Functions of Electrolytes 1. Controls the ________ of water between fluid compartments 2. Maintains the ___-___ balance 3. Production of ________ potential 4. ________ for enzymes 5. Maintenance of electrical ________

1. Osmosis 2. Acid-base 3. Action 4. Cofactors 5. Neutrality

(P) Lec 1: Electrolytes Flashcards by Kchianna Lauren Coronel

Electrolytes are:
1. (Organic/Inorganic) substances
2. Capable of (dissociating/ionizing) into ions
3. Compounds that (contain/do not contain) carbon
4. Able to form their own charges in (pure/ultrapure) water

Inorganic
Dissociating
Contain
Pure

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What are the positive (+) and negative (-) charges called?

Cations (+) and Anions (-)

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Enumerate the 5 medically important electrolytes in the body

Sodium (Na+)
Chloride (Cl-)
Potassium (K+)
Calcium (Ca 2+)
Magnesium (Mg 2+)

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Which among the 5 medically important electrolytes in the body is the sole anion?

Chloride (review its placement in the periodic table; on the right)

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Functions of Electrolytes

Controls the ________ of water between fluid compartments
Maintains the ___-___ balance
Production of ________ potential
________ for enzymes
Maintenance of electrical ________

Osmosis
Acid-base
Action
Cofactors
Neutrality

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What are the 2 body fluid compartments?

Extracellular and Intracellular

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The Extracellular and Intracellular compartments are mainly maintained by what 2 electrolytes?

Sodium (Na) and Chloride (Cl)

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What 2 electrolytes are involved in “chloride shifting” during acid-base balancing of the electrolytes?

Potassium (K+) and Chloride (Cl-)

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TOF: The body system is dependent on pOH

False (pH)

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What 2 electrolytes are needed for the production of muscle action potentials?

Potassium (K+) and Calcium (Ca 2+)

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This electrolyte plays an important role as a cofactor for enzymes; it works alongside zinc in trace elements and porphyrins

Magnesium (Mg 2+)

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This body fluid has electrical neutrality (anions = cations)

Note: if too much, it would be released and if too little, it would be produced

Blood

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Which 2 electrolytes have a 2+ charge?

Magnesium (Mg 2+) and Calcium (Ca 2+)

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Identify the function from the given electrolyte/s

Sodium (Na+) and Chloride (Cl-)

Osmosis of water

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Identify the function from the given electrolyte/s

Potassium (K+) and Chloride (Cl-)

Acid-base balance

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Identify the function from the given electrolyte/s

Potassium (K+) and Calcium (Ca 2+)

Production of action potential

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Identify the function from the given electrolyte/s

Magnesium (2+) with Zinc

Enzyme cofactor

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Refers to the difference between the cations and anions routinely measured in serum

Anion Gap

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What 4 electrolytes are used in computing for the anion gap?

Sodium (Na+)
Potassium (K+)
Chloride (Cl-)
Bicarbonate (HCO3-)

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Familiarize yourself with the 2 anion gap formulae

[Na + K] - [Cl + HCO3]
[Na] - [Cl + HCO3]

Note: The difference is between the absence and presence of K+

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What is the normal value for the anion gap (in mmol/L)?

10 to 17 mmol/L

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The anion gap (anions = cations) is significant for what?

Electrical neutrality

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Increased or Decreased Anion Gap Result?

Uremia, ketosis, lactic acidosis, dehydration, ingestion of toxins, salicylates, and paraldehyde

Increased

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Increased or Decreased Anion Gap Result?

Lithium toxicity, hypermagnesemia, multiple myeloma, polyclonal gammopathy, polymyxin B treatment, and hypoalbuminemia

Decreased

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TOF: If the electrolyte result of an individual is abnormal but the anion gap is normal, the machine may have a problem

False (electrolyte is normal but anion gap is abnormal)

Once an individual accumulates an acidic anion, it may actually (increase/decrease) the anion gap

Increase

If the accumulated electrolytes are proteins with basic properties, it will (increase/decrease) the anion gap

