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CC2 > Water & Electrolytes > Flashcards

Water & Electrolytes Flashcards

1
Q

Has an inverse relation with body weight and age

A

Water

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2
Q

Human body H2O conc.

A

40-75%

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3
Q

Whole blood H2O conc.

A

65%

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4
Q

Intra & Extra H2O conc.

A

Intra: 55%
Extra: 45%

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5
Q

Fluid inside the cell about 2/3

A

Intracellular fluid

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6
Q

Account for 1/3 body water

A

Extracellular Fluid

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7
Q

concentrations of ions within the cells and the plasma are maintained by

A

active transport and diffusion

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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%

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9
Q

Source of body water

A
  1. Consumption (Diet)
    Drinks - 1000 ml
    Food - 1 to 1.2 L
  2. Metabolism
    Fat metabolism - 100 ml/ 100 g
    CHON metabolism - 44 ml/100 g
    CHO metabolism - 60 ml/ 100 g
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10
Q

How many water is excreted per day?

A

1.5 L lost in urine /day

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11
Q

What processes causes 1000ml water excreted?

A

a. Perspiration
b. Exhalation of water vapor through lungs
c. Fecal material
d. other mechanism

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12
Q

review the urine formation in kidneys

A

Water excretion and re-absorption

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13
Q

Clinical Conditions for H20

A

Dehydration

Water retention

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14
Q

due to increase AVP production causing an increase in Na and H2O retention resulting to edema

A

Hypoalbuminemia

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15
Q

a physical property of a solution that is based on solute concentrations

A

Osmolality

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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

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17
Q

What secrets AVP?

A

posterior pituitary gland

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18
Q

acts on the cells of collecting ducts in the kidneys to increase water re-absorption

A

AVP

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19
Q

What happens when water is conserved?

A

osmolality decreases, turning off AVP secretions

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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

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21
Q

parameter of Hypothalamus response

A

plasma osmolality

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22
Q

1 to 2% increase in plasma osmolality causes

A

fourfold increase in the circulating AVP (half-life: 15 –20 min.)

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23
Q

1 to 2% decrease in plasma concentration

A

shuts off AVP production

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24
Q

Normal plasma osmolality

A

275 – 295 mOsm/Kg of plasma water

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25
Q

What happens when there is increase water in-take?

A

lowers plasma osmolality, suppression of AVP and Thirst

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26
Q

What happens when there is absence of AVP?

A

no tubular re-absorption of water causing large volume of dilute Urine

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27
Q

increase in water deficit, causes ?

A

increase plasma osmolality, thereby activation of AVP and Thirst

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28
Q

major electrolytes responsible for the osmolality in serum

A

Sodium, Chloride and Bicarbonate

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29
Q

methods of determining osmolality are based on what?

A

colligative properties of the solution such as changes in Freezing point and Vapor pressure

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30
Q

relationship of osmolality on Freezing point temperature and Vapor pressure

A

inverse

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31
Q

Specimen for Osmolality

  • Used
  • not recommended
A
  • sample maybe serum or Urine

- plasma is not recommended

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32
Q

measurement of Freezing point depression temp. used

A

– 7 degree Celsius

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33
Q

the difference between the measured osmolality and calculated Osmolality

A

Osmolality Gap

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34
Q

ions that exist in the body fluids, carrying electric charge

A

Electrolytes

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35
Q

Where does cations migrate? anions?

