Electrolity tests

Mahler Beatrice, MD, PhD,

University Assistant, Physiopathology and Immunology Chair I,
UMF “Carol Davila”,
 How is it used?

• The electrolyte panel is frequently ordered as part of a routine physical,

either by itself or as components of a basic metabolic panel or
comprehensive metabolic panel. It is used to screen for an electrolyte or
acid-base imbalance and to monitor the effect of treatment on a known
imbalance that is affecting bodily organ function. Since electrolyte and
acid-base imbalances can be present with a wide variety of acute and
chronic illnesses, the electrolyte panel is frequently ordered for
hospitalized patients and those who come to the emergency room.
 How is it used?
• If a patient has a single electrolyte that is high or low, such as sodium or
potassium, the doctor may order repeat testing of that individual
electrolyte, monitoring the imbalance until it resolves.
• If a patient has an acid-base imbalance, the doctor may order blood gas
tests, which measure the pH and oxygen and carbon dioxide levels in an
arterial blood sample, to help evaluate the severity of the imbalance and
monitor its response to treatment.
 When is it ordered?

• It may be ordered as part of a routine screening or as a diagnostic aid

when a patient has symptoms, such as edema, nausea, weakness,
confusion, or cardiac arrhythmias. It is frequently ordered as part of an
evaluation when a patient has an acute or chronic illness and at regular
intervals when a patient has a disease or condition or is taking a
medication that can cause an electrolyte imbalance. Electrolytes are
commonly used to monitor treatment of certain problems, including high
blood pressure (hypertension), heart failure, and liver and kidney disease.
 What does the test result mean?
• Electrolyte levels are affected by how much is taken in
through your diet, the amount of water in your body, and the
amount of electrolytes excreted by your kidneys.
• They are also affected by compounds such as aldosterone, a
hormone that conserves sodium and increases the loss of
potassium, and natriuretic peptides, which increase renal
losses of sodium.
 What does the test result mean?
• In specific disorders, one or more electrolytes may be in an abnormal
concentration.
• Your doctor will look at the overall balance but is especially concerned with your
sodium and potassium levels.
• People whose kidneys are not functioning properly, for example, may retain excess
fluid in the body, diluting the sodium and chloride so that they fall below normal
concentrations.
• Those who experience severe fluid loss may show an increase in potassium,
sodium, and chloride.
• Some forms of heart disease, muscle and nerve problems, and diabetes may also
have one or more abnormal electrolytes.
 What does the test result mean?
• Knowing which electrolytes are out of balance can help your
doctor to determine the cause and treatment to restore
proper balance.
• If left untreated, electrolyte imbalance can lead to dizziness,
cramps, irregular heartbeat, and possibly death.
 Is there anything else I should
know?
• Depending on which electrolyte(s) is out of balance and the extent of that
change, treatment may involve changing your diet to lower salt intake,
increasing fluids to dilute the electrolyte concentration, taking diuretics,
and medicating the imbalance.
• Once a treatment has begun, you may be asked to get regular testing to
determine how well the treatment worked and to make sure the
imbalance does not reoccur.
 Potassium
• Potassium levels can be falsely elevated by
several different specimen-collection or –
processing errors. If there are any questions as
to how your blood was collected, your doctor
may request that the test be repeated to
verify results.
 sodium
• Certain drugs such as anabolic steroids,
corticosteroids, laxatives, cough medicines,
and oral contraceptives may cause increased
levels of sodium. Other drugs such as
diuretics, carbamazepine, and tricyclic
antidepressants may cause decreased levels of
sodium.
 chloride.
• Drugs that affect sodium blood levels will also
cause changes in chloride. In addition,
swallowing large amounts of baking soda or
substantially more than the recommended
dosage of antacids can also cause low
chloride.
 bicarbonate levels
• Some drugs may increase bicarbonate (total CO2) levels
including: fludrocortisone, barbiturates, bicarbonates,
hydrocortisone, loop diuretics, and steroids. Drugs that may
decrease bicarbonate (total CO2) levels include methicillin,
nitrofurantoin, tetracycline, thiazide diuretics, and
triamterene.
 What is anion gap?
• Anion gap (AG or AGAP) is a value calculated using the results of an electrolyte
panel.
• It is used to help distinguish between anion-gap and non-anion-gap metabolic
acidosis.
• Acidosis refers to an excess of acid in the body; this can disturb many cell functions
and should be recognized as quickly as possible, when present.
• AG is frequently used in the hospital and/or emergency room setting to help
diagnose and monitor acutely ill patients.
• If anion-gap metabolic acidosis is identified, the AG may be used to help monitor
the effectiveness of treatment and the underlying condition.
 the anion gap
• Specifically, the anion gap evaluates the difference between measured and
unmeasured electrical particles (ions or electrolytes) in the fluid portion of
the blood.
• According to the principle of electrical neutrality, the number of positive
ions (cations) and negative ions (anions) should be equal.
• However, not all ions are routinely measured.
• The calculated AG result represents the unmeasured ions and primarily
consists of anions, hence the name “anion gap.”
 Anion Gap formula

• Anion Gap (AG) = Sodium - (Chloride +

Bicarbonate [total CO2])

