SEESEE 4 rest of electrolytes

SEESEE rest of electrolytes

potassium

major intracellular cation (20 times greater inside cells vs outside)

2%

total percentage of potassium circulating in the plasma

70 - 80 % in proximal convoluted tubule

percentage of potassium reabsorbed and part where it is reabosorbed

Sodium Potassium chloride cotransporter (passive)

Passive transporter that reabsorbs K, Na, Cl in the ascending loop of henle

heart contraction, Neuromuscular excitability, hydrogen ion concentration

3 function of potassium

3.5 - 5.2 mmol/L or 3.5 - 5.2 mEq/L

6.5 mmol/L - hyperkalemia

2.5 mmol/L - hypokalemia

Reference value and threshold critical value of potassium

0.5%

hemolysis of ——-% can increase level of K+ by 0.5 mmol/L (30% increase in gross hemolysis)

Plasma levels are lower (0.1 - 07 mmol/L) than serum levels

level of Plasma potassium vs in serum.

Increase of potassium in serum due to leaking

Prolonged contact of serum and red cell will result to what result in serum.

10 - 20% INCREASE

0.3 - 1.2 mmol/L increase = mild to moderate exercise

2 - 3 mmol/L increase = vigorous exercise fist clenching,

MUSCLE activities and prolonged standing increases potassium by what percentage?

Impaired renal excretion

most likely reason for hyper kalemia

Reduced aldosterone or aldosterone responsiveness,

renal failure,

and reduced distal delivery of sodium.

3 major mechanism of diminished renal potassium excretion

Decreases resting membrane of cell

lack of muscle excitability at 8 mmol/L

Altered ECG (6-7) mmo/L

Cardiac arrest at 10 mmol/l

Effects of hyper kalemia in cardiac muscle

Reduced aldosterone - hyporeninemic hypoaldosteronism

most common cause of chronic hyperkalemia

Renal failure

hyperkalemia due to decrease tubular secretion

pH imbalance = (reduction H + per unit = 0.2 - 1.7 mmol/L increase in potassium)

Cause of hyperkalemia due to increase in each unit reduction of hydrogen going into RBC in exchange of potassium moving out of RBC.

captopril

Spirolactone

Digoxin

Cyclosporine

heparin therapy

Hyperkalemic drugs

Therapeutic potassium

most common cause of hyperkalemia among hospitalized patients

Metabolic acidosis

Hyperkalemia can cause an increase in H ions resulting to?

0.2 - 1.7 increase of potassium

In acidosis the reduction of hydrogen that enters RBC in exchange of potassium moving out of cell increase K+ levels in serum, the reduction of H+ per unit affects potassium to what level?

Pseudohyperkalemia

Thrombocytosis, Leukocytosis

recentrifugation of SST

Prolonged tourniquet

excessive fist clenching

IV fluid contamination (possbile hemolysis)

High blast counts in acute accelerated phase leukemia

Hypokalemia

hypomagnesemia

Impaired function/renal loss

Extra renal loss (most common:diarrhea)

pH imbalance

Pseudohypokalemia - leukocytosis

Impaired renal function/renal loss

most common cause of hypokalemia

0.4 mmol/L per 0.1 unit of pH rise

in pH imbalance, in alkalosis potassium decreases by ?

Alkalemia = alkalosis. = low K levels in blood

promotes intracellular loss of H+ to neutralize the rise of pH so K+ and Na will move into cells for Electroneutrality.

Insulin and catecholamines

promotes entry of potassium into cell as glucose is transported inside the cell causing hypokalemia.

Pseudohypokalemia = one reason for hypokalemia

K+ when left in room temperature will be eaten up by WBC leading to?

<20mmol/L in urine low/day = Kidneys not reason

>30 mmol/L in urineHigh/day = kidneys are the reason

crtitical threshold value for urine potassium

heparinized plasma

preffered sample for potassium

Chloride

Major extracellular anion

Chloride

chief counter ion of sodium

passive transport in proximal tubule

way of reabsorption of chloride

Chloride

the only anion enzyme activator

Maintain osmolality, blood volume, and electric neutrality

funcions of chloride

98 - 107 mmol/L or 98 - 107 mEq/L

ref value of chloride

causes of hyperchloremia

renal tubular acidosis, Diabetes insipidus, salicylates intoxication, primary hyperparathyrodism, metabolic acidosis, prolonged diarrhea

causes of hypochloremia

Prolonged vomiting, (increase in bicarbonate with decrease in acids, HCL)

Aldosterone

metabolic alkalosis

salt - losing nephritis

false

Marked hemolysis may cause increase in chloride level (T or F)

Slightly lower values are seen post prandial

Post prandial specimen do not affect chloride specimens.

calcium

electrolyte exclusively present in the plasma

Calcium

electrolyte involved in: Blood coagulation, enzyme excitability of skeletal and cardiac muscle, maintenance of blood pressure

Potassium

electrolyte closely monitored and is sensitive for cardiac muscles

1.18 mmol/L

ref value of bloodionized calcium

Acidic and is absorbed in duodenum

recommended pH for absorption of Calcium and the place where it is absorbed.

