evidence, written by experts and fact checked by our trained editorial staff. This site complies with the HONcode standard for trustworthy health information: verify here. This can go undetected until discovered during a routine blood test. This medicine is also used to treat or prevent hypokalemia (low potassium levels in the blood). Track, manage and pay your Piedmont bill. https://www.kidney.org/atoz/content/hyponatremia. Antibiotics, diuretics, hormonal pills, blood pressure medications and cancer treatments can all impact electrolyte levels. Its also important to note that drinking too many fluidseither water or commercial electrolyte drinksmay lead to electrolyte imbalances as well. Children with cancer who have had a bone marrow transplant or take certain chemotherapy medications are also more susceptible to electrolyte imbalances. An electrolyte panel is a blood test that measures the levels of seven electrolytes in your blood. 2005-2023 Healthline Media a Red Ventures Company. Maintaining a balance of electrolytes in your body is relatively easy: Drink water. Make sure to read the label to check if the drink actually has electrolytes, though, since some of them don't., Eat electrolyte-rich foods. Also, some individuals require additional treatment to address the underlying problem. Electrolytes are given their name because they literally have an electric charge. (2)They separate into positively and negatively charged ions when theyre dissolved in water. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. All videos and content are the exclusive property of Piedmont Healthcare and may not be used by any third parties for any other purposes. Healthcare providers often order an electrolyte panel if you: Your provider may also order a basic metabolic panel or comprehensive metabolic panel. All rights reserved. also ensures you obtain enough other important electrolytes. Your body odor can change due to hormones, the food you eat, infection, medications or underlying conditions like diabetes. A single copy of these materials may be reprinted for noncommercial personal use only. This article discusses the role of electrolytes in health, electrolyte imbalance, and supplementation. Electrolyte disturbances are very common in many different medical conditions. Electrolyte supplements can be added to IV fluids to correct deficiencies. If a person has a more severe case of kidney disease, they may need dialysis to address an electrolyte imbalance. These 12 foods high in phosphorous can help ensure you're getting, Hemochromatosis occurs if there's too much iron in your blood. Electrolytes are present throughout the, Toddlers will often be unable to explain when they are feeling thirsty or dehydrated, but severe dehydration can be dangerous. You may be more likely to develop an electrolyte imbalance if you have: Certain medications can also affect electrolyte levels. An electrolyte imbalance occurs when your bodys mineral levels are too high or too low. For many people, a poor diet thats high in processed foods containing lots of sodium, but low in other electrolytes like magnesium or potassium, paves the way for a dangerous imbalance. Body odor is caused by a mix of bacteria and sweat on your skin. Nippoldt TB (expert opinion). Treatment depends on the specific electrolyte imbalance and cause. Sometimes, no specific cause can be identified for an electrolyte imbalance. Over-hydration is rare, but yes, its possible. Read our. Magnesium and potassium are two electrolytes that many people are low in. Make sure that your nerves, muscles, the heart, and the brain work the way they should. are clickable links to these studies. It also helps to regulate nerve function and muscle contraction. Severe electrolyte imbalances can cause serious problems such as coma, seizures, and cardiac arrest. Your kidneys are the hub for electrolyte monitoring. The added sugar and flavor in these drinks often entice people to drink a larger quantity compared to water. Electrolytes are minerals your body needs in order to perform important functions. General characteristics of patients with electrolyte imbalance admitted to emergency department. Anyone can develop an electrolyte imbalance. Your body makes electrolytes. Mayo Clinic is a not-for-profit organization. In this case, a person may be able to correct the imbalance at home over a period of days or weeks. ", Cleveland Clinic: "Electrolyte Drinks: Beneficial or Not? The information in our articles is NOT intended to replace a one-on-one relationship with a qualified health care professional and is not intended as medical advice. High sodium levels can result in hypernatremia, which leads to symptoms such as: Common symptoms of electrolyte imbalances include: Severe symptoms of electrolyte imbalances include: To self-assess for an electrolyte imbalance, a person can watch out for common symptoms, especially in hot weather or after vomiting, diarrhea, or strenuous physical activity. They help regulate myocardial and neurological function, fluid balance, oxygen delivery, acid-base balance, and other biological processes. Hyponatremia and hypernatremia. If you are a Mayo Clinic patient, this could Toffaletti JG, et al. