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1 ___________
• Second most abundant anion in the ECF
• The major component of the buffering system in the blood
• Total CO2
• __________
• __________
• __________

2 REGULATION
• ____________________
• Reabsorbs ____
• ____________________
• Reabsorbs ____
3 CLINICAL APPLICATIONS
• ____________________
4 DETERMINATION OF CARBON DIOXIDE
• For Venous Blood
• __________ or ____________________ is suitable for analysis.
• If the sample is left uncapped before analysis, CO2 escapes.
• Decrease by ____________________
• ISE and an enzymatic method.

5 REFERENCE RANGES
• Carbon dioxide, venous ____________
6 _____________
• Second most abundant intracellular ion
• ____ in bone
• ____ in muscle and other organs and soft tissue
• ____ in serum and rbc
• One third is bound to protein, primarily __________
• 61% exists in the ____________________and about 5% is complexed with other ions, such as
PO4 and citrate
7 REGULATION
• Small intestine may absorb __________of the dietary Mg2, depending on the need and
intake
• Controlled largely by the __________, which can reabsorb Mg2 in deficiency states or
readily excrete excess Mg2 in overload states
• Proximal convoluted tubule - __________reabsorb
• Ascending limb of Henle’s loop - __________
• Distal convoluted tubule - __________

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• Ascending limb of Henle’s loop - __________

• Distal convoluted tubule - __________
• Urine – __________
8 CLINICAL SIGNIFICANCE
• Cofactor of more than 300 enzymes
• Hypomagnesemia
• Rare in nonhospitalized individuals

10 SYMPTOMS
• May be asymptomatic until serum levels fall below __________
• Cardiovascular, neuromuscular, psychiatric, and metabolic abnormalities
•
• Treatment
• __________using magnesium lactate, magnesium oxide, or magnesium chloride or an
antacid that contains Mg2

11 HYPERMAGNESEMIA

12 SYMPTOMS
• Assymptomatic until the serum level exceeds __________
• __________- hypotension, bradycardia, skin flushing, increased skin
temperature, nausea, vomiting, and lethargy
• __________- Life-threatening symptoms

13 TREATMENT
• Discontinue the source of Mg2
• Supportive therapy
• __________
• Diuretic and IV fluid
14 DETERMINATION
• __________or __________plasma may be analyzed
• Oxalate, citrate, and ethylenediaminetetraacetic acid (EDTA) anticoagulants are __________

15 METHODS
• __________, __________, and __________
• The reference method for measuring Mg2 is __________
16 CALCIUM
• Essential for ____________________
• About __________ of Ca2 in the body is part of __________
• Remaining 1% is mostly in the blood and other ECF

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• About __________ of Ca2 in the body is part of __________

• Remaining 1% is mostly in the blood and other ECF
• ____ circulates as __________
• ____ is bound to protein, mostly __________
• ____ is bound to anions
17 REGULATION
• PTH, vitamin D, and calcitonin, are known to regulate serum Ca2 by altering their
secretion rate in response to changes in ionized Ca2
• PTH
• ____________________
• ____________________
• ____________________
• __________
18 CLINICAL APPLICATIONS

19 HYPOCALCEMIA
• Maintenance of a normal ionized Ca2 concentration in blood is beneficial to patients in
either ____________________
• Occurs commonly in critically ill patients, that is, those with sepsis, thermal burns, renal
failure, or cardiopulmonary insufficiency

20 HYPERCALCEMIA
• Primary hyperparathyroidism is the main cause
• Ionized Ca2 measurements are elevated in ____________________
• Total Ca2 is elevated in ____________________
• __________
•
21 DETERMINATION
• Serum or lithium heparin plasma
• Anticoagulants such as EDTA or oxalate - __________

22 METHODS
• Ortho-cresolphthalein complexone (CPC)
• Arsenzo III dye
• Reference method for total Ca2 __________
• ISE – __________________
23 REFERENCE RANGES

24 PHOSPHATE
• Found everywhere in living cells
• (DNA) and (RNA) are complex phosphodiesters
• Most coenzymes are esters of __________ or ____________________

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• (DNA) and (RNA) are complex phosphodiesters

• Most coenzymes are esters of __________ or ____________________
• Most important reservoirs of biochemical energy are ATP, creatine phosphate, and
phosphoenolpyruvate
• ____ in bone, ____ in soft tissues, ____ is active in the serum/plasma

25 REGULATION
• May be absorbed in the intestine from dietary sources, released from cells into blood,
and lost from bone
• Easily regulated by renal excretion or reabsorption
• Vitamin D acts to ____________________ in the blood
26 CLINICAL APPLICATIONS
• Hypophosphatemia
• 20% to 40% chance in patients with diabetic ketoacidosis, chronic obstructive
pulmonary disease (COPD), asthma, malignancy, longterm treatment with total
parenteral nutrition (TPN), inflammatory bowel disease, anorexia nervosa, and
alcoholism
• 60% to 80% in ICU patients with sepsis

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• Hyperphosphatemia
• Greatest risk are those with acute or chronic __________
• Neonates are especially susceptible to hyperphosphatemia caused by __________, such
as from cow’s milk or laxatives

28 DETERMINATION
• Serum or lithium heparin plasma is acceptable for analysis
• ______________________________ anticoagulants should not be used because they interfere
with the analytic method

29 REFERENCE RANGES

30 LACTATE
• A by-product of an emergency mechanism that produces a small amount of ATP when
oxygen delivery is severely diminished
• Pyruvate is the normal end product of _________________ (__________)
31 CLINICAL APPLICATIONS
• Two types of lactic acidosis
• __________ is associated with hypoxic conditions, such as shock, myocardia infarction,
severe congestive heart failure, pulmonary edema, or severe blood loss
• __________is of metabolic origin, such as with diabetes mellitus, severe infection, leukemia,
liver or renal disease, and toxins (ethanol, methanol, or salicylate poisoning)

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liver or renal disease, and toxins (ethanol, methanol, or salicylate poisoning)

32 DETERMINATION
• Should not use __________ to prevent __________
• Heparinized blood may be used but must be delivered on ____ and the plasma must be
quickly separated
•

33 METHODS
• The most commonly used enzymatic method uses lactate oxidase to produce __________
and __________.

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