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Diagnostic Studies, Unit III > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

Electrolytes

(define c qualifier, list 8)

A

Def: charged anions or cations, whose overall charge may be influenced by amino acids and proteins

Major electrolytes:

  1. Na+
  2. K+
  3. Cl-
  4. CO2(= HCO3-= TCO2)
  5. Mg2+
  6. HPO42+
  7. SO42+
  8. Ca2+
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2
Q

Roles of Electrolytes

(6)

A
  1. Maintain osmotic pressure
  2. Water distribution
  3. Maintain blood pH
  4. Enzyme cofactors
  5. Redox rxn participants
  6. Heart and other muscular fctn
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3
Q

Sodium

(4 physiological features)

A
  1. Major cation of extracellular fluid
  2. Maintains water and osmotic pressure distribution in ECF
  3. Regulated by kidney
  4. 60-70% of filtered sodium is reabsorbed along c HCO3- and water
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4
Q

Electrolyte Units

A

The same electrolyte may have different measured units at different facilities. Remember to always compare given values to the reference ranges to accurately assess electrolyte level.

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5
Q

Panic/Critical Value

A

Values emergently outside of normal limits. Usually the lab will call you if a value is panic/critical

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6
Q

Calculated Osmolality

(equation)

A

2(sodium) + glucose (mg/dL)/18 + BUN (mg/dL) / 2.8

Normal values = 275-295 mOsm/kg

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7
Q

Anion Gap Calculations

(2)

A
  • (Na) – (CO2 + Cl-) * RI = 7-16*
  • (Na + K) – (CO2 + Cl-) RI = 10-20
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8
Q

Clinical Significance, Abnml Sodium Etiologies

(2 categories, 3/2 specifics)

A

Hypernatremia

  • Profuse sweating
  • High sodium intake
  • Decreased ADH

Hyponatremia

  • Depletional - vomitting, diarrhea, polyuria
  • Dilutional - water retention (edema, cardiac failure)
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9
Q

Potassium

(2 physiological features)

A
  1. Major intracellular cation
  2. Almost completely reabsobed in proximal tubules then secreted in distal tubules
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10
Q

Clinical Significance, Abnml Serum Potassum

(2 categories, 4/4 specifics)

A

Decreased extracellular K+

  • Muscle weakness
  • Tachycardia
  • Irritability
  • Paralysis

Increased extracellular K+

  • Muscle weakness
  • Bradycardia
  • Confusion
  • Paresthesia

Note - tested in serum, compared to plasma or whole blood for other potassium values

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11
Q

Clinical Significance, Abnml Blood Potassium Etiologies

(2 categories, 3/3 causes)

A

**Hyperkalemia ***fairly common condition *

  1. K+ infusions
  2. Renal failure
  3. DKA

**Hypokalemia **

  1. Starvation
  2. Alkalosis
  3. Hypovolemia (vomiting, diarrhea, intestinal fistula)
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12
Q

Chloride

(4 physiological features)

A
  1. Major extracellular anion
  2. Significant in water distribution/osmotic pressure
  3. Passive reabsorption c sodium in proximal tubules
  4. Actively absorbed by chloride pump in ascending limb of loop of Henle
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13
Q

Clinical Significance, Abnml Blood Chloride Levels

(2 categories, 4/3 causes)

A

Hyperchloremia

  1. Childhood/infancy (non-pathologic)
  2. Dehydration
  3. Kidney disease
  4. Salicylate intoxication (>30 ug/dL) currently rare, slicylate rarely prescribed

Hypochloremia

  1. Vomiting
  2. Salt-losing nephritis
  3. Metabolic alkilosis
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14
Q

TCO2/Bicarbonate

(4 components)

A
  1. Physiologically disolved CO2
  2. Amine group/protein-bound CO2
  3. CO3-2 or HCO3-
  4. Carbonic acid

*Bicarbonate ions make up ~98% of TCO2 in plasma *

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15
Q

Clinical Significance, Abnml Blood TCO2

(2 categories, 3/4 causes)

A

Do not confuse this c partial CO2

Hypercapnia

  • Uncompensated and compensated metabolic alkalosis due to vomiting
  • Hypokalemia
  • Compensated respiratory acidosis/COPD/high pCO2(more bicarb due to body’s response to high CO2)

Hypocapnia

  • Renal disease
  • Diarrhea
  • Uncompensated respiratory alkalosis
  • Compensated and uncompensated metabolic acidosis
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16
Q

