Clinical Chemistry II
MIDTERMS: Electrolytes
:// Techniques, Principles, Correlations by Bishop 6th Edition
Electrolytes
Substances where molecules dissociate into ions when
they are placed in water
Can be CATIONS (+) or ANIONS (-)
Medically significant / Routinely ordered electrolytes
include:
Sodium
Potassium
Chloride
CO2 (in its ion form = HCO3)
Functions of Electrolytes:
Volume and osmotic regulation
Myocardial rhythm and contractility - Mg and K
Co-factors in enzymes activation
Regulation of ATPase in pumps - Mg
Acid-base balance
Blood coagulation - Ca and Mg
Neuromuscular excitability - K
Production of ATP from glucose
Hypokalemia - GB (Guillain Barre
Syndrome)
- Potassium
CJ ( Creutzfeldt-Jakob)
General dietary requirements
Most need to be consumed only in small
amounts
Excessive intake leads to increased
excretion via kidneys
Excessive loss may result in need for
corrective therapy
- Loss due to vomiting / diarrhea
requires therapy ( IV replacement,
pedialyte, etc.)
Water (the diluent for electrolytes) constitutes 40-70%
of total body and is distributed:
Intracellular - inside of cells; 2/3 of body
water
Extracellular - outside of cells; 1/3 of
body water
Interstitial - surrounds the cells in the
Sodium- outside the cell
Potassium - inside the cell
tissue
Ions exist in all of those fluids but the concentration
varies
Sodium has a pulling effect on water
Sodium affects extracellular fluids
(plasma and interstitial) equally
However, because there is considerably
more sodium outside cells than inside, the
water is pulled out of the cells into the
extracellular fluid
Sodium determines the osmotic
pressure of the extracellular fluid
you have two choices every morning: Continue to sleep with your dreams or wake up and chase them
Sodium - Potassium Pump - occurs in cell
membrane
Sodium - Potassium ATPase Pump
3 Na + 3 K - these two bind
Energy dependent
- Splitting of ATP provides energy = ADP
- Sodium ions are driven out in channels
through sodium potassium ATPase
pump
3 Na (nasa labas)
Pumasok si K (the channel allows the K to
bind)
Phosphate is released
Channel (original position reverts backs)
Passive Transport - does not require ATP
Diffusion
Factors that affect diffusion:
Size of ions
Charge of ions
Nature of the membrane
Active Transport
Requires ATP (ex. Na-K ATPase Pump)
For Na to go out of the cell; for K to go inside of
the cell
Proteins (especially albumin) inside the capillaries
strongly pulls/keeps water inside the vascular system
Albumin - provides oncotic pressure; by
keeping sodium and albumin in their places, the
body is able to regulate its hydration
When theres a disturbance in osmolality:
Body respond by regulating water intake; not
by changing electrolyte balance
Osmolality
Physical property of a solution based on solute
concentration
Concentration of solute / kg
Reported as: mOsm/kg; also mOsm/L, but not
commonly used
in osmolality stimulates two responses that
regulate water:
Hypothalamus stimulates the sensation
of thirst
Posterior pituitary secretes ADH
** In both cases, plasma water increases
ADH (Anti-diuretic Hormone) - increases
H2O reabsorption by renal collection ducts
Osmolality = 2 (Na) + (K) + Urea
 Clinical Chemistry II

Osmolality Determination: Uses glucose, BUN and Na values

Plasma sodium accounts for 90% of plasma
Plasma Osmolality: 2 (Plasma Na) + osmolality
glucose BUN glucose BUN
+ 1.86 (Na) + + =
18 2.8 18 2.8
Specimen Collection: calculated osmolality
Serum, Urine and;
Plasma - not recommended due to osmotically Osmolal Gap
active substances that can be introduced into the difference between calculated and
sample determined osmolality;
** Samples should be free of particulate matter, no should be less than 10-15 units difference
turbid samples; must be centrifuged
(measured - calculated = 10-15)
Calculated Osmolality

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