ELECTROLYTES Flashcards by V S

Ions that are capable of carrying an electric charge

Electrolytes

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Fluid that is one third of the total body water
16 Liters

Extracellular fluid

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Fluid that is two thirds of the total body water
24 L

Intracellular fluid

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Major Extracellular Cation, hence the major contributor of Osmolality

Sodium

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Sodium’s plasma concentration depends greatly on the intake and excretion of __

Water

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Reference Value of Sodium

135 - 145 mmol/L

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Promotes absorption of sodium in the distal tubule
Promotes sodium retention and potassium excretion

Aldosterone

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Blocks aldosterone and renin secretion, and inhibits the action of angiotensin II and vasopressin
Causes Natriuresis

Atrial Natriuretic Factor (ANF)

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Diabetes insipidus
Renal tubular disorder
Prolonged diarrhea
Profuse sweating
Severe burns
Vomiting
Fever
Hyperventilation

Excess Water Loss
Hypernatremia

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Hyperaldosteronism (Conn’s disease)
Sodium bicarbonate infusion
Increased oral or IV intake of NaCl
Ingestion of sea water

Increased water intake or retention
Hypernatremia

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Diuretic use
Saline infusion

Increased Sodium loss
Hyponatremia

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Renal failure
Nephrotic syndrome
Aldosterone deficiency
Cancer
Syndrome of Inappropriate ADH Secretion
Hepatic cirrhosis
Primary polydipsia
CNS abnormalities
Myxedema

Increased water retention
Hyponatremia

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Defined as an increased sodium concentration in plasma water,
Sodium levels >145 mmol/L
Caused by loss of water, gain of sodium or both

Hypernatremia

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Most common electrolyte disorder
Reduced plasma sodium concentration <135mmol/L

Hyponatremia

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Reduction in serum sodium concentration caused by a systematic error in measurements

Pseudohyponatremia

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Most common, yet not widely known cause of pseudohyponatremia is ___, a well known cause of pseudohyperkalemia

In Vitro Hemolysis

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Serum Na - Low
Urine Na - Low
24-hour Na - Low
Urine Osmolality - Low
Serum K - N/L

Overhydration

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Serum Na - Low
Urine Na - Low
24-hour Na - High
Urine Osmolality - Low
Serum K - Low

Diuretics

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Serum Na - Low
Urine Na - High
24-hour Na - High
Urine Osmolality - High
Serum K - N/L

SIADH

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Serum Na - Mildly elevated
Urine Na - Normal
24-hour Na - N/A
Urine Osmolality - High
Serum K - High

Adrenal Failure

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Serum Na - Low
Urine Na - Low
24-hour Na - High
Urine Osmolality - Low
Serum K - Low

Bartter’s Syndrome

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Serum Na - Low
Urine Na - Normal
24-hour Na - Normal
Urine Osmolality - Normal
Serum K - High

Diabetic Hyperosmolality

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Methods used for detection of Sodium levels:

Emission Flame Photometry
Ion Selective Electrode (Glass Aluminum silicate)
Atomic Absorption Spectrophotometry
Colorimetry

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Major Intracellular Cation
Single most important analyte in terms of abnormality being immediately life threatening

Potassium

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Potassium has a concentration in the RBCs of ___ which is __x its concentration in plasma

105 mmol/L 23x

It is reabsorbed together with Na & Cl by the sodium potassium chloride cotransporter in:

Ascending limb of Henle's Loop

Reference Value of Potassium:

3.5 - 5.2 mmol/L

Reference Value of Potassium:

3.5 - 5.2 mmol/L

Plasma levels are ___ compared to serum levels because of the release of platelets into serum on clot formation

LOWER

1. Acute or Chronic Renal Failure 2. Severe Dehydration 3. Addison's Disease

Hyperkalemia due to Decreased renal excretion

1. Acidosis 2. Muscle/Cellular injury 3. Chemotherapy 4. Vigorous exercise 5. Digitalis intoxication

Hyperkalemia due to Extracellular shift

Other causes of Hyperkalemia:

Increased intake Use of immunosuppressive drugs

1. Gastric suction & Laxative abuse 2. Intestinal tumor and malabsorption 3. Cancer and Radio therapy 4. Vomiting and Diarrhea

Hypokalemia due to Gastrointestinal loss

1. Diuretics use 2. Hyperaldosteronism 3. Cushing's Syndrome 4. Leukemia 5. Bartter's Syndrome 6. Gitelman's Syndrome 7. Liddle's Syndrome 8. Malignant Hypertension

Hypokalemia due to Renal Loss

1. Alkalosis 2. Insulin Overdose

Hypokalemia due to Intracellular Shift

Almost always due to impaired Renal Excretion

Hyperkalemia

Elevations in serum K can directly stimulate the adrenal cortex to release:

Aldosterone

Three major mechanisms of diminieshed renal potassium:

