Water & Electrolytes Flashcards
1
Q
Has an inverse relation with body weight and age
A
Water
2
Q
Human body H2O conc.
A
40-75%
3
Q
Whole blood H2O conc.
A
65%
4
Q
Intra & Extra H2O conc.
A
Intra: 55%
Extra: 45%
5
Q
Fluid inside the cell about 2/3
A
Intracellular fluid
6
Q
Account for 1/3 body water
A
Extracellular Fluid
7
Q
concentrations of ions within the cells and the plasma are maintained by
A
active transport and diffusion
8
Q
H20 Conc for: M&F Lean Normal Obese Infants
A
L- M: 70%, F: 60%
N- M: 60%, F: 50%
O- M: 50%, F: 42%
I- 70%
9
Q
Source of body water
A
- Consumption (Diet)
Drinks - 1000 ml
Food - 1 to 1.2 L - Metabolism
Fat metabolism - 100 ml/ 100 g
CHON metabolism - 44 ml/100 g
CHO metabolism - 60 ml/ 100 g
10
Q
How many water is excreted per day?
A
1.5 L lost in urine /day
11
Q
What processes causes 1000ml water excreted?
A
a. Perspiration
b. Exhalation of water vapor through lungs
c. Fecal material
d. other mechanism
12
Q
review the urine formation in kidneys
A
Water excretion and re-absorption
13
Q
Clinical Conditions for H20
A
Dehydration
Water retention
14
Q
due to increase AVP production causing an increase in Na and H2O retention resulting to edema
A
Hypoalbuminemia
15
Q
a physical property of a solution that is based on solute concentrations
A
Osmolality
16
Q
What will happen if there is an increase blood osmolality?
A
osmolality will triggers the secretions of arginine vasopressin hormone (AVP), formerly known as ADH
17
Q
What secrets AVP?
A
posterior pituitary gland
18
Q
acts on the cells of collecting ducts in the kidneys to increase water re-absorption
A
AVP
19
Q
What happens when water is conserved?
A
osmolality decreases, turning off AVP secretions
20
Q
A natural response which consume more fluids, thus increasing the ECF, diluting the elevated solute (Na-ion), thereby decreasing the osmolality of the plasma
A
Thirst
21
Q
parameter of Hypothalamus response
A
plasma osmolality
22
Q
1 to 2% increase in plasma osmolality causes
A
fourfold increase in the circulating AVP (half-life: 15 –20 min.)
23
Q
1 to 2% decrease in plasma concentration
A
shuts off AVP production
24
Q
Normal plasma osmolality
A
275 – 295 mOsm/Kg of plasma water
25
What happens when there is increase water in-take?
lowers plasma osmolality, suppression of AVP and Thirst
26
What happens when there is absence of AVP?
no tubular re-absorption of water causing large volume of dilute Urine
27
increase in water deficit, causes ?
increase plasma osmolality, thereby activation of AVP and Thirst
28
major electrolytes responsible for the osmolality in serum
Sodium, Chloride and Bicarbonate
29
methods of determining osmolality are based on what?
colligative properties of the solution such as changes in Freezing point and Vapor pressure
30
relationship of osmolality on Freezing point temperature and Vapor pressure
inverse
31
Specimen for Osmolality
- Used
- not recommended
- sample maybe serum or Urine
| - plasma is not recommended
32
measurement of Freezing point depression temp. used
– 7 degree Celsius
33
the difference between the measured osmolality and calculated Osmolality
Osmolality Gap
34
ions that exist in the body fluids, carrying electric charge
Electrolytes
35
Where does cations migrate? anions?
cathode (cations)
| anode (anions)
36
Maintains osmotic pressure and degree of hydration
Na, Cl and K
37
Myocardial rhythm and contractility
K , Mg, and Ca
38
Neuromuscular excitability
K, Ca
39
Co-factors in enzyme activation
Mg, Ca and Zn
40
Regulation of ATPase in pumps, production and use of ATP from glucose
Mg and PO4
41
Acid-Base balance
HCO3, K and Cl
42
Blood coagulation
Ca and Mg
43
Major cat-ions
Na , K, Mg and Ca
44
Major an-ions
Cl, HCO3, HPO4 and H2PO4
45
Trace cat-ions
Fe , Zn, Mn, Cu, Co
46
part of diet readily absorb by the intestine
Electrolyte Intake
47
during excretion/ regulation it easily pass through the membrane pores
Glomerulus - Filtration
48
In PCT 60 – 70% reabsorb Na, bring back to circulation by? then what is excreted?
