Electrolytes: Part 1 Flashcards by Marlo Roque

Biologic ions

Electrolytes

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Cation (+/-) migrates to _______ (+/-)

+
Cathode
-

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Anion (+/-) migrates to _________ (+/-)

-
Anode
+

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FUNCTIONS OF ELETROLYTES

Volume and Osmotic regulations
Myocardial rhythm and contractility
Enzyme cofactors (activators)
Regulation of ATPase-ion pumps
Neuromuscular excitability
Production and Use of ATP from Glucose
Acid-Base Balance Maintenance
DNA replication and mRNA translation

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Enzyme/s involved in Volume and Osmotic regulations

Na+, K+, Cl-

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Enzyme/s involved in Myocardial rhythm and contractility

K+, Ca2+, Mg2+

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Enzyme/s involved in Enzyme cofactors (activators)

Ca2+, Mg2+, Zn2+

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Enzyme/s involved in Regulation of ATPase-ion pumps

Mg2

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active transport that transports electrolyte in and out of the cell

ATPase-ion pumps

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Enzyme/s involved in Neuromuscular excitability

K+, Ca2+, Mg2+

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Enzyme/s involved in Production and Use of ATP from Glucose

Mg2+, PO4-

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Enzyme/s involved in Acid-Base Balance Maintenance

HCO3-, K+, Cl-, PO4-

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Enzyme/s involved in DNA replication and mRNA translation

Mg2+

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charged atoms

Ions

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dissolved in the blood and body fluids such as plasma, urine, CSF, etc.

ions

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Solvent for all processes in the body.

Water

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WATER

Human body: _______ water (___L)

40-75%
42L

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Location of water

→ Intracellular fluid (ICF)
→ Extracellular fluid (ECF)

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Intracellular fluid

___ or ___% of total body H2O (____L approx)

⅔
65%
28

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Inside the cell

→ Intracellular fluid (ICF)

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ECF

___ or __% (__L approx)

⅓
35%
14L

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Outside the cell

→ Extracellular fluid (ECF)

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Physiologic functions of Water:

→ Transports nutrients to cells
→ Determination of cell volume by its transport into and out of the cell
→ Removal of waste products
→ Body’s natural coolant

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Physiologic function of water;

→ Removal of waste products (_____)

Urine

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Physiologic function of water; → Body’s natural coolant (______)

Sweat

Sweat - contains __ mmol/L of Na & __ mmol/L of K+

15 5

2 Types of Water

Intravascular fluid Interstitial fluid

○ Inside the blood vessel

→ Intravascular fluid

○ Plasma (liquid part of unclotted blood) with ___% water

Intravascular fluid 93%

○ Gaps in between the cells; fluid that surrounds the cell

Interstitial fluid

Retained for 3L of water - will cause _____ (retention of fluids in the tissue)

Interstitial fluid Edema

Maintains concentration of electrolytes within cells and in plasma by actively promoting entry & exit of electrolytes in and out of the cell.

ION TRANSPORT MECHANISMS

● 2 Mechanisms of Ion Transport Mechanism

Active Transport Passive Transport (Diffusion)

transport mechanism that requires energy to move ion across cellular membranes.

Active Transport

movement of ions across membrane based on size and charge

Passive Transport (Diffusion)

T/F: Passive Transport needs energy

FASLSE; Passive transport does NOT need energy

Concentration of solutes per kilogram of solvent (mOsm/Kg)

OSMOLALITY

Osmolality is unaffected by:

hyperlipidemia hyperproteinemia alcohol mannitol

90% of total osmolality of osmotic activity in plasma

Na+ (and its anions)

Normal Plasma Osmolality

275-295 mOsm/Kg of plasma water

↑Na2+ and ↓H2O intake

Hyperosmolality

Function of Hypothalamus

Promote thirst Promote decrease is vasopressin

major defense of body against hyperosmolality

Thirst

T/F: Where Na+ goes, H2O follows:

TRUE

↑Na+ = (Inc/dec)H2O

inc

Results to hypervolemia = ↑BV = ↑BP = (inc/dec) plasma solute

inc

↓Na+

Hypoosmolality

Decrease plasma solutes relative to the water

Hypoosmolality

What is the meaning of RAAS System

RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM

regulates blood volume

RAAS System

mainly respond with decreased blood volume (Hypovolemia)

