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CC2 LECTURE > CHLORIDE AND BICARBONATE > Flashcards

CHLORIDE AND BICARBONATE Flashcards

1
Q
  1. HYPOCHLOREMIA
A
  1. Salt-Losing Nephritis
  2. Addisonian Crisis
  3. Prolonged Vomiting
  4. Metabolic Alkalosis
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2
Q
  1. HYPERCHLOREMIA
A
  1. Dehydration
  2. Renal Tubular Acidosis
  3. Metabolic Acidosis
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3
Q

A decreased HCO3

A
  1. Metabolic acidosis
  2. Renal failure
  3. RTA w/ hypochloremia
  4. Diarrhea
  5. States of poor tissue perfusion
  6. Respiratory alkalosis
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4
Q

An increased HCO3

A
  1. Metabolic alkalosis due to severe vomiting with the loss of Na intake, hypokalemic states, excessive intake of alkali
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5
Q

: Plasma Cl Tends To Fall As HCO; Increases

A

Metabolic Alkalosis

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6
Q
  • Assoc. W/ Prolonged Diarrhea & Loss Of Nahco3
A

Metabolic Acidosis

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7
Q

DETERMINATION OF CHLORIDE

A
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8
Q

Major extracellular anion (counterpart of na)

A
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9
Q

Major extracellular anion (counterpart of na)

A

Chloride

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10
Q

Chloride

Represents the largest fraction of the plasma total inorganic anion concentration

A

(~154 mmol/l)

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11
Q

In RBCs:

A

45 - 54 mmol/l

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12
Q

In tissue cells :

A

~1.0 mmol/l

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13
Q

Functions in the maintenance of:

A
  1. Water distribution (maintains osmolality)
  2. Osmotic pressure (and blood volume)
  3. Anion-cation balance in the ecf (electrical neutrality)
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14
Q

one of the most important

A

electrical neutrality

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15
Q

balance of the + and – charges in the system

A

electrical neutrality

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16
Q

proper/normal number and ratio of the + and – charges within and outside the cell

A

electrical neutrality

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17
Q

Chloride maintains electrical neutrality in two ways:

A
  1. Na+ is reabsorbed along w/ Cl- in the PCT & LH
  2. Chloride shift
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18
Q

CO2 generated by cellular metabolism w/in the tissue diffuses out into both the plasma & the rbc

A

Chloride shift

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19
Q

Chloride is filtered from the plasma by the.

A

glomerulus

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20
Q

passively absorbed along with sodium in the (?)

A

proximal convoluted tubules

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21
Q

active reabsorption through the chloride pump happens in the.

A

ascending loop of Henle

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22
Q

o – movement of Cl against a concentration gradient needing ezymes and energy

A

Active

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23
Q

active reabsorption by the so called

A

chloride pump

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24
Q

Excessive sweating triggers release of

A

Aldosterone

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25
Q

causes the sweat glands to reabsorb more Na+ and Chloride

A

Aldosterone

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26
Q

conserves or retains Na

A

Aldosterone

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27
Q

Reference ranges:
Plasma, serum:
Urine (24-hour) :

A

Plasma, serum: 98-110 mmol/l
Urine (24-hour) :110 - 250 mmol/l

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28
Q

Varies w/ diet
Same time in different days
Samples in the lab are submitted in a large gallon
100 to 150 mL

A

Urine (24-hour)

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29
Q

Decrease plasma concentration of Cl

A

HYPOCHLOREMIA

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30
Q

It uses diphenylcarbazone as the indicator and HgCl2 as the end product of the reaction

A

Mercumetric Titration or the Schales and Schaled method

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31
Q

It is done using spectrophotometric reading which uses diphenylcarbazone as the reagent with reddish complex end point product which is read spectrophotometrically.

A

Whitehorn Titration Method

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32
Q

When all Cl- in the sample is bound to Ag excess Ag is used to indicate the endpoint

A

Coulometric - Amperometric Titration

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33
Q

Uses an ion-exchange membrane

A

Ion-Selective Electrode

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34
Q

2nd most abundant anion in the ECF (following Cl)

A
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35
Q

Accounts for >90% of the total CO2

A
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36
Q

Total Carbon Dioxide (CTCO2) in plasma

A
  1. HCO3 or CO3 ions – bicarbonate or carbonic ions
  2. H2CO3 – carbonic acid
  3. CO2 in Physical Solution
  4. CO2 loosely bound to proteins (carbamino compounds)
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37
Q

About 85% of filtered bicarbonate is reabsorbed in the (?) and the rest (15%) in the (?)

