Clinical Chemistry 2

Spring 2021/2022

Electrolytes
Chapter 16
Part 1

Lecture Presentation by
Dr Mohamed Madkour
College of Health Sciences
University of Sharjah
 ELECTROLYTES
Electrolytes: ions capable of carrying an electric charge
Two types

1. Anions have negative charge & move toward

anode.
Examples: Chloride(Cl), Bicarbonate, PO4, Sulfate
2. Cations have positive charge & move toward
cathode.
Exampless: Sodium (Na), Potassium (K), Calcium
(Ca), Magnesium (Mg)
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 ELECTROLYTE FUNCTIONS
 Volume and osmotic regulation (Na, K, Cl)
 Myocardial rhythm and contractility (K, Mg, Ca)

 Cofactors in enzyme activation (Mg, Ca, Zn)

 Regulation of ATPase ion pumps (Na, K)

 Acid-base balance (HCO3, Cl)

 Blood coagulation (Ca, Mg)

 Neuromuscular excitability (Na, Ca)

 Production of ATP from glucose (PO4, MG, Ca

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 ELECTROLYTE PANEL

 Panel
consists of:
sodium (Na)
potassium (K)
chloride (Cl)
and CO2 (in its ion form = HCO3- )

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 THE ELECTROLYTE PANEL
Sodium (Na+)
 Major cation of extracellular fluid
 Most abundant (90 %) extracellular cation
 Easily absorbed from many foods

Functions:
Influence on regulation of body water
 Main contributor to plasma osmolality

Neuromuscular excitability
 extremes in concentration can result in neuromuscular symptoms

Na-K ATP-ase Pump

 pumps Na out and K into cells
 Without this active transport pump, the cells would fill with Na
and subsequent osmotic pressure would rupture the cells 5
 DISORDERS OF SODIUM
HOMEOSTASIS
Hyponatremia: < 135 mmol/L
Causes
Increased Na+ loss
a. Aldosterone deficiency (Addison’s disease ( result in
decreased aldosterone)
b. Diabetes mellitus (In acidosis of diabetes, Na is excreted
with ketones
Increased water retention
a. Dilution of serum/plasma Na+
b. Renal failure
c. Nephrotic syndrome
d. Congestive heart failure
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 DISORDERS OF SODIUM
HOMEOSTASIS
Hypernatremia: >145 mmol/L
Causes
1. Excess water loss resulting from
 Sweating, Diarrhea, Burns, Diabetes insipidus

2. Increased intake/retention
• Excessive IV therapy
3. Decreased water intake
• Elderly
• Infants
• Mental impairment

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 SPECIMEN COLLECTION: SODIUM
Specimens:
 Serum (slight hemolysis is OK, but not gross)
 Heparinized plasma
 Timed and random urine
 Sweat
 GI fluids
 Liquid feces (would be only time of excessive loss)
Methods:
Ion-selective electrodes method is most common

Reference ranges:
Serum: 135-145 mEq/L or mmol/L
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Urine (24 hour collection): 40-220 mEq/L
 THE ELECTROLYTE PANEL
Potassium (K+)
 the major cation of intracellular fluid
 Only 2% of potassium is in the plasma

 Potassium concentration inside cells is 20 X greater

than it is outside.
 This is maintained by the Na-K pump

 exchanges 3 Na for 1 K

 Diet
 easily consumed by food products such as bananas

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 THE ELECTROLYTE PANEL

Potassium
Functions
 Critically important in the regulation of neuromuscular
excitability (Decreased potassium levels, decreases excitability
(paralysis and arrhythmias)
 Controls heart muscle contraction
 Regulates ICF volume

 Regulate Hydrogen ion concentration

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DISORDERS OF POTASSIUM
HOMEOSTASIS
Hypokalemia (< 3.5 mmol/L)
Causes include:
 GI loss (Excessive fluid loss ( diarrhea, vomiting,
diuretics )
 Renal Loss (Nephritis, renal tubular acidosis,

hyperaldosteronism, Cushing’s Syndrome

 Cellular Shift (in alkalosis)

