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Anion
Anion Gap
Cation
Active transport
Diffusion
Electrolyte
Osmolality
Osmolality
Polydipsia
Tetany
ADH
Hypothalamus Gland
Renin - Angiotensin Aldosterone System
Na
K
Cl
CO2
Ca
Mg
PO4
= Sodium
= Potassium
= Chloride
= Carbon Dioxide
= Calcium
= Magnesium
= Phosphate
Electrolytes
Electrolytes
Substances whose molecules dissociate into ions
when they are placed in water.
ANIONS (-)
CATIONS (+)
Medically significant / routinely ordered electrolytes
include:
sodium (Na)
potassium (K)
chloride (Cl)
and CO2 (in its ion form = HCO3- )
Electrolyte Functions
Electrolytes
General dietary requirements
Electrolytes
Water (the diluent for all
electrolytes) constitutes
40-70% of total body and
is distributed:
Intracellular inside cells
2/3 of body water
(ICW)
Extracellular outside cells
Electrolytes
Electrolytes
Ions exist in all of these fluids, but the
concentration varies depending on individual
ion and compartment
The body uses active and passive transport
principles to keep water and ion concentration
in place
Electrolytes
Sodium has a pulling effect on water
Electrolytes
Proteins (especially albumin) inside the
capillaries strongly pulls/keeps water inside
the vascular system
Albumin provides oncotic pressure.
By keeping Na & albumin in their place, the
body is able to regulate its hydration.
10
Electrolytes
Laboratory assessment of body
hydration is often by determination
of osmolality and specific gravity of
urine
11
Electrolytes
Osmolality Physical property of a solution based
on solute concentration
Water concentration is regulated by
thirst and urine output
Thirst and urine production are
regulated by plasma osmolality
12
Electrolytes
Osmolality osmolality stimulates two responses that
regulate water
Hypothalamus stimulates the sensation of
thirst
Posterior pituitary secrets ADH
( ADH increases H2O re-absorption by renal
collection ducts )
13
Electrolytes
Osmolality
concentration of solute / kg
reported as mOsm / kg
another term:
Osmolarity - mOsm / L - not often
used
14
Electrolytes
Determination
2 methods or principles to determine
osmolality
Freezing point depression
(the preferred method)
15
Specimen Collection
Serum
Urine
Plasma not recommended due to
osmotically active substances that can be
introduced into sample
Samples should be free of particulate
matter..no turbid samples, must centrifuge
16
Electrolytes
Calculated osmolality
Formula:
17
Electrolytes
Increase in the difference between
measured and calculated
18
Electrolytes
Decreased osmolality
Diabetes insipidus
ADH deficiency
Because they have little / no water reabsorption, produce 10 20 liters of urine
per day
19
Electrolytes
Osmolality normal values
20
Electrolytes
Classifications of ions -
by their charge
21
Electrolytes
Anions have a negative charge - move
toward the anode
22
Electrolytes
Phosphate is sometimes discussed as
an electrolyte, sometimes as a
mineral.
HPO-24 / H2PO-4
when body pH is normal, HPO-24 is the
usual form (@ 80 % of time)
23
Electrolyte Summary
cations (+)
Na 142
K
5
Ca
5
Mg
2
154 mEq/L
anions (-)
Cl 105
HCO324
HPO4-2
2
SO4-2
1
organic acids 6
proteins
16
154 mEq/L
24
25
ATP-ase Pump
26
Regulation of Sodium
Concentration depends on:
intake of water in response to thirst
excretion of water due to blood volume or osmolality changes
Renal regulation of sodium
Kidneys can conserve or excrete Na+ depending on ECF and
blood volume
by aldosterone
and the renin-angiotensin system
this system will stimulate the adrenal cortex to
secrete aldosterone.
27
Sodium (Na)
Aldosterone
From the (adrenal cortex)
Functions
promote excretion of K
in exchange for reabsorption of Na
28
Sodium (Na)
Sodium normal values
Serum 135-148 mEq/L
Urine (24 hour collection) 40-220
mEq/L
29
Sodium (Na)
Urine testing & calculation:
30
Diabetes mellitus
In acidosis of diabetes, Na is excreted with
ketones
Potassium depletion
K normally excreted , if none, then Na
Loss of gastric contents
31
Hyponatremia
Increased water retention
Dilution of serum/plasma Na+
excretion of > 20 mmol /mEq urine sodium)
Renal failure
Nephrotic syndrome
Water imbalance
Excess water intake
Chronic condition
32
Hypernatremia
Excess water loss resulting in dehydration
(relative increase)
Sweating
Diarrhea
Burns
Dehydration from inadequate water intake,
including thirst mechanism problems
Diabetes insipidus
(ADH deficiency H2O loss )
33
Hypernatremia
Excessive IV therapy
comatose diabetics following
treatment with insulin. Some Na in
the cells is kicked out as it is
replaced with potassium.
