CHEM_LAB Electrolytes

Calcium, Potassium, Sodium, Chloride, Magnesium, Phosphorus

What is the wavelength of Potassium, Calcium, and Chloride?

578 nm

Among the electrolytes, which does not have 578nm as its wavelength?

A. Potassium

B. Chloride

C. Magnesium

D. Sodium

E. Calcium

F. Phosphorus

Answer: X,Y,Z

C,D,F

What is the wavelength of Phosphorus?

620 nm

What is the wavelength of sodium?

360 nm

What are the 3 common specimen for electrolytes?

serum, plasma, urine

What is the specimen unique to chloride?

sweat

Which electrolytes need 24 hour urine sample?

A. Potassium

B. Chloride

C. Magnesium

D. Sodium

E. Calcium

F. Phosphorus

Answer: X,Y,Z

B,E,F

What is the conversion factor of chloride?

0\.2822

What is the conversion factor of calcium?

mmol/L

mg/dL

2\.02 -2.60 mmol/L, 8.1 -10.4mg/dL

Multiplication factor of calcium

mmol/L

mg/dL

2 mmol/L, 8 mg/dL

multiplication factor of sodium

150

Multiplication factor of chloride

mmol/L

mg/dL

100 mmol/L, 355 mg/dL

Multiplication factor of magnesium

mmol/L

mg/dL

1\.03 mmol/L, 2.5 mg/dL

Multiplication factor of phosphorus

mmol/L

mg/dL

3\.2 mmol/L, 10 mg/dL

Which electrolytes do not need to be incubated?

A. Potassium

B. Chloride

C. Magnesium

D. Sodium

E. Calcium

F. Phosphorus

Answer: X,Y,Z

A,B,D

Incubation time and condition of chloride

5 minutes in the dark

Incubation time and temperature of magnesium

10 minutes in room temperature

Incubation time and temperature of phosphorus

1 minute in room temperature

Which electrolytes has a PURPLE end result?

A. Potassium

B. Chloride

C. Magnesium

D. Sodium

E. Calcium

F. Phosphorus

Answer: X,Y,Z

E,M

Which electrolytes has a BLUE end result?

Chloride

Which electrolytes has a YELLOW-BROWN end result?

Sodium

Method of Phosphorus

Photometric UV test

Methods of sodium

Mg-Uranylacetate Method, Photometric Determination

Principle of Magnesium

Absorbance of complex near UV is - proportional to phosphate concentration

directly

Major anion in the intracellular fluid which is
inversely related to calcium

Phosphorus

Phosphorus is distributed as -% in bones and teeth, -% in the intracellular fluid

85%, 15%

What increases phosphate concertation by reabsorption in the kidney?

Vitamin D

What lowers phosphate concertation by increasing renal excretion?

Parathyroid hormone

What increases phosphate concertation by regulation of skeletal growth?

growth hormone

Renal failure
Increased phosphate intake
Increased cellular phosphate release
Increased breakdown of cells

Hyperphosphatemia

Alcohol abuse (most common)
Vitamin D deficiency
Hyperthyroidism

Alcohol abuse (most common)
Vitamin D deficiency
Hyperthyroidism

Major extracellular cation which is 90% of all extracellular cation

Sodium

Functions of Phosphorus

Role in neuromuscular activity

* Durability of bones and teeth
* Helps in the formation of ATP-ADP, vitamin B utilization, transmission of hereditary traits
* Metabolism of CHO, CHON, and fats in the acid- base balance

Functions of Sodium

Neuromuscular activity, Water regulation of the body

Sodium is excreted through

Kidneys, Gastrointestinal secretions

• Excess water loss:
o Diabetes insipidus
o Renal tubular disorder
o Prolonged diarrhea
o Profuse sweating
o Severe burns
o Vomiting
o Fever
o Hyperventilation
• Decrease water intake
• Increase intake or retention:
o Hyperaldosteronism-Conn’s Disease
o Sodium bicarbonate infusion

Hypernatremia

Increase Sodium Loss:
o Diuretic use
o Saline infusion
• Increase Water Retention:
o Renal failure
o Nephrotic syndrome
o Aldosterone deficiency
o Cancer
o Hepatic cirrhosis
o Primary polydipsia
o CNS abnormalities-meningitis encephalitis
multiple sclerosis
o Myxedema
HYPERNATREMIA

hyponatremia

extreme conditions of phosphorus

Answer: hypo and hyper

Hypophosphatemia and Hyperphosphatemia

extreme conditions of sodium

Answer: hypo and hyper

Hyponatremia and hypernatremia

extreme conditions of potassium

Answer: hypo and hyper

hypokalemia and hyperkalemia

Major intracellular cation and only 2-3% found in
extracellular fluid

Potassium

being excreted through the kidney that comprises 80-90% and 20% in feces

potassium

Function of Potassium

* Promote transmission, conduction of nerve pulses that controls the contraction of skeletal, cardiac, and smooth muscles
* Regulation of intracellular osmolality
* Promotes enzyme action for cellular metabolism

Potassium

Single most important analyte in terms of abnormality being immediately life-threatening

Decrease Renal Excretion, Extracellular Shift, Increase in the Oral or IV Infusion/ Use of Immunosuppressive Drug

Hyperkalemia

Gastrointestinal Loss, Intracellular Shift, Renal Loss

Hypokalemia

Plasma potassium levels of 6-7 mmol/L

alter ECG (electrocardiogram)

Plasma potassium levels of 10 mmol/L

fatal cardiac arrest

Method of Potassium

Photometric Turbidimetric Test

extreme conditions of calcium

Answer: hypo and hyper

hypocalcemia and hypercalcemia

Location: Bones (99%), Blood (1%)

