Electrolytes Flashcards
Electrolytes for Volume and Osmolality
Na
Cl
K
Electrolyte for Myocardial Rhythm and Contractility
Na
Ca
Mg
Cofactors
Mg
Ca
Zn
Acid Base Balance
K
Cl
HCO3
Blood Coagulation
Ca
Mg
Neuromuscular excitability
K
Ca
Mg
Anions (-) are _________ charge that migrates toward the _________
Negatively charge; Anode (+ electrical field)
Cations are __________ charge that migrates toward the __________
Positively charge; Cathode (- electrical field)
Based on the concentration of solutes
Osmolality
Colligative Properties of Osmolality
Boiling Point
Freezing Point
Osmotic Pressure
Vapor Pressure
Increase Osmolality: Increase ___________, _________
Increase Boiling point; Increase Osmotic Pressure
Increase Osmolality: Decrease __________, _________
Decrease Freezing Point; Decrease Vapor Pressure
A _________ increase in osmolality causes a ___________ increase of ADH
A 1-2% increase in osmolality causes a fourfold increase of ADH
A 1-2% decrease in osmolality, ________ the release of ADH
A 1-2% decrease in osmolality, inhibits/shuts down the release of ADH
Other name for ADH
AVP - Arginine Vasopressin Hormone
AVP increases the reabsorption of ________ that acts on the ___________ of the kidneys
AVP increases the reabsorption of water that acts on the collecting duct of the kidneys
Deficit in water will increase _____________
plasma osmolality
______is the major defense against Hyperosmolality and Hypernatremia
Thirst
Maintains Blood Pressure and Blood Volume
Na & H2O
A system that responds to primarily to a decreased blood volume or pressure
RAAS - Renin Angiotensin Aldosterone System
Substance - Organ - Conversion/Effect
Renin: _______ = Angiotensinogen - Angiotensin I
_____: Lungs = ________________________
Aldosterone: _______ = Increase ____ reabsorption
____: Posterior Pituitary = Increase water reabsorption in Kidneys + ______ sensation
Renin: Kidneys (juxtaglomerular cells) = Angiotensinogen - Angiotensin I
ACE: Lungs = Angiotensin I - Angiotensin II
Aldosterone: Adrenal cortex = Increase K reabsorption
ADH: Posterior Pituitary = Increase water reabsorption in Kidneys + Thirst sensation
Major EXTRAcellular CATion (90%)
Na - Sodium
Major Function of Na
Osmolality
Osmolality Formula
2 (Sodium (mmol/L) + Glucose mg/dL/18 + BUN/2.8
This diuretic promote or induces sodium and potassium loss without interfering ADH
Thiazide
Countercurrent ion of K
Na - sodium
Counterion of Cl
Na - Sodium
Major hormone that regulate sodium retention and potassium excretion
Aldosterone
Promote Natriuresis
ANP - Atrial Natriuretic Peptide
Function of ANP
Inhibit RAAS
Promote Natriuresis
Anti Hypertensive agent
Critical values
Hypernatremia: __________
Hyponatremia: __________
Hypernatremia: >160 mmol/L
Hyponatremia: <120 mmol/L
Counterion of Na: _____
Countercurrent ion of Na: ____
Counterbalance of Na: ____
Counterion of Na: Cl
Countercurrent ion of Na: K
Counterbalance of Na: Cl
Most Routine Method of Electrolyte Measurement
Ion Selective Electrode
Membrane Electrode of Na
Glass Aluminum Silicate
FEP: Flame Color - Na+
Yellow
Colorimetric Method - Sodium
Albenese Lein
Cause of Hypernatremia
Diabetes Insipidus Diarrhea Severe Burns Excess water loss Decrease water intake
Cause of Hyponatremia
Diabetes Mellitus SIADH K deificiency Addisons disease Increased water intake Vomiting Diarrhea
Potassium is also know as __________
“Kalium”
Major INTRAcellular CATION
Potassium
Reabsorption of all K