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. There is a problem with Dirty Dozen List: Are You Eating the Most Pesticide-Laden Produce? Fatigue. However, sports drinks are often more appealing. (2018). Unexplained confusion, muscle cramps, numbness or tingling. Osmolality, sodium, potassium, chloride, and bicarbonate. This is especially likely to be the case if the imbalance is mild or if the imbalance has been coming on gradually. If not, you risk developing dehydration symptoms, kidney stones, bladder infections, urinary tract stones and potentially even heart failure. Read articles on helpful tips, health news, recipes and more. Electrolyte imbalances in your blood can lead to significant and even life-threatening problems. To provide you with the most relevant and helpful information, and understand which Usually not: Usually celiac disease does not affect electrolytes into and of itself but the diet changes induced by the disease can cause some electrolyte imbalances. We avoid using tertiary references. Thats why these are usually done as part of a group. An electrolyte imbalance can occur if the body has too much or too little water. It is a good idea to do your best to stay hydrated if youre experiencing prolonged vomiting, diarrhea, or sweating. They will do a physical exam and may order a blood test to check your kidney function., Cardiology Journal: "Electrolyte disorders and arrhythmogenesis. Sometimes that might be relatively obvious. However, a doctor should monitor this process to be sure that the person is getting the correct amounts of electrolytes. Electrolytes are critical for making sure your blood doesnt become too acidic or too alkaline. Vomiting, diarrhea, and severe burns are all causes of fluid loss that might lead to electrolyte imbalances. Electrolytes are minerals that control important physiologic functions of the body. Depending on the type of electrolyte imbalance you experience, a number of symptoms can occur including: To diagnose an electrolyte imbalance, your doctor can perform a few different tests to determine your electrolyte levels. Chloride is the predominant extracellular anion. Electrolytes must be evenly balanced for your. An electrocardiogram (ECG or EKG), an electrical tracing of your heart, may also be useful to check for any irregular heartbeats, rhythms, or ECG or EKG changes brought on by electrolyte problems. Medical treatments for electrolyte imbalances include: A significant electrolyte imbalance (either too high or too low) can cause serious, life-threatening problems. World J Emerg Med. Electrolytes are minerals that carry an electrical charge. You also ingest them through food, drinks, and supplements. How do you know when its time to speak with a doctor about whether or not you might have an electrolyte imbalance? The body responds to electrolyte imbalances in various ways. Electrolytes are minerals in the blood, tissues, and elsewhere throughout the body. Cleveland Clinic is a non-profit academic medical center. Electrolytes play a vital role in maintaining homeostasis within the body. Move wastes out of your cells. Electrolytes are minerals that the body needs to: People get electrolytes from food and beverages. Electrolyte levels that are too high or too low can cause health problems. To obtain enough calcium naturally without needing supplements, consider adding high-quality and ideally raw dairy products to your diet if you can tolerate them. Goyal R, et al. If dehydration is part of the cause, a person may need to receive intravenous fluids. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Policy. An electrolyte imbalance is caused when you lose a large amount of body fluids. Electrolyte imbalances are particularly common in elderly people and in people who are critically ill.. The major electrolytes found within the body include calcium, magnesium, potassium, sodium, phosphate and chloride. Its also used to build strong bones and teeth. An electrolyte imbalance occurs when you have too much or not enough of certain minerals in your body. They play key roles in a variety of important physiological processes in all the cells of your body. Track, manage and pay your Piedmont bill. (n.d.). Same day appointments with Primary Care, Urgent Care and QuickCare providers. Nagami GT. However, if a health condition is causing an electrolyte imbalance or if a person has any severe symptoms, they should seek guidance from a doctor. This swelling can cause many health problems, from mild to life-threatening. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, Bird Flu Deaths Prompt U.S. to Test Vaccine in Poultry, COVID Treatment in Development Appears Promising, Marriage May Help Keep Your Blood Sugar in Check, Getting Outdoors Might Help You Take Fewer Meds, New Book: Take Control of Your Heart Disease Risk, MINOCA: The Heart Attack You Didnt See Coming, Health News and Information, Delivered to Your Inbox. The typical signs and symptoms of electrolyte imbalance include: Muscle cramps. For instance, low sodium levels in the blood can cause hyponatremia. (2022). Dont hesitate to ask your medical provider about the source and treatment of your electrolyte imbalance. Balc AK, Koksal O, Kose A, et al. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Electrolytes help our, Electrolytes are important for many bodily functions, such as fluid balance and muscle contractions. Transplant surgery pioneers for liver, pancreas, kidney and heart care. Advertising revenue supports our not-for-profit mission. Cascella M, et al. Do you live in a warm climate that results in you sweating? They include chloride, phosphate, potassium, sodium, and calcium. Also, if you are an extreme exercise enthusiast, follow an intense exercise program, or if you have a medical condition that warrants close monitoring of your exercise and fluid intake, Edrea Jones, M.D., a nephrologist at Piedmont, recommends talking to your physician to ensure you know your limits and your fluid requirements. Note that the numbers in parentheses (1, 2, etc.) Conditions that cause excess water gain might also lead to other types of electrolyte imbalances. Hemodialysis. When your body temperature rises, these glands release fluids that cool your body as they evaporate. Merck Manual Professional Version. (2016). In acute hyponatremia, sodium levels drop rapidly resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death. Philadelphia, Pa.: Elsevier 2017. https://www.clinicalkey.com. Abnormally high levels of sodium are often caused by severe dehydration, which can be caused by: Hyponatremia develops when theres too little sodium. Electrolytes are minerals that carry either a positive or negative charge. You get them from the foods you eat and the fluids you drink. 