Unit: Electrolytes I - (Na, K, Cl, CO , Li, and anion gap)

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Tasks

1. Review & recall electrolyte information presented in MLAB 2360.

2. Review classroom notes covering the following:
a. flame photometry and ISE principles
b. normal and abnormal concentrations of sodium, potassium, chloride, and carbon
dioxide.
c. chloride by coulometry principle
d. principle of titration
3. Determination of Na, K, Cl, & CO2 in serum/plasma and urine
4. Review of CL– determination in CSF
6. Calculation of anion gap

Objectives

Upon completion of this exercise, the student will be able to:

Briefly explain how the internal-standard flame photometer functions.
1.
Identify components of a flame photometer and discuss the purpose of each.
2.
Review colorimetric procedures for determining Na and K, Cl and CO2 .
3.
Name three (3) common procedures for determining chloride.
4.
Define and explain the principle of titration.
5.
Explain the principle of coulometry and the use of the chloridometer.
6.
Determine chloride content using coulometric and/or titration methods.
7.
Explain manual methods most commonly employed for CO2 determinations.
8.
Explain the clinical significance of high and low Na, K, Cl, and CO2 levels.
9.
Explain the clinical significance of and calculate the anion gap.
10.
Explain modifications of internal standards of the flame photometer for lithium
11.
determinations.
Identify the specimen of choice, normal values, reagents & instrumentation, normal values,
12.
and quality control requirements for Na, K, Cl, CO2 and anion gap determination.
13. Review learning sources to define / describe the following terms: hyper/hyponatremia,
hyper/hypokalemia, hyper/hypochloremia, ion-specific electrodes, coulometry, chloridometer,
amperometric, and titration .

Supplies and Equipment

1. Sodium and Potassium - To be announced

Chloride – (chloridometer)
2.
a. Acid buffer (ASP #B5968-5A) d. Chloride meter
b. Beakers e. 100 :l pipet
c. Cl– standard solution f. Silver polish

3. Chloride – (Sigma #461)

a. Chloride reagent & standard(s)

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

b. Spectrophotometer capable of measuring absorbance at 460 nm.

c. Cuvets with optical properties suitable for use at 460 nm.
d. Pipeting devices for the accurate delivery of volumes for the assay.

4. Carbon Dioxide – (Sigma #131-UV)

a. Spectrophotometer with temperature controlled compartment capable of measuring
absorbance at 380 nm.
b. Cuvets suitable for use at 380 nm.
c. Pipeting devices for the accurate delivery of volumes required for the assay.
d. Timer
e. Carbonate/Chloride Combined Standard, Catalog No. 955-30

General Information

1. Approximate Serum Electrolyte Concentrations and Electrical Neutrality

Cations Anions
+ –
Na 142 mEq/L Cl 103 mEq/L
+ –
K 4 mEq/L HCO 3 27 mEq/L
2+ 2-
CA 5 mEq/L HPO4 2 mEq/L
2+ 2-
Mg 2 mEq/L SO4 1 mEq/L
others 1 mEq/L organic acids 5 mEq/L
Total 154 mEq/L proteins 16 mEq/L
Total 154 mEq/L

2. Normal and Panic Values

Serum Reference Panic Values
Analyte Urine
Range Low High
Na+ 135-148 mEq/L 130 mEq/L 155 mEq/L 40-220 mEq/24 hr
+
K 3.5-5.3 mEq/L 3.0 mEq/L 6.0 mEq/L 25-125 mEq/24 hr
–
Cl 98-106 mEq/L
CO2 24-30 mmol/L

4. Urine Calculation (24 hour specimen)

Note: Depending on the concentration of the specimen, a urine sample for Na/K analysis
may need to be diluted (often x 20 dilution is adequate).

Readout in mEq/L x dilution factor x # of liters in the 24 hour collection = mEq/24 hr.

Clinical Significance

1. Na+ , K+, Cl– ,& CO2 – Please refer to the chemistry lecture guide & textbook. for additional
information on these electrolytes and associated terms. Additional information on CO2 is
available in the pH/ABG lab in this manual.