99% in bone, 1% in blood and ECF

% Distribution of calcium in the body

Total Ca =

8.6 - 10 mg/dl (adult)

8.8 - 10.8 (child)

Total non ionized calcium

4.6 - 5.3 mg/dl (adult)

4.8 - 5.5 mg.dl (child)

Ref values of calcium both ionized and non ionized

ionized (active/free) calcium = 50% - most specific marker for calcium disorders

Non ionized (protein bound calcium) - 40% bound in albumin

complexed with anion - 10%

Forms of calcium

= 0.8mg/dl decrease in total calcium

1 g/dl decrease in serum albumin decrease this results to what in total calcium level.

PTH

Calcium regulation: major hypercalcemic hormone, removes calcium from bones, cause increase in calcium but decrease in phosphate due to renal secretion

1,25 DIHYRDROXYCHOLECALCIFEROL (vitamin D3)

Calcium regulation: hormone that increases both phosphate and calcium, promotes calcium absorption in small intestine and kidneys

Calcitonin

Calcium regulator:

decrease Ca in blood and place it on bones

secreted by the parafollicular C cell of the thyroid gland

Inhibits Pth and vitamin 3

Inhibits bone resorption

promotes urinary excretion of calcium

affects kidney, bone and intestine resulting to decreased Phosphate and Ca

Causes of hypercalcemia

hyperthyrodism

iatrogenic cause

multiple myeloma

sarcoidosis

cause of hypocalcemia

calcitonin

hypoparathyrodism

alkalosis

renal failure

vitamin D deficiency

specimen of choice for calcium determination

serum

omnipresent ion distribution 85% in bones and 15% in the ECF in the form of inorganic phosphate

distribution of inorganic phosphate

Inorganic phosphorus

inversely related to calcium

Maximally absorbed in jejunum

site where Inorganic phosphorus is absorbed.

hypophosphatemia

transcellular shift is the major cause of ——- in Inorganic phosphate

Inorganic phosphorus

Electrolyte essential for for insulin mediated entry of glucose and co entry of potassium

Inorganic phosphorus

most common form of phosphate in serum

2.7 - 4.5 mg/dL (adult)

4.5-5.5 mg/dL (child)

ref value of Inorganic phosphorus

Organic phosphate - principal anion within the cell

inorganic phosphate - part of blood buffer

Inorganic phosphorus exist in two forms:

Free or bound -55%

complexed with ions - 35%

protein bound - 10%

Forms of phosphate and their percentages

causes of hyperphospatemia

Causes:

hypoparathyrodism

renal failure

lymphoblastic leukemia

Hypervitaminosis D

Causes of hypophosphatemia

alcohol abuse - most common cause

Primary hyperparathyroidism

avitaminosis D (no vit D)

Myxedema

Serum, lithium, heparin plasma

methods: formation of ammonium phosphomolybdate complex

specimen required for Inorganic phosphorus determination

Magnesium

intracellular cation second in abundance to potassium

Magnesium

4th most abundant cation

Henle’s loop

location of reabsorption of Magnesium

1 mole (24g) of magnesium

The average human body contains how many moles of magnesium

True

Consumption of canned food decreases magnesium count

Majority is found in bones (53%)

46% in muscle and soft tissues

1% in RBC

Distribution of magnesium in the body

Kidneys

organ that controls magnesium in the body

5 mmol/l

Value of magnesium where it will show life threatening symptoms

1.2 - 2.1 mEq/L

reference value of of magnesium

Free Mg / ionized form - 55%

Protein bound - 30%

complexed with ions - 15%

forms of magnesium

causes of hypermagnesemia

diabetic coma

addisons disease

chronic renal failure

increased intake of antacids (contain Aluminum and magnesium)

causes of hypomagnesemia

acute renal failure
malnutrition

malabsorption syndrome

chronic alcoholism

severe diarrhea

Bicarbonate

Second most abundant anion in ECF

DECREASED bicarbonate

metabolic acidosis results to increase or decrease in bicarbonate concentration

proximal tubule - 85%

15% - tubules in kidney

Bicarbonate is reabsorbed where?

Major component of the buffering system in blood

Bicarbonate

Blood anaerobically collected, ABG

specimen required for bicarbonate concentration

21 - 28 mEq/L

bicarbonate reference range