A

cathode (cations)

anode (anions)

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36
Q

Maintains osmotic pressure and degree of hydration

A

Na, Cl and K

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37
Q

Myocardial rhythm and contractility

A

K , Mg, and Ca

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38
Q

Neuromuscular excitability

A

K, Ca

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39
Q

Co-factors in enzyme activation

A

Mg, Ca and Zn

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40
Q

Regulation of ATPase in pumps, production and use of ATP from glucose

A

Mg and PO4

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41
Q

Acid-Base balance

A

HCO3, K and Cl

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42
Q

Blood coagulation

A

Ca and Mg

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43
Q

Major cat-ions

A

Na , K, Mg and Ca

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44
Q

Major an-ions

A

Cl, HCO3, HPO4 and H2PO4

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45
Q

Trace cat-ions

A

Fe , Zn, Mn, Cu, Co

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46
Q

part of diet readily absorb by the intestine

A

Electrolyte Intake

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47
Q

during excretion/ regulation it easily pass through the membrane pores

A

Glomerulus - Filtration

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48
Q

In PCT 60 – 70% reabsorb Na, bring back to circulation by? then what is excreted?

A

HCO3, H ion is excreted

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49
Q

In Loop of Henle 25% of Na load are re-absorb and back to circulation by

A

Cl

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50
Q

In DCT ultimate retention of Na is determined by?

A

hormonal regulation and Na/K/ proton interchange

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51
Q

proportion of Calcium ion re-absorbed

A

99%

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52
Q

proportion of phosphate ion re-absorbed

A

80–90%

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53
Q

three hormones that regulate the 2 electrolytes re-absorbed

A

parathyrin, calcitonin, and calcitriol

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54
Q

steroid hormone that increases Na ion re-uptake, particularly in the DCT

A

aldosterone

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55
Q

originating from the cardiac atrium that reduces Na uptake

A

atrial natriuretic peptide (ANP)

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56
Q

transported with Na ion to maintain ionic balance

A

An-ions

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57
Q

passive players in retention and excretion of electrolyte

A

Cl, HCO3 and Hydrogen ion

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58
Q

former Anti-Diuretic Hormone (ADH) produced by hypothalamus w/c promotes water retention by increasing tubular permeability. When is it released?

A
  • Arginine Vasopressin Hormone(AVP)

- released when blood osmolality is increased

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59
Q

produced by adrenal gland and activated if sodium level or blood volume is low

A

Renin-Angiotensin-Aldosterone system

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60
Q

facilitates/control Na retention/absorption in the kidneys and help increase blood volume by conserving Na and water retention

A

aldosterone

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61
Q

major extracellular cat-ion found in the extra-cellular fluid (ECF) completely absorb from diet

A

Sodium (Na)

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62
Q

How much Na body requires per day?

A

130 – 260 mmol % /day

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63
Q

threshold substance of Na

A

110 – 130 mmol/L

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64
Q

What is the function of Na?

A

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
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65
Q

N.V. of Na

  • serum/plasma
  • CSF
A

serum/plasma 135 – 148 mmol/L

CSF 138 – 155 mmol/L

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66
Q

stimulates intake of water in response to thirst

A

plasma osmolality

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67
Q

blood volume status which affects Na excretion

A

aldosterone, angiotensin-II and ANP

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68
Q

decrease Na concentration

A

Hyponatremia

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69
Q

What are the ff. dx under DEPLETIONAL hyponatremia?

A

VADD

  1. Addison’s disease (hypo-adrenal function)
  2. Vomiting
  3. Diabetes insipidus
  4. Diabetic acidosis
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70
Q

due to water retention

A

Dilutional

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71
Q

What are the ff. dx under DILUTIONAL hyponatremia?

A

HENRe

  1. Edema
  2. Nephrotic Syndrome
  3. Hepatic cirrhosis
  4. Renal failure Hypernatremia
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72
Q

increase Na concentration characterized by excessive loss of water

A

Renal failure Hypernatremia

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73
Q

major intracellular cat-ion (inside the cell) about 2 % is extracellular

A

Potassium (K)

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74
Q

average diet for K

A

50 – 150 mmol/L

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75
Q

Sources of K

A

raw fruits

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76
Q

increases excretion of K

A

aldosterone

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77
Q

Functions of K

A
  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
Q

Where PCT re-absorb almost all K ion

A

renal tubular re-absorption

79
Q

under the influence of Aldosterone, K- ion is secreted both in the DCT and collecting duct in exchange for Na-ion

