ELECTROLYTES

Outline
I.

II.
III. IV.

Introduction Water The Electrolytes Anion Gap

Introduction

Electrolytes

Ions capable of carrying an electric charge Two types of Ions:

A.

Anions
Ions that carry (-) charge and move toward the anode E.g. Cl-, HCO3-, PO4Cations Ions that carry (+) charge and move toward the cathode E.g. Na+, K+, Mg2+, Ca2+

B.

Introduction

Functions of Electrolytes
1.
2. 3.

4.
5. 6.

7.

Volume and osmotic regulation (Na+, Cl-, K+) Myocardial rhythm and contractility (K+ , Mg2+, Ca2+) Neuromuscular Excitability (K+ , Mg2+, Ca2+) Cofactors in enzyme activation (Mg2+, Ca2+, Zn2+) Regulation of ATPase ion pumps (Mg2+) Acid-base balance (HCO3-, K+, Cl-) Production and use of ATP from glucose (Mg2+, PO4-)

Outline
I.

II.
III. IV. V.

Introduction Water The Electrolytes Anion Gap Electrolytes and Renal Function

Outline
II.

Water
A.
B.
i.

Introduction Osmolality
ii.
iii. iv.

Definition Clinical Significance of Osmolality Regulation of Blood Volume Determination of Osmolality

Water
A.

Introduction

40% - 75% of body weight Function:

a.

b.
c. d.

Transport nutrients to the cells Determines cell volume Removes waste products Act as bodys coolant Intracellular Fluid (ICF) 2/3 Extracellular Fluid 1/3

Location:
a. b.

Intravascular extracellular fluid and interstitial cell fluid

Water
A.

Introduction
Distribution of Body Water in Adult
Compartment Percent (%) of Body Weight 5 15 40 60 Percent (%) of Total BodyWater 8 25 67 100

Extracellular Plasma Interstitial Intracellular Total Body Water

Water
A.

Introduction

Concentration of ions is maintained by:

1.

Passive Transport

Passive movement of ions across a membrane

Mechanism that requires energy to move ions across cellular membranes ATPase-dependent ion pumps

2.

Active Transport

Outline
II.

Water
A.
B.
i.

Introduction Osmolality
ii.
iii. iv.

Definition Clinical Significance Regulation of Blood Volume Determination of Osmolality

Water
B.

Osmolality
i.
1. 2.

Definition
Physical property of a solution based on concentration of solutes per kilogram of solvent (millimoles/kg) Blood osmolarity is regulated by:
a. b.

Thirst Sensation Arginine vasopressin hormone (AVP)

Water
B.

Osmolality
ii.
1.

Clinical Significance
Blood osmolarity is regulated by:
a.

b.

Thirst Sensation Response to consume more fluids Prevents water deficit or dehydration Arginine vasopressin hormone (AVP) Antidiuretic Hormone (ADH) reabsorption of water in kidneys Suppressed in excess water load ( POSM) Activated in water deficit ( POSM)

Water
B.

Osmolality
iii.

Regulation of Blood Volume

Renin-angiotensin-aldosterone system blood volume/pressure Renin (kidneys) Angiotensin I Angiotensin II Vasoconstriction and aldosterone ( Na+ ) Other Factors 1. ANP - Na+ excretion in the kidney 2. AVP - water reabsorption in the kidney 3. GFR w/ vol. expansion and w/ vol. depletion 4. plasma Na+ will urinary Na+ excretion

Water
B.

Osmolality
iii.

Regulation of Blood Volume

Water
B.

Osmolality
iv.

Determination of Osmolality and Osmolal gap Specimen

Serum or urine

Osmolality
Indicates number of molecules per Kg of solvent Any substance dissolve in a solvent will: 1. the freezing point by 1.858C 2. the boiling point by 0.52C 3. vapor pressure (Dew point) by 0.3 mmHg 4. the osmotic pressure by 17,000 mmHg Main contributors are Na, Cl, Urea and Glucose

Outline
II.

Water
A.
B.
i.

Introduction Osmolality
ii.
iii. iv.

Definition Clinical Significance of Osmolality Regulation of Blood Volume Determination of Osmolality

Outline
I.

