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Chem (Clinicals) > Electrolytes > Flashcards

Electrolytes Flashcards

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1
Q

7 functions of electrolytes

A 
Hydration
Enzyme activation
pH maintenance
blood coagulation
electron transfer
Neuromuscular activity
Bone stability
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2
Q

Definition of osmolality

A

a physical property of a solution which os based on concentration of a solute (millimoles per Kg solvent).
Concentration of dissolved ions.

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3
Q

___ accounts for 90% of human serum and urine osmolality

A

Sodium (and its associated anions)

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4
Q

Osmolality reference range

A

280-300 mOsm/kg

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5
Q

AVP

A

Arganine vasopressin hormone

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6
Q

AVP secreted by…

A

pituitary gland

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7
Q

AVP causes…

A

increased water reabsorption in renal tubules and increased thirst

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8
Q

AVP excretion regulated by…

A

osmoreceptors in hypothalamus

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9
Q

How does Natriuretic peptide affect osmol?

A

decreased blood volume by excreting Na and water

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10
Q

What triggers release of renin?

A

Juxtaglomerular apparatus in kidney senses change in blood volume

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11
Q

What does renin do?

A

Converts angiotensinogen to angiotensin I

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12
Q

Angiotensin I is converted to angiotensin II in the…

A

lungs

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13
Q

What does Angiotensin II do? (2 functions)

A

increases renal blood flow
(vasoconstrictor)

stimulates aldosterone from adrenal gland

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14
Q

Aldosterone causes __ ___ and is the primary _____

A

Na retention

mineralocorticoid

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15
Q

Natriuretic peptides cause…

A

Na and H2O excretion

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16
Q

Natriuretic peptides released by heart due to (3 things)

A

Increase in volume
Increased Na
Stretching of vessel walls

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17
Q

GFR will _____ rate with increased ____

A

increase

volume

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18
Q

Causes of hyperosmolality

A 
H2O loss
Hyperglycemia
Diabetes insipidus
Alcohol intoxication
IV osmotically active drugs
Renal failure
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19
Q

Causes of hypo-osmolality

A

Loss of Na+ due to diuretics

SIAD

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20
Q

Urine osmol reference range

A

200-1000 mOsm/kg

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21
Q

Urine osmol used as a reflection of ____ ____ and as a measure of body ____

A

serum osmol

hydration

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22
Q

Urine:plasma osmol Ref range

A

1.0 to 3.0

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23
Q

Calculated osmol equation

A

2(Na) + (gluc/20) + (BUN/3)

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24
Q

Osmol gap is…

A

difference between measured and calculated osmol. Determines if osmotically active substances are present (ketones, etc)

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25
Q

Osmol measurement is based on _____ ____ of a solution. Not affected by ___ or ___ ___.

A

colligative properties

size, molecular weight

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26
Q

2 methods of measuring osmol.

A

Freezing point depression

Vapor pressure

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27
Q

Anion gap is…

A

the difference between measured anions and measured cations

there is never really a real gap

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28
Q

Anion gap equation

A

AG = (Na + K) - (Cl + HCO3)

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29
Q

Anion gap reference range

A

10-20 mmol/L

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30
Q

Patient reasons for a low anion gap

A

cancer patient, multiple myeloma

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31
Q

patient reasons for a high anion gap

A

ketoacidosis, alcohol, salicylates, lactic acidosis, high levels of urea

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32
Q

Sodium reference range

A

133-145 mEq/L

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33
Q

Sodium maintains osmotic pressure by…

A

being pumped out of cells. water follows. Prevents cells from swelling.

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34
Q

Sodium maintains acid-base balance by…

A

exchanging with H+ ions in kidneys

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35
Q

Na used in transmission of ____

A

nerve impulses

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36
Q

The kidney is able to excrete or conserve large amounts of Na as needed by responding to ____ ____ or _____

A

blood volume

aldosterone

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37
Q

How does sodium respond to low blood volume?

A

As blood volume decreases, GFR decreases, stimulating secretion of renin. Renin stimulates production and release of aldosterone, which causes retention of Na. Net effect = increased blood pressure.