A

renal tubular secretion

80
Q

N.V. of K
Plasma/serum
RBC
fatal to the patient

A

Plasma/serum 3.5 – 5.3 mmol/L

RBC - 105 mmol/L
- 10 mmol/L is fatal to the patient

81
Q

due to actual increase of K

A

Hyperkalemia

82
Q

Dis-orders due to decreased renal excretion

A
  1. Addison’s disease
  2. Anuria, Oliguria
  3. Urinary obstruction
83
Q

either due to GIT loss or renal loss

A

Hypokalemia

84
Q

Dis-orders of Hypokalemia

A

Dis-orders

  1. Alkalosis
  2. Cushing syndrome
  3. GIT fluid loss ( vomiting , diarrhea)
85
Q

Sample used for Na/K determination

A

Serum, Plasma or Urine

86
Q

what increases K conc?

A
  • Un-hemolyzed sample

- Excessive muscular activity and prolong tourniquet application

87
Q

what decreases K level?

A

heparinised blood (plasma)

88
Q

What are the colors of Na & K in Flame Emission Photometry (FEP)?

A

Na - yellow flame

K – purple

89
Q

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.

A

Ion Selective Electrode (ISE)

90
Q

what are the electrode used in Na & K of ISE?

A

Na – specialized glass electrode

K - valinomycin coated electrode

91
Q

Why does electrical potential of each electrode is developed and measured?

A

to a fixed, stable voltage established by the silver/silver chloride reference electrode

92
Q

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

A

Atomic Absorption Spectrophotometry (AAS)

93
Q

Albanese-Lein method
What is it for?
Reaction?
End color?

A

for: Na
Reaction:
Na—> Zinc uramyl acetate= Polyvinyl alcohol+ water
End color: Yellow soln

94
Q

Lock-head and Purcell
What is it for?
Reaction?
End color?

A

for: K
Reaction:
K—-> Na-cobalt nitrate= Na-K-cobalt nitrate
End color: Blue soln

95
Q

major extracellular an-ion involve passive role in water balance, maintaining osmolality, blood volume and electric neutrality

A

Chloride

96
Q

major dietary source of Cl

A

table salt

97
Q

enzyme activator for Cl

A

stimulation of starch hydrolysis

98
Q

Where does Cl is completely absorbed?

A

lumen of intestine

99
Q

What organ regulates Cl?

A

kidney

100
Q

Where does excess Cl being excreted?

A

urine and sweat

101
Q

Sample used in Cl determination

A

serum, plasma & urine

102
Q

anticoagulant of choice in Cl determination

A

lithium heparin

103
Q

mercuric titration method. where does Cl is titrated with?

A

Schales and Schales method

titrated: Hg(NO3)2

104
Q

Schales and Schales method
indicator used:
end point:

A

indicator used: diphenyl carbazone

end point: violet/blue color

105
Q

colorimetric assay where amount of SCN displaced is directly proportional to the Cl concentration

A

Zall, Fisher and Garner method

106
Q

Zall, Fisher and Garner method
Reaction:
End pt:

A

Cl + Hg(SCN)2—> HgCl + SCN

SCN + Fe(NO3)3 –> Fe(SCN) (red) 480 nm

107
Q

electrode used in Ion selective electrode (ISE)

A

silver wire coated with AgCl

108
Q

accurate, small amount of sample is required suitable for pediatric work

A

Coulometric titration method

109
Q

Catlove titrator method (Catlove chloridometer)

  • 1 st electrode:
  • 2 nd electrode:
A
  • 1 st electrode: generating electrode (producing Cl ion at constant rate)
  • 2 nd electrode: sensing electrode (detects electrical conductivity change in soln.)
110
Q