1. Reduced aldosterone 2. Renal Failure 3. Reduced distal dedlivery of sodium

Most common cause of chronic hyperkalemia due to impaired renal excretion of plasma is ____, which is caused by chronic renal insufficiency of primarily tubulointerstitial disease

Hyporeninemic Hypoaldosteronism

Reduced GFR and decreased tubular secretion causes accumulation of potassium (Mg, PO4) in plasma

Renal Failure

Plasma K levels of ___ is fatal and can cause cardiac arrest

10 mmol/L

Hyperkalemic drugs:

1. Captopril 2. Spironolactone 3. Digoxin 4. Cyclosporine 5. Heparin

1. Sample Hemolysis 2. Thrombocytosis 3. Prolonged Tourniquet Application 4. Fist Clenching 5. Blood stored in ice 6. IV fluid 7. High blast counts in acure or accelerated phase leukemias

Causes of Pseudohyperkalemia

Hpomagnesemia leads to ___ by promoting urinary loss of potassium

Hypokalemia

Most common cause of hypokalemia Can be attributed to increased activity of aldosterone or other mineralocorticoid

Impaired Renal function or Renal Loss

___ is the most common cause of extra renal loss of potassium

Diarrhea

___ can cause falsely decrease potassium levels because K is taken up by WBC

Leukocytosis

Methods to measure Potassium levels

1. Emission Flame Photometry 2. Ion Selective Electrode (Valinomycin gel) 3. AAS 4. Colorimetry (Lockhead & Purcell)

Major Extracellular Anion Chief counter ion of sodium in ECF Promotes maintenance of water balance & osmotic pressure

Chloride

Only anion to serve as an enzyme activator

Chlorine

Reference Value of Chlorine

98 - 107 mmol/L

Indicator: Diphenylcarbazone End: HgCl2 (Blue-Violet)

Mercurimetric Titration **Schales & Schales**

Mercuric Thiocyanate (Reddish) Ferric Perchlorate

Spectrophotometric Method

Cotlove Chloridometer

Coulometric Amperometric Titration

Most commonly used method for detecting Chloride levels:

Ion Selective Electrode

1. Renal Tubular Acidosis 2. Diabetes insipidus 3. Salicylate intoxication 4. Primary hyperparathyroidism 5. Metabolic acidosis 6. Prolonged diarrhea

Hyperchloremia (>107 mmol/L)

1. Prolonged vomiting 2. Aldosterone deficiency 3. Metabolic Alkalosis 4. Salt-losing nephritis

Hypochloremia (<98 mmol/L)

Present almost exclusively in the plasma Involved in blood coagulation, enzyme activity, excitability of skeletal and cardiac muscle, and maintenance of blood pressure

Calcium

Calcium is maximally absorbed in the ___, the absorption is favored at an acidic pH

Duodenum

Reference Value of Total Calcium

1. Adult: 8.6-10 mg/dL 2. Child: 8.8-10.8 mg/dL

Reference Value for Ionized Calcium

1. Adult: 4.6-5.3 mg/dL 2. Child: 4.8-5.5 mg/dL

Hypocalcemia can be a consequence of reduced plasma ___

Albumin

Increases intestinal absorption of Calcium Increases reabsorption in the kidneys Increases mobilization of calcium from bones

1,25-Dihydroxycholecalciferol (1,25-(OH)2D3) Activated Vit D3

Conserves Calcium by increasing reabsorption in the kidneys Increases the levels by mobilizing bone calcium Activates process of bone resorption Suppresses urinary loss of calcium Stimulates conversion of inactive Vit D to active Vit D3 in kidneys

Parathyroid Hormone

Secreted by the parafollicular C cells of the thyroid gland Inhibits PTH & Vitamin D3 Inhibits bone resorption Promotes urinary excretion of Calcium

Calcitonin

End Product: Oxalic Acid Purple | Calcium Methods

Clark Collip Precipitation

End: Chloranilic Acid Purple | Calcium Methods

Ferro Ham Chloranilic Acid Precipitation

Dye: Arzeno III Mg inhibitor: 8-hydroxyquinoline (chelator) | Calcium Methods

Ortho-Cresolphthalein Complexone Dyes

Reference Method for detection of Calcium levels:

Atomic Absorption Spectrophotometry

Other Methods for detecting Chloride levels:

EDTA Titration Method Ion Selective Electrode (Liquid membrane) Emission Flame Photometry

1. Primary Hyperparathyroidism 2. Cancer 3. Acidosis 4. Increased Vit D 5. Multiple Myeloma 6. Sarcoidosis 7. Hyperthyroidism 8. Milk-Alkali Syndrome

Hypercalcemia **CHIMPS**

1. Alkalosis 2. Vitamin D deficiency 3. Primary Hypoparathyroidism 4. Acute Pancreatitis 5. Hypomagnesemia 6. Malabsorption Syndrome 7. Renal Tubular Failure

