4.2 - Blood Chemistry - Electrolytes

Proverbs 16:3

a. Hyponatremia

[SODIUM]

Low concentration of Na in the blood
a. Hyponatremia
b. Hypernatremia
c. Hypokalemia
d. Hyperkalemia

• Na loss → result of aldosterone deficiency and renal disease

• Excessive water retention → diluted blood caused by CHF and cirrhosis

• May also be caused by Inappropriate secretion of ADH

• Use of Antidepressants, Amphotericin, ACEIs, Carbamazepine, Cisplatin, Cyclophosphamide, Gliclazide, Levothyroxine, NSAIDs, PPIs, Tolbutamide, Vasopressin, and Vincristine.

Causes that lead to HYPOnatremia [4]

• Antidepressants (SSRIs, TCAs)

• Amphotericin B

• ACEIs

• Carbamazepine

• Cisplatin

• Cyclophosphamide

• Gliclazide

• Levothyroxine

• NSAIDS

• PPIs

• Tolbutamide

• Vasopressin

• Vincristine

📌Mnemonic: A³ C³ “GLNP” “TVV”

Drugs that causes HYPOnatremia [13]

• Hyponatremia

• Hypomagnesemia

[DRUGS THAT CAUSE MULTIPLE CONDITIONS]

Amphotericin B

a. Hypokalemia

b. Hyponatremia

c. Hypomagnesemia

d. b and c

• Hyponatremia

• Hypomagnesemia

[DRUGS THAT CAUSE MULTIPLE CONDITIONS]

Cisplatin

a. Hypokalemia

b. Hyponatremia

c. Hypomagnesemia

d. b and c

• Hypokalemia

• Hypercalcemia

• Hypomagnesemia

[DRUGS THAT CAUSE MULTIPLE CONDITIONS]

Loop diuretics (Furosemide)

a. Hypokalemia

b. Hypercalcemia

c. Hypomagnesemia

d. b and c

e. a,b,c

• Hypokalemia

• Hypercalcemia

• Hypomagnesemia

[DRUGS THAT CAUSE MULTIPLE CONDITIONS]

Thiazide diuretics (HCTZ)

a. Hypokalemia

b. Hypercalcemia

c. Hypomagnesemia

d. b and c

e. a,b,c

• Hypokalemia (GIT Loss)

• Hypomagnesemia

[DRUGS THAT CAUSE MULTIPLE CONDITIONS]

Laxatives

a. Hypokalemia

b. Hyponatremia

c. Hypomagnesemia

d. a and c

a. Hypernatremia

[SODIUM]

_______-

• High concentration of sodium in the blood

• Occurs when there is too much water loss or too much sodium gain in the body

a. Hypernatremia
b. Hyponatremia
c. Hyperkalemia
d. Hypokalemia

a. Sodium

[Electrolytes]

Most common in the extracellular fluid
a. Sodium
b. Potassium
c. Calcium
d. Magnesium

a. Potassium (K)

[Electrolytes]

Excitability of nerve and muscle tissue, cardiac function and acid base balance
a. Potassium (K)
b. Sodium (Na)
c. Calcium (Ca)
d. Magnesium (Mg)

Hypokalemia

[Potassium]

Low concentration of K in the blood

a. Hypokalemia

b. Hyponatremia

c. Hypomagnesemia

d. b and c

• Shift of K ions from ECF into the cells (B2 agonists, parenteral insulin, catecholamines)

• Loss from GIT (laxative abuse, diarrhea, persistent vomiting)

• Loss from the kidneys (1° or 2° hyperaldosteronism (Cushing’s syndrome), renal tubular damage (e.g., gentamicin), thiazide and loop diuretics)

[Potassium]

Causes that lead to HYPOkalemia [3]

• B2 agonists (e.g., salbutamol)

• Parenteral insulin

• Catecholamines (e.g., adrenaline, theophylline)

• Loop diuretics

• Thiazide diuretics

Drugs that causes HYPOkalemia [5]

a. Hyperkalemia

[Potassium]

High concentration of Potassium in the blood
a. Hyperkalemia
b. Hypokalemia
c. Hypernatremia
d. Hyponatremia

