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Clinical Chemistry 2 (Lecture) > Electrolytes (M) > Flashcards

Electrolytes (M) Flashcards

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1
Q

What are the foods that are sources of electrolytes and what is the corresponding electrolyte that can be obtained in these foods?

A

1) Table salt (Na)
2) Banana (K)
3) Nuts (Mg)
4) Milk (Ca)

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2
Q

What does the term “electrolytes” mean when these are ordered on an individual in the clinical lab?

A

The term is understood to mean the measurement of serum Na, K, Cl, and total carbon dioxide (bicarbonate)

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3
Q

How are the serum concentration of Na, K, Cl, and HCO3 quantified?

A

Via the use of ion-selective electrodes (ISEs)

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4
Q

What is the major cation of extracellular fluid (ECF)?

A

Na^+

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5
Q

What is the normal reference range of Na?

A

135 - 145 mmol/L

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6
Q

Changes in Na result to what?

A

Changes in plasma volume

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7
Q

What is the largest constituent of plasma osmolality?

A

Na

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8
Q

When is Na excreted in the urine?

A

When the renal threshold for serum exceeds 110 - 130 mmol/L

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9
Q

What is hyponatremia?

A

It occurs when serum Na lvl is < 135 mmol/L

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10
Q

*What are the 2 types of hyponatremia?

A

1) Depletional hyponatremia

2) Dilutional hyponatremia

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11
Q

What are the causes of depletional hyponatremia?

A

1) Diuretics
2) Hypoaldosteronism (Addison disease)
3) Diarrhea
4) Vomiting
5) Severe burns
6) Trauma

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12
Q

What are the causes of dilutional hyponatremia?

A

1) Overhydration
2) Syndrome of inappropriate antidiuretic hormone (SIADH)
3) Congestive heart failure (CHF)
4) Cirrhosis
5) Nephrotic syndrome

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13
Q

What is hypernatremia?

A

It occurs when serum Na lvl is 150 mmol/L >

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14
Q

When does hypernatremia usually occur?

A

1) When H2O is lost as through:
a. Diarrhea
b. Excessive sweating
c. Diabetes insipidus
2) When Na is retained as through:
a. Acute ingestion
b. Hyperaldosteronism
3) Infusion of hypertonic solutions during dialysis

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15
Q

What is the major intracellular cation?

A

Potassium (K^+)

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16
Q

What is the normal reference range for K?

A

3.4 - 5.0 mmol/L

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17
Q

Do any hemolysis affect the serum K results? Why or why not?

A

Yes, because the concentration of K in RBCs is higher > in serum

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18
Q

What is the result of hemolysis to pt’s serum K lvls?

A

This is falsely increased

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19
Q

What is hypokalemia?

A

It occurs when serum K lvl is < 3.0 mmol/L

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20
Q

What are the causes of hypokalemia?

A

1) Decreased dietary intake
2) Hyperaldosteronism
3) Diuretics
4) Vomiting
5) Diarrhea
6) Laxative abuse
7) Excess insulin (w/c causes increased cellular uptake of K)

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21
Q

What is hyperkalemia?

A

It occurs when serum K lvl is 5.0 mmol/L >

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22
Q

What are the causes of hyperkalemia?

A

1) Increased intake
2) Renal failure
3) Hypoaldosteronism
4) Metabolic acidosis
5) Increased RBC lysis
6) Leukemia
7) Chemotherapy

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23
Q

What is the major anion of ECF?

A

Chloride (Cl^-)

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24
Q

What is the normal reference range for Cl?

A

98 - 107 mmol/L

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25
Q

Cl lvls change proportionally w/ what?

A

Na

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26
Q

What is hypochloremia?

A

It occurs when serum Cl lvl is < 98 mmol/L

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27
Q

What are the causes of hypochloremia?

A

1) Excessive vomiting
2) Use of diuretics
3) Burns
4) Aldosterone deficiency

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28
Q

What is hyperchloremia?

A

It occurs when serum Cl lvl is 107 mmol/L >

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29
Q

What are the causes of hyperchloremia?

A

1) Prolonged diarrhea
2) Renal tubular disease
3) Dehydration
4) Excess loss of HCO3

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30
Q

What is the 2nd largest anion fraction of ECF?

A

Bicarbonate (HCO3^-)

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31
Q

What is the normal reference range for HCO3?

A

22 - 29 mmol/L

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32
Q

Clinically, the concentration of total carbon dioxide (ctCO2) is measured because what?