II.
III. IV. V.

Introduction Water The Electrolytes Anion Gap Electrolytes and Renal Function

Outline
II.

The Electrolytes

Concentration of Cations and Anions in Extracellular and Intracellular Water Concentration of Water Concentration of Water Extracellular Intracellular Extracellular Intracellular Cation Anion (mmol/L (mmol/L) (mmol/L (mmol/L) Na+ 136-145 15 HCO323-29 10 K+ 3.5-5.1 150 Cl98-107 1 Ca2+ 2.15-2.5 1 HPO420.78-1.42 50 Mg2+ 0.63-1 13.5 SO420.5 10

Outline
II.

The Electrolytes
A.
B. C.

D.
E. F.

G.
H.

Sodium Potassium Chloride Bicarbonate Magnesium Calcium Phosphate Lactate

The Electrolytes
A.

Sodium (Na+)
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Sodium

The Electrolytes
A.

Sodium (Na+)
i.

Description and Regulation The most abundant cation in the ECF Major Extracellular cation Na+, K+ -ATPase ion pump moves 3 Na+ ions out of the cell in exchange for 2 K+ ions

The Electrolytes
A.

Sodium (Na+)
i.

Description and Regulation Plasma concentration depends in renal regulation a. Intake of water in response to thirst b. Excretion of water as affected by AVP H2O reabsorption c. The blood volume status, which affects Na excretion through: a. Aldosterone ( Na+ reabsorption in the kidneys) b. Angiotensin II ( aldosterone) c. ANP ( Urinary Na + Excretion )

The Electrolytes
A.

Sodium (Na+)
i.

Description and Regulation

The Electrolytes
A.

Sodium
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Sodium

The Electrolytes
A.

Sodium
ii.

Clinical Applications
Causes of Hyponatremia ( Na+)

Sodium (Na+) Loss Water Retention Hypoadrenalism ( aldosterone) Renal failure (dilution of Na+) Potassium (K+) Deficiency Nephrotic s. (COP - PV, AVP) Diuretic Use (Thiazide) CHF, Hepatic cirrhosis Ketonuria (Na+ lost with ketones) Water Imbalance Salt-losing nephropathy Prolonged vomiting or diarrhea

SIADH ( AVP , H2O retention) Pseudohyponatremia

The Electrolytes
A.

Sodium
ii.

Clinical Applications
Causes of Hypernatremia ( Na+)

Excess Water Loss

Decreased Water Intake Diabetes insipidus ( AVP) Old/Infants / Mental Impairment Renal tubular dis. ( urine conc.) Increased Intake or Retention Cushing Syn. ( Na+ reabs.) Prolonged diarrhea

Profuse sweating Severe burns

Hyperaldosteronism ( AVP) Hypertonic Salt Solution

The Electrolytes
A.

Sodium
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Sodium

The Electrolytes
A.

Sodium (Na+)
iii.

Determination of Sodium Specimen a. Serum, Plasma (lithium heparin, ammonium heparin and lithium oxalate) b. False with marked hemolysis Methods a. FES b. AAS c. ISE (Glass ion-exchange membrane)

Outline
II.

The Electrolytes
A.
B. C.

D.
E. F.

G.
H.

Sodium Potassium Chloride Bicarbonate Magnesium Calcium Phosphate Lactate

The Electrolytes
B.

Potassium (K+)
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Potassium

The Electrolytes
B.

Potassium (K+)
i.

Description and Regulation Major Intracellular cation Regulation of neuromuscular excitability and contraction of heart, ICF volume, H+ conc. K+, cell excitability (muscle weakness) K+, cell excitability (arrhythmia or paralysis)

The Electrolytes
B.

Potassium (K+)
i.

Description and Regulation Aldosterone K+ excretion in urine in exchange for Na+ Na+, K+ -ATPase pump function cellular entry hypoxia, digoxin overdose, hypomagnesemia, propanolol (-blocker) function cellular entry insulin, epinephrine with exercise, hyperosmolality (DM) and cellular breakdown

The Electrolytes
B.

Potassium (K+)
i.

Description and Regulation

The Electrolytes
B.

Potassium (K+)
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Potassium

The Electrolytes
B.

Potassium
ii.

