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Clinical Pathology > Monovalent Electrolytes, Anion Gap, and Osmolality > Flashcards

Monovalent Electrolytes, Anion Gap, and Osmolality Flashcards

1
Q

What are the monovalent electrolytes?

A 
Na
K
Cl
HCO3
Lactate
Ketones
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2
Q

What is the role of Na, K, and Cl in metabolism?

A

Responsible for shifts between ICF and ECF

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3
Q

What is the concentration of Na, K, and Cl like in ECF?

A

Na and Cl rich and K poor

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4
Q

What will changes in the ECF electrolyte concentration change?

A

Plasma electrolytes concentration

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5
Q

What electrolyte do platelets release?

A

K

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6
Q

When platelets release K, does the serum or plasma have a higher concentration?

A

Serum

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7
Q

How are electrolytes and H2O excreted or lost?

A

Via kidneys, skin, or respiration

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8
Q

How is the [HCO3] altered?

A

By changing other [electrolytes] or acid-base balance

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9
Q

What does abnormal [electrolyre] in plasma cause?

A

Decreased or increased intake
Shifts between ICF and ECF
Increased renal retention
Increased loss

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10
Q

What is [Na] in plasma equivalent to?

A

[Na] in ECF

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11
Q

What is important for [Na] interpretation?

A

Hydration

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12
Q

How does [K] affect [Na]?

A

If [K] decreases, [Na] also decreases since it enters cells to keep the electrical balance
A severe [K] increase would be necessary for [Na] to increase, but severe [K] is not compatible with life

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13
Q

What does H2O follow?

A

Na, but not in the distal nephron because there is an absence of ADH

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14
Q

What is the Na concentration regulated by?

A

Blood volume and palsma osmolality regulation

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15
Q

How does blood volume regulate [Na]?

A

Hypovolemia –> RAS –> angiotensin II and aldosterone: Angiotensin II increases Na, K, Cl resorption in proximal tubules; Aldosterone increases Na resorption in collecting ducts
Hypovolemia –> carotid sinus baroreceptors –> ADH release –> increased H2O resorption
Hypervolemia –> atrial baroreceptors –> atrial natriuretic peptide –> decreased Na resorption

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16
Q

How does plasma osmolality regulate [Na]?

A

Hyperosmolality –> hypothalamic osmoreceptors –> promotion of water intake and release of ADH –> H2O resorption and Na, K, Cl in ascending loop of henle
Hypoosmolality –> decreased water intake

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17
Q

How is [Na] self regulated?

A

Decreased [Na] –> aldosterone release, increased retention

Increased [Na] –> decreased aldosterone release, decreased retention

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18
Q

What is the most important regulator of aldosterone release?

A

[K]

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19
Q

What is dehydration the equivalent of?

A

Decreased tb-H2O

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20
Q

What happens if you have only H2O loss?

A

Decreased intake or loss of free H2O

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21
Q

What happens if you lose H2O and Na?

A

Alimentary, renal, or cutaneous loss

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22
Q

What are hypernatremic, hyperosmolar, and hypertonic dehydrations caused by?

A

Net hypoosmolar or hypotonic fluid loss –> H2O loss > Na loss

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23
Q

What are normonatremic, isoomolar, or isotonic dehydrations caused by?

A

Net isoosmolar or isotnoic fluid loss –> H2O loss = Na loss

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24
Q

What are hyponatremic, hypoosmolar, and hypotnoic dehydrations caused by?

A

Net hyperosmolar of hypertonic fluid loss –> H2O loss < Na loss

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25
Q

What are the disorders associated with hypernatremia?

A

Inadequate water intake
Pure water loss
Loss of water > loss of Na
Na excess group

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26
Q

What is the pathogenesis of loss of water > loss of Na?

A

Alimentary or renal osmotic loss

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27
Q

What is the pathogenesis of Na excess group?

A

Decreased renal excretion of Na

Excess Na intake with concurrent restricted H2O intake

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28
Q

What are symptoms of dehydration with net loss of isotonic fluids in the alimentary system?