A

Because it is difficult to measure HCO3

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33
Q

What are the components of ctCO2?

A

1) Primarily HCO3
2) Smaller amt of carbonic acid (H2CO3)
3) Smaller amt of carbamino bound CO2
4) Smaller amt of dissolved CO2

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34
Q

What is the approximate percentage of HCO3 of measured ctCO2?

A

Approx 90%

35
Q

What is the action of HCO3?

A

It is able to buffer excess H^+

36
Q

Since HCO3 is able to buffer excess H^+, HCO3 is considered as what?

A

As an impt buffer system of blood

37
Q

Decreased ctCO2 is associated w/ what conditions / disorders?

A

1) Metabolic acidosis
2) Diabetic ketoacidosis
3) Salicylate toxicity

38
Q

Increased ctCO2 is associated w/ what conditions / disorders?

A

1) Metabolic alkalosis
2) Emphysema
3) Severe vomiting

39
Q

What is the expected anion gap of Na^+ - (Cl^- + HCO3^-)?

A

7 - 16 mmol/L

40
Q

What is the expected anion gap of (Na^+ + K^+) - (Cl^- + HCO3^-)?

A

10 - 20 mmol/L

41
Q

What are the causes of increased anion gap?

A

1) Uremia
2) Lactic acidosis
3) Ketoacidosis
4) Hypernatremia
5) Ingestion of methanol
6) Ethylene glycol
7) Salicylate

42
Q

What is used as assessment of instrument errors?

A

Increased anion gap

43
Q

What are the causes of decreased anion gap?

A

1) Hypoalbuminemia

2) Hypercalcemia

44
Q

What are the forms of Ca and their corresponding percentages?

A

1) Free (ionized) (50%)
2) Bound to protein (40%)
3) Bound to anions (10%)

45
Q

What is free Ca?

A

It is the free form of Ca that is biologically active

46
Q

Decreased free Ca lvls causes what conditions / disorders?

A

1) Muscle spasms

2) Uncontrolled muscle contractions (called tetany)

47
Q

Serum Ca is controlled by what?

A

1) Parathyroid hormone (PTH)
2) Vitamin D (cholecalciferol)
3) Calcitonin

48
Q

What are the mechanisms of PTH in terms of regulation of serum Ca?

A

1) A decrease in free (ionized) Ca stimulates the release of PTH by the parathyroid gland, and a rise in free Ca terminates PTH release
2) In bone, PTH activates osteoclasts to break down bone w/ the release of Ca
3) In the kidneys, PTH increases tubular reabsorption of Ca and stimulates hydroxylation of vitamin D to the active form

49
Q

What are the mechanisms of vitamin D in terms of regulation of serum Ca?

A

1) Obtained by diet or exposure to sunlight
2) Initially, vit D is transported to the liver, where it is hydroxylated but still inactive. Then the hydroxylated form is transported to the kidneys, where it is converted to 1,25-dihydroxycholecalciferol, the active form of the vit
3) Ca absorption in the intestines is enhanced by vit D. In addition, PTH increases tubular reabsorption of Ca in the kidneys

50
Q

What are the mechanisms of calcitonin in terms of regulation of serum Ca?

A

1) Released by the parafollicular cells of the thyroid gland when serum Ca lvl increases
2) Inhibits vit D and PTH activity, thus decreasing serum Ca
3) Medullary carcinoma of the thyroid gland is a neoplasm of the parafollicular cells, resulting in elevated serum lvls of calcitonin

51
Q

What are the causes of hypercalcemia?

A

1) Primarily hyperparathyroidism
2) Other endocrine disorders:
a. Hypothyroidism
b. Acute adrenal insufficiency
3) Malignancy involving bone
4) Renal failure

52
Q

What are the causes of hypocalcemia?

A

1) Hypoparathyroidism
2) Hypoalbuminemia
3) Chronic renal failure
4) Mg deficiency
5) Vit D deficiency

53
Q

What are the methods used to measure total serum Ca?

A

1) Spectrophotometric (ortho-cresolphthalein complexone, arsenazo III dye)
2) ISE (ion-specific electrode)
3) Atomic absorption

54
Q

What is used for spectrophotometric methods (to measure total serum Ca)?

A

Metallochromic indicators

55
Q

What is the action of metallochromic indicators?

A

These bind Ca causing a color change

56
Q

What is the characteristic of spectrophotometric method (for measuring total serum Ca)?