RAAS System

secreted by Renal glomeruli

Renin

converts angiotensinogen to angiotensin 1

Renin

secreted by the adrenal cortex

Aldosterone

secreted by the hypothalamus

ADH/Vasopressin/Arginine-Vasopressin Hormone

OTHER FACTORS AFFECTING BLOOD VOLUME

1. Atrial Natriuretic Peptide and B-type Natriuretic Peptide 2. Blood Volume Receptors 3. Glomerular Filtration Rate

Atrial Natriuretic Peptide and B-type Natriuretic Peptide Promotes Na+ (secretion/excretion) (H2O excretion) - (low/high) Blood volume & Blood pressure

Excretion low

Vasodilation

Atrial Natriuretic Peptide and B-type Natriuretic Peptide

acts against hypervolemia by promoting Na+

Atrial Natriuretic Peptide

Stimulates vasopressin secretion (retains H2O) – (dependent/independent) of Osmolality

Blood Volume Receptors Indepentent

Glomerular Filtration Rate Hypervolemia - (inc/dec) GFR Hypovolemia - (inc/dec)GFR

Hypervolemia - ↑GFR Hypovolemia - ↓GFR

What is the old name of Sodium

Natrium

The major extracellular cation (most abundant)

Sodium

The major contributor to osmolality (____%)

Sodium 90

The principal extracellular osmotic particle

Sodium

SODIUM Reference range: Serum

135-145 mmol/L

SODIUM Reference range: CSF

136-150 mmol/L

SODIUM Reference range: Urine

40-220 mmol/day

Sodium is maintained by:

Water intake Water excretion

Threshold Critical Values: → _____ mmol/L - Hypernatremia → ____ mmol/L - Hyponatremia

160 120

Renal Threshold:

110-130 mmol/L

Concentration where the kidney stops reabsorption

Renal Threshold:

Active Transport - requires energy

Na+/K+-ATPase ion Pump

Prevents osmotic rupture of cells

Na+/K+-ATPase ion Pump

When there is prevention of osmotic rupture of the cells, the water inside (inc/dec)

dec

Requires ATP

ATP-Driven

Maintained by promoting exit of __ Na+ outside the cell in-exchange with __ K+

3 2

Functions of Na+/K+-ATPase ion Pump Maintains high concentration of intracellular ___ Maintains high concentration of extracellular ___

K+ Na+

What does sodium regulates?

Thirst Water excretion Blood volume status Atrial Natriuretic Peptide Renal Regulation:

WATER EXCRETION ↑H2O excreted = (inc/dec) Na+

inc

Blood volume status affect Na+ excretion through ____________, _____________, and ____.

aldosterone angiotensin II ANP

Atrial Natriuretic Peptide blocks ______ and ______ secretion

aldosterone renin

Atrial Natriuretic Peptide inhibits action of ___________ and ___________.

angiotensin II vasopressin

Responds to hypervolemia

Atrial Natriuretic Peptide

Atrial Natriuretic Peptide Promotes “___________” - sodium excretion

Natriuresis

Sodium: Renal Regulation ________ of filtered Na+ are reabsorbed by ____

60-75% PCT

Hormone responsible for Renal Regulation of Sodium

Aldosterone

Decreased plasma sodium concentration

Hyponatremia

Levels of decreased during Hyponatremia

<135 mmol/L

Most common electrolyte disorder

Hyponaterima

__________mmol/L hyponatremia symptoms occurs

125-130 mmol/L

results to severe neuropsychiatric symptoms (momentary memory loss)

<125 mmol/L

_______________ causes hyponatremia

Hyperglycemia

ongoing renal sodium and water loss

Urine Sodium of 20 mmol/day

For every 100 mg/dL ↑in glucose = _____ mmol/L ↓in Na+

1.6

____________ = ↓K+ in blood = Hyponatremia

Hypokalemia

Causes of Hyponatremia

Increased Na2+ loss Increased Water Retention Water Imbalance

Enumerate the diseases/conditions involving increased NA2+ loss

Hypoadrenalism Potassium deficiency Diuretic Ketonuria Salt-losing nephropathy Prolonged vomiting or diarrhea Severe burns