A

Vomit
Diarrhea
Sequestration

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29
Q

What are symptoms of dehydration with net loss of isotonic fluids in the renal system?

A

Polyuric renal diseases with defective tubular functions
Osmotic diuresis
Increased diuresis

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30
Q

What are symptoms of dehydration with net loss of isotonic fluids cutaneously?

A

Profuse sweating in horses

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31
Q

What can create either normonatremia or hyponotremia?

A

Edema or transudation with net retention of isotonic fluids

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32
Q

What are causes of edema or transudation with net retention of isotonic fluids?

A

Congestive heart failure
Hepatic cirrhoses
Nephrotic syndrome (PLN)

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33
Q

What are the 2 theories associated with hepatic cirrhosis?

A

Underfilling theory

Overflow theory

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34
Q

What are the disorders associated with hyponatremia?

A 
Na deficit
H2O excess
Shifting water ICF --> ECF
Shifting of Na from ECF to ICF
Shift of Na from IV to EV
K depletion
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35
Q

What are the causes of Na deficit with hyponatremia?

A

Alimentary, renal, cutaneous, or third space loss

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36
Q

What causes H2O excess with hyponatremia?

A

Water retention > Na retention (edematous disorders)

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37
Q

Where does shifting of water from ICF to ECF that causes hyponatremia occur?

A

Osmotic draw

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38
Q

Where does shifting of Na from ECF to ICF that causes hyponatremia occur?

A

Muscle

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39
Q

Where does shifting of Na from IV to EV that causes hyponatremia occur?

A

Uroperitoneum

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40
Q

What is potassium concentration dependent on?

A

Mostly on tbK and movement into and out of the cell in response to changes in acid-base status

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41
Q

Why are most cells K rich?

A

Na/K ATPase pump

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42
Q

What is plasma K regulated through?

A

ECF ICF

Renal excretion

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43
Q

What should be considered when interpreting [K+]?

A

Acid base status

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44
Q

What may cause hyperkalemia to shift ICF to ECF?

A

An inorganic acidosis

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45
Q

Does an organic acidosis cause hyperkalemia?

A

Not typically

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46
Q

What may cause hypokalemia?

A

Treatment of acidosis

Metabolic alkalosis

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47
Q

What promotes K uptake?

A

Epinephrine and insulin

Hyperkalemia causes cellular uptake of K

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48
Q

Where is K resorbed?

A

Before the distal nephron

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49
Q

What is K secreted by?

A

Principal cells of collecting tubules, promoted by aldosterone

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50
Q

What are the major stimulants of aldosterone secretion?

A

Hyperkalemia and angiotensin II

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51
Q

What happens to K in hypochloremic states?

A

Resorption of Na without Cl establishes electrochemical gradients that promotes K secretion

52
Q

When does hyperkalemia typically occur?

A

In decreased K renal excretion or shifts from ICF to ECF

53
Q

What are the disorders associated with hyperkalemia?

A

Shifting of K from ICF to ECF
Increased total body K
Repeated chylous effusion drainage

54
Q

What are causes of shifting of K from ICF to ECF?

A 
Metabolic inorganic acidosis
From muscle
Massive intravascular hemolysis, massive tissue necrosis
Hypertonicity: diabetes mellitus
Pseud-hyperkalemia
55
Q

What are causes of increased total body K?

A

Renal insufficiency: oliguric, anuric
Urinary tract obstruction or leakage
Hypoaldosteronism, hypoadrenocorticism

56
Q

When do you have hypokalemia?

A

ECF —> ICF
Decreased intake
Increased loss

57
Q

What are the disorders associated with hypokalemia?

A

ECF —> ICF
Decreased total body K
Hypokalemic renal failure in cats

58
Q

What are causes of ECF —> ICF associated with hypokalemia?

A

Metabolic alkalosis

Increased insulin activity

59
Q

What are causes of decreased total body K?

A

Decreased intake
Increased renal loss: increased fluid flow, ketonuria, lacturia, bicarbonaturia, and hypochloremic metabolic alkalosis
Vomiting, diarrhea, excessive salivation
Sweating in horses

60
Q

What are causes of a decreased Na:K ratio?