A

proximal convoluted tubules

distal convoluted tubules

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38
Q

Tubules are known to be only slightly permeable to bicarbonate because bicarbonate after being filtered into the tubules combines with hydrogen to form (?).

A

carbonic acid

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39
Q

Bicarbonate do no as is enters the cell, but is reabsorbed back as

A

carbon dioxide

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40
Q

Little bicarbonate is loss in

A

urine

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41
Q

then dissociates into molecules of water and carbon dioxide where carbon dioxide readily diffuses back into the ECF.

A

Carbonic acid

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42
Q

Alterations of (?) in plasma are characteristic of acid-base imbalance.

A

HCO3 & CO2

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43
Q

: provide a definitive picture of the over-all pattern of imbalances.

A

Evaluation of blood gases & pH

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44
Q

A decreased HCO3

A
  1. Metabolic acidosis
  2. Renal failure
  3. RTA w/ hypochloremia
  4. Diarrhea
  5. States of poor tissue perfusion
  6. Respiratory alkalosis
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45
Q

An increased HCO3

A
  1. Metabolic alkalosis
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46
Q

may occur from metabolic acidosis as HCO3- combines with H to produce CO2, which is exhaled by the lungs

A

Metabolic acidosis

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47
Q

– great reduction in the normally functioning nephrons

A

Renal failure

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48
Q

– exchange of fluid, ions, and gasses are disrupted

A

States of poor tissue perfusion

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49
Q

CO2 in the blood decreases

A

Respiratory alkalosis

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50
Q

ex. Hyperventilation – rapid inhalation; removing high amount of CO2 =

A

Respiratory alkalosis

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51
Q

Management: paper bag

A

Respiratory alkalosis

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52
Q

Metabolic alkalosis due to

A

severe vomiting with the loss of Na intake, hypokalemic states, excessive intake of alkali

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53
Q

(antacids like Kremil-S for hyperacidity/heartburn containing bicarbonate supplements: only 7 tablets per day)

A

Alkali

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54
Q

HCO3 specimen

A

Serum or Lithium heparinized plasma (from venous or capillary blood)

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55
Q

Specimen drawn in (?): unopened & centrifuged ASAP

A

evacuated tube

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56
Q

Analyzed promptly after the tube is

A

opened

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57
Q

Note: Exposure to air = CO2 loss; decrease by (?) within an hour

A

6 mmol/L

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58
Q

Ideal collection

A

Arterial Blood Collection

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59
Q

Collection from the artery

A

Arterial Blood Collection

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60
Q

Complex procedure performed by trained personnel

A

Arterial Blood Collection

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61
Q

Arterial Blood Collection
To determine

A

arterial blood gasses

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62
Q

Sample is collected via catheter placed in artery or direct syringe puncture (pre-heparinized)

A

Arterial Blood Collection

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63
Q

Handled to minimize air exposure

A

Arterial Blood Collection

64
Q

Arterial Blood Collection
Primary site of collection:

A

radial artery (thumb site)

65
Q

Arterial Blood Collection
Other sites:

A

brachial, femoral (inguinal)

66
Q

Arterial Blood Collection
Ideal gauge:

A

20, 23, 25

67
Q

Use of syringe w/ cover is used to prevent excess O2 entering the sample

A

Arterial Blood Collection

68
Q

hold the syringe like a dart

A

Arterial Blood Collection

69
Q

Arterial Blood Collection
Angle:

A

45o

70
Q

When advancing the needle, allow the flush back to appear

A

Arterial Blood Collection

71
Q

Ideal to not to pull the plunger • Let the pressure push the plunger up

A

Arterial Blood Collection

72
Q

Performed to check for collateral circulation

A

Allen’s Test

73
Q

Inflammation test
1. Pressing the radial and ulnar to block the access of blood
2. Release the hand pressing the ulnar artery
• Collateral: flushing red – can be used
• Remains white: cannot be used for the procedure

A

Allen’s Test

74
Q

Cl acts a

A

rate-limiting component

75
Q

Na absorption will depend on the number on the amount of[?] available for reabsorption

A

Cl

76
Q

Ex. 20 Cl ions and 50 Na ions in the PCT: [?] Na ions will be reabsorbed back

A

20

77
Q

Both are reabsorbed back in the circulation but the number varies

A

Na and Cl

78
Q

The number of Na that will be reabsorbed will depend on the[?] available for reabsorption

A

Cl

79
Q

Carbon dioxide will form a complex with water forming a complex, [?] by the catalytic activity of [?].