• Excessive intake of K → decreased elimination or shift of K+

from cells to the ECF

• Renal Failure → inability to excrete K+

• K+ sparing diuretics (e.g., amiloride or spironolactone)

• ACEIs

Causes that lead to HYPERkalemia [2]

• K sparring diuretics (e.g., amiloride or spironolactone)

• ACEIs

Drug that cause HYPERkalemia [2]

a. Magnesium (Mg)

[Electrolytes]

Essential cation, found primarily in bone, muscle and soft tissue, with around 1% of the total body content in the ECF

a. Magnesium (Mg)
b. Calcium (Ca)
c. Potassium (K)
d. Sodium (Na)

a. Hypomagnesemia

[Magnesium]

Low concentration of Mg in the blood due to GI and renal losses, surgery (e.g., esophageal) , trauma, infection, malnutrition, sepsis
a. Hypomagnesemia
b. Hypermagnesemia
c. Hypocalcemia
d. Hypercalcemia

• GI losses

• Renal losses

• Surgery (e.g., esophageal)

• Trauma

• Infection

• Malnutrition

• Sepsis

[Magnesium]

Causes that lead to HYPOmagnesemia [7]

• Cisplatin

• Amphotericin B

• Ciclosporin

• Aminoglycosides

• Laxatives

• Pentamidine

• Tacrolimus

• Carboplatin

• Furosemide

• HCTZ

• Digoxin

'📌Mnemonic: “CACA” LPT “CFHD”

Drugs that causes HYPOmagnesemia [11]

a. Hypermagnesemia

[Magnesium]

______-

• High concentration of magnesium in blood

• Caused by renal insufficiency

a. Hypermagnesemia
b. Hypomagnesemia
c. Hypercalcemia
d. Hypocalcemia

Renal insufficiency

[Magnesium]

Causes that lead to HYPERmagnesemia [1]

c. Calcium

[Electrolytes]

Most important component of bones wherein 40% of it is bound in albumin

a. Phosphorus
b. Magnesium
c. Calcium
d. Potassium

Parathyroid/Vitamin C Deficiency

[Calcium]

Causes that lead to HYPOcalcemia [1]

• Loop diuretics

• Thiazide diuretics

Drugs that causes HYPERcalcemia [2]

• Malignancy

• Hyperparathyroidism (Osteoporosis)

• Paget’s Disease – bone breakdown

• Diuretics (Loop, Thiazide)

• Vit. D intoxications

📌Mnemonic: “MHP” DV

[Calcium]

Causes that lead to HYPERcalcemia [4]

a. Osteomalacia

Caused by hypoparathyroidism wherein there is a low phosphate level that can cause bone softness making them weak and brittle

a. Osteomalacia
b. Osteoporosis
c. Paget's Disease
d. Osteoarthritis

a. Paget's Disease

It increases bone breakdown that causes reorganization of bones.
a. Paget's Disease
b. Osteomalacia
c. Osteoporosis
d. Osteoarthritis

• Aluminum antacids

• Renal losses

• Hyperparathyroidism

[Electrolytes]

Causes that lead to HYPOphosphatemia[3]

Aluminum antacids

Drug that causes HYPOphosphatemia [1]

• Renal dysfunction

• Vitamin D toxicity

• Hypothyroidism

[Phosphate]

Causes that lead to HYPERcalcemia [3]

b. Calcium and Phosphate

[Bone and Mineral Homeostasis]

These two are the major constituents of bone
a. Calcium and Magnesium
b. Calcium and Phosphate
c. Phosphate and Magnesium
d. Sodium and Potassium

• Parathyroid Hormone (PTH)

• Vitamin D

Principal Regulatory Hormones include ______ [2]

c. Parathyroid Hormone (PTH)

[Principal Regulatory Hormones]

This hormone stimulates osteoclastic bone resorption (high Ca = low phosphate)

a. Calcitonin
b. Vitamin D
c. Parathyroid Hormone (PTH)
d. Thyroid Hormone

c. Parathyroid Hormone (PTH)

This hormone inhibits reabsorption of PO⁴ in the proximal tubule

a. Calcitonin
b. Vitamin D
c. Parathyroid Hormone (PTH)
d. Thyroid Hormone

TRUE

[Principal Regulatory Hormones]