HCO3, H ion is excreted
49
In Loop of Henle 25% of Na load are re-absorb and back to circulation by
Cl
50
In DCT ultimate retention of Na is determined by?
hormonal regulation and Na/K/ proton interchange
51
proportion of Calcium ion re-absorbed
99%
52
proportion of phosphate ion re-absorbed
80–90%
53
three hormones that regulate the 2 electrolytes re-absorbed
parathyrin, calcitonin, and calcitriol
54
steroid hormone that increases Na ion re-uptake, particularly in the DCT
aldosterone
55
originating from the cardiac atrium that reduces Na uptake
atrial natriuretic peptide (ANP)
56
transported with Na ion to maintain ionic balance
An-ions
57
passive players in retention and excretion of electrolyte
Cl, HCO3 and Hydrogen ion
58
former Anti-Diuretic Hormone (ADH) produced by hypothalamus w/c promotes water retention by increasing tubular permeability. When is it released?
- Arginine Vasopressin Hormone(AVP)
| - released when blood osmolality is increased
59
produced by adrenal gland and activated if sodium level or blood volume is low
Renin-Angiotensin-Aldosterone system
60
facilitates/control Na retention/absorption in the kidneys and help increase blood volume by conserving Na and water retention
aldosterone
61
major extracellular cat-ion found in the extra-cellular fluid (ECF) completely absorb from diet
Sodium (Na)
62
How much Na body requires per day?
130 – 260 mmol % /day
63
threshold substance of Na
110 – 130 mmol/L
64
What is the function of Na?
Why NEver Been pressured? (Water, NErve transmission, Blood pressure?
1. regulation of water balance
2. major factor in nerve transmission
3. helps maintain blood pressure
65
N.V. of Na
- serum/plasma
- CSF
serum/plasma 135 – 148 mmol/L
CSF 138 – 155 mmol/L
66
stimulates intake of water in response to thirst
plasma osmolality
67
blood volume status which affects Na excretion
aldosterone, angiotensin-II and ANP
68
decrease Na concentration
Hyponatremia
69
What are the ff. dx under DEPLETIONAL hyponatremia?
VADD
1. Addison's disease (hypo-adrenal function)
2. Vomiting
3. Diabetes insipidus
4. Diabetic acidosis
70
due to water retention
Dilutional
71
What are the ff. dx under DILUTIONAL hyponatremia?
HENRe
1. Edema
2. Nephrotic Syndrome
3. Hepatic cirrhosis
4. Renal failure Hypernatremia
72
increase Na concentration characterized by excessive loss of water
Renal failure Hypernatremia
73
major intracellular cat-ion (inside the cell) about 2 % is extracellular
Potassium (K)
74
average diet for K
50 – 150 mmol/L
75
Sources of K
raw fruits
76
increases excretion of K
aldosterone
77
Functions of K
1. Integral part of transmission of nerve impulses
2. Involve in the synaptic process
3. Acts as catalyst in various cell enzymatic processes
4. Muscular contraction
5. Respiration
6. Myocardial function
78
Where PCT re-absorb almost all K ion
renal tubular re-absorption
79
under the influence of Aldosterone, K- ion is secreted both in the DCT and collecting duct in exchange for Na-ion
renal tubular secretion
80
N.V. of K
Plasma/serum
RBC
fatal to the patient
Plasma/serum 3.5 – 5.3 mmol/L
RBC - 105 mmol/L
- 10 mmol/L is fatal to the patient
81
due to actual increase of K
Hyperkalemia
82
Dis-orders due to decreased renal excretion
1. Addison's disease
2. Anuria, Oliguria
3. Urinary obstruction
83
either due to GIT loss or renal loss
Hypokalemia
84
Dis-orders of Hypokalemia
Dis-orders
1. Alkalosis
2. Cushing syndrome
3. GIT fluid loss ( vomiting , diarrhea)
85
Sample used for Na/K determination
Serum, Plasma or Urine
86
what increases K conc?
- Un-hemolyzed sample
| - Excessive muscular activity and prolong tourniquet application
87
what decreases K level?
heparinised blood (plasma)
88
What are the colors of Na & K in Flame Emission Photometry (FEP)?
Na - yellow flame
| K – purple
89
converts the activity of a specific ion dissolved in a solution into an electrical potential, which can be measured by a voltmeter or pH meter.
Ion Selective Electrode (ISE)
90
what are the electrode used in Na & K of ISE?
Na – specialized glass electrode
| K - valinomycin coated electrode
91
Why does electrical potential of each electrode is developed and measured?
to a fixed, stable voltage established by the silver/silver chloride reference electrode
92
based on the light absorbed at wavelength of resonance line by un-excited atom Flame Emission Photometry (FEP), has emission of color when burned/excited
Atomic Absorption Spectrophotometry (AAS)
93
Albanese-Lein method
What is it for?
Reaction?