Decrease

# Electrolyte Exclusion The electrolyte exclusion effect is performed in what measurement of serum or plasma?

Water Phase Measurement

# Electrolyte Exclusion For blood chemistry analysis, the blood should be (clotted/in liquid form) before centrifuging

Clotted

# Electrolyte Exclusion What 3 layers are formed after centrifuging a blood sample?

1. Plasma/serum 2. Buffy coat 3. Packed RBCs

# Electrolyte Exclusion What aliquot is obtained and used from the centrifuged tube for this procedure?

Plasma/serum (the liquid portion)

# Electrolyte Exclusion How much (in percentage) does the plasma/serum make up the blood sample in the tube?

60%

# Electrolyte Exclusion How much (in percent) of the plasma/serum is water? Note: The water is what will be measured

98%

- The most abundant EXTRACELLULAR CATION and electrolyte in general - Has an intracellular to extracellular ratio of 1:12 - Functions as the principal osmotic pressure maintainer

Sodium (Na+)

What is the old name of Sodium?

Natrium

# Sodium Regulation - This hormone is for water retention/absorption - If water is retained, sodium is also retained because sodium follows where water goes - Therefore, it increases sodium in the system as well

Antidiuretic Hormone (ADH)

# Sodium Regulation - This is for the reabsorption of sodium in the DCT of the kidney - It increases sodium value

Aldosterone

# Sodium Regulation - A marker for congestive heart failure (CHF) - It is produced by the heart to promote natriuresis (sodium is excreted out of urine) - Therefore it decreases sodium levels

Atrial Natriuretic Peptide (ANP)

# Sodium Regulation Which among ADH, Aldosterone, and ANP increases sodium in the system?

ADH and Aldosterone

# Sodium Regulation Which among ADH, Aldosterone, and ANP decreases sodium in the system?

ANP only

# Sodium Regulation Aldosterone is responsible for the reabsorption of sodium in what part of the kidney?

DCT

# Hyponatremia or Hypernatremia? Overhydration, diuretic therapy, metabolic acidosis, Addison's disease, and diarrhea

Hyponatremia

# Hyponatremia or Hypernatremia? Dehydration, Cushing's syndrome, insulin therapy, profuse sweating, diarrhea, and diabetes insipidus

Hypernatremia

This is caused by sodium loss or high water intake

Hyponatremia

This is caused by low water intake/dehydration/ water depletions or too much intake of sodium

Hypernatremia

# Sodium Measurement What specimen is ideally used?

Serum (plasma can be used but for emergency cases only)

# Sodium Measurement If plasma is to be used in emergency cases, what anticoagulant must be used?

Heparin | Note: Avoid a tube that uses sodium salt as it will increase sodium

# Sodium Measurement TOF: A hemolyzed sample will increase sodium levels

False (decrease; pseudohyponatremia)

# Sodium Measurement Hemolysis and too much lipids and plasma proteins causes what condition?

Pseudohyponatremia

# Sodium Measurement - This method selectively measures a specific ion - Uses a glass membrane electrode - May be direct or indirect

Ion Selective Electrode (ISE)

# Sodium Measurement The Ion Selective Electrode (ISE) for sodium uses what kind of electrode?

Glass Membrane Electrode

# Sodium Measurement In the Ion Selective Electrode (ISE) method, what technique requires no dilution (no pseudohyponatremia)?

Direct

# Sodium Measurement In the Ion Selective Electrode (ISE) method, what technique requires dilution (pseudohyponatremia is possible)?

Indirect

# Sodium Measurement - This is a spectrophotometric method that uses flames as a light source - The sample, upon contact with the flame will produce its own color

Flame Emission Spectrophotometry (FES)

# Sodium Measurement In Flame Emission Spectrophotometry (FES), what flame color does sodium produce?

Yellow

# Sodium Measurement In this method, sodium forms a complex with the reagent to form sodium uranyl acetate

Colorimetric/Spectrophotometric

# Sodium Measurement What method in the Colorimetric/Spectrophotometric technique uses Zinc Uranyl Acetate?

Albanese-Lein Method

# Sodium Measurement What method in the Colorimetric/Spectrophotometric technique uses Magnesium Uranyl Acetate?

Maruna Trinder

# Sodium Measurement In both the Albanese-Lein Method and Maruna Trinder Method, sodium forms a complex with the reagent to produce what?