2005 - 2023 WebMD LLC. Electrolytes like salt, potassium, and calcium perform a variety of important functions within your body. Sodium is an electrolyte that plays a significant part in the bodys ability to retain or release water, so if your diet is very high in sodium, more water isexcreted by the kidneys, and this can cause complications with balancing other electrolytes. Electrolyte imbalances can cause problems with many different bodily systems, which may even be life-threatening if severe. This imbalance may be a sign of a problem like kidney disease. In hyponatremia, one or more factors ranging from an underlying medical condition to drinking too much water cause the sodium in your body to become diluted. These are usually done as part of a problem with Dirty Dozen List are. If not, you risk developing dehydration symptoms, kidney and heart Care excess water might! Electrolyte levels that are too high or too low can cause hyponatremia a amount... Include having a high fever and taking medications that increase urination hypokalemia ( low potassium in. Diarrhea, or sweating, due to hormones, the food you,... Imbalances are particularly common in elderly people and in people who are critically ill can. Electrolytes, as well might also lead to electrolyte imbalances can cause many health problems, from mild to.! Minerals in your blood body as they evaporate chloride are the exclusive property of Piedmont Healthcare may... The foods you eat, infection, medications or underlying conditions like diabetes imbalances are particularly common in people! Very high or low potassium levels in the ECF, maintaining the electrical neutrality of fluid... Space, and chloride by our trained editorial staff yes, its possible elsewhere throughout the body risk! Imbalance if they drink very large amounts of water that cool your body needs in order to perform important.. That carry either a positive or negative charge sodium level is between 135 and milliequivalents! Helps regulate the amount of water that & # x27 ; s in and around your cells containing. Philadelphia, Pa.: Elsevier 2017. https: //www.clinicalkey.com from dehydration in you sweating other purposes too chloride... Heart Care, potassium, and supplementation in and around your cells begin to swell name because they have! Electrolytes like salt, potassium, chloride, can help rehydrate the body imbalance when. Risk of hyponatremia and hypernatremia during a routine blood test as part of body. Excess water gain might also lead to other types of electrolyte imbalance in a warm climate that results in sweating! This could Toffaletti JG, et al article is based on scientific,... May need to receive Intravenous fluids illness, for example, sometimes people can also electrolyte... Amounts of electrolytes are low in 2017. https: //www.clinicalkey.com like sodium functions to balance cations in blood. Treatment to address an electrolyte panel if you are at risk of hyponatremia and hypernatremia the ECF maintaining. Fluid balance and muscle contractions with cancer who have had a bone marrow transplant or take certain chemotherapy medications also. To electrolyte imbalances will depend on the underlying problem imbalances in your blood doesnt too. The major electrolytes found within the body lead to other types of electrolyte imbalances chloride. Play key roles in a warm climate that results in you sweating added sugar and flavor these! Drinking too many fluidseither water or commercial electrolyte drinksmay lead to significant and even life-threatening.... Osmolality, sodium, potassium, chloride, phosphate, and it helps regulate the amount of body fluids out., drinks, and other biological processes, which may even be life-threatening severe! Electrolytes that many people are low in appointments with Primary Care, Urgent Care and providers. Mix of bacteria and sweat on your skin substances in blood likely to be sure that nerves! Play key roles in a specific electrolyte imbalance occurs when your body to function smoothly other substances in.! Low sodium levels if youre experiencing prolonged vomiting, diarrhea, or sweating, due to an illness for. To IV fluids to correct the imbalance at home over a period of days or.. No specific cause can be added to IV fluids to correct deficiencies cells! Blood pressure medications and cancer treatments can all impact electrolyte levels, drinks, bicarbonates... ; s acid/base ( pH ) level kidney and heart Care are low in a larger quantity compared to.. Minerals your body needs in order to perform important functions verify here your., urinary tract stones and potentially even heart failure sweat on your skin measures. Book author basic metabolic panel or comprehensive metabolic panel or comprehensive metabolic panel or comprehensive metabolic or... Marrow transplant or take certain chemotherapy medications are also more susceptible to electrolyte imbalances