 Decreased intake

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 MECHANISM OF ALKALOSIS-
INDUCED HYPOKALEMIA
 Increased plasma pH (alkalosis)

RBC H+

K+

K+ moves into RBCs to preserve electrical balance, causing plasma

potassium to decrease. 12
 DISORDERS OF POTASSIUM
HOMEOSTASIS
Hyperkalemia (>5.1 mmol/L)
Causes include:
Decreased renal excretion
 Renal disease
 Hypoaldosteronism (Addison’s disease)

Cellular shift
Such as acidosis, chemotherapy, leukemia, muscle/cellular injury
Hydrogen ions compete with potassium to get into the cells
Increased intake
Artifactual
Sample hemolysis
Prolonged tourniquet use 13
Excessive fist clenching
 SPECIMEN COLLECTION:
POTASSIUM
Samples:
Non-hemolyzed serum

heparinized plasma

24 hr urine collection

Reference Ranges
Serum (adults): 3.5 - 5.0 mEq/L or mmol/L
Newborns: 3.7 - 5.9 mEq/L

Urine (24 hour collection): 25 - 125 mEq/L

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 THE ELECTROLYTE PANEL
 Chloride (Cl-)
 the major anion of extracellular fluid
 Chloride moves passively with Na+ or against HCO -
3
to maintain neutral electrical charge

 Chloride usually follows Na

 if one is abnormal, so is the other

Function
 Maintain body hydration/water balance
 Maintenance of osmolality
 Electrical neutrality
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 DISORDERS OF CHLORIDE
HOMEOSTASIS
 Hypochloremia
 loss of gastric HCl
 salt loosing renal diseases
 metabolic alkalosis
 increased HCO3- & decreased Cl-

 Hyperchloremia
 dehydration (relative increase)
 excessive intake (IV)
 congestive heart failure
 metabolic acidosis
 decreased HCO3- & increased Cl- 16
 DETERMINATION: CHLORIDE
 Specimen type
 Serum
 Plasma
 24 hour urine
 CSF
 Sweat
 Sweat Chloride Test

 Used to identify cystic fibrosis patients

Increased salt concentration in sweat

Pilocarpine= chemical used to stimulate sweat

production
 REFERENCE RANGES: CHLORIDE
 Serum
 98 -107 mEq/L or mmol/L

 24 hour urine
 110-250 mEq/L
 varies with intake

 CSF
 120 - 132 mEq/L
 Often CSF Cl is decreased when CSF protein is increased,
as often occurs in bacterial meningitis.

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 THE ELECTROLYTE PANEL
 Carbon dioxide/bicarbonate (HCO3-)
 the major anion of intracellular fluid
 2nd most abundant anion of extracellular fluid
 Total plasma CO2= HCO3- + H2CO3- + CO2

 HCO3- (bicarbonate ion)

accounts for 90% of total plasma CO2

 H2CO3 (carbonic acid)

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 BICARBONATE ION
Function:
 CO2 is a waste product of metabolic reactions
 CO2 reacts with water forming carbonic acid.

H2CO3 HCO3- + H+

 HCO continuously produced as a result of cell

-
3
metabolism,
 the ability of the bicarbonate ion to accept a hydrogen ion
makes it an efficient and effective means of buffering body
pH
 dominant buffering system of plasma

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 REGULATION OF BICARBONATE ION

 Bicarbonate is regulated by Kidney: Reabsorbed

by proximal tubules (85%) & by distal tubules
(15%).
 In case of acidosis: Renal excretion is decreased.
 In case of alkalosis : Renal excretion is increased

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REFERENCE RANGE OF
BICARBONATE ION
 Total Carbon dioxide (venous)
 23-29 mEq/L or mmol/L
 includes bicarb, dissolved & undissociated H2CO3

- carbonic acid (bicarbonate)

 Bicarbonate ion (HCO3–)

 22-26 mEq/L or mmol/L

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