ELECTROLYTES
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DIETARY SOURCES OF ELECTROLYTES
 JUICE, calcium, chloride, vitamin c, Energy drinks are
reach in electrolytes
Are substances that help our organs to function normally
like the analyte calcium and potassium that helps our
heart to function properly.
In electrolytes, we examine the sodium, magnesium,
calcium, potassium and chloride. And these are the basic
electrolytes that we are going to examine in clinical
chemistry.
There are some machines tatlo lang ang ineexamine, it is
Sodium, Potassium, and the Calcium.
Ang magnesium mejo special yan so mahal yung machine
pag may magnesium and chloride or pag lima siya.
Usual doon sa primary and secondary laboratories, we
have only 3 electrolytes that are being examined.
Going back to our laboratory, we have Primary, Secondary,
and Tertiary Laboratory. The difference between Primary
and Secondary is naidagdag ang electrolytes that’s why
naging secondary sya.
Electrolytes come from what you eat and drink
Basics are Sodium, potassium, chloride
They balance fluids in your body
Maintain your blood’s proper pH
They carry electrical signals to power your nerves and
muscles
Pedialyte has the electrolytes
Foods rich in electrolytes:
 Oresol (contains sodium chloride)
 Gatorade
 Banana (contains potassium)
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Sodium chloride, magnesium, potassium they balance
the body fluid , they maintain your blood proper ph and
they carry electrical signals from yuor muscles, and they
nano electrolyte (di ko maintindihan) andelectrolyte
substance that will conduct electricity when dissolve in
water and also in some polar covalescent compounds are
electrolytes.
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Ano yung tinatawag na table salt? Sodium and chloride
ELECTROLYTE
Calcium
Chloride
Potassium
Magnesium
Dietary sources of electrolytes:
1. Banana - rich in Potassium and calcium=for nagtatae
2. Yogurt= calcium and probiotics = for healthy gut
3. Potatoes = potasium
4. Spinach = calcium and magnesium
5. Celery = sodium content
6. Milk = calcium
7. Almond= calcium
8. Coconut water= sodium/ potassium
9. Egg= calcium
Sodium
What do electrolytes Do?
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Promotes neuromuscular impulses
Maintain body fluid volume and osmolarity
Ditribute body water between fluid compartments
Regulate acid base balance
Note: We cannot leave without electrolytes in our body
because it distribute water . we need to replenish it imediately
to avoid fainting.
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FUNCTIONS
IN
THE BODY
Necessary
for
muscle
contraction,
nerve function,
blood
clotting,
cell
division,
healthy
bones
and teeth
Maintains fluid
balance in the
body
Regulates heart
contaction, helps
maitain
fluid
balance
Necessary
for
muscle
contaction, nerve
function,
heart
rhythm,
bone
strength,
generating
energy
and
building protein
Maintains fluid
balance
and
necessary
for
muscle
contaction and
nerve function
NORMAL ADULT
RANGE
4.5-5.5 mEqL
97-107 mEqL
3.5-5.3 mEqL
1.5-2.5 mEqL
136-145 mEqL
WHat are they?
Electrolytes are minerals found in the body fluids that
carry an electrical charge and are essential to keeping the
heart, nerves and muscles functioning properly.
 As such, it is important to maintain a precise and constant
balance of electrolytes.
- CATION- positively charges
- ANION- negatively charged
 Cations = anions for hemostasis to exist in each fluid
compartment
 Commonly measured in mEq/L
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CATIONS
 SODIUM (Na+
 POTASSIUM (K+)
 CALCIUM (Ca++)
 MAGNESIUM (Mg+)
ANIONS
 CHLORIDE
 BIOCARBONATE
 PHOSPHORUS
 SULFATE
2.
Electrolytes are charged particles (ions) that are dissolved in
body fluid.
3.
(Diko ma ss yung pic, masyadong malabo)
Major Cations
 Extracellular
- sodium
 Intracellular
-potassium
4.