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

2. Li – Although it can be found naturally in drinking water, the electrolyte / mineral lithium is
not normally found in serum in detectable amounts. Lithium carbonate salts are used to treat
and prevent manic depression. Lithium levels are monitored to avoid toxicity. Therapeutic
range = 0.5-1.5 mmol/L (mEq/L). Toxicity may occur at levels >1.5, while little therapeutic
value is obtained at low levels.

Methods of Determination

1. Sodium (Na+ ) and Potassium (K+)

a. Emission flame photometry

Solutions containing alkali ions diluted with an internal standard (usually lithium or
cesium) are aspirated into the flame. The atoms emit light at one or more distinctive
wavelength:

Na+ – 589 nm
K+ – 768 nm
Li+ – 761 nm
Cs+ – 852 nm

The light emissions are measured directly or indirectly.

Since the emission energy varies with flame temperature and other conditions, there is
a need to monitor these variations with an internal standard. Lithium (or cesium)
solution is continuously being aspirated along with the sodium and potassium in the
patient sample, control sera, or Na/K standard. Changes in emission energy of the
sodium/potassium due to flame temperature variation, aspiration rate, etc. would also
occur to the emission energy of the lithium, therefore the concentrations of Na+ and K+
are determined by comparing their emission ratios with that of the Li internal standard.

High Li concentration in the diluting fluid prevents interference in determination of K

levels from transfer of energy from Na to K during excitation.

Review of the principle of flame photometry.

1. Outer shell electrons of Na, K, Li, Cs, etc. expand their orbits when heated.
2. As they cool, returning to ground state, the energy is given off in the form of light.
3. The wavelength of light is characteristic for the particular element.
4. The intensity of the light is proportional to the amount of the element being
measured.
5. An internal standard is added to the diluent to compensate for variation in flame
temperature, flow rate, etc.

b. Atomic Absorption Flame Spectrophotometry

Measures the amount of energy absorbed by Na and K rather than emitted. This technique
is more sensitive but less convenient than flame photometry.

Review of the principle of atomic absorption photometry.

1. A hot flame releases metallic atoms from molecules.

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 UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

2. The ground state atoms will absorb monochromatic light generated by a hollow
cathode tube containing the element being measured.
3. The amount of monochromatic light being absorbed (by the specimen element)
is proportional its concentration.

c. Colorimetric Assays Using Precipitation and Isolation as Complex Salts (obsolete)

1) Na – precipitate as sodium uranyl acetate
2) K – precipitate as potassium, sodium-cobalnitrate

d. Electrochemical Measurement using Ion-Specific Electrodes (ISE) – (Ion-Selective

Electrodes)

Newest technique used in automated equipment. Refer to Instrumentation IV, section

on Ion-Selective Electrodes for specifics on sodium and potassium measurement by
ISE.

e. Approaches by Discrete Clinical Analyzers - The DuPont ACA , Beckman ASTRA,

Biomedical NOVA 4+4, Kodac Ektachem and many other modern analyzers
quantitatively measure electrolytes in serum, heparinized plasma, and pre-diluted urine
by ISEs. These instruments may also provide for the calculation of anion gap.

2. Chloride Ion (Cl– )

Methods of chloride determination.

a. Titration methods
{ Whitehorn Titration Method – The chloride present in a protein-free filtrate is
precipitated as silver nitrate solution. The surplus silver nitrate is then titrated with
thiocyanate using ferric ammonium sulfate as the indicator.

{ Schales and Schales Titration Method – The sample is titrated with a standardized
mercuric nitrate solution in the presence of diphenylcarbazone as indicator.
Chloride ions (Cl– ) in the sample combine with mercuric ions (Hg ++ ) to form
mercuric chloride (HgCl2 ), a colorless, soluble, but only slightly ionized compound.
As long as chloride ions are present, mercuric ions preferentially react with them.
At the end point, when all chloride ions have been complexed, the excess mercuric
ions produce a violet color in the presence of diphenylcarbazone.

Hg++ + 2 Cl– 6 HgCl2

Hg++ + Diphenylcarbazone 6 violet color

Bilirubin or hemoglobin may obscure the endpoint, therefore, protein-free

filtrates should be prepared from icteric or hemolyzed specimens.
Information on titration:
*Titration is a method of quantitative analysis. It is a method of measuring the concentration of
one solution by comparing it with a measured volume of a solution whose concentration is known.
The mathematical equation (V1 C1 = V2 C2 ) is used to convert solutions of one normality to another.