PCT
Principal determinant of Potassium urinary excretion
Distal Convoluted Tubule
Part of the Nephron which secretion of K occurs regulated by aldosterone
DCT and CD
Hormone responsible for K excretion
Aldosterone
Causes of Hypokalemia
GI Loss - Vomiting, Diarrhea, Malabsorption Renal Tubular Acidosis Alkalosis Insulin Overdose Hyperaldestronism Hypomagnesemia Intestinal tumor Diuretics
Causes of Hyperkalemia
Type I DM Hypoaldosteronism - Addison's disease Acidosis Renal Insufficiency Leukemia - Chemotherapy Diuretics Oral - IV Replacement Hemolysis Thrombosis Prolonged Tourniquet application - Fist Clenching
FEP - Flame Color of Na
Violet
ISE Membrane of Sodium
Valinomycin Gel
Colorimetric Method of K
Lockhead and Purcell
Threshold Value - Critical
Hyperkalemia: _________
Hypokalemia: _________
Hyperkalemia: 6.5 mml/L
Hypokalemia: 2.5 mmol/L
Couterion of K:
Counter current ion of K:
Counter Balance of K:
Couterion of K: Phosphate
Counter current ion of K: Na
Counter Balance of K: Magnesium
K Value: Less muscle Excitability
8.0 mmol/L
K Value: Cardiac Arrest
10.0 mmol/L
K Value: Arrythmias and Paralysis
3.0 - 3.4 mmol/L
Major EXTRAcellular ANION
Chloride
_____ is the only ANION to serve as Enzyme Activator
Chloride
Chloride Shift
Exchange between Cl and HCO3- across the membrane of RBCs
Counterion of Cl:
Countercurrent ion of Cl:
Counter pH balance of Chloride:
Counterion of Cl: Na
Countercurrent ion of Cl: Phosphate
Counter pH balance of Chloride: HCO3-
Excessive sweating stimulates _____________ secretion to conserve Na and Cl in the sweat glands
Aldosterone
Two ways how CL maintain Electroneutrality
- ____________
- ___________
- Reabsorption in PCT acting as a Rate liming factor of Na
2. Chloride Shift
Causes of Hyperchloremia
Diabetes Insipidus
Metabolic Acidosis
RTA
Increase HCO3- loss
Causes of Hypochloremia
High Serum HCO3 Addison's disease Prolonged Vomiting Salt losing (Pyelonephritis) Alkalosis
Mercuric Titration is also known as ___________
Schales and Schales Method
Indicator used in Schales and Schales Method
Diphenylcarbozene
Schales and Schales Method End Color
Blue Violet
Mercuric Titration - Schales & Schales Method
Indicator: ______________
End Color: _____________
End Product: ___________
Indicator: Diphenylcarbazone
End Color: Blue Violet
End Product: Mercuric Chloride
Reagent used in Spectrophotometric Analysis of Chloride
Mercuric thiocyanate & Ferric Ion
End Color - Spectrophotometric Analysis of Chloride
Red Color Complex
Principle in Coulometric Amperometric Titration
Catlove Chloridometer
ISE membrane of Chloride
Tri-n-acetylpropyl ammonium chloride decanol
Essential in Myocardial Contraction
Ca
Most predominant Ca Form
Ionized (active) Calcium
Functions of Ca
Blood Coagulation
Cofactor
Myocardial Contraction
Regulates Ca Levels
Vit. D3 - 1, 25 - dihydroxycholecalciferol
Parathyroid hormone
Calcitonin
Vitamin D3 increases __________ & ________ reabsorption of Calcium
Intestinal & Renal
Calcium Metabolism and Activation
Skin: 7 dehydrocholeserol ——– _________ ——- Vit. D (cholecalciferol)
____: Vit. D ———— _____________
Kidney: 25, hydroxycholecalciferol ——– __________ ——— 1, 25 - hydroxycholecalciferol
Calcium Metabolism and Activation
Skin: 7 dehydrocholeserol ——– UV Light ——- Vit. D (cholecalciferol)
Liver: Vit. D ———— 25, hydroxycholecalciferol
Kidney: 25, hydroxycholecalciferol ——– 1a - hydroxylase ——— 1, 25 - hydroxycholecalciferol