Release is stimulated by: raised sympathetic
tone, falling plasma volume, and certain
prostagladins, such as PGE2
 No direct effects promoting Na+ retention, it
controls the renin-angiotensin-aldosterone
axis
Angiotensin II:
 Levels rise as a result of renin release
 In turn, it stimulates the realease of
aldosterone
 Also increase tone in the efferent glomerular
arteriole. The next effect is to enhance Na+
reabsorption from proximal tubule
Aldosterone:
 Steroid hormone released from the adrenal
cortex
 End product of the RAAS system
 Acts on the distal tubule and collecting duet
to increase Na+ and water reabsorption
(proportionately more Na+ than water)
Arginine vasopressin (AVP), anti-diuretic hormone
(ADH)
 Neuron cell bodies in supra-optic and
paraventricular nuclei of the hypothalamus
 Stored in posterior pituitary
 Passive absorption of water from the
collecting ducts along with a small degree of
Na+ re-absorption, concentrating the urine
RENIN-ANGIOTENSIN-ALDOSTERONE SYSTEM (RAAS
SYSTEM )
SODIUM (Na+)
INTRODUCTON:
 Most prevalent cation in the ECF
 Total body sodium is about 5000 mEq
 In normal individuals, the kidney strives to achieve Na+
balance - that is to have Na+ excretion equal to Na+
ingestion
FUNCTION:
 Maintain balance of extracellular fluid, thereby it
controls the movement of the water between fluid
compartments
 Transmission of nerve impulses
 Neuro muscular and myocardial impulse transmission
1.
REGULATION:
A. Hormones increasing sodium reabsorption
1. Renin:
 released from the juxtaglomelular apparatus
of the kidney
2.
SODIUM (Na+): REGULATION
B. Hormones Increasing Sodium Concentration:
Atrial Natriuretic Peptide (ANP):
 A small peptide produced from the atrial wall as
a result of atrial stretching
 Increase Na (and hence water) excretion by
increasing GFR and blocking Na reabsorption in
PCT
Brain Natriuretic Peptide (BNP):
 Secreted by the hypothalamus, termed Brain
Natriuretic Peptide (BNP)
 Have similar roles
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SODIUM (Na+): SAMPLE COLLECTION
Serum: venous blood sample in gel vacutainer
Urine:
o 24 hours urine collection
o No preservative is required
o Store at 2-8 degree centigrade
SODIUM (Na+): METHOD ESTIMATION
Ions
selective
electrode
o
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2.
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Potentiometric measurements:
 Potentio-metry is to
determine
the
difference in potential
between a working
(an
indicator)
electrode
and
a
counter (a reference)
electrode,
 Cathode
is
the
working / indicator
electrode.
 Anode is the counter /
reference electrode.
 Indicator
Electrode:
Electrode that responds
to analyte and donates /
accepts electrons
 Reference Electrode:
Second ½ cell at a constant potential
 Cell voltage is difference between the indicator and
reference electrode
Ecell = Ec - Ea
○ Where: Ee is the reduction potential at the cathode
○ Ea is the reduction potential at the anode.
SODIUM (Na+): BIOLOGICAL REFERENCE RANGE
 Serum: 135 - 145 mEq/L
 Urine:
o 24 hr urine sample: 40-220 mEq/day
Note: For random, it is better to do FeNa+ Also used in
calculation of Anion gap & Osmolality
SODIUM (Na+): PANIC VALUE
 Serum level: >160 and <120 mEq/L
SODIUM (Na+): ERRORS AFFECTING Na+ RESULT
1. Pseudohyponatremia (pag masyadong mababa)
 Sample collection from IV site, thus the sample is diluted
by the hypotonic fluid (5% dextrose). - confirmed by
dilution effect on other parameters
 High plasma glucose level: increase 100 mg/dl lowering
Na 1.6 mmol/L, after 400 mg/dl, every 100 mg/dl lowering
2.4 mmol/L
Corrected Sodium = [0.016 x (serum glucose - 100)]
+ serum Na
Increased viscosity due to the Hyperproteinemia,
Hyperlipidemia due subsequent decreased watery portion
of plasma can thus cause false low sodium concentrations
Pseudohypernatraemia (Increase level of sodium)
Sample collection
from IV site confirmed
by
measurements of CL
and K+
Drugs - SSRI, sodium
valproate etc.