Calcium

Functions of calcium

* Neuromuscular activity


* Cardiac contraction
* Cell permeability
* Coagulation (Factor IV)
* Structure of bones and teeth

Total Ca+2 in the Blood is divided into 3 forms:

Ionized Calcium, complex Calciu, Protein bound Calcium

unbound, active, 50% of total calcium

Ionized Calcium

protein bound calcium

40% bound to albumin

10% carboxylated calcium

complex calcium

Calcium is excreted at - from

at 200 mg/day, urine and bile

Primary Hypoparathyroidism, Hypomagnesemia, Hypermagnesemia, Hypoalbuminemia, Acute pancreatitis, Vitamin D deficiency, Renal disease, Rhabdomyolysis, Pseudohypoparathyroidism

Hypocalcemia

Primary hyperparathyroidism, Hyperthyroidism, Benign familial hypocalciuria Malignancy, Multiple myeloma, Increased vitamin D, Thiazide diuretics, Prolonged immobilization

Hypercalcemia

false Increase Ca+2

Hemolysis

false Decrease Ca+2

EDTA and Oxalates

Method of calcium

Ortho-Cresolpthalein Complexone (CPC) method anf Phot0metric test

false decrease of sodium (anticoagulant should not be used because it tends to increase plasma volume)

oxalates

false increase of sodium

unpurified distilled water

Function of Chloride

Water balance and osmotic pressure (w/ Na+), regulates acid-base balance (Chloride shift/Hamburger phenomenon\*), Contributes to the acidity of gastric juice

Major extracellular anion which is the counterpart of Na+

Chloride

Chloride is excreted

Gastrointestinal tract, Kidneys, Sweat

Process which occurs in cardiovascular system and refers to the exchange of bicarbonate and chloride across membrane of RBCs

hamburger phenomenon

nationality and name of the person that coined the hamburger phenomenon

hartog Jacob Hamburger

extreme conditions of chloride

Answer: hypo and hyper

hypochloremia and hyperchloremia

Prolonged vomiting, Diabetic ketoacidosis, Aldosterone deficiency, Salt losing renal diseases such as pyelonephritis, Metabolic alkalosis, Profuse sweating, Addison's disease (low cortisol and aldosterone)

hypochloremia

Dehydration
o GI losses
o Renal Tubular Acidosis (RTA)
o Metabolic acidosis
o Congestive Heart Failure
o Cushings syndrome

Hyperchloremia

Method of Chloride

TPTZ Method, Photometric Colorimetric Test

extreme conditions of magnesium

Answer: hypo and hyper

hypomagnesemia and hypermagnesemia

Function of magnesium

Neuromuscular activity ● Cardiac contraction ● Part of enzyme activation (cofactor) ● Utilization of K+, Ca++, and CHON (carbon, hydrogen, oxygen, & nitrogen) ● Vasodilator (pregnant women; decrease uterine hyperactivity in eclamptic states and increase uterine blood flow)

increases renal excretion of Mg++

Aldosterone and Thyroxine

increases renal reabsorption of Mg++

PTH

reabsorbed by proximal convoluted tubule (PCT)

Kidney (25-30%)

excreted in the feces (60%) and 40% through the kidneys (urine)

magnesium

magnesium is the - most abundant cation, - major intracellular cation

4th and 2nd

Magnesium

\-% (bone), -% (muscle, organs, and soft tissues)

53%, 46%

false increase because Mg++ is greater (20x) inside RBC

hemolysis

Method of Magnesium

Photometric Colorimetric Test with Lipid Clearance Factor

Method of Magnesium

Mg++ + Calmagite → Reddish violet (532 nm)

Calmagite

Method of Magnesium

Mg++ + Dye → Colored complex (660 nm)

Formazan Dye

Method of Magnesium

Mg++ + Chromogen → Colored complex

Methylthymol blue

Interferences of Chloride

Slightly lower in postprandial specimen and serum with high concentration of HCO3-, Hemolysis (False decreased)

Accurate method of Chloride

Gives direct read-out chloride concentration • Adaptations: Cotlove (digital) titrator or chloridometer

AMPEROMETRIC – COULOMETRIC

Cl ions + Mercuric nitrate to form mercuric
chloride (Soluble) with drop of Mercuric
nitrate, the indicator will change from colorless
or faint pink to violet.

SCHALES and SCHALES

Method of Magnesium

Mg++ + Titan Yellow → Red Lake Colloidal Precipitate

Titan Yellow/Dye Lake Method/Clayton Yellow/Thiazole Yellow

Method of Magnesium

Mg++ + 8-hydroxy-5-quinoline sulfonic acid → Fluorescence (380-410 nm) ● More sensitive (limit of detection is lower) ● Expensive

Fluorometric Method

Method of Magnesium

Reference method/Gold Standard

Atomic Absorption Spectrophotometry

Decreased Absorption

Increased Renal Excretion

Increased Endocrine Excretion

Reduced Intake Increased Dr6ug InducedExcretion

Miscellaneous (Excess lactation and pregnancy)

hypomagnesemia

Decreased Excretion, Increased Intake, Miscellaneous (Dehydration, Bone carcinoma, Bone metastasis)

Hypermagnesemia

GEDTAA is used as masking agent for CA+++

Glycol ether diamine N N N N tetraacetic acid

The absorbance - is - to the magnesium concentration in the sample.

increase, proportional

Most frequently observed in hospitalized individuals in intensive care units or those receiving diuretic therapy or
digitalis therapy

hypomagnesemia

The absorbance of this complex is - to the calcium concentration in the sample.

proportional

Reagent contains Mercuric thiocyanate and
ferric nitrate.
• Reddish brown ferric thiocyanate

ZALL COLOR REACTION

The - between - (without precipitation of sodium) and - is proportional to the sodium concentration.

difference, reagent blank, analysis