Sodium Uranyl Acetate

# Sodium Measurement This is the reference method wherein electrolytes are measured in their atomic forms

Atomic Absorption Spectrophotometry (AAS)

- The most abundant INTRACELLULAR CATION important for maintaining the acid-base balance of the body - It is the most clinically significant and sensitive in terms of increasing value as it can lead to cardiac failure

Potassium (K+)

TOF: Potassium increases whenever there is cell lysis

True (because it is found INSIDE the cell; an intracellular electrolyte)

- It has an intracellular to extracellular ratio of 25:1 - It helps in nerve impulse transmission, action potential production, and is a major ion affecting cardiac cells - If imbalanced, it could lead to motor imbalances and skeletal/cardiac problems

Potassium (K+)

- This hormone regulates potassium by excretion as it also promotes sodium reabsorption - When sodium gets reabsorbed, potassium gets excreted

Aldosterone

# Hypokalemia or Hyperkalemia Alkalosis and Insulin Therapy

Hypokalemia

# Hypokalemia or Hyperkalemia Acidosis, cell damage, and mineralocorticoid deficiency

Hyperkalemia

TOF: The increasing and decreasing value of potassium levels are caused by the shifting in position from extracellular going to intracellular

False (from intracellular going to extracellular)

# Hypokalemia or Hyperkalemia From the serum, it will enter the RBC

Hypokalemia

# Hypokalemia or Hyperkalemia From the RBC, it goes to the plasma

Hyperkalemia

- This is aka pseudohyperkalemia, the false increase of potassium - The most collection-sensitive analyte

Artifactual Hyperkalemia

What is the number 1 reason for pseudohyperkalemia?

Collection (leads to hemolysis)

Which among the ff. is not a cause for pseudohyperkalemia? - Hemolysis - Low platelet count - Delayed separation - Refrigeration

Low platelet count (should be high)

# Potassium Measurement This uses a liquid ion exchange membrane incorporated with valinomycin

Ion Selective Electrode (ISE)

# Potassium Measurement What color of flame does potassium emit using the Flame Emission Spectrophotometry (FES) Method?

Purple/Lilac

# Potassium Measurement This method consists of Turbidimetric and Lockhead and Purcell sub-methods

Colorimetric/Spectrophotometric

# Potassium Measurement - In the colorimetric/spectrophotometric method, this sub-method uses sodium tetraphenyl boron - A positive result is the precipitation of potassium

Turbidimetric

# Potassium Measurement In the turbidimetric method, what is the positive result after using sodium tetraphenyl boron?

Precipitation of potassium

# Potassium Measurement In the turbidimetric method, what is the main component of the reagent?

Sodium tetraphenyl boron

# Potassium Measurement - In the colorimetric/spectrophotometric method, this sub-method uses sodium cobaltinitrite - A positive result is color red in the presence of potassium

Lockhead and Purcell

# Potassium Measurement In the Lockhead and Purcell method, what is the positive result after using sodium cobaltinitrite?

Color red (in the presence of K+)

# Potassium Measurement In the Lockhead and Purcell method, what is the main component of the reagent?

Sodium cobaltinitrite

# Potassium Measurement What is the reference method?

Atomic Absorption Spectrophotometry (AAS)

- This is the most abundant EXTRACELLULAR ANION - It regulates osmotic pressure and water balance alongside sodium - Wherever sodium goes, water follows along with this electrolyte

Chloride (Cl-)

- An important function of chloride in maintaining the acid-base balance in RBCs - The RBC exchanges some of its hydrogen ions

Chloride Shifting

# Hypochloremia or Hyperchloremia? Metabolic alkalosis and respiratory acidosis

Hypochloremia

# Hypochloremia or Hyperchloremia? Metabolic acidosis and respiratory alkalosis

Hyperchloremia

# Chloride Measurement - This uses the principle of Schales and Schales - An old colorimetric method where mercury reacts with chloride to form mercuric chloride - It is then titrated using diphenyl carbazon forming a blue-colored compound upon measurement

Mercumetric Titration

# Chloride Measurement In Mercumetric Titration, what principle does it use?

Schales and Schales

# Chloride Measurement In Mercumetric Titration, mercuric chloride is titrated using what?

Diphenyl Carbazon

# Chloride Measurement In Mercumetric Titration, what is the end product's color?

Blue

# Chloride Measurement What are the 2 techniques involved in the mercuric thiocyanate method?

1. Skegg's modification 2. Whitehorn titration technique

# Chloride Measurement In the Mercuric Thiocyanate method: - This technique allows mercuric thiocyanate to react with chloride forming mercuric chloride and thiocyanate (they separate) - It is then treated with a ferric ion to produce ferric thiocyanate - The end color is reddish-brown

Skegg's Modification

# Chloride Measurement In Skegg's Modification of the Mercuric Thiocyanate Method, mercuric thiocyanate + chloride forms what?

Mercuric chloride and thiocyanate

# Chloride Measurement In Skegg's Modification of the Mercuric Thiocyanate Method, mercuric chloride and thiocyanate + ferric ion forms what?

Ferric Thiocyanate

# Chloride Measurement In Skegg's Modification of the Mercuric Thiocyanate Method, what is the color of the end product (ferric thiocyanate)?

Reddish brown

# Chloride Measurement In the mercuric thiocyanate method, this is considered as the old methodology for measuring colorimetric methods

Whitehorn Titration Technique

# Chloride Measurement This is the reference method

Colorimetric-Amperometric Titration

# Chloride Measurement This technique in the colorimetric-amperometric titration method uses electrodes with silver ions which react with chloride to form a silver chloride precipitate

Cotlove Technique

# Chloride Measurement - This technique uses collected sweat using the Gilbson and Cooke principle - It is collected through pilocarpine iontophoresis which uses pilocarpine nitrate

Sweat Chloride Determination

# Chloride Measurement In Sweat Chloride Determination, what principle is used?

Gilbson and Cooke

# Chloride Measurement In Sweat Chloride Determination, how is the sample collected?

Pilocarpine iontophoresis

# Chloride Measurement In Sweat Chloride Determination, what chemical is used?

Pilocarpine nitrate

- This is the 5th most abundant mineral in the body - Majority of it is present in the skeletal system - Functions in blood coagulation, neuromuscular conduction, and cardiac and skeletal muscle excitability

Calcium (Ca 2+)

Majority of calcium is present in the skeletal system in the form of what?

Hydroxyapatite crystals

How much (in percentage) of hydroxyapatite crystals are in bones and how much are in plasma?

98% in bones and 2% in plasma

The 2% of ________ in plasma are composed of ionized calcium, protein-bound calcium, and anion-bound calcium

Hydroxyapatite crystals

Give the percentages of the ff. components of the 2% hydroxyapatite crystals found in plasma - Ionized/free calcium - Protein-bound - Anion-bound

- Ionized/free calcium (50%) - Protein-bound (40%) - Anion-bound (10%)

This is regulated by PTH, vitamin D, and calcitonin

Calcium (2+)

# Calcium PTH, Vitamin D, or Calcitonin? A hypercalcemic agent which allows calcium to be reabsorbed in the kidneys and bones

PTH

# Calcium PTH, Vitamin D, or Calcitonin? A hypercalcemic agent that directly increases calcium in blood

Vitamin D

# Calcium PTH, Vitamin D, or Calcitonin? A hypocalcemic agent

Calcitonin

# Calcium PTH, Vitamin D, or Calcitonin? Which are hypercalcemic and which are hypocalcemic?

- Hypercalcemic: PTH and Vit. D - Hypocalcemic: Calcitonin

# Calcium TOF: Vitamin D promotes PTH synthesis to increase calcium levels

False (reverse; it is PTH that promotes the synthesis of Vit. D)

# Hypocalcemia or Hypercalcemia? Hypoparathyroidism, steatorrhea, renal diseases, and pancreatitis

Hypocalcemia

# Hypocalcemia or Hypercalcemia? Hyperparathyroidism, multiple myeloma, tuberculosis, and antacids

Hypercalcemia

# Calcium Measurement Pre-ionized calcium + protein-bound calcium + anion-bound calcium = ?

Total Calcium

# Calcium Measurement (TOTAL CALCIUM) In this colorimetric method: - Calcium is treated with ammonium oxalate to form calcium oxalate - Then an acid is added to dissolve the crystals to form oxalic acid - Oxalic acid is titrated with potassium permanganate producing a purple to colorless reaction

Clark and Collip

# Calcium Measurement (TOTAL CALCIUM) In Clark and Collip, calcium + ammonium oxalate = ?

Calcium oxalate

# Calcium Measurement (TOTAL CALCIUM) In Clark and Collip, calcium oxalate + acid = ?

Oxalic Acid

# Calcium Measurement (TOTAL CALCIUM) In Clark and Collip, oxalic acid titrated with potassium permanganate produces what color reaction?

From purple to colorless

# Calcium Measurement (TOTAL CALCIUM) In this method: - Calcium is mixed with Calcin Red followed by titration with an anticoagulant - It becomes yellowish with a green fluorescence - The calcium-calcin complex will be lost and the end product is salmon pink in color

EDTA titration

# Calcium Measurement (TOTAL CALCIUM) In EDTA titration, what is mixed with calcium to form a yellowish product with green fluorescence?

Calcin Red

# Calcium Measurement (TOTAL CALCIUM) In EDTA titration, what is the final end color upon losing the calcium-calcin complex?

Salmon pink

# Calcium Measurement (TOTAL CALCIUM) In this method: - It is more on dye-binding - Has 3 sub-methods: O-Cresolphthalein, Alizarin, and Arsenazo III

Spectrophotometric

# Calcium Measurement (TOTAL CALCIUM) In spectrophotometry, this is the most popular and it produces a violet end color

O-Cresolphthalein

# Calcium Measurement (TOTAL CALCIUM) In spectrophotometry, this uses 8-hydroxyquinoline

Alizarin

# Calcium Measurement (TOTAL CALCIUM) This is the reference method

Atomic Absorption Spectrophotometry (AAS)

# Calcium Measurement (TOTAL CALCIUM) What are the 4 methods for total calcium measurement?

1. Colorimetric 2. EDTA Titration 3. Spectrophotometric 4. Atomic Absorption Spectrophotometry

# Calcium Measurement (IONIZED CALCIUM) In this method, the pH is maintained in a sample as calcium ionization is pH dependent

Ion Selective Electrode (ISE)

# Calcium Measurement (IONIZED CALCIUM) TOF: A higher pH correlates to lower ionization

True

# Calcium Measurement (IONIZED CALCIUM) TOF: Blood is directly proportional to pH

False (indirect)

- This is found in bones, muscles, and ECF - It functions in structural support, energy generation, and storage - It exists in the form of a buffer phosphate - Is influenced by PTH, Vit. D, and Calcitonin - Is inversely proportional to calcium

Phosphorus

If PTH and Vit. D increase calcium, what happens to phosphorus?

Decreases

If Calcitonin decreases calcium, what happens to phosphorus?

Increases

# Phosphorus Measurement This is the reference method

Atomic Absorption Spectrophotometry (AAS)

# Phosphorus Measurement In this method: - It measures the end product phosphomolybdenum blue at 600nm - It is the most popular method in measuring phosphorus - The reagent is ammonium molybdate

Spectrophotometric (Fiske and Subbarow)

# Phosphorus Measurement In Fiske and Subbarow, when ammonium molybdate reacts with phosphorus, it produces what?

Phosphomolybdate (colorless)

# Phosphorus Measurement In Fiske and Subbarow, when a reducing agent such as ascorbic acid is added, it becomes what?

Phosphomolybdenum Blue

# Phosphorus Measurement In Fiske and Subbarow, what is the end product?

Phosphomolybdenum Blue

# Phosphorus Measurement In Fiske and Subbarow, phosphomolybdenum blue is measured at what wavelength?

600nm

- Its main function is to be a cofactor - It is the 2nd most abundant INTRACELLULAR CATION and 4th most abundant cation in the body

Magnesium (Mg 2+)

# Magnesium Measurement This is the reference method

Atomic Absorption Spectrophotometry (AAS)

# Magnesium Measurement What color of flame does magnesium emit when using the Flame Emission Spectrophotometry (FES) method?

