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Na+ is the most abundant cation in the ECF

Potassium (K+) is the major intracellular cation


Cl- is the major extracellular anion
Bicarbonate is the second most abundant anion in the ECF
Magnesium (Mg2+) is the fourth most abundant cation in the body and second most abundant
intracellular ion
Calcium - regulated by PTH, vitamin D, and calcitonin
Phosphate is the predominant intracellular anion
Lactate – hypoxia leading to conversion of lactate to pyruvate from glycolysis (anaerobic)
Anion Gap - Na+, K+, Cl−, and HCO3

Functions
Sodium: determines osmolality of plasma
Potassium – regulation of neuromuscular excitability, contraction of the heart, ICF volume, and H+
concentration.
Chloride maintaining osmolality, blood volume, and electric neutrality
Magnesium – cofactor, important in glycolysis; transcellular ion transport; neuromuscular transmission;
synthesis of carbohydrates, proteins, lipids, and nucleic acids; and the release of and response to certain
hormones, significant in cardiovascular, metabolic, and neuromuscular disorders

Specimen
Osmolality – serum or urine
Sodium – serum, plasma, and urine (24 hour), sweat
Potassium – serum, plasma, and urine (24 hour)
Chloride – serum or plasma, urine (24 hour), sweat
Bicarbonate - venous serum or plasma
Magnesium - Nonhemolyzed serum or lithium heparin plasma, 24 hour urine with HCl
Calcium - heparinized whole blood, serum or lithium heparin plasma without venous stasis, urine
acidified 5mol/L HCl (1mL per 100mL urine)
Phosphate - Serum or lithium heparin plasma, 24 hour urine
Lactate – heparin with Iodoacetate and fluoride

Anticoagulant of choice
Sodium - lithium heparin, ammonium heparin, and lithium oxalate
Potassium – heparin
Chloride – lithium heparin
Bicarbonate – lithium heparin
Magnesium - lithium heparin
Calcium – dry heparin

Hemolysis
Sodium – does not cause significant change
Potassium – false increase
Chloride – does not cause significant change
Magnesium – should be avoided
Phosphate - higher concentrations inside the red cells

Method
Sodium – ISE
Potassium – ISE – valinomycin membrane
Chloride – ISE*, amperometric-coulometric titration (Ag+)
Bicarbonate – ISE ( acid reagent to convert all the forms of CO2 to CO2 gas and is measured by a pco2
electrode and an enzymatic method (phosphoenolpyruvate carboxylase then MDH)
Magnesium – AAS*, colorimetric
Calcium – AAS*, ortho-cresolphthalein complexone (CPC) with 8-hydroxyquinoline or arsenazo III dye
Phosphate - ammonium phosphomolybdate – colorless, if reduced, molybdenum blue complex
Lactate – Enzymatic - lactate oxidase to produce pyruvate and H2O2, also Peroxidase

Source of error
Sodium – protein buildup – less sensitivity
Potassium – clotting – hyperkalemia
Bicarbonate - uncapped before analysis, CO2 escapes. Levels can decrease by 6 mmol/L/h
Calcium – liquid heparin can lower Ca
Phosphate - venous stasis will increase lactate levels

Principles

↑ osmolality ↓ freezing point temperature and vapor pressure

↓ K+, hypoxia

↓ K+, ↓ resting membrane potential, ↑ cell excitability (cell more negative), hyperpolarize cannot
contract then muscle weakness

↑K+, ↑ resting membrane potential, depolarize but then cannot repolarize thus cannot contract

Pseudohyponatremia - RBC lysis - false decrease

↑HCO3- ↓Cl-

↑insulin (high K uptake in cell) – hypokalemia

Hyperaldosteronism (↑Na to blood from tubule, excrete K to urine) – hypokalemia

Addison’s disease (primary adrenal insufficiency) – hyperkalemia

K loss – hypoxia, hypomagnesemia, digoxin

Catecholamine – uptake

Propanolol – inhibit uptake

Na goes, Cl follows
↓Cl- - respiratory acidosis (HCO3 out Cl in), diabetic ketoacidosis (low insulin, high ketones thus acidic),
aldosterone deficiency

↓HCO3- - metabolic acidosis

Mg – parathyroid hormone

↑ Ca, ↑ Na, ↑ Mg excretion

↓ Mg ↓ intracellular K

Hypokalemia, hypomagnesemic

Mg – vasodilator

Pesudohypermagnesemia – dehydration

↑Mg – inhibit PTH – hypocalcemia

Bone resorption – osteoclast bone, Ca release to ECF


Kidney – reabsorption Ca
Vit D3 – Ca absorption in intestine

↑ PO4, ↓ Ca

Mg and Ca

Hormones
AVP is secreted by the posterior pituitary gland
PTH – bone
Thyroxine and GH deficiency (increase reabsorption Mg) - ↑ Mg

When ↓ Ca, ↑ PTH

When ↑ Ca, ↓ PTH

Calcitonin – thyroid gland

Anion Gap

Questions

elevated CO2 concentrations – metabolic alkalosis?

Hypocalcemia vitamin D metabolism, hypercholesterolemia, hyperphosphatemia, and hypomagnesemia