CHAPTER III  ELECTROLYTES USED FOR REPLACEMENT

MAJOR INTRA & EXTRACELLULAR ELECTROLYTES THERAPY

 Body Fluids – solutions of inorganic & NaCl

organic solutes
 Concentration balances of the various
components - maintained for the cells &
tissues to have a constant environment
 Regulatory mechanisms to maintain internal
hemeostasis which control:
pH osmotic balances
ionic balances
 Replacement Therapy
- products used when the body is unable to
correct electrolyte imbalance due to a change the
composition of its fluids products are:
Electrolyte blood products amino acids
Acids & base, carbohydrates proteins
 
Electrolytes
 concentration vary in the different fluid
compartments which include:
- Intracellular fluid
- Interstitial fluid
- Plasma & vascular fluid
 Extracellular fluid includes:
- interstitial & vascular fluids (Na + & Cl-)
 3 compartments
- separated by membranes that are
permeable to H2O & many organic & inorganic
solutes
 Permeable to certain ions:
- Na+, K+ & Mg+2
 Impermeable to macromolecules
- such as proteins
 Found in the plasma & interstitial fluid: Na+
& Cl-
 Found in the intracellular fluid: K+, Mg+2,
PO4-3
REFER TO THE TABLE IN THE NOTES:
LIST OF MAJOR PHYSIOLOGICAL -
PRINCIPAL METABOLIC - CLINICAL
MANIFESTATIONS
IONS FUNCTIONS OF DEFICIENCY
 Synonyms:
- Table Salt; Sea Salt; Sal; Asin
 Occurrence:
- solid state - rock salt, halite, fossil salts &
sal gemmae
 NaCl Preparation:
 obtained from sea H2O concentrated in
very large flat basins connected in
series called “salt pans”
 Heat from the sun effects the evaporation
of the H2O
 purified for medical purposes/required to
contain nlt 99.5% NaCl
 Method of purification depends on the
nature of impurities:
Ca & Mg
- Removed by pptation with:
 addition of conc. Na2CO3 to the brine (NaCl
solution)
 evaporation to the saturation point
 saturate cooled solution with hydrogen
chloride when pure NaCl
precipitates
 crystals are collected by decantation or
centrifugation & dried

NaCl Property:
- soluble in glycerine & slightly soluble in
alcohol
 Uses:
 Isotonic solution (0.9% w/v)
- wet dressings for irritating body cavities or
tissues
- Injection when fluids & electrolytes have
been depleted in isotonic proportions
 Hypotonic Solutions
- for maintenance therapy when patients are
unable to take fluid & nutrients orally for
1- 3 days
Dextrose (glucose) – caloric source
 Hypertonic Injections
- used when there is loss of Na in an excess
of H2O

