LEC4 - POTASSIUM AND CHLORIDE Flashcards
1
Q
what are the measured analyte in the body
A
Na, Cl, K, HCO3
2
Q
methods for determination of unmeasured analyte
A
AAS - ground state - calcium
FES - excited by flame
3
Q
is the major intracellular cation in the body
A
Potassium (K+)
4
Q
potassium is known as
A
kalium
5
Q
the concentration of potassium inside is how many times greater than the outside
A
20 times greater
6
Q
In laboratory, Only how many percent of the body’s total K+ circulates in the plasma?
A
2% - only two percent is detected in serum
7
Q
it is the single most important analyte in terms of an abnormality being immediately life threatening
A
potassium
8
Q
in ascending loop of henle, potassium is absorbed passively together with what electrolytes
A
chloride and sodium in sodium-potassium-chloride co transforter
9
Q
how many percent of potassium are being reabsorbed in our kidney tubules
A
70-80%
10
Q
potassium’s regulation includes
A
o Neuromuscular excitability
o Contraction of the heart
o Intracellular fluid volume regulation
o Hydrogen ion concentration
11
Q
potassium has a major effect on the contraction of
A
skeletal muscles and cardiac muscles
12
Q
potassium’s plasma concentration is greatly influenced by the +__
A
kidneys and aldosterone
13
Q
about how many mmol/ L are found in ECF
serum ref range of potassium
A
3.5-5.1 mmoll/L
14
Q
principal determinant of urinary potassium
A
distal nephron
15
Q
how can potassium helps in intracellular fluid volume
A
Correct water distribution inside the cell to prevent bursting or shrinking
16
Q
this hormone regulates the urinary loss of potassium in the cortical collecting duct
A
aldosterone
17
Q
this hormone provides a channel for the cellular entry of the potassium
A
epinephrine
18
Q
promotes entry of potassium into skeletal muscles and hepatic through the action of the Na-K ATPase
A
insulin
19
Q
a slight hemolysis around 50 mg/dl of hemoglobin can increase potassium level by
A
3% / 0.5 mmol
20
Q
a severe hemolysis around >500m mg/dl of hemoglobin can increase potassium level by
A
30%
21
Q
muscular activity such as exercise and prolonged standing can increased potassium by
A
10% to 20%
22
Q
prolonged contact of serum and red cell can cause false __ in potassium
A
increase
23
Q
A
24
Q
a stable electrical charge across a neuron’s membrane when it is not actively sending signal
A
resting membrane potential - RMP
25
relationship of the values of potassium, RMP, and action
inversely
26
if someone is moving, what is happening to the potassium values
increased
27
if someone is moving, what is happening to the RMP values
decrease
28
an increased in heartbeat will affect the potassium values and the RMP, in what way it can influence the values of potassium and RMP
increase potassium and decrease RMP
29
the elevated potassium, and an increase in heart beat will affect the heart in what way
it can cause sudden stoppage of heart or heart attack
30
this ion is the one responsible in the pH of blood for being acidic
hydrogen ion
31
once the potassium goes out of the cell, the Na and hydrogen ions will replace the lost potassium.
correct?
correct
32
an increase of hydrogen ion will cause
metabolic acidosis
33
a decrease of hydrogen ion will cause
alkalosis
34
if there's metabolic acidosis, the hydrogen ions in the blood is elevated. To lessen or correct it, what will be the role of potassium?
potassium will go out of the cell so the hydrogen ions can go inside the cell and lower the amount of hydrogen ions in the blood that causes acidosis.
35
if there's metabolic alkalosis, the hydrogen ions in the blood is decreased. To elevate or correct it, what will be the role of potassium?
potassium must go inside the cell so the hydrogen ions can go outside and go to the bloodstream and elevate the number of hydrogen ions.
36
Na+-K+ ATPase pump mechanism, what type of transport
active transport
37
2 REGULATION OF POTASSIUM
the use of Na+-K+ ATPase pump
and the Diffusion of potassium out of the cell into the ECF and plasma
38
when do potassium uses passive diffusion instead of active transport?