↓aldosterone excretion

Hypoadrenalism

Examples of Diuretic the Increased NA2+ loss

Thiazides

inhibit renal Na+ reabsorption in the DCT

Diuretic (Thiazides)

excreted along with blood Na in the urine

Ketonuria

Enumerate the Diseases/Conditions involving the increase of water retention

1. Renal Failure 2. Nephrotic syndrome 3. Hepatic cirrhosis 4. Congestive Heart Failure

Enumerate the Diseases/Conditions involving the increase of water retention

Polydipsia Syndrome of Inappropriate ADH secretion (SIADH) Pseudohyponatremia

dilution of plasma causing dilution of its electrolytes

Polydipsia

The dilution of plasma causing dilution of its electrolytes causes excessive __________

Thirst

Syndrome of Inappropriate ADH secretion (SIADH) ↑ADH = - (inc/dec) Urine Output (Inhibit Urination)

dec

False ↓ in Na+

Pseudohyponatremia

Happens only during measurement (systematic error)

Pseudohyponatremia

Pseudohyponatremia happens when using __________________________________

Indirect Ion Selective Electrode

In patients with hyperlipidemia and hyperproteinemia

Pseudohyponatremia

Increased plasma sodium concentration (_____ mmol/L)

Hypernatremia >145

Water deficit affects plasma concentration (_____ deficit will result to thirst)

Hypernatremia 1-2%

Moderate H2O deficiency

150-160 mEq/L

Severe H2O deficiency

>165 mEq/L

indicative of hypothalamic disease

Chronic hypernatremia

Causes of Hypernatremia

Excess Water Loss Decreased Water Intake Increased Na2+ intake or retention

Most common cause of Hypernatremia

Excess Water Loss

Enumerate the diseases/conditions involving excess water loss

1. Diabetes insipidus 2. Renal tubular disorder 3. Profuse sweating 4. Hyperventilation 5. Diarrhea 6. Severe burns 7. Vomiting 8. Fever

polyuria because of deficient vasopressin

Diabetes insipidus

impairment to retain urine at SG of 1.010

Renal tubular disorder

1L of water loss/day

Profuse sweating

1L of water loss/day

Hyperventilation

Who is affected by Decreased Water Intake

Older persons, infants, mental impairment

Enumerate the diseases/conditions involving Increased Na2+ intake or retention

1. Hyperaldosteronism 2. Sodium Bicarbonate Infusion 3. Increased NaCl administration (Oral/IV) 4. Ingestion of Sea Water

Hyperaldosteronism aka

Conn’s Disease

in Conn’s Disease, what hormone is increased?

Aldosterone

Why does ingestion of Sea Water increases Na2+ intake?

Sea water has high levels of Na Content

Specimens used for the Laboratory Analysis of Sodium

Serum Plasma 24hr Urine Sweat Whole Blood

What type of Plasma is only used in the laboratory analysis of sodium?

lithium heparin ammonium heparin lithium oxalates

This specimen is used in some analyzers (with acceptability precautions)

Whole blood

This specimen is used in Sodium testing

Sweat

Variables in the Laboratory Analysis of Sodium

Marked hemolysis

In marked hemolysis, _____________ leading to false decrease

dilutional effect

Method used for collection of sweat

GIBSON AND COOKE PILOCARPINE IONTOPHORESIS

Sweat sample must be tightly sealed because it is ____________ (easily evaporates)

volatile

GIBSON AND COOKE PILOCARPINE IONTOPHORESIS Sweat Inducer

Pilocarpine + Mild Current (Iontophoresis)

GIBSON AND COOKE PILOCARPINE IONTOPHORESIS Output: ____ mg of sweat within __ minutes

>50 30

Methods used in Sodium

Ion Selective/Specific Electrode Atomic Absorption Spectrophotometry Emission Flame Photometry Chemical Methods (Albanese Lein)

Membrane used in Ion Selective/Specific Electrode

Glass Aluminum Silicate

Atomic Absorption Spectrophotometry → measurement of ____________ ions

unexcitable

Emission Flame Photometry → measurement of __________ ions

excitable

Used in Chemical Methods (Albanese Lein)

Cupric sulfate NaOH

Old name of Potassium

Kalium

The major intracellular cation (_____ mmol/L in RBC)