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

So, if the concentration of a solution is unknown, it can be found by measuring the volume of the
unknown solution that will read with a measured amount of a solution of known concentration
(called a standard solution). This process is known as titration.

When titration is used to determine concentration, the concentration is traditionally expressed in

terms of normality or equivalents. Normality is employed because it is a unit that provides a basis
for direct comparison of strength for all solutions. Remember that normality is the number of gram
equivalents per liter of solution. A gram equivalent is the amount of a compound that will liberate,
combine with, or replace one gram atom of hydrogen. Therefore, one equivalent of a compound
will react with exactly one equivalent of any other compound. For example, one equivalent of any
acid will exactly neutralize one equivalent of any base.

In any titration procedure, certain things must be present:

1) A standard solution of known concentration.

2) An accurately measured volume of standard solution or unknown.

3) An indicator to show when the reaction has reached completion.

4) A buret to measure volume of solution required to reach the end point.

The point at which equal concentrations of the standard and the unknown are present is called
the end point of the titration. Various means of detecting the end point are used. Sometimes the
formation of a precipitate indicates that the end point has been reached. A change in color of one
of the reacting solutions can also indicate the end point. The common method is through the use
of an indicator solution which is a third solution added in the titration procedure (in addition to the
standard and unknown).

The procedure for chloride determination based on the method of Schales and Schales
incorporates a mercuric titration using diphenylcarbazone as indicator.

b. Coulometric titration - Chloridometer principle – When a constant direct current is

applied to silver generator electrodes, a constant flow of silver ions is released into the
solution. The silver ions combine with chloride in the sample to form silver chloride
precipitate. When all chloride has been precipitated, free silver ions cause an increase
in current which then stops a timer. The chloride concentration is determined as a
function of time.

c. Colorimetric procedures - Colorimetric procedures for determination of chloride are

relatively simple and often adaptable to automation.

{ Autoanalyzer Method – The specimen is mixed with a solution of mercuric

thiocyanate. As a result of the high affinity of chloride for mercury ions, undis-
sociated mercuric chloride is formed, resulting in the release of free thiocyanate.
This reacts with the iron in the ferric nitrate reagent to form the highly colored
compound which is measured photometrically. This method is used by the ACA.

{ Manual Method - The Sigma Diagnostics Chloride method is based upon the
quantitative displacement of thiocyanate by chloride from mercuric thiocyanate.
The liberated thiocyanate forms a red complex with ferric ions with an absorbance

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

maximum at 460 nm. The color intensity at 460 nm is directly proportional to

chloride concentration in the sample.

3. Carbon Dioxide (CO2 )

Total CO2 content is a measure of the bicarbonate and the dissolved CO2 and carbonic acid.

a. Manometric/Gasometric Analysis Method – The Natelson microgasometer is used.

Carbon dioxide is liberated from an aqueous solution by lactic acid. Under reduced
pressure, the CO2 is shaken out, brought to constant volume and the pressure
measured.

The carbon dioxide is then absorbed into sodium hydroxide, the residual gases are
brought to the same constant volume and the second pressure measured. The drop
in pressure in mm can be multiplied by factors to bring the results to volumes percent
or mEq/L.

b. Van Slyke-Cullen Method – Acid is added to plasma and the CO2 produced in this
reaction is liberated by means of a partial vacuum and measured. Caprylic alcohol is
used to prevent foaming.

c. Colorimetric & Enzymatic methods of carbon dioxide measurement are available. Sigma
Diagnostics #131 is an enzymatic endpoint reaction measured in the ultraviolet
wavelength range.

4. Anion Gap

a. The anion gap is a mathematical approximation of the difference between the

unmeasured anions and cations in serum or plasma. About 2/3 of a normal anion gap
is caused by plasma proteins, and the remaining 1/3 by phosphate and sulfate ions and
organic acids.

b. Clinical Significance – The anion gap is useful in differentiating or monitoring certain

conditions of metabolic acidosis and metabolic alkalosis.

c. Calculations (two options); and Normal Values:

1) Na + K - (Cl + HCO3 – )
NV 7-14 mEq
2) Na - (Cl + HCO3 – )
NV 8-12 mEq

d. Causes of an Increased Anion Gap

1) Decreased unmeasured cations
2) Increased unmeasured anions

e. Causes of a Decreased Anion Gap

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

Although a true decreased anion gap rarely occurs, it has been noted in some multiple
myeloma patients. Possibility of instrument error should be eliminated before reporting
a decreased anion gap.