when there's a decrease in pump activity such as
o Depletion of metabolic substrate > e.g.glucose for ATP production
o Competition for ATP between the pump and other energy-consuming activities
o Slowing of cellular metabolism
39
Three factors that influence the distribution of K+ between cells
and ECF are as follows:
(1) K+ loss frequently occurs whenever the Na+, K+ ATPase pump is inhibited
(2) insulin
(3) catecholamines
40
(1) K+ loss frequently occurs whenever the Na+, K+ ATPase pump is inhibited by conditions such as __, __, and ___
hypoxia, hypomagnesemia, or digoxin overdose
41
(2) insulin promotes acute ____ by increasing Na+, K+-ATPase activity;
entry of K+ into skeletal muscle
and liver
42
insulin promotes the entry of potassium into the cell thus will result in what condition
hypokalemia
43
a catecholamines that is a B stimulator that promotes cellular entry of K
epinephrine
44
a catecholamines that is a B blocker that impairs cellular entry of K
propanolol
45
difference of epinephrine to propanol when it comes to potassium
epinephrin - pasok sa cell
propanolol - wag papasok oki? di ka muna papasok sa school
46
OTHER FACTORS that might affect distrbution of potassium aside from inhibited atpase pump, insulin, and cathecolamines
exercise
hyperosmolality
cellular breakdown
47
exercise can cause false __ in potassium, please explain why as well
false elevations as the K is released from muscle cells during exercise
48
increase plasma K+ by ___mmol/L with
mild to moderate exercise
0.3 to 1.2
49
increase plasma K+ by ___mmol/L with
exhaustive exercise
2-3 mmol/L
50
can elevations due to exercise be reversed?
These changes are usually reversed after several minutes of rest
51
causes water to diffuse from the cells,
carrying K+ with the water, which leads to gradual
depletion of K+ if kidney function is normal
Hyperosmolality
52
conditions we can observe elevation of potassium that results from cellular breakdown are
are severe trauma, tumor lysis syndrome, and massive blood transfusions.
53
the K in potassium came from the word
Kalium = kalemia
54
It is a serum potassium concentration above the upper limit
of the reference interval.
HYPERKALEMIA
55
, Hyperkalemia is seen in the following conditions:
o acute or chronic renal failure
o Dehydration (less water more concentrated K )
o Addison's disease (hypoaldosteronism - aldosterone is responsible for excretion of K in the urine, so naiipon lang sa plasma
o salt losing nephropathy - nawawala si sodium and water, lower plasma volume concentrated si K
o immunosuppressive drugs
56
Plasma K+ increases by ______ mmol/L for each 0.1 unit reduction of pH
0.2 to 1.7
57
this one is primarily caused by medtech resulting to hyperkalemia
artifactual - prolonged tourniquet
58
explain why acidosis caused hyperkalemia
it's for the compensation. Since hydrogen ions are elevated in the blood, potassium will gou out of the cell and will cause an increase in K values
59
why chemotherapy is included in hyperkalemia
because of the cytotoxicity that causes destruction of cell leaking the potassium to the blood
60
how thrombocytosis can affect potassium
platelet releases potassium upon clotting or coagulation process. Since we are using serum, it adds up
61
SYMPTOMS OF HYPERKALEMIA
Hyperkalemia can cause
muscle weakness, tingling,
numbness, or mental confusion by altering neuromuscular
conduction.
62
Muscle K+ weakness does not usually develop until plasma
reaches ____ mmol/L
8
63
Hyperkalemia disturbs ____, which can lead to cardiac arrhythmias and possible cardiac arrest
cardiac conduction
64
Plasma K+ concentrations of ____ mmol/L may alter the
electrocardiogram (ECG),
6-7
65
Plasma K+ concentrations of 6-7 mmol/L may alter the
electrocardiogram (ECG), and concentrations_____ mmol/L
may cause fatal cardiac arrest.
>10
66
Hypokalemia is a plasma K+ concentration below the lower
limit of the reference range
HYPOKALEMIA
67
HYPOKALEMIA
It is seen in the following condition
o Alkalosis
o Vomiting
o Over hydration
o Use of Loop diuretics
o Syndrome of Inappropriate ADH (SIADH) secretion
o Bartter's syndrome
gastric suction and laxative use
intestinal tumor
malabsorption
cancer and radio therapy
vomiting and diarrhea
68
SYMPTOMS OF HYPOKALEMIA
Symptoms (e.g., weakness, fatigue, and constipation) often
become apparent as plasma K+ decreases ____ mmol/L.
<3
69
Hypokalemia can lead to muscle weakness or paralysis,
which can interfere with
breathing
70
The dangers of hypokalemia concern all patients, but
especially those with ____ because of
an increased risk of arrhythmia, which may cause sudden
death in certain patients.
cardiovascular disorders
71
Mild hypokalemia (3.0 to 3.4 mmol/L) is usually
asymptomatic
72
acute leukemia is one of the symptoms of hypokalemia, what are the 3 acute leukemia involved?