Clinical Applications
Causes of Hypokalemia ( K+) Renal Loss Diuretics, Nephritis, CHF RTA (H+,K+ excretion) Cushings syn. (Na+,K+ reabs.) Hyperaldosteronism

GI Loss Vomiting, Diarrhea Gastric suction Intestinal tumor, malabsorption Cancer therapy, laxatives Cellular Shift - K+ uptake Alkalosis (Plasma)-H+Na+K+ Insulin Overdose

Hypomagnesemia: aldosterone
Decreased Intake

The Electrolytes
B.

Potassium
ii.

Clinical Applications
Cause of Hyperkalemia (K+) Cellular Shift Acidosis (Plasma H+, K+) Muscle/cellular injury Chemotherapy / Leukemia Hemolysis

Decreased Renal Excretion

Renal Failure Hypoaldesteronism ( Na+) Addisons D.(Na+, K+ reabs)

Increased Intake

Artifactual Oral/IV - K + replacement therapy Hemolysis, Thrombocytosis Prolonged tourniquet

The Electrolytes
B.

Potassium (K+)
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Potassium

The Electrolytes
B.

Potassium (K+)
iii.

Determination of Potassium Specimen a. Serum, Plasma (heparin) b. False with hemolysis c. 24 hour urine Methods a. FES b. AAS c. ISE (Use valinomycin membrane)

Outline
II.

The Electrolytes
A.
B. C.

D.
E. F.

G.
H.

Sodium Potassium Chloride Bicarbonate Magnesium Calcium Phosphate Lactate

The Electrolytes
C.

Chloride
i.
ii. iii.

Description and Regulation Clinical Applications Determination of Chloride

The Electrolytes
C.

Chloride
i.

Description and Regulation Major Extracellular Anion Involve in maintaining osmolality blood volume and electric neutrality (Chloride shift) Rate limiting component in Na+ reabsorption

The Electrolytes
C.

Chloride
i.
ii. iii.

Regulation Clinical Applications Determination of Chloride

The Electrolytes
C.

Chloride
ii.

Clinical Applications
Cause of Hypochloremia (Cl-) Excess Loss of ClProlonged Vomiting Diabetic Ketoacidosis Aldosterone Deficiency Salt-losing pyelonephritis

Cause of Hyperchloremia (Cl-) Excess Loss of HCO3GI Losses RTA Metabolic acidosis

The Electrolytes
C.

Chloride
i.

Determination of Chloride Specimen a. Serum, Plasma (lithium heparin) b. False with marked hemolysis (dilution) c. 24 hour urine Methods a. ISE (Use ion exchange membrane) b. Amperometric-coulometric (Cotlove Chloridometer)

The Electrolytes
C.

Chloride
i.

Determination of Chloride Methods c. Schales and Schales Titration with mercuric nitrate Indicator S-diphenylcarbazone

d.

Colorimetric

Outline
II.

The Electrolytes
A.
B. C.

D.
E. F.

G.
H.

Sodium Potassium Chloride Bicarbonate Magnesium Calcium Phosphate Lactate

The Electrolytes
D.

Bicarbonate (HCO3-)
i.
ii.

Regulation and Clinical Applications Determination of Sodium

The Electrolytes
D.

Bicarbonate (HCO3-)
i.

Regulation and Clinical Applications 2nd Most Abundant anion in the ECF Accounts for more than 80% of total CO2 with HCO3Major component of the buffering system of the blood
HCO3 HCO3Metabolic acidosis

Metabolic Alkalosis

Severe vomiting, Hypokalemia Hypoventilation Excessive alkali intake

Hyperventilation

The Electrolytes
D.

Bicarbonate (HCO3-)
i.
ii.

Regulation and Clinical Applications Determination of Sodium

The Electrolytes
D.

Bicarbonate (HCO3-)
ii.

Determination of Sodium Specimen a. Serum, Plasma (heparin) b. False if left uncapped ( 6mmol/L per hour) Methods a. ISE (Use of pCO2 electrode) b. Enzyme method

Outline
II.

The Electrolytes
A.
B. C.

D.
E. F.

G.
H.

Sodium Potassium Chloride Bicarbonate Magnesium Calcium Phosphate Lactate