Hypocalcemia **CHARD**

Inversely related to Calcium Maximally absorbed in the jejunum Essential for the insulin-mediated entry of glucose into cells by a process involving phosphorylation of the glucose and co-entry of K+

Inorganic Phosphorus

Reference Value of Phosphorous

Adult: 2.7 - 4.5 mg/dL Child: 4.5 - 5.5 mg/dL

Principal anion within cells

Organic Phosphate

Part of the blood buffer

Inorganic Phosphate

Decreases phosphate by renal excretion

Parathyroid Hormone

Inhibits bone resorption

Calcitonin

Increases phosphate renal absorption

Growth Hormone

Most commonly used method to measure serum inorganic phosphate End: ammonium-molybdate complex (unstable)

Fiske Subbarow Method Ammonium Molybdate Method

Most common reducing agent for Fiske Subbarow Method:

Pictol Amino Naphthol Sulfonic Acid

1. Hypoparathyroidism 2. Renal Failure 3. Lymphoblastic leukemia 4. Hypervitaminosis D

Hyperphosphatemia

1. Alcohol Abuse (MCC) 2. Primary Hyperparathyroidism 3. Avitaminosis D (No Vit D) 4. Myxedema

Hypophosphatemia

Major cause of hypophosphatemia Increase shift of phosphate into cells can deplete phosphate in the blood

Transcellular Shift

Intracellular cation second in abundance to potassium 4th most abundant cation in the body; enzyme activator A Vasodilator and cause decrease uterine hyperactivity

Magnesium

Reference Value of Magnesium

1.2 - 2.1 mEq/L

Increases renal reabsorption of Magnesium Increases intestinal absorption of Magnesium

Parathyroid Hormone

Increases renal excretion of Magnesium

Aldosterone & Thyroxine

1. Diabetic coma 2. Addison's disease 3. Chronic renal failure 4. Increased intake of antacids, enemas & cathartics

Hypermagnesemia

1. Acute renal failure 2. Malnutrition 3. Malabsorption Syndrome (Sprue) 4. Chronic Alcoholism 5. Severe diarrhea

Hypomagnesemia

End: Reddish-Violet complex | Magnesium Methods

Calmagite Method

End: Colored complex

Formazen Dye Method | Magnesium Method

End: Colored Complex

Magnesium Thymol Blue Method | Magnesium Method

Second most abundant anion in the ECF Accounts for 90% of the total CO2 at physiologic pH Buffers excess hydrogen ion by combining with acid

Bicarbonate

Specimen for Bicarbonate:

Blood anaerobically collected

Reference Value for Bicarbonate:

21-28 mEq/L

Difference between the unmeasured cations (Sodium & Potassium) and unmeasured anions (Chloride & Bicarbonate)

Anion Gap

Used to monitor recovery from diabetic ketoacidosis

Anion Gap (AG)

Anion Gap formula:

AG = Na - (Cl + HCO3) AG = (Na + K) - (Cl + HCO3)

1. Uremia/ Renal Failure 2. Ketoacidosis 3. Poisoning by Methanol, Ethanol, Ethylene glycol, or Salicylate 4. Lactic Acidosis 5. Hypernatremia 6. Instrument Error

Increased Anion Gap

1. Hypoalbuminemia 2. Hypercalcemia 3. Hyperlipidemia 4. Elevated Myeloma proteins

Decreased Anion gap

Usually recognized in infancy or early childhood Produce abnormally thick secretions of mucus, elevation of sweat electrolytes, increased organic and enzymatic constituents of saliva and overactivity of the ANS

Cystic Fibrosis Mucoviscidosis

Diagnostic Test for Cystic Fibrosis

Sweat Test - Coulometry | Increased Na & Cl

Positive result for Cystic Fibrosis for Pilocarpine Iontophoresis

(> 65 mmol/L) of sweat electrolytes

Common metallic element important for the synthesis of hemoglobin Prooxidant, contributing to lipid peroxidartion, atherosclerosis, DNA damage and carcinogenesis Stored as Ferritin and Hemosiderin primarily in spleen, bone marrow and liver

Iron

Reference Value of Iron:

Male: 50-160 ug/dL Female: 45-150 ug/dL

Refers to the amount of iron that could be bound by saturating transferrin and other minor-iron binding proteins present in the serum & plasma sample

Total Iron Binding Capacity (TIBC)

TIBC is a direct measure of the total number of functional ferrous ion-binding sites in ____

Transferrin

Reference Value of TIBC

Adult: 245-425 ug/dL (>40 yrs old: 10-250 ug/dL) Newborn & Child: 100-200 ug/dL

also known as: Transferrin saturation Ratio of serum iron to TIBC

Percent Saturation

Normal Ratio of Percent Saturation

1:3

Lowest levels of Percent Saturation is seen in:

Iron Deficiency Anemia

Reference Value of % Saturation

20-50%

ELECTROLYTES Flashcards

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