A 
Hypoadrenocorticism
Diarrhea
Renal failure
Urinary tract obstruction or uroperitoneum
Diabetes mellitus with ketonuria
Third space loss
61
Q

What is serum [Cl] equal to?

A

ECF [Cl]

62
Q

What is [Cl] influenced by?

A

Na and HCO3

63
Q

What controls [Cl]?

A

Renal resorption and secretion

Alimentary tract functions

64
Q

What does hyperchloremia typically occur with?

A

Hypernatremia: increased [Na] –> increased [Cl]

Occasionally with low bicarb: decreased [HCO3] –> increased [Cl]

65
Q

What are diseases and conditions associated with hyperchloremia?

A

Water deficit (inadequate water intake, pure water loss)
Excess Cl
Hyperchloremic metabolic acidosis: alimentary, renal
Chronic respiratory alkalosis

66
Q

What does hypochloremia typically occur with?

A

Hyponatremia or increased serum bicarb

Also metabolic acidosis with increased anion gap

67
Q

What are conditions assoicated with Hypochloremia?

A

Cl deficit
H2O excess (water retention > Cl retention)
Shifting water ICF to ECF (osmotic draw)
Shift of Cl from IV to EV (uroperitoneum)

68
Q

What are causes of Cl deficit?

A

Hyponatremic dehydration: Alimentary, renal, cutaneous or third space loss
Acid base disturbances: metabolic alkaloses, metabolic acidoses with increased anion gap

69
Q

What is bicarb?

A

A major buffer that helps maintain the blood pH

70
Q

What is bicarb produced from?

A

H2O and CO2 by carbonic anhydrase

71
Q

What does total CO2 reflect?

A

Total amount of CO2 gas that can be liberated from serum

72
Q

What percent of the potential CO2 gas is in the form of HCO3?

A

95% (5% is dissolved)

73
Q

What is [tCO2] nearly equal to?

A

[HCO3]

74
Q

What causes increased [HCO3] or [tCO2]?

A

Metabolic alkalosis, primary or compensating

75
Q

What are conditions associated with increased [HCO3] or [tCO2]?

A

Loss of H from the body
Shift of H from ECF to ICF due to hypokalemia
Administration
Contraction alkalosis

76
Q

What are causes of loss of H+ from the body?

A 
Gastric loss (vomiting, pyloric obstruction)
Renal loss of H+ (loop of Henle diuretics, thiazide diuretics, secondary to respiratory acidosis, hypokalemia)
77
Q

What causes decreased [HCO3] or [tCO2]?

A

Metabolic acidosis, primary or compensating

78
Q

What are conditions associated with decreased [HCO3] or [tCO2]?

A

Generation of excess H+
Decreased renal excretion of H+
Increased HCO3 loss
Dilutional acidosis

79
Q

What are causes of generation of excess H?

A

Tirational acidoses
Lactic acidosis
Ketoacidosis
Ingestion of certain compounds (ethylene glycol, methanol)

80
Q

What are causes of decreased renal excretion of H?

A

Renal failure
Urinary tract obstruction and uroperitoneum
Distal renal tubular acidosis
Hypoaldosteronism in hypoadrenocorticism

81
Q

What are causes of increased HCO3 loss?

A

Alimentary (intestinal and pacreatic secretions are HCO3 rich)
Renal (proximal renal tubular acidosis: defect in HCO3 conservation)

82
Q

What is a cation?

A

Atom or molecule with positive charge

Monovalents, divalents

83
Q

What is measured cation charge?

A

Na and K
Monovalents measured as free ions
[ion] = [charge]

84
Q

What is unmeasured cation charge?

A

[Charge] of all other cations of blood
fCA, fMg, and cationic globulins
[charge] > [ion]

85
Q

What is an anion?

A

Atom or molecule with negative charge

Monovalent, divalent, trivalent

86
Q

What is measured anion charge?

A

Cl and HCO3
Monovalents and measured as free ions
[ion] = [charge]

87
Q

What is unmeasured anion charge?