 as fluid & electrolyte replenisher – in the

form of NaCl Injection USP XX (0.9% NaCl)
& tablets
  to prevent development of cramps – given
orally to workers & athletes who perspire
profusely
 antidote – to Ag poisonings, condiment &
preservation
 KCl
Synonym:
 Kalium Chloratum
Occurrence:
 found in large deposits in the form of
SYLVITE
- in combination with NaCl
 form of Carnallite: MgCl2. KCl.6H2O
 - nervous disorders
KCl Properties:
 drug of choice for oral replacement of K,
preferably as a solution
 irritating to the GIT so it should be diluted
 tablets must be enteric coated
- several authorities do not recommend use of
tablets because they:
 produced intestinal ulceration
 absorption is undependable
 therapy
KCl USES:
 component in the Official Ringer’s Injection
& Solution Lactated Ringer’s Injection
Injection form – as fluid & electrolyte
replenisher
Solution – for topical purposes
 Injection – given to patients with severe
hypopotasemia or if the patient is unable to
take K orally
 treatment of familial periodic paralysis
(recurring, rapidly progressive, flaccid
paralysis)
 Treatment of Meniere’s Syndrome (disease
of the inner ear which includes dizziness &
noise in the ear)
 antidote to digitalis intoxication
 Maintains/increases the K content in the
body when adrenal steroids ACTH/diuretics
chlorothiazide are administered (decrease
the K content of the body)
When given orally:
- KCl is mixed with fruit or vegetable juices to
mask saline salts
 CaCl2
Synonym:
 Muriate of Lime
Properties:
 sharp bitter saline taste & very deliquescent
 great solubility in H2O:
-salt forms an excellent freezing mixture
with ice
 one part of the salt mixed with 2/3 of its
weight of crushed ice
- gives a temperature of -45 oC
 CaCl2 USES:
 Electrolyte replenisher as Ringer’s Injection
& Lactated Ringer’s Injection
 An internal haemorrhages in:
- certain bone diseases
- deficiency of Ca in the system
 CaCl2 is irritating to the veins, the ff. are
substitutes, are non- irritating:
 Calcium gluconate – treatment of choice for
hypocalcemia
given orally and
intravenously
 Calcium lactate – oral Ca replacement
PHYSIOLOGICAL ACID-BASE BALANCE
Acids constantly produced during metabolism
- carbonic acid from CO 2
- lactic acid from anaerobic metabolism
Metabolic reactions occur within a very narrow
pH range,
-body utilizes several efficient buffer systems
which are:
 HCO3-/H2CO3 – found in the plasma &
kidneys
 HPO42-/H2PO4- - found in the cells & kidneys
 Haemoglobin & protein – found in the RBC
- most effective single system for buffering
H2CO3 produced during metabolic processes
Due to a variety causes:
 Body’s acid levels
- may increase
- acid levels (pH) may decrease (below 7.38)
causing acidosis
 Alkali levels
- decrease below normal
-alkali levels increase (pH) above normal
(pH 7.42), causing alkalosis
 Compensatory Mechanisms of the Body
 REFER TO THE TABLE IN THE NOTES
CONDITIONS (causes) - Buffer System - ELECTROLYTES IN ACID-BASE THERAPY
Respiratory Function - Renal Function
CH3COONa
Acid excretion in the kidneys occurs as follows: Synonym
 glomerular filtration  Acetate of Soda
- Na salts of mineral & organic acids Property
removed from the plasma  efflorescent in warm, dry air
 Na-H exchange - CO2 metabolized to HCO3- 
- Na (removed from the renal filtrate or USES:
tubular fluid and in the tubule cells) reacts with  effective buffer in metabolic acidosis of
H2CO3 (formed by the carbonic anhydrase) acute cholera
is catalyzed in reaction of CO2 and H2O  Infusion in uremic acidosis (acidic urine)
Na+ + H2CO3 → Na+ + HCO3- + H+  Diuretic
 NaHCO3 returns to the plasma (and  Diaphoretic
removed from the lungs as CO2) and the  Aperient (relieves constipation)
protons enter the tubular fluids  Systemic alkalizer
- acids of the anions of the Na salts are
formed CH3COOK
Synonym
3 mechanisms working together for maintenance of  Diuretic Salt
normal acid-base balance in the plasma: Property
 Buffers of the body fluids and RBC  deliquesces on exposure to moist air
 Pulmonary excretion of excess CO2 USES
 Renal excretion of either acid or base  diaphoretic and diuretic in 1-4 g
(which ever is in excess)  Cathartic in large doses
 Alkalizer
 Found in K triplex
ELECTROLYTES IN ACID-BASE THERAPY  All the precaution for KCl also apply to
 NaCH3COO KHCO3 CH3COOK
 KCH3COO Na3C6H5O7
 NaHCO3 K3C6H5O7 NaHCO3
Synonym
Metabolic acidosis is treated with sodium salts of:  Baking Soda
 HCO3- CH3COO- Properties
 Lactate C6H5O7-3  Loses H2O & CO2 when heated → normal
CO3-2
Administration of HCO3-  Accounts as a major difficulty in sterilizing
- increases HCO3-/H2CO3 ratio when there is HCO3- the dry salt or its solution
deficit - Na2CO3 is more alkaline than the CO3-2 solution
and therefore dangerous to use
Normal components of metabolism and will be parenterally
degraded to CO2 & H2O by the tricarboxylic acid Ways of sterilizing HCO3-
cycle (TCA)/Kreb’s Cycle  Bacteriological filtration
 Lactate  Autoclaving
 CH3COO- – CO2 is passed through the solution for one
 C6H5O7-3 minute and placing the solution in gas –
tight containers for autoclaving process
CO2 + carbonic anhydrase → treated with NH4 salts  Heating HCO3- solution in an open vessel &
Action in the kidneys then resaturating the cooled solution with
- retards the Na-H exchange sterile CO2