• Each laboratory formula will have an established normal range that should be referenced.
 Anion Gap
• The anion gap is non-specific.
• It is increased when the number of
unmeasured anions increases, indicating a
state of anion-gap metabolic acidosis, but it
does not tell the doctor what is causing the
imbalance
 Anion Gap
• . The metabolic acidosis must be treated to restore the acid/base balance,
but the underlying condition must also be identified and treated.
• Causes can include uncontrolled diabetes, starvation, kidney damage, and
ingestion of potentially toxic substances such as antifreeze, excessive
amounts of aspirin, or methanol.
• A low anion gap can also occur; this is most commonly seen when albumin
(an anion as well as a protein) is low, while immunoglobulins (cations as
well as proteins) are increased.
 Potassium test
• Blood is typically drawn from a vein, usually from the inside of the elbow
or the back of the hand.
• The site is cleaned with germ-killing medicine (antiseptic).
• The health care provider wraps an elastic band around the upper arm to
apply pressure to the area and make the vein swell with blood.
• The blood collects into an airtight vial or tube attached to the needle.
 The Potassium Function

• is a very important mineral to the human body. It has various roles in

metabolism and body functions and is essential for the proper function of
all cells, tissues, and organs:

– It assists in the regulation of the acid-base balance.

– It assists in protein synthesis from amino acids and in carbohydrate

metabolism.

– It is necessary for the building of muscle and for normal body growth.
 Food Sources
• Many foods contain potassium. All meats (red meat and chicken) and fish such as
salmon, cod, flounder, and sardines are good sources of potassium. Soy products
and veggie burgers are also good sources of potassium.
• Vegetables including broccoli, peas, lima beans, tomatoes, potatoes (especially
their skins), sweet potatoes, and winter squashes are all good sources of
potassium.
• Fruits that contain significant sources of potassium include citrus fruits,
cantaloupe, bananas, kiwi, prunes, and apricots. Dried apricots contain more
potassium than fresh apricots.
• Milk and yogurt, as well as nuts, are also excellent sources of potassium.
 drugs that may affect the test
• Drugs that can increase potassium -Aminocaproic acid,
Antineoplastic drugs, ACE inhibitors, Certain diuretics, Epinephrine,
Heparin, Histamine, Isoniazid, Mannitol, succinylcholine
• Drugs that can decrease potassium- Acetazolamide, Aminosalicylic
acid, Amphotericin B, Carbenicillin , Cisplatin, Certain diuretics, Insulin,
Laxatives, Penicillin G, Phenothiazines, Salicylates, sodium polystyrene
sulfonate

 The factors can interfere with the
test

• Infusion of potassium-containing fluids

• Infusion of glucose or insulin

 Normal Results

• The normal range is 3.5 to 5.2 mEq/L

• Note: mEq/L = milliequivalent per liter

 High levels of potassium
• Addison's disease (rare)
• Blood transfusion
• Crushed tissue injury
• Hyperkalemic periodic paralysis
• Hypoaldosteronism (very rare)
• Kidney failure
• Metabolic or respiratory acidosis
• Red blood cell destruction
 Low levels of potassium
• Chronic diarrhea or use of laxatives
• Cushing syndrome (rare)
• Diuretics such as hydrochlorothiazide, furosemide, and indapamide
• Hyperaldosteronism
• Hypokalemic periodic paralysis
• Not enough potassium in the diet
• Renal artery stenosis
• Renal tubular acidosis (rare)
 Clinical alert in hyperkalemia
• Sinus bradycardia
• Sinus arrest
• First –degree atrioventricular block
• Ventricular tachycardia
• Ventricular fibrillation
 Clinical alert in hypokalemia
• Ventricular premature beats
• Atrial tachycardia
• Nodal tahicardia
• Ventricular tachycardia
• Ventricular fibrillation
 Sodium
• is the most cation ,
• the primary functions in the body are to
maintain osmotic pressure and acid-base
balance,
 Normal values

• Adults -136-145 mEq/l

• Children -136-145 mEq/l

 Clinical alert
• < 125 mEq/l- cause weakness, dehydration
• 90-105 mEq/l –causes sever neurologic
symptoms, vascular problems,
• > 152 mEq/l –results in cardiovascular and
renal symptoms,
• >160 mEq/l- can cause heart failure
 hyponatriemia
• Sever burns
• Congestive heart failure
• Excessiv fluid loss
• Excessiv i.v. induction
• Addison disease
• Nefrotic syndrome
• Edema
 Hypernatriemia
• Desydration
• Insufficient water intake
• Conn syndrome
• Coma
• Cushing disease
• Diabetes insipidus
 Chloride test
• Chloride is the major anion

• Exist predominantly in the extracellular

spaces,
 Normal value
• 96-106 mEq/l
• Procedures -5 ml venous blood sample. In a
heparinized vacutainer tube.
 Decresed blood chloride
• Sever vomoting
• Gastric suction
• Burns
• Metabolic alkalosis
• Congestive failure
• Acute intermitens porfiphyria
 Increased blood chloride
• Dehydratation
• Cushing syndrom
• Hyperventilation
• Metabolic acidosis
• Diabet insipidus
• eclampsia
 Clinical alert
• <70 mEq/l
• >120 mEq/l