ELECTROLYTES

What is an electrolyte?

 Are particles that carry electrical charge and are

present in blood, plasma and urine.

 Substances whose molecules dissociate into ions

when placed into water
cations- positively charged e.g Na+, K+, Mg++, Ca++
anions – negatively charged e.g Cl - ,
 Electrolytes

 Essential minerals necessary for nerve

and muscle function
 Maintain body fluid balance
 Regulate acid base balance
 Types of electrolytes

 Positive cations :
potassium K+, sodium Na +, magnesium Mg2+, calcium 2+

 Negative cations :
phosphate PO4 3-, chloride Cl_

 Buffer : bicarbonate HCO3-

 Distribution

 Intracellular fluid (ICF) :-

prevalent cation – K+, Mg++
prevalent anion - PO4- - -

 Extracellular fluid ( ECF) :-

prevalent cation – Na+
prevalent anion - Cl-
 POTASSIUM or K+

 Transmission and conduction of nerve and muscle

impulse
 Required for repolarization of cell membrane to a
resting state after an action potential
 Maintenance of cardiac rhythms
 Acid base balance
 Normal : 3.5 -4.5 mmol/l
 Hyperkalaemia

 High serum K caused by :-

 massive intake
 impaired renal secretion
 shift from ICF to ECF : massive cell destruction e.g
brain injury, crush injury
 Hyperkalaemia

Manifestation :
Weak or paralysed skeletal muscles
VF or cardiac standstill
Small P waves and high peaked T waves

REMEMBER ALS GUIDELINES

 Hyperkalaemia

 CORRECTION
 increase elimination ( diuretics, dialysis)
 Force K+ from ECF to ICF by IV insulin with dextrose or
sodium bicarbonate
 reverse membrane effects of elevated ECF K+ by
administrating Calcium Gluconate IV
 HYPOKALAEMIA

 CAUSES :
 Kidney malfunction
 Diabetic ketoacidosis
 Gastrointestinal tract losses : vomiting, diarrhoea
 Mg deficiency : alcohol abuse
 Metabolic alkalosis
 HYPOKALAEMIA

Clinical signs / Correction

 Cardiac arrthymias : gradual sagging ST segment,
flattening of T waves , appearance of U wave
 Severe muscle weakness
 shallow respiration : threatening respiratory function
 Correction : oral or IV
 SODIUM or Na+

 Most prevalent cation in ECF

 Plays a major role :-
ECF volume and concentration : retain body water
 Generation and transmission of nerve impulse
pH balance
Normal concentration : 135- 145 mmol/l
 Hypernatraemia

 Elevated serum sodium: mostly water deficit

 causes hyper osmolality lead to cellular dehydration
 Primary protection: thirst mechanism from
hypothalamus
 Hypernatraemia

Clinical signs
 Seizures, coma leading to irreversible brain damage

Correction :
 not with WATER !!

Giving NaCl solution or with addition to dextrose: gradually

reduced to avoid cerebral oedema
 Hyponatremia

Causes:
 Low Na in plasma caused by liver failure, kidney failure and
overhydration .
 Proportional to excess water :SIADH (syndrome of inappropriate anti-
diuretic hormone secretion)
Manifestation :
 nausea, vomiting, headache, confusion, lethargy , restlessness, muscle
weakness, spasms, cramps, seizures, coma .
 Non cardiogenic pulmonary oedema .
 Hyponatremia

Correction :- Find the cause

 Hypervolemia : both water and sodium level high
 liver cirrhosis, CHF,
correction :- address liver and cardiac function
 Euvolaemic hyponatremia: excess water but body Na + level is same
 Hypothoridism , steroid (glucosteroid deficiency )
Correction : water restriction
 Hypovolaemic hyponatraemia : both water and sodium low
 prolonged vomiting, severe diarrhoea, decreased oral intake , diuretic use
Correction : administration of NaCl.
 Magnesium

 2nd most abundant cation in ICF

 Energy metabolism : glucose utilisation , fatty acid
synthesis, muscle contraction
 Na+ – K + pump
 Affects Ca ++ homeostasis
 Release and action of PTH
 Hypomagnesaemia

Malabsorption : inflammatory bowel disease

Alcoholism
Following parathyrodiectomy
Hypercalaemia

Correction : IV MgSO4
 Hypermagnesaemia

 Block synaptic transmission : deep tendon reflexes

 Effect on smooth muscles : ileus and urinary retention
 Bradycardia and hypotension : effects on Ca++ & K +

 Correction:
IV Ca++
Renal patient : dialysis
 CALCIUM

 Transmission of nerve impulse

 Muscle contraction :Myocardial
 Blood clotting
 Formation of bones and teeth
Balance controlled by :
 parathyroid hormone
 Calcitonin
 Vitamin D
 Hypocalcaemia

 Eating disorder
Lack of parathyroid hormone
 Hypercalcaemia

Hyper parathyroid hormone

Vitamin D overdose
Prolonged immobilisation
 Clinical symptoms

 Decreased memory
 Confusion , fatigue
 Constipation

Correction :- excretion of excess Ca++ with loop

diuretics
Hydration with isotonic saline
 _
Bicarbonates HCO3

 Maintains acid-base status

 Kidney regulation
 Good indictors of acid-base balance
THANK YOU
Any questions ???