Another characteristic reaction of HCO3- salt:
 CO2 is liberated when they are treated with
acids
Bubbles formed from the liberation –
effervescence  powders, fire extinguishers, carbonated
 Effervescent tablets & salts
→ reaction of NaHCO3 with acid
- no reaction: in the dry state HCO3- + acid
when introduced into H2O →vigorous evolution
of CO2 t
 Reaction takes place in moist air
- accounts for their incompatibilities in dry
prescription mixtures of NaHCO3 with ASA or
other acidic substances
USES: (principal HCO3- of drug use and its action -
serves as guide to consideration of other
HCO3-
NaHCO3 considered from the standpoint of 2
relationships:
 Its relationship to the body economy as a
buffer component
 HCO3-/H2CO3 buffer system
– most important plasma buffer
 An excess of acid liberated to the body
- neutralized by some of the NaHCO 3
 Excess H2CO3
- decomposes into H2O and CO2
 CO2 is excreted through the lungs
- until the normal HCO3-/H2CO3 ratio is
achieved
 CO2 – end product of metabolism there is
always abundant supply upon which to
draw
 Excess alkali
– combines with H2CO3 to form HCO3-
- more H2CO3 is formed from the CO2 & H2O
to restore balance
  Its therapeutic & miscellaneous uses:
 acid-neutralizing properties
 combat gastric hyperacidity & to combat
systemic acidosis
 Oral administration
– lessening of the acidity of urine or even
produce alkalinization
Ex. Sulphanilamide – treatment of certain
types of urinary tract infections
  Its therapeutic & miscellaneous uses:
 inhibits activity of the administered drug
when it is simultaneously administered with
other drugs
Ex. NaHCO3 & Sod. Salicylate – retards the rise
in the serum salicylate level
 combat systemic acidosis (drug of choice)
when administered parenterally & orally
 treatment of CH3OH poisoning
 Manufacture of effervescent salts, baking
drinks & cleaning mixtures
KHCO3
Synonym
 Salaeratus
Property
 solutions are neutral or alkaline to litmus
 Soluble in water and insoluble in alcohol
 Deliquescence indicative of the presence of
CO3-2
USES
 electrolyte replenisher
 Component along with CH3COOK & citrate
of K triplex
 Oral effervescent K replacement solution (K-
lyte)
 Antacid for those that are restricted of their
sodium intake - risk of hyperpotassemia at
prolonged use
Na3C6H5O7 (sodium citrate)
Properties
 anhydrous or contains 2 moles of H2O of
hydration
 Citrate is a component of the TCA or Kreb’s
cycle, rapidly metabolized to CO2 & then to
HCO3-
 Label must indicate the physical form
 Na3C6H5O7
USES
 anticoagulant for whole blood
 Chelates serum calcium thereby removing
one of the components of blood clotting
 Citrates also used for the chelation of other
cations
Ex. Benedict’s solution & FeSO 4 syrup
 Citric acid & salts also used as buffering
agents
 For chronic acidosis to restore HCO3- reserve
 With diuretic effect due to increased body
salt concentration
K3C6H5O7
Properties
 with cooling saline taste
 Deliquescent when exposed to moist air
 USES - Maintenance as soon as intake of usual
 systemic alkalizer foods & liquids is discontinued
 Diuretic - Before serious fluid losses or deficits occur
 Diaphoretic  To replace mild to moderate fluid losses
 Expectorant due to:
 Laxative - Diarrhea
 Gastric antacid - Other conditions associated with excessive fluid
loss or deficit fluid intake
ELECTROLYTE COMBINATION THERAPY Ex. Pedialyte Lytren
-short term therapy such as following
surgery may be adequate is the infusion of:
 standard glucose
 Saline solution

for severe deficits, solutions containing:

 Additional electrolytes are required

2 groups of combination products

 Fluid maintenance
 Electrolyte replacement

Maintenance therapy with IV fluids is intended to

supply normal requirements for:
 H2O
 Electrolytes
- For patients who cannot take them orally

5% dextrose – all maintenance solutions in addition

to dextrose should contain these general electrolyte
(ions) components:
 Na+ Cl- HCO3- Mg+2 P+5

OFFICIAL COMBINATION ELECTROLYTE INFUSIONS

Ringer’s Injection USP
 1 L contains:
8.6 g NaCl
0.3 g KCl
0.33 g CaCl2
 Or 100 mL contains:
860 g NaCl
30 g KCl
33 g CaCl2
Lactated Ringer’s Injection USP
 Each 100 mL contains:
600 mg (0.6g) NaCl
30 mg (0.03 g) KCl
310 mg (0.31 g) Na lactate
20 mg (0.02g) CaCl2

USES of oral electrolyte solutions

 To supply H2O & electrolytes in amounts
needed for: