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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

also Peroxidase Source of error Sodium – protein buildup – less sensitivity Potassium – clotting – hyperkalemia Bicarbonate .↓Cl- ↑insulin (high K uptake in cell) – hypokalemia Hyperaldosteronism (↑Na to blood from tubule. colorimetric Calcium – AAS*. ↓ resting membrane potential. hyperpolarize cannot contract then muscle weakness ↑K+. ↑ resting membrane potential. excrete K to urine) – hypokalemia Addison’s disease (primary adrenal insufficiency) – hyperkalemia K loss – hypoxia.venous stasis will increase lactate levels Principles ↑ osmolality ↓ freezing point temperature and vapor pressure ↓ K+. depolarize but then cannot repolarize thus cannot contract Pseudohyponatremia .false decrease ↑HCO3. ortho-cresolphthalein complexone (CPC) with 8-hydroxyquinoline or arsenazo III dye Phosphate . hypomagnesemia. digoxin Catecholamine – uptake Propanolol – inhibit uptake Na goes. if reduced. molybdenum blue complex Lactate – Enzymatic . Levels can decrease by 6 mmol/L/h Calcium – liquid heparin can lower Ca Phosphate . 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*.lactate oxidase to produce pyruvate and H2O2. hypoxia ↓ K+.uncapped before analysis.ammonium phosphomolybdate – colorless. Cl follows .higher concentrations inside the red cells Method Sodium – ISE Potassium – ISE – valinomycin membrane Chloride – ISE*.Magnesium – should be avoided Phosphate .RBC lysis . CO2 escapes. ↑ cell excitability (cell more negative).

Ca release to ECF Kidney – reabsorption Ca Vit D3 – Ca absorption in intestine ↑ PO4. diabetic ketoacidosis (low insulin. aldosterone deficiency ↓HCO3. hypomagnesemic Mg – vasodilator Pesudohypermagnesemia – dehydration ↑Mg – inhibit PTH – hypocalcemia Bone resorption – osteoclast bone. hypercholesterolemia. ↓ PTH Calcitonin – thyroid gland Anion Gap Questions elevated CO2 concentrations – metabolic alkalosis? Hypocalcemia vitamin D metabolism. ↓ Ca Mg and Ca Hormones AVP is secreted by the posterior pituitary gland PTH – bone Thyroxine and GH deficiency (increase reabsorption Mg) . high ketones thus acidic).↓Cl.respiratory acidosis (HCO3 out Cl in).↑ Mg When ↓ Ca.metabolic acidosis Mg – parathyroid hormone ↑ Ca. hyperphosphatemia... ↑ PTH When ↑ Ca. and hypomagnesemia . ↑ Na. ↑ Mg excretion ↓ Mg ↓ intracellular K Hypokalemia.