Potassium 105

RBC K+ is ____ than of the plasma/serum K+

23x

The single most important analyte in terms of abnormality

Potassium

Functions of Potassium

Skeletal and Cardiac Muscle Contraction Neuromuscular excitability ICF volume regulation Hydrogen Ion Concentration

slight ↑/↓in K+

Skeletal and Cardiac Muscle Contraction

affect acid-base balance

Hydrogen Ion Concentration

Threshold Critical Values: → ___ mmol/L (hyperkalemia) → ___ mmol/L (hypokalemia)

6.5 2.5

diseased/conditions in hypokalemia

cardiac arrhythmia Tachycardia

T/F: Only one is significant in Hyperkalemia and Hypokalemia therefore, only one must be regulated

FALSE; both are significant and should be regulated

Potassium Reference range: Serum

3.5-5.1 mmol/L (2%)

Potassium Reference range: Plasma (MALE)

MALE: 3.5-4.5 mmol/L

Potassium Reference range: Plasma (FEMALE)

3.4-4.4 mmol/L

Potassium Reference range: Urine (24H))

25-125 mmol/d

Potassium regulation

Kidneys Cellular uptake

In which organ: 70-80% of filtered K+ is reabsorb (________________________)

Kidneys proximal tubules

Which hormone causes the Kidneys to excrete potassium

Aldosterone

CELLULAR UPTAKE Acute K+ elevation will result to rapid (entry/exit) of K+ in the cell

entry

What promotes cellular entry of Potassium?

→ Insulin → Catecholamines → Beta-Blockers

therapeutic drugs (cardioactive drugs)

Beta-Blockers

Decreased plasma K+ concentration

HYPOKALEMIA

Hypokalemia may result in:

arrhythmia and paralysis

HYPOKALEMIA If <2.5 mmol/L = _______________

induce Cardiac Arrhythmia

Causes of Hypokalemia

A. Gastrointestinal Loss B. Renal Loss C. Cellular Shift D. Decreased K+ intake

Enumerate the diseases/conditions in Gastrointestinal Loss

1. Diarrhea 2. Vomiting 3. Gastric Suction 4. Intestinal Tumor 5. Malabsorption 6. Cancer therapy 7. Large doses of Laxatives

most common cause of extrarenal hypokalemia

Diarrhea

result to ↑K+ loss through GIT

1. Diarrhea 2. Vomiting

↑K+ loss in stool

4. Intestinal Tumor 5. Malabsorption 6. Cancer therapy 7. Large doses of Laxatives

Enumerate the diseases/conditions in Renal Loss

1. Diuretics (thiazide-type) 2. K+-losing Nephritis 3. Renal Tubular Acidosis 4. Hyperaldosteronism 5. Cushing’s Syndrome 6. Hypomagnesemia 7. Acute Leukemia

most common cause of renal loss

Diuretics (thiazide-type)

Lead to ↓hydrogen ion excretion promoting ↑K+ excretion

Renal Tubular Acidosis

condition in renal loss wherein: Hypernatremia (sodium is absorbed)

Hyperaldosteronism

What hormone is increased in Crushing's Syndrome

↑cortisol

Cortisol is secreted by the _____________

adrenal cortex

What is the action of cortisol?

mimics the action of aldosterone

Condition in renal loss wherein: ↓Mg2+ in blood

Hypomagnesemia

The decrease of Mg2+ in the blood causes enhanced aldosterone (secretion/excretion)

secretion

↑immature WBC/blasts

Acute Leukemia

Enumerate the diseases/conditions in Cellular Shift

1. Alkalosis 2. Insulin overload 3. Catecholamines

alkaline pH of blood

Alkalosis

Normal pH concentration of the blood

(7.35-7.45)

Alkalosis ↓0.4 mmol/L/0.1 pH unit (increase/decrease)

increase

pH of the blood in alkalosis

>7.45

pH of the blood in acidosis

7.20

hyperglycemic hormone

Catecholamines

only occurs during analysis

Pseudohypokalemia

Pseudohypokalemia occurs especially if patient has ____________________

leukocytosis

↑WBC because WBC takes up K+ if sample is left at room temp.