A

carbonic acid

carbonic anhydrase

80
Q

will split into water and bicarbonate.

A

Carbonic acid

81
Q

Inside the RBC, hydrogen will be buffered by the oxyhemoglobin, while [?] will diffuse out into the plasma.

A

bicarbonate

82
Q

– (-) charge ion that diffuses out of the plasma, causing imbalance

A

Bicarbonate

83
Q

Shifting of Cl from extracellular to intracellular in exchange of[?] moving out of the cell

A

bicarbonate

84
Q

almost the same cause of Na disturbance; Na follows both water and Cl

A

HYPOCHLOREMIA

85
Q

tubular or medullary condition affecting Na and Cl transportation or reabsorption

A

Salt-Losing Nephritis

86
Q

problem in the tubule causing excessive loss of Na and Cl

A

Salt-Losing Nephritis

87
Q

adrenal insufficiency – body cannot produce enough aldosterone

A

Addisonian Crisis

88
Q

causing loss of Na

excretion of Na and Cl in inc amount

A

aldosterone

89
Q

Addisonian Crisis

triggered by

A

traumatic events, severe and viral infection

90
Q

Excessive GIT loss

A

Prolonged Vomiting

91
Q

When bicarbonate moves out of the plasma, bicarbonate increase the pH of blood causing alkalosis

A
92
Q

Caused by increase movement of bicarbonate from intracellular fluid extracellularly

A
93
Q

bicarbonate moving out of the cell = Cl entering the cell = Cl conc in the plasma

A

↑

↑

↓

94
Q

Always measure conc in the plasma

A

extracellularly

95
Q

kidneys are unable to appropriately excrete acid

A

Renal Tubular Acidosis

96
Q

Problems w/ Na and Cl reabsorption

A

Renal Tubular Acidosis

97
Q

[?] is secreted out of the urine in exchange of the reabsorption of [?]

A

H

Na

98
Q

[?] filtered must go back to the circulation

A

Na

99
Q

– passageway of filtered ions and chemicals filtered by the glomeruli; electrolytes filtered by the glomerulus

A

Lumen of PCT

100
Q

– division between the lumen and the blood circulation

A

PCT cell

101
Q

PCT cell
[?]is present
[?] will form a complex in the presence of [?] forming [?], which splits into [?]

A

Water

CO2; CA; carbonic acid; hydrogen and bicarbonate

102
Q

[?] diffuses out of the tubular cell in exchange for[?]

A

H; Na

103
Q

[?] will return back to the circulation in exchange for more [?]

A

Bicarbonate and Na; hydrogen

104
Q

[?]is reabsorbed back first in the cell, but in exchange of [?] (electrical neutrality of + charges)

A

Na; hydrogen

105
Q

With the movement of the cell from the lumen,[?] will form a complex

A

bicarbonate

106
Q

Bicarbonate + Hydrogen = Carbonic Acid (dissociates into water and CO2) by the catalytic activity if

A

carbonic anhydrase

107
Q

diffuses back in the tubular cell

A

CO2

108
Q

Accumulation of hydrogen in the case of RTA, preventing Na reabsorption

A

RTA

109
Q

Cl in the sample is determined by direct titration with (?) (standard)

A

mercuric nitrate solution

110
Q

Cl binds to mercury liberating

A

nitrate

111
Q

Excess mercury is made to react w/ diphemylcarbazone (indicator) forming a

A

blue-violet color

112
Q

Intensity of color is [?] to the conc of Cl

A

inversely proportional

113
Q

Cl is made to react w/ mercuric thiocyanate, yielding

A

mercuric chloride and thiocyanate

114
Q

Cl is made to react w/ mercuric thiocyanate, yielding

A

mercuric chloride and thiocyanate

115
Q

Liberated thiocyanate is made to react w/ iron = ferric thiocyanate ([?]@ 480 nm)

A

reddish color

116
Q

: used as a substitute for mercuric thiocyanate (intense blue)

A

Tripyridyl triazine

117
Q

Cl reacts w/ [?] forming a colored complex

A

ferric perchlorate

118
Q

Intensity of color is directly proportional to the conc of Cl

A

Whitehorn Titration Method

119
Q

Because HCO3 - composes the largest fraction of total CO2,[?] is indicative of HCO3- measurement

A

total CO2 measurement

120
Q

Bicarbonate do no as is enters the cell, but is reabsorbed back as [?]