Testable Electrolyte States in Nml Plasma

(3)

A
  1. Free
  2. Protein bound
  3. Complex
17
Q

Calcium Locations

(2)

A

99% in

  1. hydroxyapatite
  2. teeth
18
Q

Calcium Functions

(5)

A
  1. Nerve impulse transmission
  2. Cofactor for some enzymes
  3. Blood coagulation
  4. Skeletal mineralization
  5. Cell membrane integrity and permeability
19
Q

Calcium regulation

(3 contributing organs, 3 contributing hormones)

A

Organs

  1. Small intestine
  2. Kidney
  3. Skeleton

Hormones (not limited to this list)

  1. parathyroid hormone (PTH, parathormone)
  2. 1,25-dihydroxycholecalciferol
  3. Calcitonin (role undetermined)
20
Q

Free/Ionized Calcium

(laboratory significance, 3 measurement factors)

A
  • Significance - *Ca2+ is the best indication of calcium status because it is biologically active and tightly regulated by PTH and Vitman D
  • Measurement*
  • Unit - ISE
  • Measured from whole blood or serum
  • Temperature and pH dependent (some labs may correct this to 7.4)
21
Q

Clinical Significance, Abnml Calcium

(2 categories, 5/7 causes)

A

Hypercalcemia

  • hyperparathyroidism
  • hyperthyroidism
  • cancer metastatic to bone/lung/kidney
  • multiple myeloma - plasma cell dysgrasia
  • sarcoidosis - benign disease causes inc. in plasma PRO, thus inc. in calcium

Hypocalcemia

  • Hypoparathyroidism
  • Hypothyroidism
  • Vitamin D deficiency
  • Malabsorption
  • Renal failure
  • Rickets
  • Osteomalacia
22
Q

“Electrolytes” on Lab Readouts

(3)

A
  1. Calcium
  2. Phosphorus
  3. Magnesium
23
Q

Phosphorus

(3 physiological features)

A
  1. Human body contains ~ 620 g of phosphorus entirely in the form of phosphate
  2. Equal intra/extracellular PO4 distribution
  3. Intracellularly, occurs as component of macromolecules (phospholipids, phosphoproteins)
24
Q

Clinical Significance, Abnml Blood Phosphate

(2 categories, 4/3 causes)

A

Note - Calcium and phosphorous usually act together. Looking at just phosphorous is usually insignificant unless evaluating for laboratory error

Hypophosphatemia/PO4 Depletion

  1. Intracellular shifts
  2. Lowered renal PO4 threshold
  3. Decreased intestinal PO4 absorption
  4. Intracellular PO4 loss

Hyperphosphatemia

  1. Decreased renal excretion
  2. Increased PO4 intake
  3. Increased extracellular PO4 load
25
Q

Magneisum

(2 physiological features)

A
  1. ~55% of total body Mg is in the skeleton and intracellular
  2. Serves as cofactor for 300+ enzymes
    • ​Required for enzyme-substrate formation
    • Activates many enzyme systems
26
Q

Clinical Significance, Magnesium Deficiency

A

Overall, represented as neuromuscular impairment:

  • hyperirritability
  • tetany
  • convulsions
  • EKG changes
27
Q

Clinical Process, Magnesium Deficiency

A
  1. R/O hypercalcemia and hypocalcemia
  2. Evaluate parathyroid fctn in the presence of renal failure
  3. Evaluate parathyroid fctn in the presence of bone/mineral disorders
28
Q

Causes of Magnesium Depletion

(5)

A
  1. Hypertension
  2. MI
  3. Cardiac dysrhythmia
  4. Coronary vasospasm
  5. Premature arteriosclerosis
29
Q

Causes, Hypomagnesemia

(9)

A
  1. Chronic alcoholism
  2. Hyperthyroidism
  3. Childhood malnutrition
  4. Diabetic acidosis (during tx)
  5. Malabsorption
  6. Acute pancreatitis
  7. Chronic glomerulonephritis
  8. Aminoglycoside tx
  9. Primary hypoparathyroidism
30
Q

Clincal Significance, Hypermagnesemia

(4)

A
  1. End stage renal disease/failure (reduced excretion)
  2. Addison’s disease - aldosterone
  3. Hypothyroidism
  4. Excessive intake
    • ​antacids
    • rectally
    • purgation (cleansing)
    • parenterally (tx of pregnancy-induced htn or magnesium deficiency)

Diagnostic Studies, Unit III (6 decks)

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