leukocytosis

Increased plasma K+ concentration

HYPERKALEMIA

HYPERKALEMIA ____ mmol/L - can alter ECG trace

6-7

HYPERKALEMIA __ mmol/L - can cause lack of muscle excitability/ muscle weakness

HYPERKALEMIA ___ mmol/L - can cause cardiac arrest

Causes of Hyperkalemia

A. Decreased Renal Excretion B. Cellular Shift C. Increased K+ intake D. Artifactual (Pseudohyperkalemia)

Most common cause of Hyperkalemia

Decreased Renal Excretion

Enumerate the diseases/conditions involved in Decreased Renal Excretion

1. Acute or Chronic Renal Failure 2. Hypoaldosteronism 3. Addison’s Disease 4. Diuretics

Condition in Decreased Renal Excretion wherein: an adrenal insufficiency

Addison’s Disease

Example of an adrenal insufficiency

hypoaldosteronism

Enumerate the diseases/conditions involved in Cellular Shift (Hyperkalemia)

1. Acidosis 2. Muscle/Cellular Injury 3. Diabetes mellitus 4. Chemotherapy 5. Leukemia 6. Hemolysis

acidic pH of blood (↑H+ )

Acidosis

ACIDOSIS ↑ 0.2-1.7 mmol/L/0.1 pH unit (increase/decrease)

decrease

K+ can’t enter the cell due to insulin deficiency

Diabetes mellitus

Oral or Intravenous Potassium replacement therapy

Increased K+ intake

Artifactual causes of Hyperkalemia

1. Sample hemolysis 2. Thrombocytosis 3. Prolonged tourniquet use 4. Excessive fist clenching

Sample hemolysis → ↑K+ because RBC K+ is ___ (~___ mmol/L) than serum/plasma

23x 110

K+ are released from platelets when clotting

Thrombocytosis

In thrombocytosis, never measure the K+ because it causes false (inc/dec)

Increase

can promote cellular exit of K+

Prolonged tourniquet use Excessive fist clenching

Specimen used in Potassium Laboratory Analysis

Heparinized Plasma Serum Urine

Most preferred sample in Potassium Laboratory Analysis

Heparinized Plasma

potassium specimen Serum (______ mmol/L higher than plasma)

0.1-0.7

Potassium specimen Do not use EDTA = false (increase/decrease)

increase

○ K2EDTA – ____________ ○ K3EDTA – _____________

versene sequestrene

Variables in the Laboratory Analysis of Potassium

1. Hemolysis 2. Prolonged tourniquet application 3. Unseparated whole blood sample stored in ice/refrigerator 4. Lipemia 5. Exercise and Prolonged Standing

Slight hemolysis (50 mg/dL Hgb) –____ ↑ in K+

Gross hemolysis (>500 mg/dL Hgb) – ___ ↑ in K+

30%

Unseparated whole blood sample stored in ice/refrigerator Promotes exit of K+ from the cell (due to cold temp) = (inc/dec)in K+

inc

causes elevated serum potassium

Lipemia

10-20% increase in potassium

Exercise and Prolonged standing

Mild-moderate exercise: _______ mmol/L increase

0.3 - 1.2

Vigorous exercise (fist clenching): ____ mmol/L increase

2-3

Laboratory Methods in Potassium

● Ion Selective Electrode ● Atomic Absorption Spectrophotometry ● Flame Emission Photometry ● Colorimetry (Lockhead and Purcell)

K+-specific Membrane:

Valinomycin gel

The major extracellular anion

Chloride

Chief counter ion of sodium in plasma

Chloride

____ and ___ almost always exist as one

Na+ Cl-

○ Na+ = ______ ○ Cl- = _____

cation anion

inverse relationship of two electrolytes

Counter ion:

Chloride is excreted in:

Urine and Sweat

excess sweating

Perspiration

Perspiration (inc/dec) Cl- = (inc/dec) Na+ in the blood

dec dec

To retain sodium, __________ secretion/production are stimulated

aldosterone

Aldosterone promotes reabsorption of sodium in the ___________________

DCT

Absorption: dietary Cl- are almost completely (excreted/absorbed) by the intestinal tract

absorbed

T/F: Chloride's function is NOT well defined

Enumerate the functions of Chloride

→ Maintains plasma osmolality and blood volume (in conjunction with Na+) → Maintains electroneutrality → Enzyme activator

Cl- is an _______ activator

Amylase

the only anion that serve as enzyme activator

Chloride

Chloride Reference range: Serum/Plasma

98-107 mmol/L

Chloride Reference range: Urine (24hr)

110-250 mmol/d (or 24 hrs)

Where does regulation of chloride occurs?