TRUE OR FALSE

In Parathyroid Hormone (PTH)

• Increase bone resorption → increase calcium → decrease phosphate

c. Vitamin D

[Principal Regulatory Hormones]

_______-

• Produced from the skin

• Stimulates intestinal Ca and PO4 transport and absorption

• This increases both calcium and phosphate

a. Parathyroid Hormone (PTH)
b. Calcitonin
c. Vitamin D
d. Thyroid Hormone

c. Vitamin D

[Principal Regulatory Hormones]

Stimulates intestinal Ca and PO4 transport and absorption

a. Parathyroid Hormone (PTH)
b. Calcitonin
c. Vitamin D
d. Thyroid Hormone

a. Calcium and Phosphate

[Principal Regulatory Hormones]

Vitamin D increases both _____ and ______

a. Calcium and Phosphate
b. Sodium and Potassium
c. Magnesium and Calcium
d. Phosphate and Magnesium

b. D3 (cholecalciferol)

[Principal Regulatory Hormones]

Most common Vitamin D that came from animal source
a. D2 (ergocalciferol)
b. D3 (cholecalciferol)
c. D1 (calciferol)
d. D4 (dihydrotachysterol)

c. D2 (ergocalciferol)

[Principal Regulatory Hormones]

It is a vitamin D that is a plant source
a. D3 (cholecalciferol)
b. D1 (calciferol)
c. D2 (ergocalciferol)
d. D4 (dihydrotachysterol)

• Estrogen

• Calcitonin

• Glucocorticoids

Secondary Regulatory Hormones include [3]

c. Calcitonin

[Secondary Regulatory Hormones]

This inhibits osteoclastic resorption (low calcium and low phosphate)

a. Parathyroid Hormone (PTH)
b. Vitamin D
c. Calcitonin
d. Thyroid Hormone

a. Glucocorticoids

[Secondary Regulatory Hormones]

_______-

• This antagonizes Vitamin D

• This stimulates renal excretion of Calcium

a. Glucocorticoids
b. Mineralocorticoids
c. Estrogens
d. Androgens

a. Glucocorticoids

[Secondary Regulatory Hormones]

This stimulates renal excretion of Calcium

a. Glucocorticoids
b. Mineralocorticoids
c. Estrogens
d. Androgens

c. Estrogens

[Secondary Regulatory Hormones]

Inhibits the PTH bone resorption activity

a. Glucocorticoids
b. Mineralocorticoids
c. Estrogens
d. Androgens

a. Hypercalcemia, Hypophosphatemia

[Regulatory Hormones]

Too high levels of PTH will result to
a. Hypercalcemia, Hypophosphatemia
b. Hypocalcemia, Hyperphosphatemia
c. Hypercalcemia, Hyperphosphatemia
d. Hypocalcemia, Hypophosphatemia

b. Hypercalcemia, Hypophosphatemia

[Regulatory Hormones]

Too high levels of Vitamin D will result to
a. Hypocalcemia, Hyperphosphatemia
b. Hypercalcemia, Hypophosphatemia
c. Hypercalcemia, Hyperphosphatemia
d. Hypocalcemia, Hypophosphatemia

a. Hypercalcemia, Hypophosphatemia

[Regulatory Hormones]

Too high levels of Calcitonin will result to
a. Hypercalcemia, Hypophosphatemia
b. Hypocalcemia, Hyperphosphatemia
c. Hypercalcemia, Hyperphosphatemia
d. Hypocalcemia, Hypophosphatemia

b. Hypercalcemia, Hypophosphatemia

[Regulatory Hormones]

Too high levels of Cortisol will result to
a. Hypocalcemia, Hyperphosphatemia
b. Hypercalcemia, Hypophosphatemia
c. Hypercalcemia, Hyperphosphatemia
d. Hypocalcemia, Hypophosphatemia

a. Hypercalcemia, Hypophosphatemia

[Regulatory Hormones]

Too high levels of Estrogen will result to
a. Hypercalcemia, Hypophosphatemia
b. Hypocalcemia, Hyperphosphatemia
c. Hypercalcemia, Hyperphosphatemia
d. Hypocalcemia, Hypophosphatemia