Clinical Chemistry II Notes

Causes of Decrease Anion Gap

 Instrumentation error- causes decrease anion
ELECTROLYTES
gap

CATIONS
“PiSo” ( Potassium in; Sodium out )
 Potassium- Major intracellular cation
 Sodium- major extracellular cation
ANIONS
“PhiChol” or “BiCo”
 Phosphorus (inorganic)- major intracellular anion
 Chloride- major extracellular anion
Counter ion- Opposite ion charge
Counter current ion- same ionic charge
Example question:
1. What is the counter ion of potassium? Phosphorus
2. What is the counter ion of sodium? Chloride
3. What is the counter current ion of potassium?
Sodium
CYSTIC FIBROSIS
GIBSON AND COOKE PILOCARPINE
IOTROPHORESIS
Specimens:
 Sweat
Procedure: you will get a filter paper and then you pre-
weigh it (must be O weight first) and then there is a
SWEAT INDUCER that is given to the patient then you
collect sweat from the patient by blotting the weighed
filter paper in the skin of the patient in all of his body
sweat within 30 mins and then after that weigh again
the filter paper and read the results.
Sweat Inducer- Pilocarpine

Normal values: 5-40 mmol/L (exceeds the normal

value means diagnostic for cystic fibrosis)

METHODS Positive result- 60 mmol/L of sweat electrolytes

Diagnostic value- > 50 mmol/L

ION SELECTIVE ELECTRODE (ISE)

 Most common used and different in every
electrolytes
 GOLD STANDARD for electrolyte measurements. ACID BASE BALANCE
Sodium (Na)- Plus aluminum silicate
Potassium (K)- Valinomycin gel
Chloride (Cl)- Tri-n-octylpropyl ammonium chloride
Specimen:
Example question:  Arterial blood
1. Ion selective electrode of sodium is? D 2 organs involve:
a. Valincomycin gel a. Lungs
b. Tri-n-octylpropyl ammonium chloride - Carbon dioxide (CO2)
c. Potassium b. Kidney
d. ISE - Bicarbonate (HCO3)
 Vice versa in compensation
FISKE- SUBBAROW METHOD
 Conventional method Normal Value:

Phosphorus- the only one electrolyte that uses this 1. Blood pH: 7.40
method o Reference range: 7.35-7.45
o High than NM- alkalosis
o Lower than NM- acidosis
o Low normal- 7.35-7.39 (Basal 7.40)
o High normal- (7.41-7.45)
2. Carbon dioxide: 35-45 mmHg
ANION GAP 3. Bicarbonate: 21-28 mEQ/L
4. Oxygen: 61-80 mmHg

 Difference between positively charge ions and B:C ratio (Bicarbonate to Carbon dioxide ratio)
negatively charge ions  20:1

Causes of Increase Anion Gap 4 Major Problems/ Solution/ Compensation

M-ethanol  Vice versa in compensation
U- remia  Full or Partial
D- iabetic ketoacidosis o Full- normal pH level
P-oisoning o Partial- Abnormal pH level
I - ron inhalation/ Isoniazid 1. Hypoventilation (Lungs)
L- actic acidosis 2. Hyperventilation (Lungs)
E- thylene glycol/ Ethanol ketoacidosis 3. Bicarbonate reabsorption (Kidneys)
S- alicylates/ Starvation Ketoacidosis/ sympathomineties 4. Bicarbonate excretion (Kidneys)

Prepared by: MAEdForRMT 1

Clinical Chemistry II Notes

Compensation- directly proportional

 CO2 is low---- HCO3 is low

Measurement of CO2 is inversely proportional to

Ventilation
 CO2 is low--- Ventilation is high
 The problem is HYPERVENTILATION

ACID-BASE ORGAN PRIMARY ORGAN TO COMPENSATION

DISTURBANCES DEFECTIVE CAUSE COMPENSATE
RESPIRATORY Lungs Hypoventilation Kidney HCO3 through
ACIDOSIS HCO3
Excessive reabsorption
accumulation of
CO2 in the
lungs (CO2)
METABOLIC Kidney Bicarbonate Lungs HCO3 through
ACIDOCIS excretion hyperventilation
Excessive
bicarbonate loss
(HCO3)
METABOLIC Kidney Bicarbonate Lungs CO2 through
ACIDOSIS reabsorption hypoventilation
Too much HCO3
accumulation
(HCO3)
RESPIRATORY Lungs Hyperventilation Kidney CHO3 through
ALKALOSIS HCO3 excretion
Excessive CO2
loss (CO2)

In the computation always remember the mnemonics

“ROME” and compare the Problem and the pH also.
 Respiratory-Opposite
 Metabolic- Equal

1. Example:
pH: 7.50 
CO2: 30 
HCO3: 20 

How to answer?

 Alkalosis
 Respiratory
o pH and CO2- Opposite
o pH and HCO3- Opposite

 Problem: Respiratory Alkalosis (CO2)

o Excessive CO2 loss (CO2)

 Compensation (HCO3 is also low)

o With Partial compensation

Answer: Respiratory Alkalosis With

o
Partial compensation
2. Example
pH: 7.37 (Normal) Acidosis
CO2: 50 
HCO3: 29 

Answer: Respiratory Acidosis with Full

compensation

3. Example
pH: 7.49 
CO2:37 Normal
HCO3: 29 

Answer: Metabolic Alkalosis

Uncompensated

Prepared by: MAEdForRMT 2