Blue

# Magnesium Measurement In spectrophotometry, specifically dye-binding, give the end point colors of the ff. reagents: - Calmagite - Formazan dye - Methylene

- Calmagite - green - Formazan dye - dark blue - Methylene - blue

# Magnesium Measurement In this method: - It is considered as an old colorimetric method - One of the first methods used for testing magnesium - Produces a yellow to red dye in the presence of magnesium

Titan Yellow (Colorimetric)

# Magnesium Measurement In the Titan Yellow (Colorimetric) method, what color is produced in the presence of Mg 2+?

Yellow to red dye

- This is a basic substance important for the acid-base balance - The 2nd most abundant anion in the ECF

Bicarbonate (HCO3-)

Give the 2 methods for measuring bicarbonate (HCO3-)

1. Acid Titration and pCO2 Electrode 2. Alkalinization and Enzymatic Method

All electrolytes have Atomic Absorption Spectrophotometry (AAS) as their reference method, except for one, what is that electrolyte?

Chloride (Cl-)

Give all the EXTRACELLULAR electrolytes

1. Sodium (cation) 2. Chloride (anion) 3. Phosphorus (neither an anion or cation) 4. Bicarbonate (anion)

Give all the INTRACELLULAR CATIONS

1. Potassium (K+) 2. Calcium (Ca 2+) 3. Magnesium (Mg 2+)

Give all the EXTRACELLULAR ANIONS

1. Chloride (Cl-) 2. Bicarbonate (HCO3-)

TOF: All the anions discussed are intracellular but not all cations discussed are extracellular

False (all anions discussed are extracellular)

What is the only EXTRACELLULAR CATION among all the electrolytes discussed?

Sodium (Na+)

# Give the electrolyte correspondent to the given Has an intracellular to extracellular ratio of 1:12

Sodium (Na+)

# Give the electrolyte correspondent to the given Has an intracellular to extracellular ratio of 25:1

Potassium (K+)

# Give the electrolyte correspondent to the given In terms of its intracellular to extracellular ratio, it is found more inside the cell than it is outside

Potassium (K+)

# Give the electrolyte correspondent to the given In terms of its intracellular to extracellular ratio, it is found more outside the cell than it is inside

Sodium (Na+)

# Give the electrolytes correspondent to the given What are the electrolytes that make use of the Flame Emission Spectrophotometry (FES) Method?

1. Sodium (Na+) 2. Potassium (K+) 3. Magnesium (Mg 2+)

# Give the electrolytes correspondent to the given Aldosterone involvement

Sodium (Na+) and Potassium (K+)

# Give the electrolytes correspondent to the given Involvement of PTH, Vit. D, and Calcitonin

Calcium (Ca 2+) and Phosphorus

# Give the electrolyte correspondent to the given Albanese-Lein Method and Maruna Trinder Method

Sodium

# Give the electrolytes correspondent to the given Uses the Ion Selective Electrode (ISE) Method

1. Sodium (Na+) 2. Potassium (K+) 3. Calcium (Ca 2+)

# Give the electrolyte correspondent to the given Uses a glass membrane electrode

Sodium (Na+)

# Give the electrolytes correspondent to the given Turbidimetric and Lockhead and Purcell Method

Potassium (K+)

# Give the electrolyte correspondent to the given Mercuric Titration and Mercuric Thiocyanate Method

Chloride (Cl-)

# Give the electrolytes correspondent to the given Colorimetric-Amperometric Titration

Chloride (Cl-)

# Give the electrolytes correspondent to the given Skegg's Modification and Whitehorn Titration

Chloride (Cl-)

# Give the electrolyte correspondent to the given Cotlove Technique

Chloride (Cl-)

# Give the electrolyte correspondent to the given Clark and Collip under Colorimetric Method

Calcium (Ca 2+)

# Give the electrolyte correspondent to the given EDTA Titration

Calcium (Ca 2+)

# Give the electrolyte correspondent to the given O-Cresolphthalein, Alizarin, and Arsenazo III

Calcium (Ca 2+)

# Give the electrolyte correspondent to the given Fiske and Subbarow Method

Phosphorus

# Give the electrolyte correspondent to the given Titan Yellow under Colorimetric Method

Magnesium (Mg 2+)

# Give the electrolyte correspondent to the given - Acid Titration and pCO2 Electrode - Alkalinization and Enzymatic Method

Bicarbonate (HCO3-)