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