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38
Q

3 factors that stimulate aldosterone secresion

A

Decreased blood volume
Decreased extracellular fluid Na
Increased extracellular K

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39
Q

Na and Cl levels are ____ with loss of renal function

A

decreased

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40
Q

2 main causes of hyponatremia

A

Excess loss of Na (depletional)

Excessive intake of H2O

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41
Q

Conditions/factors leading to loss of Na

A 
Diuretics
renal tubular disorder
loss of renal fx
GI loss
loss via skin
diabetic ketoacidosis
SIADH
K deficiency
Addison's
edema from nephrotic symdrome or cardiac failure
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42
Q

S/S of hyponatremia

A 
May go into shock if extreme rapid loss of Na
hypotension
weakness, fatigue, lethargy, nausea, HA
muscle cramps
Neurologic symptoms!!
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43
Q

The ____ __ ____ is most important for hyponatremia, because…

A

rate of decline

brain swells when hyponatremia occurs quickly

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44
Q

Must increase Na conc. ____ to prevent….

A

slowly

cerebral demyelination

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45
Q

2 main causes of hypernatremia

A

Loss of H2O

Excess Na

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46
Q

Reasons for loss of H2O leading to hypernatremia

A

H2O loss disproportionate to Na loss- sweating, vomiting, diarrhea, polyuria

Decreased production of AVP

Hypothalamic disorder that affects thirst mechanism

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47
Q

Reasons for excess Na leading to hypernatremia

A

Cushing’s (secondary)

Conns syndrome (primary- tumor on adrenal gland)

Brain injury causing impairment of adrenocorticoid production

Response to insulin in an uncontrolled diabetic (Na replaces glucose in plasma when glucose pushed into cells)

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48
Q

S/S of hypernatremia

A 
Primary problems associated with CNS
Weakness, nausea, HA, lethargy
Seizures, coma
blood volume expansion, HTN
Hypokalemia (usually)
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49
Q

Need to correct hypernatremia ____ or will lead to ____ ____

A

slowly

cerebral edema

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50
Q

2 ways to measure Na

A

Flame photometry

ISE

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51
Q

Na ISE uses a ___ membrane

A

glass

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52
Q

Direct ISE uses a ____ specimen

A

nondiluted

53
Q

Indirect ISE uses a _____ specimen. One problem with it is the possibility of ______ if patient has a certain condition.

A

diluted

pseudohyponatremia

54
Q

Pseudohyponatremia occurs when…

A

Patient has high lipid or monoclonal Ab content in plasma. Specimen for Indirect ISE test does not dilute correctly. H2O dispersement causes sample to be overdiluted and have falsely low Na.

55
Q

Potassium reference range

A

3.5-5.0 mEq/L

56
Q

K ions exchanged for __ in the ____ ___ ____. This causes ___ to remain in body and __ to be excreted.

A

Na
Distal Convoluted tubule
Na remains; K lost

57
Q

Electric neutrality is maintained by the kidneys…

A

retaining Na and excreting K

58
Q

4 main purposes of K

A

Nerve impulse conduction
Muscle contraction
Maintains acid-base balance
Maintains osmotic pressure

59
Q

3 ways potassium is regulated

A
  1. Dietary intake of K
  2. Kidney fx (no renal threshold): A/B balance, exchange H for K
  3. Cellular regulation w/ Na/K pump (needs ATP)
60
Q

Renal disease typically causes ___ K

A

increased

61
Q

4 causes of hypokalemia

A

Renal loss
Decreased dietary intake
IV fluids without K+
Insulin therapy (causes K to go into cells)

62
Q

Renal loss of K (4 ways)

A
  1. renal tubular acidosis
  2. K+ losing nephropathy
  3. diuretics
  4. primary aldosteronism
63
Q

Symptoms of hypokalemia

A

Cardiac arrhythmias leading to circulatory failure and HTN

Muscular cramps, weakness, confusion
Absence of peristalsis

64
Q

4 main causes of hyperkalemia

A
  1. Rapid infusion of K+ rich fluids
  2. Decreased excretion of K+ by kidney
  3. Redistribution of K+ into ECF
  4. Massive transfusion
65
Q

Causes of decreased K+ via kidney

A

Acute or end stage renal failure ass. w/ oligura or anuria

Acidosis: H+ leaves body in exchange for K+ being retained

Addison’s: Excrete Na and retain K

66
Q

dialysis patients always have high ___

A

potassium

67
Q

Causes for K+ to be redistributed into ECF

A

dehydration, shock, exercise
DKA
intravascular hemolysis

68
Q

Symptoms of hyperkalemia (4 main)

