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Electrolytes and Inorganic ions  Increases sodium

 Proximal Convoluted Tubules = Where 70% of


Electrolytes = Inorganic subs that dissociates into ions: cation anion the filtered sodium is passively reabsorbed
- They are charged - Atrial natriuretic peptide:
- It has different specialties  CHF marker
Anion Gap  Produced by the heart when it works too much.
 Used for Electrolyte profile  Natriuresis = sodium excretion in the urine
 Makes use of 4 major electrolytes (water follows) that causes the blood volume to
- Sodium decrease that in turn alleviates its work load
- Potassium  RAAS – Renin is produced in low BP (low salt
- Chloride concentration). In turn i will promote sodium
- Bicarbonate reabsorption at Distal Convoluted Tubules
 Formula: [Na+] – [Cl- + HCO3]  Related Imbalances:
 Normal Value = 10-17mmol/L - Hypernatremia
 Quality control purposes: low normal, normal, high for - Hyponatremia
electrolytes result - (plasma water has an effect in sodium levels in the
 Cation = + ion blood;
 Anion = - ion  Hyponatremia
 Electrical Neutrality = Electrolytes exists in the body with a - Overhydration = water retention.
0 net charge. - It is due to excessive loss
- In the body, electrical neutrality must be maintained - Dietary is not a quite significant cause
 Sum of cation = sum of anion - Addison’s disease
- difference arise due to the presence of other  Adrenal gland problem
electrolytes  Primary Hypoadrenalism
 We only use them for prob id esstimate = o Low Aldosterone production that causes
 Increase in anion gap was observed in: decreased sodium conservation
- Uremia - It can be a result of diarrhea
- DM complication - Pseudohyponatremia
- Ketoacidosis  Artefctual
- Dehydration  High glucose, lipids and protein levels (especially
from DM patients, MM patients and
 Decrease in anion gap was observed in:
dyslipidemia)
- Monoclonal and Polyclonal Gammopathies
- Electrolyte Exclusion Effect = Principles followed by
- Lithium toxicity
the electrolytes in the blood especially when it comes
- Hypermagnesemia
to their measurement
 Electrolytes are only measured in the water
Functions:
phase of the plasma (93-95% of water), because
 Maintain fluid balance (Mainly Na)
electrolytes are only found in water phase.
 Acid base balance (Mainly HCO3)
 All electrolytes measurements are in low
 Production of action potential (Mainly K)
concentration due to the total volume of the
 It can act as a cofactor for different enzyme systems (Mg = specimen.
most widely used activator) - Sodium is the most affected in imbalance
 Maintenance of electrical neutrality  Hypernatremia:
- Dehydration
Sodium (Na; Natrium) - High sodium levels
 Maintains the fluid balance in the body. - Insulin therapy
 It is the most abundant extracellular cation in the body. - Cushing syndrome and DM insipidus
- Monovalent cation  Its hallmark is high sodium
- 1:12 intracellular:extracellular ratio  Excessive aldosterone production
 It controls osmosis of the water between different fluid  Reference value: 135-150
compartments.
 Analytical techniques:
 Principal osmotic particle:
- Use serum as a specimen = no additives that might
- It is osmoticaly active which draws water (so as Cl)
interfere with the reaction performed
that creates osmotic pressure in the plasma.
- Almost half of the osmolality of the plasma water  11-30 min to clot
attributes to sodium. - Heparinized plasma is the second preferred specimen
 ~280-290 mOsmol/kg  Specimen processing is faster
- Osmolality must be balanced to maintain blood  You will not wait for clotting.
volume and blood pressure  Sodium Heparin must not be used in Sodium
 Regulation: measurement.
- ADH (vasopressin) - secreted from the posterior - Ion Selective Electrode
pituitary gland. It promotes water absorption.  Potentiometry = method of choice. It measures
 It affects sodium balance if imbalance. electrode that binds to the electrolyte.
- Aldosterone – secreted by adrenal cortex. It promotes o Glass electrode must be used in sodium
sodium reabsorption.
- 2 types of ISE (2 modes of operation). o Acidosis = Potassium is pushed out of the
 Direct cell and hydrogen comes in which causes
o No specimen dilution high potassium levels
o The risk of pseudohyponatremia will not be - As seen in Insulin therapy where potassium comes
a problem along as the glucose comes in.
o Most oftenly used - Potassium loss
- Asssociated with GI and Renal due to massive
 Indirect
excretion
o Specimen dilution.
