Electrolytes

Introduction

These are cations and anions that moves in an electric field

Cations are positively charged while anions are negatively charged.

Major cations are sodium, potassium, magnesium and calcium

Major anions are chlorides, bicarbonates, phosphates and sulphates.

Electrolytes helps to maintain stability of body fluids

Usually sodium, potassium and chlorides are major electrolytes requested by clinicians.

Electrolytes balance is essential for the maintenance of electrical neutrality in the body.

Sodium & chlorides are required in small amounts while calcium & phosphorus in large amounts.

Abnormal loss of electrolytes is through vomiting, diarrhea, sweating & moderate to severe burns.

Electrolyte determination is usually requested before surgery or in renal patients.

Most potassium is intracellular (inside the cell) while most sodium is extracellular (outside cell).

Laboratory investigation of acid-base disorders includes measurement of blood pH, CO2 & bicarbonates

Roles of electrolytes
• Maintains osmotic pressure and water balance in the body compartments
• Regulation of heart functions and functions of other body tissues.
• Participates as catalysts and co-factors
• Involved in oxo-reduction potential
• Maintain a normal body pH

Serum/plasma Acceptable reference ranges

Pottasium - 3.5 - 5.0 Mmol/L

Sodium - 135 – 145Mmol/L

Calcium - 2.2 – 2.7 Mmol/L

Magnesium - 0.8 – 1.3 Mmol/L

Inorganic Phosphorus - 0.8 – 1.5 Mmol/L

Chloride - 75 -105 Mmol/L

Bicarbonates - 24 - 32 mEq/L

Water Balance

Total volume of fluid in a normal adult is about 42L, 60% of which is water.

In infant, total volume is about 2L, 70% of which is water.

Fluid found within the cell is known as intracellular while extracellular is fluid found between cells.

Plasma is the fluid part of the blood found in blood vessel, this is known as intravascular.

Total water intake equals total water output

Body’s loss of water is through urine, feaces, sweat and expired air.

Intracellular fluid (ICF)

• Makes –up about 28L of total body fluid in adult and about 1L in infants
• Cations in intracellular fluid are Potassium and magnesium with low calcium and sodium.
• Main anions are proteins, phosphates with low: chlorides, bicarbonates, sulphates & organic acids.

Extracellular fluid (ECF)

• Constitutes of about 11L of fluid in an adult and about 1 L in an infant.
• Composed of lymph, Csf, pleural fluid, saliva, synovial fluid, amniotic fluids & aqueous humour.

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 • It prevents the cell from being directly affected by any alteration in plasma.

Intravascular fluid (Plasma)

Accounts for about 3 – 3.5 L in an adult and about 250 ml in an infant.

Main cations are high concentration of Sodium but low conc. of K+, Mg2+ and Ca2+

Main anions are high concentration of Chlorides but low conc of HCO3-, SO42-, PO42-

Sodium
 Major cation in the ecf and it represents about about 90% of inorganic cation in plasma.
 Accounts for about 50% of plasma osmolarity.
 Keep the correct water balance in the body and also useful for heart & other muscles function
 Initially filtered by the glomerulus but about 60 -70% is reabsorbed by proximal tubules.
 Amount in the body is controlled by a hormone aldosterone (it enhances Na+ reabsorption)
 High aldosterone levels in patients’ leads to low Na+ in urine and high K+.
 Re-absorption of sodium is followed by water and phosphorus.

Causes of hypernatraemia (high sodium levels)

Not very common

Excessive salt intake either through mouth of through intravenous infusion

Sodium retention due to renal disease

High aldosterone levels

Causes Hyponatraemia (low sodium levels)

Salt losing nephritis

Gastrointestinal fluid loss

Excessive sweating, adrenal insufficiency.