Used to equalize reaction rate over the entire electron surface in Catlove

A

gelatin

111
Q

serves as diluent in Catlove, prevents reduction of precipitated HgCl2

A

Nitric acid and acetic acid

112
Q

for the diagnosis of exocrine glandular disorder or Cystic fibrosis

A

Sweat chloride determination

113
Q

electrical device used to elicit perspiration

A

iontophoresis

114
Q

Sweat chloride determination
N.V.
above the ref. value affected children:
adult:

A

N.V. 5 – 45 mmol/L
above the ref. value affected
children: 60 mmol/L
adult: 70 mmol/L

115
Q

N.V. Plasma chloride

A

98 – 108 mmol/L

116
Q

Clinical significance in Cl

A

Hyper-chloremia

Hypo-chloremia

117
Q

5th most abundant element in the body approximately 99% found in the bone

A

Calcium

118
Q

Ca is found in the bone as

A

Hydroxy-apatite

119
Q

dietary calcium requirement

A

400 – 500 mg

120
Q

excreted Ca per day

A

200 mg of calcium /day

121
Q

How many % of protein mostly bounded to albumin in Ca?

A

40%

122
Q

% of Free or Ionized calcium

A

45%

123
Q

What are the anionic materials where Ca is coplexed?

A

HCO3, citrate, lactate

124
Q

both ionized and complex calcium are known as

A

ultra-filtrable calcium

125
Q

Urine calcium conc.

A

15 % complex, 85 % ionized

126
Q

parameters known to accurately evaluate Calcium level

A

pH & protein

127
Q

enhance intestinal absorption & enhance resorption from bone

A

Vitamin D metabolites

128
Q

triggered by decrease in ionized calcium stimulates osteoclastic activity

A

PTH (Parathyroid Hormone)

129
Q

stimulates Vit. D synthesis in Ca

A

activation of 1-alpha-hydroxylase

130
Q

What decreased PTH will cause?

A

decrease in serum Calcium level

131
Q

from medullary cells of thyroid Gland released if Calcium level is decreased

A

Calcitonin

132
Q

Ca (serum) precipitated with ammonium oxalate converted to oxalic acid

end color:

A

Clark-C0llip

-purple

133
Q

calcium is precipitated with chloranilic acid

end color:

A

Ferro-Ham method

-purple

134
Q

Bachra, Dauer and Sobel method

  • chelating titration:
  • indicator:
  • end color:
A
  • chelating titration: EDTA
  • indicator: Calcien red
  • end color: Salmon pink (EDTA-Ca complex)
135
Q

Ca is remove from protein by acidification of the sample

end color:

A

Ortho-cresolphthalein

  • red
136
Q

what does Ortho-cresolphthalein used to prevent interference from Mg

A

8-hydroxyquinolone

137
Q

Reference method for Ca

A

AAS

138
Q

N.V. of Ca

A

8.6 – 10 mg/dl (2.15 – 2.50 mmol/L)

139
Q

4th most abundant cat-ion in the body & 2 nd most abundant intracellular cat-ion

A

Magnesium (Mg)

140
Q

dietary sources of Mg

A

cereal grains, raw nuts, fruits, meat, fish and green vegetables - “hard” drinking water

141
Q

Average conc. for the absorption of Ca

A

30-350 mg /day 20 - 65% absorbed by GIT

142
Q

renal threshold of Ca

A

0.60 – 0.85 mmol/L

143
Q

distribution:
- bone
- muscle
- soft tissues
- serum
- red blood cells

A

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
Q

forms of Mg in circulation

  1. protein bound -
  2. free Mg -
  3. complexed -
A
  1. protein bound - 33 %
  2. free Mg - 55 %
  3. complexed - 12 %
145
Q

what is the % of reabsorbed Mg in PCT & DCT?