Cushing's syndrome - opposite of
Addisons
34
Specimen Collection:
Sodium (Na)
heparinized plasma
timed urine
sweat
GI fluids
35
Sodium (Na)
Note:
Increased lipids or proteins may
cause false decrease in results.
artifactual/pseudo-hyponatremia
36
Sodium (Na)
Sodium determination
Ion-selective (specific) electrode
Membrane composition = lithium aluminum silicate glass
Semi-permeable membrane allows sodium ions to cross
300X faster than potassium and is insensitive to hydrogen
ions.
direct measurement
Sodium (Na)
Flame emission spectrophotometry (flame
photometer)
Na emits 589 nm (yellow)
Use internal standard of lithium or cesium
Possible for a dilutional error to occur in some
flame photometer systems, but literature does
not dwell on it.
38
Routinely measured
electrolytes
Potassium
(K)
OUTSIDE
1
39
Potassium
(K)
40
Potassium
(K)
Regulation
Diet
Kidneys
41
Potassium
(K)
42
Hypokalemia
Decrease in K concentration
Effects
43
Causes of hypokalemia
Excessive fluid loss ( diarrhea, vomiting,
diuretics )
Aldosterone promote Na reabsorption
K is excreted in its place (Cushings
syndrome = hyper aldosterone)
Insulin IVs promote rapid cellular potassium
uptake
44
Causes of hypokalemia
Increased plasma pH ( decreased Hydrogen ion )
RBC
H+
K+
K+ moves into RBCs to preserve electrical balance,
causing plasma potassium to decrease.
( Sodium also shows a slight decrease )
45
Hyperkalemia
Increased K concentration
Causes
IVS or other increased intake
Renal disease impaired excretion
Acidosis (Diabetes mellitus )
H+ competes with K+ to get into cells & to be
excreted by kidneys
Decreased insulin promotes cellular K loss
Hyperosomolar plasma (from glucose) pulls
H2O and potassium into the plasma
46
Hyperkalemia
Causes
Tissue breakdown ( RBC hemolysis )
Addisons - hypo- adrenal; hypoaldosterone
Specimen Collection:Potassium
Non-hemolyzed serum
heparinized plasma
24 hr urine.
47
Potassium
(K)
Determination
Ion-selective electrode (valinomycin
membrane)
insensitive to H+, & prefers K+ 1000 X
over Na+
Flame photometry
- K 766 nm
48
Chloride ( Cl
Chloride moves passively with Na + or against HCO3to maintain neutral electrical charge
Chloride usually follows Na (if one is abnormal, so
is the other)
Function - not completely known
body hydration
osmotic pressure
electrical neutrality & other functions
49
Chloride shift
50
51
Chloride ( Cl
52
Chloride ( Cl
Normal values
Serum 100 -110 mEq/L
24 hour urine 110-250 mEq/L
varies with intake
53
Hypochloremia
Decreased serum Cl
54
Hyperchloremia
Increased serum Cl
55
Serum
heparinized plasma
24 hr urine
sweat
56
Chloride ( Cl
Determination
Amperometric/Coulometric titration
involves titration with silver ions.
57
Chloride ( Cl
58
59
Chloride ( Cl
Colorimetric
Procedure suitable for automation
Chloride complexes with mercuric
thiocyanate
forms a reddish color proportional to
amt of Cl in the specimen.
60
Chloride ( Cl
Sweat chloride
61
Chloride ( Cl
CSF chloride
NV = 120 - 132 mEq/L (higher than
serum)
Often CSF Cl is decreased when CSF
protein is increased, as often occurs
in bacterial meningitis.
62
63
carbonic anhydrase
66
- carbonate ion
67
68
70
methods
71
Electrolyte balance
Anion gap an estimate of the unmeasured
anion concentrations such as sulfate,
phosphate, and various organic acids.
72
Electrolyte balance
Calculations
1. Na - (Cl + CO2 or HCO3-) =
NV 8-12 mEq/L
Or
2. (Na + K) - (Cl + CO2 or HCO3-)
14 mEq/L
NV 7-
73
Electrolyte balance
Increased AG
uncontrolled diabetes (due to lactic & keto acids)
severe renal disorders
Decreased AG a decrease AG is rare, more often it occurs when one test/instrument error
74
Normal Ranges
SODIUM
135 145
mEq/L
POTASSIUM
3.5 5.0
mEq/L
CHLORIDE
100 110
mEq/L
CO2
20 30
mEq/L
ANION GAP
10 - 20
PLASMA OSMOLALITY
CALCIUM
8.5 10.0
IONIZED Ca
4.5
MAGNESIUM
PHOSPHATE
2.5
LACTATE
0.5 17.0
meq / L
275 - 295 mOsmol / kg
mg/dL
5.5
mg/dL
1.2 2.1
mEq/L
4.5
mg/dL
mgl/dl
75
ELECTROLYTE TOP 10
Osmolality is detected by the Hypothalamus Gland
Thirst sensation
and secretion of ADH by Posterior Pituitary Gland. ADH increases renal
reabsorption of water
Blood Volume stimulates Renin - Angiotensin - Aldosterone system.
Aldosterone secretion by the Adrenal Cortex stimulates increased renal
absorption of sodium