End color?
for: Na
Reaction:
Na---> Zinc uramyl acetate= Polyvinyl alcohol+ water
End color: Yellow soln
94
Lock-head and Purcell
What is it for?
Reaction?
End color?
for: K
Reaction:
K----> Na-cobalt nitrate= Na-K-cobalt nitrate
End color: Blue soln
95
major extracellular an-ion involve passive role in water balance, maintaining osmolality, blood volume and electric neutrality
Chloride
96
major dietary source of Cl
table salt
97
enzyme activator for Cl
stimulation of starch hydrolysis
98
Where does Cl is completely absorbed?
lumen of intestine
99
What organ regulates Cl?
kidney
100
Where does excess Cl being excreted?
urine and sweat
101
Sample used in Cl determination
serum, plasma & urine
102
anticoagulant of choice in Cl determination
lithium heparin
103
mercuric titration method. where does Cl is titrated with?
Schales and Schales method
| titrated: Hg(NO3)2
104
Schales and Schales method
indicator used:
end point:
indicator used: diphenyl carbazone
| end point: violet/blue color
105
colorimetric assay where amount of SCN displaced is directly proportional to the Cl concentration
Zall, Fisher and Garner method
106
Zall, Fisher and Garner method
Reaction:
End pt:
Cl + Hg(SCN)2---> HgCl + SCN
SCN + Fe(NO3)3 --> Fe(SCN) (red) 480 nm
107
electrode used in Ion selective electrode (ISE)
silver wire coated with AgCl
108
accurate, small amount of sample is required suitable for pediatric work
Coulometric titration method
109
Catlove titrator method (Catlove chloridometer)
- 1 st electrode:
- 2 nd electrode:
- 1 st electrode: generating electrode (producing Cl ion at constant rate)
- 2 nd electrode: sensing electrode (detects electrical conductivity change in soln.)
110
Used to equalize reaction rate over the entire electron surface in Catlove
gelatin
111
serves as diluent in Catlove, prevents reduction of precipitated HgCl2
Nitric acid and acetic acid
112
for the diagnosis of exocrine glandular disorder or Cystic fibrosis
Sweat chloride determination
113
electrical device used to elicit perspiration
iontophoresis
114
Sweat chloride determination
N.V.
above the ref. value affected children:
adult:
N.V. 5 – 45 mmol/L
above the ref. value affected
children: 60 mmol/L
adult: 70 mmol/L
115
N.V. Plasma chloride
98 – 108 mmol/L
116
Clinical significance in Cl
Hyper-chloremia
| Hypo-chloremia
117
5th most abundant element in the body approximately 99% found in the bone
Calcium
118
Ca is found in the bone as
Hydroxy-apatite
119
dietary calcium requirement
400 – 500 mg
120
excreted Ca per day
200 mg of calcium /day
121
How many % of protein mostly bounded to albumin in Ca?
40%
122
% of Free or Ionized calcium
45%
123
What are the anionic materials where Ca is coplexed?
HCO3, citrate, lactate
124
both ionized and complex calcium are known as
ultra-filtrable calcium
125
Urine calcium conc.
15 % complex, 85 % ionized
126
parameters known to accurately evaluate Calcium level
pH & protein
127
enhance intestinal absorption & enhance resorption from bone
Vitamin D metabolites
128
triggered by decrease in ionized calcium stimulates osteoclastic activity
PTH (Parathyroid Hormone)
129
stimulates Vit. D synthesis in Ca
activation of 1-alpha-hydroxylase
130
What decreased PTH will cause?
decrease in serum Calcium level
131
from medullary cells of thyroid Gland released if Calcium level is decreased
Calcitonin
132
Ca (serum) precipitated with ammonium oxalate converted to oxalic acid
end color:
Clark-C0llip
-purple
133
calcium is precipitated with chloranilic acid
end color:
Ferro-Ham method
-purple
134
Bachra, Dauer and Sobel method
- chelating titration:
- indicator:
- end color:
- chelating titration: EDTA
- indicator: Calcien red
- end color: Salmon pink (EDTA-Ca complex)
135
Ca is remove from protein by acidification of the sample
end color:
Ortho-cresolphthalein
- red
136
what does Ortho-cresolphthalein used to prevent interference from Mg
8-hydroxyquinolone
137
Reference method for Ca
AAS
138
N.V. of Ca
8.6 – 10 mg/dl (2.15 – 2.50 mmol/L)
139
4th most abundant cat-ion in the body & 2 nd most abundant intracellular cat-ion
Magnesium (Mg)
140
dietary sources of Mg
cereal grains, raw nuts, fruits, meat, fish and green vegetables - “hard” drinking water
141
Average conc. for the absorption of Ca
30-350 mg /day 20 - 65% absorbed by GIT
142
renal threshold of Ca
0.60 – 0.85 mmol/L
143
distribution:
- bone
- muscle
- soft tissues
- serum
- red blood cells
distribution:
- 50 % in the bone
- 25 – 28 % located in the muscle
- 20 % in soft tissues
- 0.3 % in serum
- 0.5 % red blood cells
144
forms of Mg in circulation
1. protein bound -
2. free Mg -
3. complexed -
1. protein bound - 33 %
2. free Mg - 55 %
3. complexed - 12 %
145
what is the % of reabsorbed Mg in PCT & DCT?