 Diuretic = potassium decrease
o Electrolyte exclusion effect o Potassium sparring diuretic which prevents
o More prone in pseudohyponatremia. potassium loss
o Hemolysis specimen = Most common cause  Remedy: Eat foods rich in Potassium
of pseduhyponatremia  Hyperkalemia
 Ruptured RBC can lead to - high potassium
electrolytes increase. - Opposite reasons
 False decrease in sodium and - Acidosis
chloride, due to dilution. - Cell damage
- Flame photometry for sodium measurement; - Renal failure
 Obsolete - Mineralocorticoid deficiency
 Performs dilution  Deficiency in Aldosterone which promotes
potassium excretion
 Sodium = yellow flame
o If the aldosterone levels are high the
- Spectrophotometric and Colorimetric Method
potassium level decreases
 Uses Bradbury method (Yellow end color)
o If deficient the potassium level increases
 Adopted in: - Pseudohyperkalemia
o Albanese Lein - Zinc urinylacetate  Artefactual
o Maruna Trinder - Mg uranylacetate  False hyperkalemia
- Enzymatic Sodium Method o Potassium is collection sensitive
 Uses beta-galactosimase o Most significantly affected in hemolysed
 Sodium act as an activator samples
- Atomic absorption  RBC contains ~105 mmol/L of
 Gold standard Potassium against in serum that
 Reference method contains only 3.85 - 5.5 mmol/L
 Reference Values: o Excessive tourniquet time
- Serum= 135 - 150 mmol/L o Excessive clenching of fist
- CSF= 136 - 150 mmol/L o Delayed separation and refrigeration can
- Urine= 40 - 220 mmol/day (24-hr urine) result to pseudohyperkalemia due to
- Conversion of mmol/L to mEQ/L is based on the cellular activity
number of valence. o The same is true if the specimen is high
platelet count
Potassium (K; Kalium)  When the blood clots the platelets will
 Potassium balance. rapture and potassium will be release.
 Generation of action potential.  Remedy: use plasma
 Involved in muscle contraction and nerve impulse  Serum potassium is a little higher
transmission due to clotting process than
 Most important in normal cardiac function plasma potassium val has a diff.
- Too much or little can make the heart stop beating  Barter syndrome
- If not that extreme, only the muscles will be affected. - Low sodium
 Most abundant intracellular cation - Low potassium
- 23:1 intracellular:extracellular ratio  Analytical technique:
 Low levels in blood serum. - Potassium Ion Selective Electrode
 Levels are controlled by aldosterone in an opposite  Uses liquid membrane electrode with
manner valinomycin incorporated as a potassium binder.
- Potassium excretion = decreases potassium in the  Valinomycin is part of the electrode that serves
body as potassium binder
 Hypokalemia - Flame photometry
- Due to potassium shift from extracellular  Potassium = Violet flame
compartment to intracellular compartment as seen in - Spectrophotometric technique
alkalosis  Lockhead and Purcell
 Potassium replaces hydrogen as it goes out of o Old method
the cell to compensate alkalosis o Blue violet to violet
o Electrical neutrality = Hydrogen needs - Turbidimetric
replacement to balance the charges  Hillman and Beyer
o Uses sodium tetraphenylboron which
produces turbidity
- Atom Absorption Spectroscopy o Sodium is also elevated
 Gold standard o Elevation of chloride = 60mmol/L or higher
 Reference Value: sweat chloride in CF.
- Serum = 3.8-5.5 mmo/L  How to collect the sweat?
- Urine = 25-125 mmol/day o Use Pilocarpine Iontophoresis
 Devised by Gibson Coolie
Chloride  Uses pilocarpine nitrate to induce
 Counter-ion of sodium sweating (so does increase salivation
- Regulates osmotic pressure and water balance but this is not we are up to), then
together with sodium. collected in goose pad then pathlab
 Has a role in acid-base balance chlorinometer.
- Chloride shift  Reference Values:
 Bicarbonate acts as its reciprocal ion. - Serum = 98-106 mmol/L
 Serves as its “Kapalitan” to preserve electrical - Urine = 110-250 mmol/day
neutrality - Sweat = 5-45mmol/L (Higher than 60 implies Cystic
 Bicarbonate is an important base if it needs to Fibrosis)
cross the membranes and go other places, the
chloride take its place. Calcium
 Reciprocal in relationship  5th most abundant mineral element in the body
 Most abundant extracellular anion  Lower than potassium
 Hyperchloridemia  98% is found in the bones in the form of hydroxylapatite
- Metabolic alkalosis crystals
- Respiratory acidosis  2% is left for the other parts of the body
 Hypochloridemia  Ca is also a clotting factor
- Metabolic acidosis  For muscle contraction
- Respiratory alkalosis  Regulated by PTH produced by the parathyroid hormone
 Analytical techniques: - PTH can cause blood calcium levels elevation by a
- Ionic Selective Electrode process called bone resorption
 Uses Silver chloride  1% of bone calcium is exchangeable in the
- Colorimetric method plasma then calcium will go to the plasma which
 Schales and Schales causes calcium elevation
o Uses mercurimetric titration - PTH promoting calcium absorption in the kidneys
 Mercury has high affinity for chloride. - Promotes vitamin D synthesis
Chloride and Mercury will react to - Elevates calcium due to intestinal absorption of
produce HgCl, titrated with calcium and phosphorous:
diphenylcarabazome to a blue end  Acetone, came from thyroid gland, has an
point opposite effect which decreases blood calcium.
