Chapter III: Major Intra- and Extracellular Electrolytes

The concentrations of electrolytes vary in the different fluid compartments:

a. Intracellular fluid
b. Interstitial fluid Extracellular
c. plasma and vascular fluid

- separated from each other by membranes permeable to water and many organic and inorganic
solutes.
- impermeable to macromolecules such as proteins
- selectively permeable to sodium, potassium and magnesium

SODIUM & CHLORIDE

- found in plasma and interstitial fluids(extracellular)
POTASSIUM, MAGNESIUM & PHOSPHATE
- found in intracellular fluid

Major Physiological Ions Principal Metabolic Functions Clinical Manifestation of

Deficiency
CHLORIDE Maintains normal hydration, Hypochloremic Alkalosis
osmotic pressure, (pernicious vomiting)
gastric HCl,
acid-base balance,
electrolyte balance
SODIUM Buffer constituent acid-base balance, Dehydration
water balance, acidosis
CO2 transport, tissue atrophy
osmotic pressure, edema
cell membrane permeability, hypertension
muscle irritability
POTASSIUM Buffer constituent acid-base balance, Acidosis
water balance, Renal Damage
CO2 transport,
neuromuscular irritability
CALCIUM Formation of apatite in bones Poor growth
and teeth Osteoporosis
Blood clotting Rickets
MAGNESIUM Co-factor for PO4 transferring enzymes muscular tremor
constituent of bones and teeth chloreiform movement
PHOSPHOROUS Constituent of bones and teeth, Renal rickets
(as HPO42-) of buffers ATP, NAD and FAD Cardiac Arrhythmia
Osteomalacia

Electrolytes Used for Replacement Therapy

SODIUM CHLORIDE
- Table salt, Sea salt, Sal gemme
- colorless, cubic crystals/white crystalline powder having saline taste
- soluble in glycerin and slightly in alcohol
- occurs in solid states called rock salt, halite, fossil salts, and sal gemme
- prepared under the heat of the sun using “salt pans” (Mg+2 & Ca+2 present as impurities)
o impurities readily precipitated by adding sodium carbonate to the brine (NaCl solution),
crystals are collected by decantation or centrifugation
- must be purified for medical purposes (100%)

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy
 USES:
 Isotonic Solutions – for physiological fluids’ tonicity (0.9%w/v, NSS)
- dressings for irritating body cavities/tissues
- as injections when fluids and electrolytes are depleted
**build up of extensive extracellular fluid due to administration of isotonic sodium
chloride may lead to both pulmonary and peripheral edema

 Hypotonic solutions – for maintenance therapy when patients are unable to take fluids and
nutrients orally
- dextrose (glucose) is the caloric source

 Hypertonic injections – used when there is loss of sodium in an excess of water

 Sodium Chloride injection – fluid and electrolyte replenisher

 Antidote to silver poisoning, condiment and preservative

POTASSIUM CHLORIDE (KCl)

- Kalium Chloratum, Kali Chloridum
- colorless, elongated prismatic/cubical crystals OR as white granular powder
- odorless, with saline taste
- neutral to litmus, solutions
- found in large deposits in the form of silvite and carnalite; sometimes in combination with NaCl
- drug of choice for ORAL REPLACEMENT OF K+
- irritating to the gastrointestinal tract, must be enteric-coated

USES:
 drug of choice for ORAL REPLACEMENT OF K+
 component of Ringer’s injection and Solution & Lactated Ringer’s Injection
o injection - fluid and electrolyte replenisher
- patients with severe hypopotassemia*
*defiency of K+, resulting to muscle weakness
o solution – topical purposes
 treatment of:
 familial periodic paralysis
 Meniere’s Syndrome
- inbalance, noise in the inner ear

 antidote to Digitalis intoxification

CALCIUM CHLORIDE (CaCl2●2H2O)

- Muriate of Lime
- white, odorless, slightly translucent granules with slightly saline taste
- colligative property – less than zero freezing point
- very deliquescent, mixed with lactose to reduce deliquescence
- irritating to the veins
USES:
 electrolyte replenisher
 in internal hemorrhages
 certain bone diseases
 nervous disorders
 deficiency of Calcium in the system
 osteomalacia – softening of the bones

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy
BUFFER SYSTEMS IN THE BODY
1. Bicarbonate/Carbonic Acid (HCO3-/H2CO3)
- found in plasma and kidneys
2. Monohydrogen/Dihydrogen phosphate (HPO4-2/H2PO4-)
- found in cells and kidneys
3. Hemoglobin and proteins
- found in red blood cells
- buffer for carbonic acid

Acidosis – body’s acid levels increase, decrease alkali below normal

Alkalosis – alkali levels increase, decreasing acid below normal
𝒂𝒄𝒊𝒅𝒐𝒔𝒊𝒔 ↓ 𝟕. 𝟑𝟖 − 𝟕. 𝟒𝟐 ↑ (𝒂𝒍𝒌𝒂𝒍𝒐𝒔𝒊𝒔)