acute myelogenous leukemia
acute myelomonocytic leukemia
acute lymphocytic leukemia
73
COLLECTION OF SAMPLES
* Prevent artifactual hyperkalemia
t/f
true
74
a serum used if can't be tested immediately is stored in
refrigerator
75
a whole blood used if can't be tested immediately is stored in
room temp
76
the important anticoagulant for potassium is
heparin
77
if we store the whole blood in cold temperature, what will happen to the potassium
result in falsely increased vales, promotes release of K in serum
78
Hemolysis → ___% increase in K+ (falsely elevated)
3-30
79
grades of Hemolysis → 3-30%
o Slight hemolysis (3%)
o Gross hemolysis (30%)
80
the most common cause of artifactual hyperkalemia
Hemolysis
81
Flame Emission Spectrophotometry (FES)
PERFORMING TO, EMIT COLORED FALMES
o SODIUM
yellow
82
Flame Emission Spectrophotometry (FES)
PERFORMING TO, EMIT COLORED FALMES
o potassium
violet
83
method for determination of potassium
EMISSION FLAME PHOTOMETRY
ION-SELECTIVE ELECTRODE
ATOMIC ABSORPTION SPECTROPHOTOMETRY
COLORIMETRY- LOCKHEAD AND PURCELL
84
what is the critical hypokalemic symptom
arrythmia - may cause sudden death
85
the most common cause of extrarenal loss of potassium
diarrhea (low urine anion gap )
86
most common cause of hypokalemia
impaired renal function/renal loss
can be attributed to increased activity of aldosterone
87
whenever glucose is transported into the cell, it is accompanied by __
potassium
88
relationship of potassium to aldosteron
aldosterone promotes potassium excretion and hydrogen ion
so in acidosis, magiincrease si aldosterone para malabas si hydrogen ion. Since makakaaffect din si ALDO kay K, magcacause ng hypokalemia
89
first step in differential diagnosis of hyperkalemia
to rule out pseudohyperkalemia
90
what are the 3 major causes of hyperkalemia
increased K intake
shift of K from the cell
impaired renal excretion
91
first step in the differential diagnosis of hypokalemia
measure excretion of potassium
92
if urinary K excretion is low, what are the causes of hypokalemia
low intake, extrarenal loss of K, intracellular shift
93
if urinary K excretion is normal or increased, what are the causes of hypokalemia
renal loss - must measure the plasma renin activity and plasma aldosterone
94
is the major extracellular anion
CHLORIDE
95
the chief counter ion of sodium in ECF
chloride
96
it is involved in maintaining osmolality, blood volume, and electric neutrality
CHLORIDE
97
csf chloride is a significant test in the diagnosis of
meningitis
98
may also occur when there is an excess
loss of HCO3 (bicarbonate)
Hyperchloremia
99
Hyperchloremia
It can be seen in the following conditions
o Dehydration
o Renal tubular acidosis (RTA)
o salicylate intoxication
o primary hyperparathyroidism
o Acute renal failure
o Metabolic acidosis
o prolonged diarrhea
100
why is there HYPERCHLOREMIA in metabolioc acidosis
there's an increase of hydrogen ions. Bicarbonate is the one that is supposed to counter hydrogen ions, however, if there's a loss of bicarbonate ions, chloride will compensate thus results to elevated values of chloride.
chloride has negative charge thus will neutralize hydrogen ions
101
MEASUREMENT OF CHLORIDE TO SWEAT SAMPLE is for what disease or condition
CYSTIC FIBROSIS
102
in CYSTIC FIBROSIS there's a defect in
cystic fibrosis transmembrane conductance
regulator (CFTR)
103
in laboratory, we induce sweating using
pilocarpine iontophoresis
104
pilocarpine iontophoresis
diagnostic level of sweat chloride is
> 60 mmol/L
105
Most commonly used for chloride
Ion-selective electrode
106
Colorimetric method for chloride determination
Schales-Schales method
107
Schales-Schales method uses what reagent
mercuric thiocyanate and
ferric nitrate
/ mercuric nitrate
108
Mercurimetric Titration (Schales-Schales method complex colored formed
blue violet (mercuric chloride)
109
Mercurimetric Titration (Schales-Schales is measured as what nm
480 nm
110
Cotlove Chloridometer uses how many molecules if silver and chloride
2 molecules of silver
2 molecules of chloride
111
Amperometric-coulometric Titration (Cotlove Chloridometer)
what are the components used
Silver ion use to react chloride molecule to form silver
chloride
112
methods used for chloride determination
Ion-selective electrode
spectrophotometric assay - reddish complex
Mercurimetric Titration (Schales-Schales method - blue violet
Amperometric-coulometric Titration (Cotlove Chloridometer)
Colorimetry
113
REFERENCE INTERVAL for chloride
Normal serum concentration:
98-106 mmol/L
114
Daily urinary output of chloride
110-250 mmol/L
o Urine (24h) mmol/d, varies with diet
115
116