Procedures

Cl– Labconco Digital Chloridometer

1. Obtain chloride standard, controls, and unknowns and warm them to room temperature.

2. Thoroughly clean all four electrodes with silver polish, rinse with distilled water and buff with
tissue. Be certain no residue remains between the indicator electrodes at their common
mounting post. Avoid getting skin oils on the electrodes.

3. After cleaning, place a vial filled with @ 4 mL of Chloridometer Acid Reagent (or 4 mL of acid
solution and 4 drops of gelatin reagent) in the vial holder. Set the RANGE switch to LOW,
the TITRATION switch to AUTO and raise the holder so that the electrodes are immersed
and the stirrer begins.

4. If a reading does not appear after 30 seconds, re-rinse the electrodes and re-titrate using
a fresh vial. Do this until a reading is obtained.

5. Place RANGE switch in the HIGH position.

6. Pipet 100 :L of the 100 mEq/L standard into the acid reagent. The addition of a sample with
a chloride concentration greater than 30 mEq/L will automatically reset the display and begin
the titration. If the titration endpoint displayed is 100 mEq/L ± 2 mEq, continue with
unknowns. If standard's concentration endpoint is unsatisfactory after several attempts,
contact instructor.

7. To analyze controls and unknowns, pipet 100 :L of sample into the acid reagent after the
endpoint is reached and the number is recorded, a new sample may be added. Analyze in
duplicate, and record results.

8. As the solution becomes whiter with precipitated silver chloride, the delay before a titration
begins will increase until a titration cannot be initiated. May need to replace solution after
10-15 analysis when using 100 microliter size sample.

9. Lower the vial, replace with fresh vial and, after raising the new vial, proceed as described
in step c above.

10. For each new vial, the titration procedures is the same. The electrodes only need to be
cleaned if there are visible deposits. When the instrument is not in use, leave the electrodes
immersed in distilled water and set the TITRATION switch to STANDBY or the RANGE
switch to POWER OFF.

Procedure : Chloride (Sigma #461) colorimetric

Principle

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

See product insert.

Specimen

Serum or heparinized plasma. Promptly separate specimen from cells or clot to prevent shifts in
ionic equilibria. Chloride in serum or heparinized plasma is stable for 1 week refrigerated or
frozen.

Reagents

See product literature for contents of Sigma Diagnostics Chloride Reagent . DANGER: Reagent
may be fatal or cause blindness if swallowed. Vapor harmful. Combustible. Wear suitable
protective clothing, gloves and eye / face protection. In case of contact with eyes, flush with large
volume of water and seek medical advise. See product insert for additional information.

Deterioration: Chloride Reagent is not suitable for use its absorbance at 460 nm is more than
0.300.

Manual Procedure

1. Set spectrophotometer wavelength at 460 nm, temperature to the assay temperature

(ambient), and the absorbance reading to zero with water as reference. NOTE: Assay
temperature can range from ambient / RT to 37°C as long as the temperature of the reagent
should be the same for all tubes.

2. Label tubes for REAGENT BLANK, STANDARD(S), CONTROL(S) and PATIENT SAMPLES.

3. Pipet 3.0 mL of Chloride Reagent into each tube and warm to assay temperature.

4. Pipet 25 uL of water, standard and samples into their respective tubes.

5. Mix gently by inversion and incubate for 5 minutes. (NOTE: The color is stable for at least
1 hour provided the temperature of the reaction mixture remains the same.)

6. Read and record absorbance of each at 460 nm.

7. Subtract the absorbance of the BLANK from the absorbance of STANDARD(S),

CONTROL(S) and PATIENT SAMPLES the to obtain change in absorbance due to chloride
content (ªA Standard, ªA Specimen).

Calculations

Determine the Chloride content of the sample as follows.