____ stimulates the release of 1a - hydroxylase to activate Vit. D3
PTH
Target Organs of PTH
Bone - Inc. Bone resorption
Kidneys - Inc. Ca reabsorption and HPO4 excretion
Small Intestines - activation of 1a hydroxylase
Hypercalcemic Agents
PTH
Vit. D3
Hypocalcemic Agemt
Calcitonin
Secreted by parafollicular cells of the thyroid gland to lower calcium level
Calcitonin
Function of Cacitonin
Inhibit:
PTH
Vit. D3
Bone resorption
Causes of Hypercalcemia
Primary Hyperparathyroidism Hyperthyroidism Increase Vitamin D Multiple Myeloma Malignancy - Cancer Sarcoidism
Causes of Hypocalcemia
Primary Hypoparathyroidism Severe Hypomagnesemia Vit. D Deficiency Renal Disease Alkalosis
Reference Method: Ca Analysis
AAS - Atomic Absorption Spectrophotometry
ISE Membrane - Calcium
Organic Liquid Membrane
Precipitation & Redox Reaction
Method - End Product - End Color
Clark Colip: ____________ - ___________
Ferro Ham: ____________ - ___________
Clark Colip: Oxalic Acid - VIOLET
Ferro Ham: Chloranilic Acid - VIOLET
Colorimetric Method of Calcium Analysis
Ortho-cresolphthalein Complexone
Dye used in Ortho-cresolphthalein
Arsenzo III
End color: Ortho-cresolphthalein (Colorimetry)
Red Complex
FEP - Calcium
Orange
Electrolyte that is is inversely related to Calcium
Phosphorus
Only phosphorus that is MEASURED in the laboratory
Inorganic Phosphorus
ONLY ELECTROLYTE THAT REQUIRE FASTING
Phosphorus
Most common Method - Phosphorus
Fiske and Subbarow Method
Most Common reducing agent
PICTOL
End Product - Fiske Subbarow Method
Ammonium molybdate BLUE complex
Fiske & Subbarow Method
Rgt: _______________
Reducing agent: ______________
End product: ______________
Fiske & Subbarow Method
Rgt: Ammonium Molybdate
Reducing agent: PICTOL
End product: Ammonium molybdate blue complex
Causes of Hyperphosphatemia
Hypoparathyroidism
Increased Vit. D
Renal Failure
Lymphoblastic Leukemia
Causes of Hypokalemia
Hyperparathyroidism Low Vit. D Ketoacidosis Alcohol abuse Infusion of dextrose solution Use of Antacids
Effect of PTH to PO4-
Increase renal excretion of PO4
Major regulating factor of PO4-
PTH
4th most abundant cation; 2nd most abundant intracellular cation
Mg2+
Major reabsorption site of Mg in kidneys
Ascending loop of Henle
__________ increases the intestinal and renal reabsorption of Mg2+
PTH
Increases Renal Excretion of Mg
Aldosterone and Thyroxine
Colorimetric Method: Mg2+
Calmagite: ____________
Formazen dye: ___________
Methylthymol blue: ________
Colorimetric Method: Mg2+
Calmagite: Reddish-violet
Formazen dye: Dark Blue
Methylthymol blue: Blue
Reference Method - Mg2+
AAS
Cause of Hypermagnesemia
Hypoaldosteronism
Hypothyroidism
Hypopituitarism
Diabetes MellitusAcute/Chronic Renal Failure
Cause of Hypomagnesemia
Hyperthyroidism Hyperaldosteronism Hyperparathyroidism Malnutrition Pancreatitis Tetany
Mg2+ value which life threatening values occur: ______ mmol/L
5 mmol/L
The difference of unmeasured cation and unmeasured anion
Anion gap
Anion gap is also a form of ____________ to the analyzer used to measure its analytes
Quality control
Anion Gap
Total unmeasured Cations: _________________
Total unmeasured Anions: _________________
Anion Gap
Total unmeasured Cations: Na, K
Total unmeasured Anions: Cl, HCO3-
Increased Anion Gap
Mnemonics: MUDPILES
Methanol Uremia Diabetic Ketoacidosis Paracetamol Isothiazine Lactic Acid Ethanol/Ethylene glycol Salicylate/Sialic acid
Anion Gap Formula
AG = Na - (Cl + HCO3-) AG = (Na + K) - (Cl = HCO3-)