in various.. Levels of seven electrolytes in health, electrolyte imbalance is caused when you have an electric charge is dehydrated muscle. Of conditions, et al theyre dissolved in water positively and negatively charged ions when theyre dissolved in water to. Many bodily functions, such as fluid balance, oxygen delivery, acid-base balance, delivery... Surgery pioneers for liver, pancreas, kidney stones, bladder infections, urinary stones... Drink a larger quantity compared to water and heart Care take certain medications! Electrolytes in your blood role of electrolytes of seven electrolytes in your blood of electrolytes blood become... Potassium levels in the blood, tissues, and bicarbonate out these best-sellers and offers. Food, drinks, and other biological processes part of the body cancer treatments can impact. Sodium, potassium, chloride, can help ensure you 're getting, Hemochromatosis occurs if 's..., oxygen delivery, acid-base balance, oxygen delivery, acid-base balance, oxygen delivery, acid-base,...: people get electrolytes from food and beverages, muscle cramps, numbness or tingling appointments with Primary Care Urgent..., Cleveland Clinic: `` electrolyte drinks: Beneficial or not enough of certain minerals in your is... Can tell you whether you have too much chloride in the blood ), cramps... Special offers on books and newsletters from Mayo Clinic patient, this could JG... Red Ventures Company can be added to IV fluids to correct deficiencies to.! Risk factors include having a high fever and taking medications that increase.! Yourself from dehydration with Primary Care, Urgent Care and QuickCare providers, Pa.: Elsevier 2017. https //www.clinicalkey.com... To an illness, for example, someone might have an electrolyte imbalance occurs when your body #. Pa.: Elsevier 2017. https: //www.clinicalkey.com if you are a Mayo Clinic.. Muscle cramps large amount of water that & # x27 ; s acid/base ( pH level. Case, a person has a more severe case of kidney disease like kidney disease, they may need receive... Get electrolytes from food and beverages fluidseither water or commercial electrolyte drinksmay lead to imbalances... Is vital for your body as they evaporate exercise in the heat as. You drink use only negatively charged ions when theyre dissolved in water: the. Warm climate that results in you sweating may even be life-threatening if severe in order to perform important within... And chloride systems, which may even be life-threatening if severe, a... Specific electrolyte imbalance if they drink very large amounts of electrolytes in your body are at risk of and! A Red Ventures Company pancreas, kidney and heart Care best-sellers and special offers on books newsletters. 12 foods high in phosphorous can help rehydrate the body include calcium, phosphate, supplementation. To emergency department, etc. blood tests check for electrolytes, as well hesitate to ask your medical about... Heart, and calcium perform a variety of important functions sodium levels having too water! Tips, health news, recipes and more amount of water that & # x27 ; in... Sometimes, no specific cause can be identified for an electrolyte imbalance cause. Underlying problem underlying conditions like diabetes the right amount for you and content are exclusive!, seizures, and supplements no specific cause can be added to IV to. Pressure medications and cancer treatments can all impact electrolyte levels, including very high or little... Added to IV fluids to correct deficiencies warm climate that results in you sweating `` drinks...: muscle cramps, numbness or tingling rare, but yes, its.... And 145 milliequivalents per liter ( mEq/L ) these blood tests check electrolytes. Of seven electrolytes in your blood can cause serious or life threatening symptoms regulate myocardial and neurological function, balance! Process to be sure that the numbers in parentheses ( 1, 2 etc. Get electrolytes from food and beverages imbalance is mild or if the imbalance at over. Potassium levels in the body has too much iron in your blood the Most Pesticide-Laden Produce,! And Research ( MFMER ) ( 2 ) they separate into positively negatively. For medical Education and Research ( MFMER ), hormonal pills, pressure! To do your best to stay hydrated if youre experiencing prolonged vomiting, diarrhea, or sweating patients electrolyte... Sports drink versus oral rehydration solution during exercise in the blood ) J.! Meq/L ) level is between 135 and 145 milliequivalents per liter ( mEq/L.. If severe imbalance can occur if the imbalance at home over a period of days or weeks through. Imbalance include: Intravenous ( IV ) fluids, typically containing sodium chloride, can ensure. Between 135 and 145 milliequivalents per liter ( mEq/L ) know you are at of... Depend on the underlying problem specific cause can be added to IV fluids to correct the imbalance is or. Scientific evidence, written by experts and fact checked by our trained editorial staff yourself from.... Of sodium disorders: hyponatremia and hypernatremia water or commercial electrolyte drinksmay lead to significant even. You are a Mayo Clinic patient, this could Toffaletti JG electrolyte imbalance body odor et al disturbances are very common many! Some individuals require additional treatment to address an electrolyte imbalance if they drink very large amounts of.! Process to be the case if the body and bicarbonates high in phosphorous can rehydrate. Systems, which may even be life-threatening if severe the typical signs and symptoms of an electrolyte..
Call Center Training Material Ppt, Somalia Elephant Silver Coin Mintage, Articles E