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Clinical Pathology > Electrolytes > Flashcards

Electrolytes Flashcards

1
Q

What are the major ECF ions

A

Na and Cl

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2
Q

What are the major ICF ion

A

K

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3
Q

how is Hco3 generated

A

Carbonic anhydrase reactions in the lungs, gastric mucosa, kidney and RBC

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4
Q

TCO2

A

Total extractable CO2 from serum or plasma by addition of an acid. Most of it (955) bicarb. and HCO2 and TCO2 are essentially equal

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5
Q

What can cause abnormal electrolyte concentrations in plasma or serum

A
  1. Increased or decreased intake
  2. Shift between ECF and ICF
  3. Increased renal retention
  4. Increased loss through GI, renal, skin, airway
    Hydration is essential to assessment
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6
Q

Mechanisms of dehydration and Na changes

A
  1. Loss or sequestration of hypotonic fluid (hypertonic dehydration)
  2. Loss of isotonic fluid (isotonic dehydration)
  3. Loss of hypertonic fluids (hypotonic dehydration)
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7
Q

Hypertonic dehydration

A

-Pure water loss results in hypernatremia
-ICF and ECF share burden but ECF has greater osmolality so water shifts to ECF

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8
Q

Causes of hypertonic dehydration

A

No access to water with continued insensible loss
(Panting, hyperventilation, fever)

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9
Q

Isotonic dehydration

A

-Fluids lost have the same amount of electrolytes as blood or serum
-Normonatremia
-ICF osmolality=ECF
-Animal shows other signs of dehydration (skin turgor, hyperalbuminemia, relative erthrocytosis)

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10
Q

Causes of isotonic dehydration

A

Vomiting and Diarrhea

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11
Q

Hypotonic dehydration

A

-Fluids with more electrolytes lost compared with blood/serum
-ECF osmolality < ICF fluid shifts into ICF

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12
Q

Hypotonic dehydration causes

A

Secretory diarrhea

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13
Q

Tonicity

A

Effective osmolality of a solution
Effective osmole-> do not cross permeable membranes
Ineffective osmoles-> readily cross membranes

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14
Q

Measured osmolality

A

Uses freezing point (lower if the concentration is raised) and measures effective and ineffective osmoles

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15
Q

Calculated osmolality

A

2(Na + K) if glucose and UN normal
Typically 300-310 and 10mOsm less than the measured

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16
Q

Osmolar gap

A

Measured osm- calculated osm
Normally 10mOsm

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17
Q

Increased osmolal gap

A

Increased number of osmotically active particles in blood not accounted for in equation (Lactate, ketones, alcohols, ethylene glycol, mannitol, oxalic acid, salicylic acid)

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18
Q

What is the mahor determinant of extracelullar tonicity

A

Na

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19
Q

Plasma Na controlled by

A
  1. Regulation of blood volume
  2. Regulation of plasma osmolality/ tonicity
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20
Q

Serum Na is dependent on what

A

Ratio of total body Na/tbH2O
Hypernatremia means that increase in Na means tbH2O is normal or there is normal Na but decreased tbH2O or decrease in Na leads to severe decrease in tbH2)

21
Q

Mechanisms of hypernatremia

A

-Decreased H2O intake
-Pure H2O loss
-H2O loss> Na loss
-Excess Na intake
-Decreased Na excretion

22
Q

Hyponatremia mechanisms

A

-Na loss> H2O loss
-Renal Na wasting
-H2O retention> Na retention (with or without edema)
-Osmotic shifting of H2O to ECF
-Shift of Na down concentration gradient from intravascular to extravascular

23
Q

Normonatremia

A

Does not necessarily mean normal tbNa
-Hypervolemic
-Hypovolemic/dehydration

24
Q

Serum K is dependent on

A
  1. Shifting of K in and out of cells
  2. TbK (from intake and excretion)
    If acid base is normal-> K reflects tbK
    If not normal A/B-> abnormal tbK
25
Q

Alkalosis and K

A

Increased bicarb-> hypokalemia

26
Q

Inorganic Acidosis and K

A

Decrease bicarb-> hyperkalemia

27
Q

Organic acidosis and K

A

No hyperkalemia because as H enters the cell it is travelling with its anion (lactate) and maintains electroneutrality

28
Q

Excess K loss and acid base

A

Leads to alkalosis because K enters the plasma from the cell and H enters the cell

29
Q

Mechanisms of hyperkalemia

A

-Shift in exchange for H
-Cellular necrosis
-Pseudohyperkalemia
-Insulin deficiency
-Decreased renal excretion of K
-Increased intake

30
Q

Pseudohyperkalemia

A

Marked thrombocytosis and take a serum sample which clots and releases K from platelets and if they have a lot of platelets have a lot of K. to determine but it in a heparinized tube (green top)

31
Q

Mechanisms of hypokalemia

A

-ECF-> ICF shift in exchange for H
-Insulin administration
-Decreased K intake
-Increased K excretion
-Increased alimentary K loss

32
Q

Sodium: Potassium ratio

A

If it Na decreased , K may be ok
If K is increased , Na may be ok
If Na is decreased, K may be increased

33
Q

Hypoadrenocorticism and Na: K ration

A

Increased Na loss and increased K retention
<15

34
Q

Control of Cl

A
  1. Renal resorption and excretion
  2. Alimentary tract functions
35
Q

Shifts in Cl

A

Maintain electroneutrality
-Usually follows Na
-Inverse to HCO3

36
Q

Interpreting Hyperchloremia

A

-Concurrent hypernatremia-> same cause
-Normonatremia-> due to decreased HCO3
-Hyperchloremic metabolic acidosis-> Loss of NaHCO3 fluid (diarrhea)

37
Q

Interpreting hypochloremia

A

-Concurrent hyponatremia-> same cause
-Normonatremia-> due to increased HCO3 and loss of HCl
-Normonatremia-> decreased HCO3-> must have unmeasured anions present (metabolic acidosis)

38
Q

Alimentary tract causes of hypochloremia

A

HCl is not being recycles but still get bicarb is being made. Cl has to leave ECF due to the bicarb and you get Cl loss. Causes metabolic alkalosis

39
Q

Renal mechanisms for hypochloremia

A

Occurs with metabolic acidosis. Look at chart

40
Q

If Na and Cl change in same direction

A

THink hydration problems

41
Q

If Na and Cl change in opposite directions

A

Think acid/base abnormalities

42
Q

Metabolic alkalosis

A

Increase in HCO3, usually due to loss of H or compensation for chronic respiratory acidosis

43
Q

Metabolic acidosis

A

Decrease of HCO3, usually due to generation of excess H or loss of HCO3. May see with compensation for chronic respiratory alkalosis

44
Q

Mechanisms for increased HCO3

A

-Gastric loss of H
-Renal loss of H
-Shift from ECF to ICF in exchange for K (Hypokalemia)

45
Q

Mechanisms for decreased HCO3

A

-Increased H from metabolic process and HCO3 gets used up
-Decreased renal H clearance and HCO3 used up
-Alimentary losses
-Renal loss

46
Q

Lactate production

A

Product of anaerobic glycolysis during hypoxia in skeletal muscles and can then be used for glyconeogenesis

47
Q

Types of hyperlactatemia

A
  1. Hypoxia
  2. Metabolic: grain overload
48
Q

Metabolic hyperlactemia

A

Grain overload leads to increase formation of L lactate and (D lactate by bacteria) increases lactate absorption by ruminal mucosa and increases plasma lactate

Clinical Pathology (70 decks)

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