A

PCT- 20-35%

DCT- 2-5%

146
Q

PTH increases

A

renal reabsorption

147
Q

aldosterone increases

A

renal excretion

148
Q

based on the absorption of light of various dyes in a given wavelength in the presence of Mg - dyes used

A

Colorimetric

149
Q

Mg binds with the dye to form reddish-violet complex, measured at 532 nm

A

Calmagite

150
Q

method of Yoe, magenta red

A

Titan yellow

151
Q

Mg binds to a chromogen

A

Methyl thymol blue

152
Q

Mg binds with the dye to form colored complex , measured at 660 nm

A

Formazan

153
Q

N.V. (serum, Colorimetric)

A

0.63 – 1.0 mmol/L

154
Q

Phosphorous (%)

  • bone
  • muscles
  • average phosphorous/day consumed by normal adult
  • absorb in the intestine, regulated by vitamin D
  • daily intake is excreted (stool)
  • pH
A
  • 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
Q

Sample used in Phosphorus determination

A

serum or Lithium heparin plasma

156
Q

preferred reducing agents in Phosphorus

A

Stannous chloride and Pictol

157
Q

Fiske Subbarow Method:
reducing agent:
Enzymes used:
N.V.

A

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
Q

O2 binding in hemoglobin & Cellular oxidative mechanism

A

Iron (Ferrous and Ferric)

159
Q

Source of Fe

A

Bakery products etc.

160
Q

When does Iron being excreted where 1 mg is lost ?

A
  1. Internal bleeding
  2. Menstruations
  3. breakdown of epithelial cells in the intestine and skin
161
Q

facilitates disposal of Fe

A

Haptoglobin

162
Q

removal from circulation of Fe

A

Hemopexin

163
Q

chromogen used in Fe Colorimetric Assay

A

2,4,6- Tripyridyl-5-Triazine (TPTZ)

164
Q

assess depletion of Iron stores

A

Ferritin Assay

165
Q

N.V. Serum Iron:

A

Male 65 - 180 ug/dl ,

Female: slightly lower - 10 % higher in morning than evening

166
Q

S.I. Factor in Fe

A

0.1791

167
Q

TIBC in Fe (adult)

A

250 – 450 mg/dl

168
Q

What is the organ affected in iron overload?

A

Liver

169
Q

Iron chelating agent

A

desferioxamine

170
Q

incorporated in ceruloplasmin & important in the diagnosis of Wilson’s disease (marked decrease of ceruloplasmin, < 20 mg/ml)

A

Copper (Cu)

171
Q

Method of choice in Cu

A

AAS

172
Q

N.V. in Cu

A

N.V. 70 - 140 ug/dl or 11 – 22 umol/L

173
Q

For RNA and DNA synthesis development of connective tissues

A

Zinc

174
Q

cholesterol synthesis of various mucopolysaccharide & oxidative phosphorylation

A

Manganese

175
Q

integral part of vit. B12 (cobalamin) & red cell synthesis

A

Cobalt

176
Q

active sites of enzymes & uric acid synthesis (precursor of Xanthine and Hypoxanthine)

A

Molybdenum

177
Q

stabilize nucleic acid structure

A

Nickel

178
Q

essential component of glucose tolerance factor (maintains normal insulin response)

A

Chromium

179
Q

causes Alzheimer’s disease

A

Aluminum toxicity

180
Q

“self-regulated” electrolyte

A

Mg

181
Q

counterpart of Sodium?

A

K

182
Q

What are the electrolytes in extracellular & inta?from major to minor

A 
EC = Na>Cl>HCO3>Ca>P
IC = K>Mg
183
Q

major defense against hyperosmolality and hypernatremia?

A

Thirst

184
Q

TIBC in Fe

A

Transferrin

185
Q

has reciprocal relationship with H+?

A

Potassium

186
Q

Phosphorous fasting time

A

6-8 hrs

187
Q

principal determinant of plasma osmolality?

A

Na

188
Q

3 hormones that regulate Ca

A

PTH, Vit. D, Calcitonin

189
Q

3 hormones that regulate Ca

A

PTH, Vit. D, Calcitonin

190
Q

% of normal plasma (intravascular)

A

93%

191
Q

Surrounds the cells

A

Interstitial fluid

CC2 (1 decks)

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