A

Mental confusion
weakness
myocardial irregularities (EKG changes)
Cardiac standstill and peripheral vascular collapse (K+ >7.0 mEq/L)

69
Q

Treatment of hyperkalemia

A

Ca++ infusion (antagonist of effects of K on heart)

Move K back into cells with NaHCO3, insulin

Kidney dialysis

70
Q

Serum K+ ____ than plasma K because…

A

0.2 higher

platelets are activated to make clot

71
Q

K+ ISE uses _____ membrane

A

valinomycin

72
Q

1 analyte affected by phlebotomy and specimen handling

A

Potassium

73
Q

Chloride reference range

A

98-107 mEq/L

74
Q

Cl- follows ___ and helps maintain ___ and ___ ___

A

Na+
pressure
electo-neutrality

75
Q

Chloride regulation (3 ways)

A
  1. Dietary Cl- almost entirely absorbed into GI tract
  2. Cl- filtered by glomerulus and reabsorbed in conjunction with Na in PCT
  3. If serum Cl <100 mEq/L = little urinary excretion
76
Q

Chloride ISE uses ____ membrane

A

Anion exchanger with ammonium salts

Not specific for chloride- other dissolved anions may interfere (ex. salicylates)

77
Q

Purpose of chloride shift

A

To maintain electrically neutral environment, Cl may shift with HCO3

CO2 created inside cells

As HCO3 builds up in RBCs, it diffuses out into plasma. Cl goes into cells to maintain neutrality.

78
Q

Causes of hyper and hypochloremia

A

Mineralcorticoid or adrenocorticoid disorders

Renal tubular disorders

Na disorders

Vomiting, diarrhea, burns, dehydration

79
Q

Reference measurement of Cl-

A

Amperometric-Coulometric Titration

80
Q

Total CO2 or Bicarb reference range

A

19-30 mEq/L

81
Q

Bicarb’s major function

A

component in blood buffer system (maintains pH)

Toxic CO2 in plasma converted to HCO3 which can be eliminated

82
Q

Total CO2 = ___ HCO3

A

90%

small amt carbonic acid, small amt CO2

83
Q

Major regulator of bicarb is ____

A

kidney

kidney exchanges bicarb for H+ to maintain pH balance

84
Q

Causes of high TCO2

A

Metabolic alkalosis (vomiting, antacids, aldosteronism)

Compensated respiratory acidosis (Emphysema, COPD), can cause negative anion cap due to increased CO2

85
Q

Causes of low CO2

A

Metabolic acidosis (DKA, severe diarrhea, dehydration, salicylate poisoning)

Compensated respiratory alkalosis

86
Q

3 ways to measure TCO2

A
  1. Calculated HCO3-, after pCO2 measurement (ABL analyzer)
  2. ISE- glass
  3. Enzymatic- Roche
87
Q

TCO2 will ____ if sample left uncapped

A

decrease

88
Q

Calcium reference range

A

8.5-10.5 mg/dL

89
Q

Adult iCal range

A

4.6-5.3 mg/dL

90
Q

___ of calcium id found in blood and tissues, with about ___ ionized and ___ bound to protein. ___ is bound to anions.

A

1%
45% ionized
40% protein-bound
15% anion-bound

91
Q

6 ways calcium is significant

A
  1. Contraction of (cardiac) muscle fibers
  2. Secretion of fluids, hormones, etc.
  3. Activation of anzymes
  4. Transfer of ions across membranes
  5. Blood coag
  6. Neuromuscular activity
92
Q

Decreasing the pH by 0.1 unit will ____ the ionized Ca by ____.

A

increase

0.05 mmol/L

93
Q

Effect of uncapped tube on iCal

A

Decreased (pH up from loss of CO2)

94
Q

3 things that regulate calcium

A
  1. Calcitonin
  2. PTH
  3. Vitamin D
95
Q

Effect of calcitonin on Calcium, PTH and Vit D.

A

Decreases calcium levels by causing bone building.

Inhibits PTH and vit D.

96
Q

Calcitonin originates in _____ in response to _____ _____.

A

medulla cells of thyroid

Increased calcium

97
Q

PTH is released in response to ___ calcium

A

decreased

98
Q

effect of PTH on calcium

A

Acts on kidneys and bones to increase calcium levels (bones break down, kidneys retain)

99
Q

Effect of vit D on calcium

A

Increases absorption in intestine and kidneys.

Increases calcium levels.