PCT- 20-35%
| DCT- 2-5%
146
PTH increases
renal reabsorption
147
aldosterone increases
renal excretion
148
based on the absorption of light of various dyes in a given wavelength in the presence of Mg - dyes used
Colorimetric
149
Mg binds with the dye to form reddish-violet complex, measured at 532 nm
Calmagite
150
method of Yoe, magenta red
Titan yellow
151
Mg binds to a chromogen
Methyl thymol blue
152
Mg binds with the dye to form colored complex , measured at 660 nm
Formazan
153
N.V. (serum, Colorimetric)
0.63 – 1.0 mmol/L
154
Phosphorous (%)
- bone
- muscles
- average phosphorous/day consumed by normal adult
- absorb in the intestine, regulated by vitamin D
- daily intake is excreted (stool)
- pH
- 80 % found in the bone (
- 15 % in the muscles
- 800 – 1200 mg average phosphorous/day consumed by normal adult
- about 80 % is absorb in the intestine, regulated by vitamin D
- 30 – 40 % of daily intake is excreted (stool)
- pH 7.4
155
Sample used in Phosphorus determination
serum or Lithium heparin plasma
156
preferred reducing agents in Phosphorus
Stannous chloride and Pictol
157
Fiske Subbarow Method:
reducing agent:
Enzymes used:
N.V.
reducing agent: Stannous chloride, ANSA
Enzymatic method
- Enzymes used: phosphorylase, G-6-PD phosphoglucomutase
N.V. 2.4 – 4.7 mg/dl, 0.78 – 1.5 mol/L
158
O2 binding in hemoglobin & Cellular oxidative mechanism
Iron (Ferrous and Ferric)
159
Source of Fe
Bakery products etc.
160
When does Iron being excreted where 1 mg is lost ?
1. Internal bleeding
2. Menstruations
3. breakdown of epithelial cells in the intestine and skin
161
facilitates disposal of Fe
Haptoglobin
162
removal from circulation of Fe
Hemopexin
163
chromogen used in Fe Colorimetric Assay
2,4,6- Tripyridyl-5-Triazine (TPTZ)
164
assess depletion of Iron stores
Ferritin Assay
165
N.V. Serum Iron:
Male 65 - 180 ug/dl ,
| Female: slightly lower - 10 % higher in morning than evening
166
S.I. Factor in Fe
0.1791
167
TIBC in Fe (adult)
250 – 450 mg/dl
168
What is the organ affected in iron overload?
Liver
169
Iron chelating agent
desferioxamine
170
incorporated in ceruloplasmin & important in the diagnosis of Wilson’s disease (marked decrease of ceruloplasmin, < 20 mg/ml)
Copper (Cu)
171
Method of choice in Cu
AAS
172
N.V. in Cu
N.V. 70 - 140 ug/dl or 11 – 22 umol/L
173
For RNA and DNA synthesis development of connective tissues
Zinc
174
cholesterol synthesis of various mucopolysaccharide & oxidative phosphorylation
Manganese
175
integral part of vit. B12 (cobalamin) & red cell synthesis
Cobalt
176
active sites of enzymes & uric acid synthesis (precursor of Xanthine and Hypoxanthine)
Molybdenum
177
stabilize nucleic acid structure
Nickel
178
essential component of glucose tolerance factor (maintains normal insulin response)
Chromium
179
causes Alzheimer's disease
Aluminum toxicity
180
"self-regulated" electrolyte
Mg
181
counterpart of Sodium?
K
182
What are the electrolytes in extracellular & inta?from major to minor
```
EC = Na>Cl>HCO3>Ca>P
IC = K>Mg
```
183
major defense against hyperosmolality and hypernatremia?
Thirst
184
TIBC in Fe
Transferrin
185
has reciprocal relationship with H+?
Potassium
186
Phosphorous fasting time
6-8 hrs
187
principal determinant of plasma osmolality?
Na
188
3 hormones that regulate Ca
PTH, Vit. D, Calcitonin
189
3 hormones that regulate Ca
PTH, Vit. D, Calcitonin
190
% of normal plasma (intravascular)
93%
191
Surrounds the cells
Interstitial fluid