A

These methods are easily automated

57
Q

What is the principle of ISE (in terms of determination of total Ca)?

A

W/ ISE analysis, the sx must be acidified to convert protein bound and complexed Ca to the free form in order to measure total Ca

58
Q

Among the methods used to measure total Ca, what is considered as the reference method?

A

Atomic absorption

59
Q

*What is measured in atomic absorption?

A

Free (ionized) serum Ca

60
Q

What is measured by ISE?

A

Free form

61
Q

True or False

Measurement (of / for total serum Ca) is temp sensitive, and generally analysis is performed at 37 DC

A

True

62
Q

What are the sources of error for measuring total serum Ca?

A

Cannot use the ff anticoagulants:

1) Oxalate
2) Citrate
3) EDTA

63
Q

What are the interferences for spectrophotometric methods?

A

1) Hemolysis
2) Icterus
3) Lipemia

64
Q

What are the interferences for ISE methods?

A

1) Protein buildup on electrode

2) Change in blood pH in vitro before analysis

65
Q

What is the normal reference range of total Ca for adults?

A

8.6 - 10.3 mg/dL

66
Q

What is the normal reference range of free Ca for adults?

A

4.6 - 5.3 mg/dL

67
Q

What are the mechanisms for regulation of phosphorus?

A

1) Phosphate in the blood is absorbed from dietary sources, released from cells, or released from bone. Regulation occurs by reabsorption or excretion by the kidneys
2) Most impt regulatory hormone is PTH, w/c increases renal excretion of phosphate
3) Vit D regulates phosphate by causing intestinal absorption and renal reabsorption

68
Q

What are the causes of hyperphosphatemia?

A

1) Renal failure
2) Hypoparathyroidism
3) Neoplastic diseases
4) Lymphoblastic leukemia
5) Intense exercise

69
Q

What are the causes of hypophosphatemia?

A

1) Diabetic ketoacidosis
2) Hyperparathyroidism
3) Asthma
4) Alcoholism
5) Malabsorption syndrome

70
Q

What are the different methods for measuring phosphorous lvls?

A

1) Ammonium molybdate + phosphate ions = phosphomolybdate complex (colorless) read at 340 nm
2) When aminonaphtholsulfonic acid is used to reduce the complex, a colored product is formed and read at 600 - 700 nm
3) Phosphomolybdenum + electrons = molybdenum blue

71
Q

What are the sources of error for measuring phosphorus lvls?

A

1) Hemolysis
2) Lipemia
3) Icterus
4) Cannot use the ff anticoagulants:
a. Oxalate
b. Citrate
c. EDTA

72
Q

What is the normal reference range of phosphorous for adults?

A

2.5 - 4.5 mg/dL

73
Q

What are the different forms of Mg and their corresponding percentages?

A

1) Free (ionized) (55%)
2) Bound to protein (30%)
3) Complexed (15%)

74
Q

What is free form of Mg?

A

It is the free form of Mg that is biologically active

75
Q

What are the mechanisms for regulation of Mg?

A

1) The Mg lvl is regulated by the kidneys through reabsorption and excretion
2) PTH enhances reabsorption by the kidneys and intestinal absorption

76
Q

What are the causes of hypermagnesemia?

A

1) Renal failure

2) Excess antacids

77
Q

What are the causes of hypomagnesemia?

A

1) GIT disorders

2) Renal diseases

78
Q

*What are the causes of hypomagnesemia?

A

1) Hyperparathyroidism (hypercalcemia)
2) Drugs
a. Diuretic therapy
b. Cardiac glycosides
c. Cisplatin
d. Cyclosporine
3) Diabetes mellitus (DM) w/ glycosuria
4) Alcoholism due to dietary deficiency

79
Q

What are the methods used to measure total serum Mg?

A

1) Calmagite
2) Methylthymol blue
3) Atomic absorption spectrophotometry
4) ISE

80
Q

What is the reference method for measuring total serum Mg?

A

Atomic absorption spectrophotometry

81
Q

What method is used to measure free (ionized) serum Mg?

A

ISE

82
Q

What are the sources of error for measuring Mg lvls?

A

1) Hemolysis
2) Cannot use the ff anticoagulants:
a. Oxalate
b. Citrate
c. EDTA

83
Q

What is the normal reference range for Mg for adults?

A

1.7 - 2.4 mg/dL

Clinical Chemistry 2 (Lecture) (17 decks)

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