A

carbon dioxide

121
Q

Little [?] is loss in urine

A

bicarbonate

122
Q

– great reduction in the normally functioning nephrons

A

Renal failure

123
Q

– exchange of fluid, ions, and gasses are disrupted

A

States of poor tissue perfusion

124
Q

Analysis of an arterial sample collected anaerobically for BGA preserves

A

dissolved CO2

125
Q

Content of the sample

A

(CTCO2)

126
Q

HISTORICAL METHODS

A
127
Q

Used prior to automated methods used in the lab

A

HISTORICAL METHODS

128
Q

SMAC, TECHNICON INSTRUMENTS

A

Continuousflow analysis

129
Q

gaseous CO2 diffuses across a silicone membrane into a recipient solution (w/ phenolphthalein) buffered at ph 9.2

A

Continuousflow analysis

130
Q

decrease in ph: reduction in the red color (determined spectrophotometrically)

A

Continuousflow analysis

131
Q

sample is acidified: converts CO2 in plasma into gaseous form

A

Manometric method

132
Q

alkalinize: converts gaseous CO2 to H2CO3 then to HCO3

A

Manometric method

133
Q

Change in pH: measured with phenolphthalein indicator

A

Manometric method

134
Q

Mostly used in research

A

Manometric method

135
Q

(NATELSON MICROGASOMETER)

A

Manometric method

136
Q

– brand or automated machines

A

BECKMAN INSTRUMENTS

137
Q

BECKMAN INSTRUMENTS

A

INDIRECT ELECTRODE: ASTRA METHOD

138
Q

Gaseous CO2 is determined by a PCO2 electrode

A

INDIRECT ELECTRODE: ASTRA METHOD

139
Q

The relationship between the sample and the signal generated by the internal pH is logarithmic and governed by nernst equation

A

INDIRECT ELECTRODE: ASTRA METHOD

140
Q

Reference range:
Total CO2 (venous):
HCO3:

A

23 - 29 mEq/L or mmol/l

22 - 26 mEq/L or mmol/l

141
Q

(ACA DUPONT)

A

Enzymatic method

142
Q

Total CO2 (venous) includes

A

bicarbonate, dissolved undissociated H2CO3

143
Q

Bicarbonate is made to react with

A

phosphoenol pyruvate

144
Q

Reaction is catalysed by [?]

A

phosphoeneol pyruvate carboxylase

145
Q

Like the coupled-enzymatic reaction; only 1 enzyme is involved in the reaction

A

Enzymatic method

146
Q

2nd enzyme:[?] – converts oxaloacetate to malate with the subsequent conversion of NADH to NAD

A

MDH

147
Q

Measurement of rate of conversion from NADH to NAD that will give a linear equivalent of the conc of bicarbonate

A

Enzymatic method

148
Q

catalyses the formation of oxaloacetate at liberation of inorganic phosphates from the reaction that will take place

A

phosphoeneol pyruvate carboxylase

149
Q

• Mathematical formula used to demonstrate electroneutrality of body

A

Anion Gap

150
Q

• Difference between cations and anions that are not actually measured analytically when serum “electrolytes” are quantified

A

Anion Gap

151
Q

Two calculations

A

• Na - (Cl + HCO3) = Anion gap
• (Na + K) - (Cl + HCO3) = Anion gap

152
Q

• Na - (Cl + HCO3) = Anion gap
Expected anion gap:

A

7 – 16 mmol/l

153
Q

• (Na + K) - (Cl + HCO3) = Anion gap

A

Expected anion gap: 10 – 20 mmol/l

154
Q

DIAGNOSTIC SIGNIFICANCE OF ANION GAP
Increased

A

• Uremia
• Lactic acidosis
• Ketoacidosis
• Hypernatremia
• Ingestion of methanol, ethylene glycol, or salicylate.

155
Q

DIAGNOSTIC SIGNIFICANCE OF ANION GAP
Decreased

A

• Hypoalbuminemia
• Hypercalcemia

CC2 LECTURE (33 decks)

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