A

[Charge] of all other anions of blood
PO4, albumin, anions or organic acids, and SO4
[charge] > [ion]

88
Q

What is total cation or anion charges?

A

Total [charge]

Measured and unmeasured

89
Q

What is the anion gap?

A

Difference in the [charge] between uA and uC

90
Q

What is the charge of serum?

A

Neutral

91
Q

What are the major contributors to anion gap?

A

Cations: Na and K (95%)
Anions: Cl and HCO3

92
Q

What is the major purpose of calculating anion gap?

A

Identify increase uA, thus detect increased circulating anionic molecules

93
Q

What is the anion gap of a healthy animal?

A

uA are greater than uC

94
Q

What is the anion gap almost equivalent to in a health animal?

A

[Anions] from organic acids and proteins, PO4, and SO4

95
Q

What is the anion gap of normochloremic and hypochloremic metabolic acidosis?

A

Increased AG due to increased uA

96
Q

What is the anion gap of hypochloremic metabolic alkalosis?

A

No change in AG

97
Q

What is the AG of an animal with hyponatremia and hypochloremia?

A

No change in AG

98
Q

What is the anion gap on an animal with hypoproteinemia?

A

Decreased AG

99
Q

What are causes of increased AG?

A

Metabolic acidosis

Hyperalbuminemia

100
Q

What is decreased AG often due to?

A

Hypoalbuminemia

101
Q

What is the glycolytic pathway?

A

Anaerobically converts glucose into ATP and generate pyruvate

102
Q

What is the major tissue source of lactate?

A

Skeltal muscle

103
Q

What is gluconeogenesis?

A

L-lactate –> glucose (Cori cycle)

L-lactate –> ATP (Krebs)

104
Q

What is the primary reason for hyperlactemia?

A

Hypoxia

May also be due to defective metabolic pathways

105
Q

What are disorders associated with hyperlactemia?

A

Inadequate delivery of O2 to tissues (stagnant hypoxia, demand hypoxia)
Increased production by metabolic pathways
Sepsis
Canine babesiosis
Liver disease
Transfusion of stored erythrocytes

106
Q

What is the relationship between lactate and AG?

A

Both L-lactate and D-lactate will contribute to an anion gap

107
Q

What is ketogenesis in hepatocytes promoted by?

A

Glucagon

108
Q

What is ketogenesis in hepatocytes inhibited by?

A

Insulin

109
Q

What is increased ketine body concentration in blood called?

A

Ketonemia

110
Q

What is the clinical disorder of increased ketone body concentration?

A

Ketosis

111
Q

Why does ketosis occur?

A

Excess glucagon or insulin deficiency

In negative energy status: oxidation of lipids with inadequate amount of oxaloacetate

112
Q

What are causes of ketonemia in all mammals?

A

Starvation
Prolonged anorexia
Diabetes mellitus

113
Q

What are causes of ketonemia in cattle?

A

Bovine ketosis in lactation
Displaced abomasum
Hepatic lipidosis

114
Q

What are causes of ketonemia in dogs?

A

Starvation
Lactation
Endurance racing

115
Q

What are causes of ketonemia in horses?

A

Endurance racing

116
Q

What is osmolality?

A

Concentation of a solute in moles/kg

117
Q

What is osmolarity?

A

Concentration of a solute in moles/L

118
Q

What is osmotic pressure?

A

Force required to counterbalance the force of osmotic solvent flow through

119
Q

What is osmosis?

A

Passage of solvent from a solution of lower concentration to a solution of higher concentration through a semipermeable membrane

120
Q

What is tonicity?

A

Effective osmolality of a solution

121
Q

What is a solute?

A

Substance dissolved in a solvent

122
Q

What is colloidal osmotic pressure?

A

Osmotic pressure exerted by colloidal particles

123
Q

What are colloidal particles?

A

Macromolecules too small to settle out by gravity

124
Q

What is the major solute in serum?

A

Na

Cl is second

125
Q

What are causes of increased osmolality?

A

Increased Na, urea, glucose

Increased concentration of nonanionic compound

126
Q

What are causes of decreased osmolality?

A

Hyponatremia

Clinical Pathology (16 decks)

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