A SAMPLE - A BLANK
Chloride (mEq/L) of sample = ______________ X Concentration of Standard
A STANDA RD - A BLANK

Limitations

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

Procedure is linear from 50 to 130 mEq/L. If sample exceeds linearity, dilute with deionized water,
repeat assay and multiply result by dilution factor.

Expected Values

The expected range of chloride concentration was determined to be from 97 - 106 mEq/L. This
range is similar to reference values reported in the literature. It is strongly recommended that each
laboratory establish its own expected range characteristic for the population of the local area.

Procedure : Carbon Dioxide (Sigma #131-uv) Enzymatic

Principle

Phosphoenol pyruvate carboxylase (PEPC) catalyzes the reaction between phosphoenol pyruvate
and carbon dioxide (bicarbonate) to form oxalacetate and phosphate ion. In the second step of
the reaction, catalyzed by malate dehydrogenase (MDH), oxalacetate is reduced to malate with
simultaneous oxidation of equimolar amount of reduced nicotinamide adenine dinucleotide
(NADH) to (NAD). This results in a decrease in absorbance at 380 nm which is directly
proportional to the CO2 level.

Specimen

Serum or heparinized plasma. Ideally, venous blood should be collected and handled
anaerobically. After prompt separation from cells or clot, specimen should be kept tightly
stoppered. CO2 content of blood is stable for 1 hour when stored at 2-4°C under anaerobic
conditions.

Reagents

Reagents should be reconstituted according to directions. See product literature for contents of
Sigma CO2 REAGENT A, CO2 REAGENT B, and CO2 DILUENT. These reagents are for In Vitro
diagnostic use only. *DANGER: They contain sodium azide which is toxic if ingested any may
react with lead and copper plumbing for form highly explosive metal azides. On disposal flush with
large volume of water. Avoid contact and inhalation of CO2 REAGENT B.

Reagent Preparation for Sample Start Procedure (Alternate Procedure)

1. Reconstitute CO2 Reagent A with volume of deionized water indicated on vial label.
2. Reconstitute CO2 REAGENT B with volume of CO2 Diluent. Stopper vials and mix
several times by gentle inversion.
3. Prepare Sample Start Reagent by adding 1 mL of CO 2 Reagent B to 10 mL of CO2
REAGENT A and use immediately.

Note: Avoid contamination of the reagents with CO2 . Do not blow into pipets, since breath
contains a high content of CO2 . Do not leave bottles open unnecessarily, since CO2
from air can contaminate the reagent.

Deterioration: Reagents are not suitable for use if the absorbance at 380 nm of freshly combined
reagent, is less than 1.000.

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

Manual Alternate Procedure

1. Prepare CO2 Sample Start Reagent according to instructions. (Each bottle does 5 tests.)

2. Set spectrophotometer wavelength at 380 nm, temperature to the assay temperature

(ambient), and the absorbance reading to zero with water as reference. Note: Procedure
can be performed at ambient / RT, 30° or 37°C temperature.

3. Label tubes for REAGENT BLANK, STANDARD, and SAMPLES.

4. Pipet 2 mL of CO2 Sample Start Reagent into each tube and warm to assay temperature.

5. Pipet 20 uL of water, standard and samples into their respective tubes.

6. Mix gently by inversion and incubate for 10 minutes.

7. Read and record absorbance of each at 380 nm.

8. Subtract the absorbance of the STANDARD and SAMPLE from the absorbance of the
BLANK to obtain change in absorbance due to CO2 content.

Calculations

Determine the CO2 content of the sample as follows.

- A SAMPLE
A BLANK
Carbon Dioxide (mEq/L) of sample = ____________
X Concentration of Standard
A BLANK - A STANDA RD

Limitations

Procedure is linear to 50 mEq/L..

Expected Values

See product insert and information reported in the literature. It is strongly recommended that each
laboratory establish its own expected range characteristic for the population of the local area.

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

Name_________________________________
Date_________________________________

Electrolyte Worksheet
I. Chloride Sigma # 461

Wavelength _____________
Linearity _____________ Spectrophotometer Used ______________________
Identification Absorbance Abs test - Abs blank Concentration (units)
Blank
Standard
____________
Standard
____________
Control 1
____________
Control 2
____________

Calculation formula(s) and examples

Quality Control
Your Results Controls’ range of expected results. In control? Yes /
No
Level 1
ID______________
Level
2ID_______________
Accepting Patient Results? Reason

II. Chloride by Chloridometer

(NOTE: Work to obtain results that check within ± 2 mEq.)