- Skeggs modification  It has different forms in the blood
 Uses mercuric thiocyanate - Not exclusively ions compared to others.
o Mercuric thiocyanate will react with  Some fractions cannot be measured by ISE due to its many
chloride to produce HgCl. forms:
o Then thiocyante ions are liberated (this is - 10% anion bound (not a subject to ISE)
we are up to), - 50% - free or ionized form (active form)
o Ferric iron is reacted to thiocyante to - 40% - protein bound (bound to albumin)
produce a red or reddish brown complex of - Ionization of calcium is pH dependent
ferric thiocyanate:  Increase in pH
- Colometric ampherometric o Decrease ionized fraction
 Gold standard  Decrease in pH
 Cotlove chlorinometer o Increase in ionized fraction
o Electrochemical technique like ISE Ionization and pH has an Inversely
o An electrode is used that will produce silver proportional relationship
ions then it will react with the chloride in  Analytical techniques:
the specimen producing silver chloride - 2 Types of Calcium testing:
precipitate (basis).  Ion Selective Electrode
o The instrument will correlate the timed o Ionized fraction measurement
elapse from the start to the end of the silver  Specimen consideration:
chloride production  Closed system – don’t open the
 Correlated in chloride concentration. tube unless for testing. It will be
- Sweat chloride determination at risk for aerosol contamination,
 Special area in chloride testing hence a false results will be
 Specifically designed to detect Cystic Fibrosis generated.
o Mucoviscidosis  For ionized calcium, if the
 The patient has viscous secretions to tube was left open, the pH
the point that the internal organs are will increase due to
affected (e.g pancreas, lungs). liberation of CO2.
 Atomic absorption Magnesium
o Total calcium methodology  2nd most abundant intracellular cation
- Colorimetric method for total calcium  4th most abundant cation in the body
 Clark and Collip  Forms in the Blood: Free or Ionized (2/3) and Protein
o Calcium is treated with ammonium oxalate Bound (1/3) with Albumin.
then calcium oxalate is precipitated this  Acts as an activator
then converts calcium oxalate to oxalic acid.  Analytical Method:
After which we titrate with potassium - Atomic absorption spectroscopy
permanganate (purple end color; but its  Reference method
endpoint is colorless (colorless manganese)) - Flame photometry
- EDTA titration  Magnesium = blue flame
 Bachra,Dawer & Sobel - Colorimetric and Spectrophotometric method
 Use of indicator called Calcin red (pinkish), then  Titan yellow
place a drop in the solution with calcium, afterso o A yellow dye that becomes red in the
it will form a yellowish green fluorescence. Apply presence of magnesium.
EDTA. o Not that sensitive
It will compete with calcin red via chelation so  Calmalite green formazan with methylene blue
that calcin red will be degraded. After (dye binding)
degradation it will form salmon pink end color  Cynidil blue (dye binding is the most common in
- Spectrophotometry Mg and Ca)
 Dye binding
 O-cresolpthalein complex method Bicarbonate
o It turns into a violet solution  Acid base balance maintenance, act as an important base
o Has an additional reagent, 8-  2nd most abundant in extracellular anion
Hydroxyguinoline to prevent magnesium  Could be a part in Blood Gas analysis (collected in arterial
interference. blood)
 Because calcium and magnesium - Venous blood has a higher bicarbonate levels than
interfere with each other’s’ arterial
reaction.  Because bicarbonate originates in carbon dioxide
- Atomic absorption which is a waste product of cellular metabolism.
 Has AAS but it has phosphate.  Acidifying the specimen
o This is the reason why we add lanthanum - All the bicarbonate will be converted into gaseous
chloride which prevents phosphorous to Carbon dioxide which then measured using pCO2
interact with calcium producing Calcium Electrode
phosphate
 Anion that measures partial pressure of CO2
- If alkalinized = enzymatic
Phosphorous
 Coupled enzyme assay
 It has inverse relationship with Calcium in the body o Uses 2 enzymes:
 Influenced by PTH, Calcitonin and Vitamin D  phospoinolpyruvate carboxylase
 For structural support  mallate dehydrogenase as copling
 Energy generation and storage enzyme
 Majority of which is found in the bone in the form of
hydroxyapatite crystals around 85%;
 Widely distributed
 Analytical Techniques:
- Colorimetric
 Fiske and Subarrow Method
o inorganic P (PI) is reacted with ammonium
molybdate which produces
phosphomolybdic/date acid (colorless) read
in 340nm. It could be continued to a visible
method, just add reducing agents:
 Ascorbic acid
 Stannous chloride
 P-aminonapthtolsulfonic acid
And it will turn to a colored end product
called phospomolybdenum blue – blue and
red at 600nm wavelength