Renal (kidneys)

T/F: Chloride is freely filtered by glomerulus

Chloride is reabsorbed by _____________ (with Na+)

proximal tubules

T/F: reabsorption of Na+ is NOT dependent on the availability of Cl-

FALSE; reabsorption of Na+ is dependent on the availability of Cl- (excess will be excreted in the urine)

stimulates aldosterone secretion (retains Cl- with Na+)

Perspiration

balance in the number of electrons in the plasma

Electroneutrality

Whenever there is aerobic biochemical process (requires O2) in the body it will produce _______

CO2

CO2 will enter the _______

red cell

Within RBC, CO2 will form _________ by the enzyme _______________

carbonic acid carbonic anhydrase

Carbonic acid will be split into __________ (H+) and __________ (HCO3 -)

hydrogen ion bicarbonate ion

one of the principle ion that contributes to the acidity of the blood or any substance

Hydrogen ion

↑H+ = ↓ph = (inc/dec) acidity

inc

hemoglobin that doesn’t have oxygen bound to it

Deoxyhemoglobin

It will buffer the H+ to maintain pH

Deoxyhemoglobin

____________ (anion) will diffuse out of the cell

Bicarbonate ion

↑ Cl- + ↑ bicarbonate = electroneutrality is _______________ = result in (inc/dec) in number of negatively charged substance in the plasma

disturbed inc

To maintain the electroneutrality, ____(abundant in plasma) will enter the cell along with _____

Cl- Na+

When bicarbonate exit the cell, it will exit along with ____

Na+

T/F: Cl- passively follows Na+

T/F: Disorders related to Cl- is NOT same as Na+

FALSE; Disorders related to Cl- is the same as Na+

Other causes of Chloride Shift

1. Hyperchloremia (↑Cl-) 2. Hypochloremia (↓Cl-)

Excessive loss of HCO3-

Hyperchloremia (↑Cl-)

Excessive loss of HCO3- is due to:

GIT loss metabolic alkalosis renal tubular acidosis

Excessive Cl- loss

Hypochloremia (↓Cl-)

Excessive Cl- loss is due to

Vomiting Diabetic Ketoacidosis Aldosterone deficiency Salt-losing nephropathies

Elevated blood HCO3- (disturbs electroneutrality)

Hypochloremia (↓Cl-)

Elevated blood HCO3- is due to:

compensated respiratory acidosis metabolic alkalosis

Specimen used in Laboratory Analysis of Chloride

Serum Heparinized Plasma 24hr Urine

Type of Heparinized Plasma used in Chloride

Lithium heparin

Method of Collection of Sweat in Chloride Laboratory Analysis

Gibson and Cooke Pilocarpine Iontophoresis

Variables in Chloride Laboratory Analysis

Marked Hemolysis: Interfering Substances:

Marked Hemolysis causes ________________ (false decrease)

DIlutional effect

Enumerate the interfering substances

Bromide cyanide, cysteine

The interfering substances causes false (inc/dec) as these are measured as Cl- in chemical/coulometry method)

inc

Laboratory methods in chloride

1. Schales and Schales (Mercurimetric Titration) 2. Spectrophotometric Methods 3. Coulometric Amperometric Titration (Cotlove Chloridemeter) 4. Ion Selective Electrode (ISE)

Indicator used in Schales and Schales (Mercurimetric Titration)

Diphenylcarbazone

End product in Schales and Schales (Mercurimetric Titration)

Mercuric chloride (HgCl2)

Mercuric chloride (HgCl2) shows what color?

blue violet color

Spectrophotometric Methods Forms reddish complex

Mercuric thiocyanate (Whitehorn Titration Method)

Spectrophotometric Methods Forms colored complex

Ferric perchlorate

Reagent used in Coulometric Amperometric Titration (Cotlove Chloridemeter)

Silver

End product of Coulometric Amperometric Titration (Cotlove Chloridemeter)

Silver Chloride

T/F: The number of silver used to form silver chloride is equivalent to the Cl- ions present in the sample

Membrane used in Ion Selective Electrode (ISE)

tri-n-octylpropylammonium chloride decanol

Electrolytes: Part 1 Flashcards

(286 cards)