HYPONATREMIA
NOTE: For burns: ang lumalabas sa may burned part is white
cell hindi dugo kaya ang sinasalin is Fresh Frozen Plasma
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Summary of Natremic Disorders
Hyponatremia
Hypernatremia
Hypovolemic
Na - 
H2O - 
Na - 
H2O - 
Eu-volemic
Na - N
H2O - 
Na - N
H2O - 
Hypervolemic
Na - 
H2O - 
Na - 
H2O - 
HYPERNATREMIA
04.06
PART 1: 28-30:45
PART 2: 0-2
POTASSIUM
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K
Madami sa banana, apple, peanuts, legiums,
orngaes and lemons
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in the picture, indicated are the atomic number,
symbol, name, weight
it also rich in beet greens, salmon, tomatoes, white
button mushrooms, etc.
 major intracellular cation
 untreated changes in K+ levels can lead to serious
neuromuscular and cardiac problems
 Normal K+ levels: 3.5-5 mEq/L
 Total body K+ content in a normal adult: 30004000mE1
 98% intracellular, 2% in ECF
Health Benefits of Potassium
 Contains potassium
 Regulates sugar
 Muscle contraction
 Low pressure
 Alkaline content
 Treats cramps
 Retains fluid
 Builds muscle
 Removes tiredness
Balancing Potassium
 Most K+ ingested is excreted by the kidneys
 Three other influential factors in K+ balance:
o Na+/K+ pump
o Renal regulator
o pH level
HYPOKALEMIA (POTASSIUM DEFICIT)
 Serum K+ <3.5 mEq/L
 Caused by:
 SUDDEN
o patients in Diabetic coma
 GRADUAL
o Diarrhoea – Villous + UC
o PS + GOO
o Duodenal fistula
o Ileostomy/USD
o Poisoning
o Beta agonists
 Alkalosis
 Shallow Respirations
 Irritability
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Confusion drowsiness
Weakness. Fatigue
Arrythmias – irregular rate, tachycardia
Lethargy
Thready pulse
↓ Intestinal Motility
Nausea
Vomiting
Ileus
What do you see?
 Irritability
 Paresthesia
 Muscle weakness (especially legs)
 ECG changes (tented/peak T wave)
 Irregular pulse
 Hypotension
 Nausea, abdominal cramps, diarrohea
CALCIUM
Errors affecting K+ result
B. Pesudohypokalemia
1. Sample collection form IV site, thus the sample is
diluted by the hypotonic (5% dextrose). – confirmed
by dilutional effect on other parameters
2. High plasma glucose level
3. Increased viscosity
ORDER OF COLLECTION BY CLSI
1.
2.
3.
4.
5.
6.
7.
8.
Sterile blood culture
Coagulation (light blue)/Citrate
Non-additive (red top/Plain
Gel separator tube (red or gold)/Plain
Heparin tube (green top)
EDTA (lavender/purple top)
Fluoride tube (grey top)
All other tubes
HYPERKALEMIA
 Muscle twitches → Cramps → Paresthesia
 Irritability and anxiety
 ↓ BP
 EKG changes
 Dysrhythmias – irregular rhythm
 Abdominal cramping
 Diarrhea
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99% percent in bones, 1% in serum and soft tissue
(measured by serum Ca++)
 Works with phosphorous to form bones and teeth
 Role in cell membrane permeability
 Affects cardiac muscle contraction
 Participates in blood clotting
 Normal value 8.5-10.5 mg/dL
 Most abundant mineral in human beings
 Total calcium in an average adult is about 1,000 gm
 99% in bones and teeth, hair, nails
 Rest in various tissues in body fluids
 Present in bones mainly in the foprm of calcium
phosphate
 About 50% is bound to protein (protein-bound or
non-diffusible calcium)
 About 5% with organic anions e.g. citrate (diffusible)
 The remaining 45%: free ionized calcium (freely
diffusible)
 Ionized calcium: active form
Functions
 Formation od bones and teeth
 Excitability and conductivity of nerves
 Neuromuscular transmission
 Excitability and conductivity of myocardium
 Coagulation of blood
 Action of hormones
Sample Collection
 Serum: venous blood sample in gel vacutainer
 Urine:
o 24 hours urine in collection
o No preservative is required
o Store at 2-8 degrees
Method of Estimation
1. T. Calcium- Arsenzo III Spectrophotometric method
Ca++ =Arsenzo III
Ca-Arsenzo III complex
(purple)
2. Ionized Calcium: ISE
Biological Reference Range
 T. SerumL 8.5-10.5 mg/dL