A. Instrument set-up/Standardization B. Measurements (in duplicate)
Sample Lot #/ID # (Cl– ) mEq/L
Cl– Standard 1) 2) avg.

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 UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

Control I (expected values ) 1) 2) avg.

Control II (expected values ) 1) 2) avg.
Unknowns Patient ID & Specimen Type

1) 2) avg.
1) 2) avg.
1) 2) avg.
III. Carbon Dioxide

Procedure Instrument Wavelength

Sample Lot #/ID # Abs. 380 nm (CO2 ), mEq/L

Standard
Control I (expected values )
Control II (expected values )
Unknowns Patient ID & Specimen Type

Calculations:

Quality Control
Your Results Controls’ range of expected In control? Yes /
results. No
Level 1 ID______________
Level 2ID_______________
Accepting Patient Results? Reason

IV. Anion Gap

A. Formula for calculations:

B. Anion Gap Normal Values:

C. Using the information provided, calculate the AG for the following patient.

Patient 1: Na = 140 mEq/L, K = 5.1 mEq/L, Cl = 105 mEq/L, CO2 = 28 mEq/L

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D. Calculations

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

Name

Date_________________________________

Study Questions

Instructions: Legibly write your answers in the space provided. Unless otherwise indicated, each
question is worth one point. Using lecture notes, reading assignments and information presented
in this lab, answer the following questions.

1. How could poor collection/handling process affect the electrolyte results?

2. Using flame photometry methodology, what is the relationship between the intensity of color
(wavelength) produced and the amount of element being measured?

3. What is the purpose of the lithium diluent?

4. What other compound can be used in place of lithium as an internal standard in flame
photometry?

4. What is the body's major intracellular cation?

5. What is the body's major extracellular cation?

6. Which plasma electrolyte, in high or low concentrations, may cause cardiac arrest? List two
causes of increased and decreased plasma concentrations of this electrolyte. (2 points)

7. According to your readings in this lab, define titration.

8. List the four things that must be present to perform a titration procedure. (2 points)

9. What equation is used to convert solutions of one normality to another?

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UNIT: Electrolytes I (Na, K, Cl, CO2 Li, and anion gap (continued)

10. Chloride is the major intracellular/extracellular anion. (circle one)

11. Briefly describe the anion gap. Include what causes it and how it is used. (3 points)

12. Calculate the following anion gaps.

sodium 142 137

potassium 4.0 3.8
chloride 105 99
carbon dioxide 28 32
anion gap

For your own study / review

CASE STUDY: Electrolytes
A medical laboratory technician obtained the following results on a routine renal profile.

Sodium: 139 mEq/L CO2: 20 mmol/L

Potassium: 4.1 mEq/L BUN: 19 mg/dL
Chloride: 118 mEq/L Creatinine: 0.9 mg/dL
Glucose: 250 mg/dL

The sodium, potassium, and CO2 are measured by ion selective electrodes. The chloride is measured by
the ferric thiocyanate method. Upon reviewing the results, the technician performs a quick written calculation
and decides that the specimen should be re-analyzed, believing that the results are not valid.

1. Which of the above results seem unusual?

2. Provide the simple calculation that can be used to check the validity of these results.

3. Calculate the anion gap.

4. State the normal values for the anion gap.

5. What are some possible causes of an increased abnormal anion gap value?

6. What are some possible causes of a decreased anion gap value?

7. How can the anion gap be used to evaluate the validity of electrolyte analysis?

CASE STUDY: Electrolytes and Water Balance

A 58 year old woman with a history of hypertension arrived in the ER complaining of nausea, oliguria, and
vomiting. The following are electrolyte results obtained.

Sodium: 115 mmol/L

Potassium: 3.5 mmol/L
Chloride: 68 mmol/L
The patient was regularly taking medication to control the hypertension.

1. Evaluate the electrolytes for abnormalities.

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2. What treatment might correct the situation?

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