In general, the invention is directed to methods and devices for determining an ion concentration in the extracellular fluid of a patient. As examples, the ion may be one or more of potassium, sodium, chloride, or calcium. A system includes an electrode deployed in or near a tissue, such as a skeletal muscle, of the patient. A pulse generator supplies one or more stimulations to the tissue, and a sensor, such as an accelerometer, detects the response of the tissue to the stimulations. A processor determines a concentration of ions in the extracellular fluid as a function of the response. The system may detect an ion imbalance based upon the determined concentration of ions.