 Ionized calcium: 0.9-1.3 mmol/L
 Urine: 24h urine sample: 100-250 mg/day
4/6/22 (2-7 2ND VID)
CALCIUM
ERRORS AFFECTING Ca++ level
A. Pseudohypercalcemia:
1. Cleaning the venipuncture site
2. Tourniquet application
3. Clenching fist
4. Needle or syringe
5. Order of drawing tubes
6. Centrifugation and vigorous shaking of sample
7. Storage
8. Sample type
9. Lymphocytosis and thrombocytosis
B. Pseudohypocalcemia
1. Sample collection from IV site
2. High plasma glucose level
3. Increased viscosity
HYPERCALCEMIA
Hyperparathyroidism
Hypervitaminosis D
Bone cancer
Multiple myeloma
Leukemia
Polycythemia
Milk-alkali syndrome
Sarcoidosis
Idiopathic infantile
hypercalcemia
HYPOCALCEMIA
Hypoparathyroidism
Rickets
Osteomalacia
Chronic renal failure
Nephrotic syndrome
HYPOCALCEMIA
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Serum calcium <8.9 mg/dL
Caused by inadequate intake, malabsorption,
pancreatitis, thyroid or parathyroid surgery, loop
diuretics, low magnesium levels
Clinical manifestations of hypercalcemia:
Immobilization
Bone demineralization
CHLORIDE
Calcium accumulates in the ECF and passes
through the kidneys
Calcium stones
Calcium precipitation
Cardiac dysrhythmias
Mental status changes: lethargy, confusion,
memory loss
Decreased GI motility
Nausea
Constipation
vomiting
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The total amount of chlorine in an average adult is
about 80 gm
 Chlorine, in the form of chloride ions, is the chief
anion of extracellular compartment
 Normal serum chloride level is 98-107 mEq/L (355375 mg/dl)
 The chloride content of cerebrospinal fluid is 120 to
130 mEq/L
 The interstitial fluid contains only about 4 mEq/L
FUNCTIONS:
1. Maintenance of osmotic pressure
2. Maintenance of pH
3. Formation of hydrochloric acid
Sample collection:
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Serum: venous blood sample in gel vacutainer
Urine :
24 hours urine collection
No preservative is required
Store at 2-8 degree
Method of estimation:
By ion selective electrode
Abnormal serum chloride levels:
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Changes in serum chloride level are parallel to
those in serum sodium level
Serum chloride level is raised (hyperchloraemia)
in dehydration, respiratory alkalosis, metabolic
acidosis and adrenocortical hyperactivity.
Serum
chloride
level
is
decreased
(hypochloraemia) in severe vomiting, prolonged
gastric suction, respiratory acidosis, metabolic
alkalois and Addison’s disease.
MAGNESIUM
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-
Tetany=”nag lock jaw?”
FOODS RICH in magnesium: peanuts, beans
-
Convulsions
WHAT DO WE DO?
 Mild
Dietary replacement
 Severe
IV or IM magnesium sulfate
 Monitor
Neuro status
Cardiac status
Safety
HYPERMAGNESEMIA
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MAGNESIUM
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cofactor for many enzymes- ATP utilization in muscle
fiber
 role in protein synthesis and carbohydrate
metabolism
 helps cardiovascular system function(vasodilation)
 regulates muscle contractions
HYPOMAGNESEMIA
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Serum Mg++ level < 1.5 mEq/L
Caused by poor dietary intake, poor GI absorption,
excessive GI/ urinary losses
HIGH RISK CLIENTS:
Chronic alcoholism
Malabsorption
GI/urinary system disorders
Sepsis
Burns
Wounds needing debridement
CLINICAL MANIFESTATIONS OF HYPOMAGNESEMIA:
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Confusion
Depression
Cramps
SERUM Mg++ level>2.5 mEq/L
Not common
Renal dysfunction is most common cause
Renal failure
Addison’s disease
Adrenocortical insufficiency
Untreated DKA
What do we do?
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Increased fluids if renal function normal
Loop diuretic if no response to fluids
Calcium gluconate for toxicity
Mechanical
ventilation
for
respiratory
depression
Hemodialysis (Mg++ free dialysate)