Clinical Chemistry 2 LAB MT305 RLH3

ELECTROLYTES  Hepatic cirrhosis

 Ions capable of carrying electric charge  Congestive heart failure
 Electrolytes for volume and regulation: Na, K
 Electrolytes for myocardial rhythm and Water imbalance
contractility: K, Mg  excess water intake
 Cofactors in enzyme activation: Ca, Mg, Zn  SIADH
 Regulation of ATPase ion pumps: Mg  pseudohyponatremia
 Acid base balance: K, Cl
 Blood coagulation: Ca, Mg Determination of Sodium
 Neuromuscular excitability: K, Ca, Mg Specimen considerations:
1. Serum is the preferred sample. Plasma and urine
SODIUM are also acceptable. Sweat is also used.
 major extracellular cation 2. Suitable anticoagulants: lithium heparin,
 Most abundant cation (90%) ammonium heparin, lithium oxalate
 Central role in maintaining the normal 3. Blood samples should not be taken after muscular
distribution of water and osmotic pressure in the exercise/activity.
ECF compartment
 Maintains acid-base balance Methods
 Excreted through kidneys, small amounts appear 1. Chemical methods (Trindler)
in feces and sweats. 2. Flame Emission Spectrophotometry
3. Atomic Absorption Spectrophotometry
Relationship to Adrenal Glands 4. ISE (Ion Selective Electrode)
 controls the metabolism of sodium
 Releases aldosterone Trindler method
 Functions of aldosterone  serum is added to an alcoholic solution of
a. decreases urinary output of Na magnesium uranyl acetate
b. facilitates renal excretion of water  Sodium is precipitated as sodium magnesium
uranyl acetate and proteins are precipitated by
Clinical applications ethyl alcohol.
 Hypernatremia
 Increased Na concentration Sodium Albanese and Lein method
 Cushing's syndrome  sodium is precipitated as sodium uranyl zinc
(hyperadrenalism) acetate which is then dissolved in water and
 Severe dehydration due to primary determined photometrically by its yellow color
water loss
 Certain types of brain injury Easylite plus Analyzer
 Diabetic coma after insulin therapy  completely automated, microprocessor-
 Extreme treatment with sodium salts controlled electrolyte system that uses ISE (Ion
 Hyponatremia selective electrode)
 Low sodium level (<135 mmol/L)
 Most common in hospitalized and POTASSIUM
nonhospitalized patients  Major intracellular cation
 Functions:
Increased sodium loss  Catalytic action in various enzymatic
 Hypoadrenalism reactions in the cells
 Potassium deficiency  Helps maintain normal pH of the body fluid
 Diuretic use  Helps maintain normal movement of ICF
 Ketonuria  Regulation of neuromuscular excitability
 Salt-losing nephropathy  Contraction of skeletal and cardiac muscles
 Prolong vomiting or diarrhea
 Severe burns Clinical applications
 Hyperkalemia
Increased water retention  increased potassium level
 Renal failure
 Nephrotic syndrome
Clinical Chemistry 2 LAB MT305 RLH3
Decreased Renal Excretions  Acts indirectly as a factor in the maintenance
 acute or chronic renal failure of body water
 Hypoaldosteronism  Maintains osmotic pressure
 Addison's disease
 Diuretics Clinical applications
 Hyperchloremia
Cellular Shift:  nephritis
 acidosis  Eclampsia
 Muscle/cellular injury  Prostatic obstruction
 Chemotherapy  Anemia
 Leukemia  Hyperventilation
 Hemolysis  Hypoproteinemia
 Serum sickness
Increased intake:  Urinary obstruction
 oral or IV K replacement therapy  Increase intake of Cl
 Dehydration
Artifactual  Decrease renal blood
 sample hemolysis
 Thrombocytosis  Hypochloremia
 Prolong tourniquet or excessive fist clenching  Addison's disease
 Burns
Hypokalemia  Fever
 low K level  Intestinal obstruction
1. Postassium deficiency  Metallic poisoning
2. Prolong diarrhea  Pneumonia
3. Prolong vomiting  Heat cramps
4. Hyperadrenalism  Diarrhea
5. Hyperinsulinism  Vomiting
6. Diabetes  Uremia
7. Chronic nephritis  Polycythemia vera
8. Hereditary periodic paralysis  Hypercortico-adrenalism

Specimen considerations Specimen Consideration

1. Specimen required is serum or heparinized blood.
2. Hemolyzed serum should not be used
3. Muscular activity prior to blood extraction is not
recommended this may increase potassium assay
Methods
1. ISE = method of choice
2. Flame photometry
3. Lockheed and Purcell (chemical method)
4. Jacob and Rowland (chemical method) Methods
Lockheed and Purcell
 Potassium is precipitated directly from the serum
or plasma as potassium sodium cobaltinitrite
 Alkaline solution is cobalt reduces the Folin-
Ciocalteau phenol reagent to a blue color
1. Do not use a tourniquet when withdrawing blood
for this test.
2. Chloride level in venous samples is found to be
3-4 mmol/L lower than in arterial sample
3. Lipemic or hemolyzed samples should not be
used
4. Do not take blood from the arm with an IV fluid
drip in place
1. ISE
2. Conductimetric method

CHLORIDES
 major extracellular anion
 Functions
 plays a role in acid base equillibrium