100
Q

6 causes of hypercalcemia

A
  1. hyperparathyroidism (increased PTH - increased Ca)
  2. Paget’s disease (bone disease)
  3. Malignancies
  4. Chronic renal disease (retains Ca)
  5. Sepsis
  6. Cardiopulmonary insufficiency
101
Q

Corrected calcium

A

takes albumin into account when less than 3.5 g/dL. Low albumin causes low plasma calcium

102
Q

9 causes of hypocalcemia

A

Hypoparathyroidism
Decreased vit D
GI disease causing decreased absorption of vit D or Ca
Nephrotic symdrome, decreased plasma protein
Magnesium deficiency
Chronic renal disease (cant make active vit D)
Alkalosis
Massively transfused pts
Neonates

103
Q

Only way to measure iCal

A

ISE

104
Q

Ways to measure Ca (not iCal)

A 
Atomic absorption
Color complex (arsenazo III or orthocresolphthalein complexone)
105
Q

Only 2 ions where hemolysis not a problem

A

Na and Cl

106
Q

Magnesium RR

A

1.8 - 2.4 mg/dL

107
Q

50% of magnesium stored in ____, 49% stored in…

A

bone

skeletal muscle, liver, myocardium

108
Q

Regulation of magnesium

A

Obtained via diet
Regulated by kidneys
Relationship with Ca

109
Q

PTH causes ____ reabsorption of Mag

A

increased

110
Q

Mag relationship to Ca

A

compete for renal tubular absorption

Mag needed for release of PTH and action of hormone on target tissues

111
Q

Causes of hypermagnesemia

A 
Antacids
Chronic renal disease
Severe dehydration
Adrenal insufficiency (aldosterone deficiency)
Stopping premature labor
Bone carcinoma
112
Q

Symptoms of hypermagnesemia

A 
CNS depression
Decreased reflexes
slow heartbeat
hypotension
abnormal hemostasis
lethargy
hyperkalemia, hypercalcemia
113
Q

Causes of hypomagnesemia

A 
Decreased absorption
Increased GI loss via vomiting, diarrhea
Chronic IV fluid therapy, diuretics (diluted)
PO4 depletion
Metabolic acidosis
Primary aldosteronism
vit D deficiency
AMI
114
Q

Symptoms of hypomagnesemia

A 
Neuromuscular- lethargy, weakness, tetany
Arrhythmia and cardiac problems
GI- n/v
Hypocalcemia (decreased PTH)
Hypokalemia (renal issues)
pre-term labor
115
Q

Renal issues usually cause ___ magnesium

A

increased

116
Q

2 ways to measure Mag

A 
Atomic absorption
Chlorophosphonazo III (binds, abs increase at 659)
117
Q

PO4 RR

A

2.5-4.6 mg/dL

118
Q

80-85% of PO4 is combined with ___ in ___ in the compound ____

A

calcium
bone
hydroxyapatite

119
Q

PO4 levels are ____ in morning

A

highest

120
Q

Uses for PO4

A 
storage and transfer of energy- ATP
Metabolism of glucose and lipids
Maintenance of acid-base balance
generation of bone
O2 carrying capacity of Hgb
Constituent in DNA and RNA
121
Q

PO4 regulation

A

Dietary PO4 absorbed in intestine
Control linked closely to Ca regulation
Kidneys

122
Q

PO4 has ___ relationship with calcium

A

inverse

123
Q

PTH causes ___ PO4

A

decreased

124
Q

kidney disease ___ phosphate

A

increases

125
Q

causes of hyperphosphatemia

A 
kidney dysfunction
hypoparathyroidism
Chemo- esp ALL
Acidosis
High vit D levels
126
Q

Causes of hypophosphatemia

A 
malnourishment- alcoholics, nutritional recovery symdrome
Hyperparathyroidism
Ricketts or ostermalacia
diabetic coma
Hyperinsulinism
antacids that bind PO4
127
Q

symptoms of hypophosphatemia

A

Respiratory and cardiac insufficiency
Hematologic disorders
Muscular weakness- rhabdomyelosis, myocardial dysfunction
Kidney- metabolic acidosis
RBC formation of 2,3-DPG affected, impaired O2 delivery
CNS dysfunction

128
Q

Measurement of PO4

A

forms an ammonium phosphomolybdate complex with ammonium molybdate in presence of sulfuric acid

Chem (Clinicals) (4 decks)

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