Burns, congestive heart failure, diuretic drugs

Potassium
 Major cation in the icf.
 Amount in the body is controlled by a hormone aldosterone (it enhances K+ excretion)
 High aldosterone levels in patients’ leads to high K+ in urine and low Na+.
 Useful for heart & other muscles function
 Loss of K+ leads to cardiac failure, muscle weakness and heart rate failure.

Causes of hyperkalaemia (high potassium levels)

 Insulin insufficiency, Dehydration
 Severe renal failure, Dietary intake
 Ketoacidosis, increased hemolysis
 Systemic lupus erythromatous, Rapid K+ Infusion
 Low aldosterone levels,

Causes of hypokalaemia (low potassium levels)

 Decreased dietary intake
 Chronic alcoholism
 Chronic diarrhea and vomiting
 Renal disorders (renal tubular acidosis)
 Insulin therapy, diabetic ketosis, Leukemia
 High aldosterone
 Drugs such as gentamycin

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 Chloride

Major extracellular anion and occurs in the body mainly as sodium chloride

It helps to maintain proper water distribution, osmotic pressure and acid-base balance in ecf.

There are two main methods of plasma chloride estimation:-
o Mercuric nitrate (Schales and Schales method)
o Use of chlorine meter.
Clinical significance

Decrease in serum/plasma chloride occurs in low serum/plasma Na+ and or raised HCO3-

Loss of chloride is associated with nephritis, diabetic acidosis or excessive fluid loss

High levels of chloride are observed in congestive heart failure and decreased renal blood flow.

Pathological parameters are the same as those of sodium.

Magnesium

Main cation in the Icf (intracellular cation)

About 55% of Mg in the body in the body is in the bones, muscles and mobilized during deficiency

Mg is involved in transfer of phosphate group in ATP

Mg also required in RNA and DNA reaction

Mg is also an essential factor in some enzymatic reaction by forming mettalloenzymes.

Mg increases when Ca2+ decreases and vice versa.

Blood for Mg should be collected without applying pressure.

Low Mg causes :-
• Growth failure
• Hyper-irritability
• Diarrhea in Aids patients and children below 5yrs especially those in Camp.

Calcium

Forms part of structural mineral in bone. It is a major cation in the body

Some methods depends on precipitation of insoluble calcium

Such methods includes:- atomic absorption flame photometry and titration with EDTA.

Other methods include Dye-binding methods have become popular

Such methods includes:- methyl-thymol blue or cresopthalein complexone methods.

Causes of hypercalcaemia (high calcium levels)

• Alkalosis (diet for peptic ulcer)
• Cancer metastasis in bones
• Multiple myeloma
• Hypervitaminosis
• Hyperthyroidism

Causes of hypocalcemia (low calcium levels)

• Chronic glomerulonephritis
• Malabsorption syndrome
• Hypoparathyroidism
• Acute pancreatitis
• Rickets

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 Phosphorus
• Found in every cell in the body
• Body contains about 17mol of phosphorus whose 80% is combined with Ca2+ in bones and teeth.
• Phosphorus in the blood can be classified into four groups:
o Inorganic phosphorus (H2PO4-)
o Organic/ester phosphorus (glyceralphosphate & nucleotide phosphate)
o Lipid phosphorus (lecithin, cephalin and sphingomyelin)
o Residual phosphorus

NB:
• Red cells contains larger amount of phosphorus than plasma.
• This is because it contains more ester phosphates.
• The metabolism of phosphorus is closely associated with that of calcium.

Clinical significance
• Increase in serum phosphorus is found in:-
o Hypoparathyroidism
o Chronic nephritis
o Vitamin D excess
• Decrease in serum phosphates is found in:-
o Increased in carbohydrate utilization
o Hyperparathyroidism
o Renal imparement
o Osteomalacia
o Rickets

Functions of phosphorus
1. Formation of bones and teeth
2. Production of ATP
3. Assists in contraction of muscles
4. Maintains the regularity of the heartbeat and nerve conduction
5. Plays a role in body’s utilization of carbohydrates and fats
6. Assists in the functions of kidney

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