Compensatory Mechanisms of the Body

Condition/Causes Buffer System Respiratory Function Renal Function
Metabolic acidosis HCO3-/H2CO3 Hyperventilation Increased acid
- HCO3- deficit carbonic acid
CO2 + H2O
increased excretion of H2CO3 excretion
as CO2 by Na+ -- H+ exchange
: diabetic acidosis, renal
increased NH3 formation
failure, diarrhea HCO3- reabsorption
Metabolic alkalosis HCO3-/H2CO3 CO2 retention, Decreased ↑
-
- HCO3 excess increased H2CO3 concentration
: administration of excess
alkali, vomiting
Respiratory Acidosis Hemoglobin and Increased CO2 *Metabolic Acidosis
- H2CO3 excess protein excretion
: cardiac disease, lung through the lungs
damage, drowning
Respiratory Alkalosis *Metabolic Alkalosis *Metabolic Alkalosis *Metabolic Alkalosis
- H2CO3 deficit
: fever, hysteria, anoxia,
salicylate poisoning

Steps in Kidney’s Acid Excretion

1. Glomerular filtration – sodium salts of mineral and organic acids are removed from the
plasma
2. Sodium-hydrogen exchange – sodium is removed from the renal filtrate/tubular fluid and
tubule cells
Na+ + H2CO3 ----------------> Na+ + HCO3- + H+
3. Sodium bicarbonate returns to the plasma and removed from the lungs as CO2

3 Mechanisms Maintaining the Normal Acid-Base Balance of the Plasma:

1. Buffers of the body fluids and red blood cells
2. Pulmonary excretion of excess CO2
3. Renal excretion of either acid or base, whichever is in excess
Metabolic acidosis is treated with Sodium:
 Bicarbonate
 Lactate
 Acetate
 Citrate
Metabolic alkalosis is treated with AMMONIUM SALTS, retards sodium-hydrogen exchange

SODIUM ACETATE (CH3COONa●3H2O)

- Acetate of Soda
- colorless, transparent crystals/white granular powder/white flake
- faint acetous odor
USES:
 buffer in metabolic acidosis of acute cholera
 treatment for uremic acidosis (by infusion)
 Systemic alkalizer
 diuretic, diaphoretic, aperients

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy
POTASSIUM ACETATE (CH3COOK)
- Diuretic Salt
- colorless monoclinic crystals/white crystalline powder
- has a saline/alkaline taste
- deliquesces on exposure to moist air, never prescribed in dry state
USES:
 Diaphoretic and Diuretic (1-4 grams)
 Cathartic (16-30 grams)
 Alkalizer

SODIUM BICARBONATE (NaHCO3)

- Baking Soda
- white crystalline powder
- its alkanility in solutions increases as it stands
- CO2 is liberated when treated with acids
effervescence (bubbling)

Ways of Sterilizing Sodium Bicarbonate

1. Bacteriological filtration
- use of filterthingy with very small pores impermeable to bacteria
2. Autoclaving
- ensures backward reaction, preserving the sodium bicarbonate
3. Heating the bicarbonate solution in an open vessel
USES:
 Combat gastric hyperacidity and systemic acidosis(orally&parenterally)
o drug of choice for systemic acidosis
 lessening of the acidity of the urine (orally)
 inhibits the activity of other drugs when taken simultaneously with it
 treatment of methyl alcohol poisoning
 in the manufacture of effervescent salts, baking powder, fire extinguisher, carbonated drinks
and cleaning mixtures

POTASSIUM BICARBONATE (KHCO3)

- Salaeratus
- transparent monoclinic prisms/white granular powder, odorless
- solutions: neutral or alkaline to litmus
- presence of carbonate indicated by deliquescence

USES:
 electrolyte replenisher
 component of Potassium Triplex (Acetate, Citrate, Bicarbonate)
 oral effervescent potassium replacement solution
 antacid

SODIUM CITRATE (C6H5Na3O7)

- colorless crystals/white crystalline powder
USES:
 anticoagulant
o chelates serum calcium, removing one of the components of blood clotting
o fibrin - clot
 chelation/sequestering of other cations
 in chronic acidosis to restore bicarbonate reserve
 diuretic effect due to increased body salt concentration

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy
POTASSIUM CITRATE (C6H5K3O7●H2O)
- white granular powder, odorless, cooling saline taste
- deliquescent
USES:
 systemic alkalizer
 diuretic
 diaphoretic
 expectorant
 laxative
 gastric antacid

Electrolyte Combination Therapy

1. Fluid Maintenance
- intended to supply normal requirements for water and electrolytes for patients who cannot take
them orally
- should contain atleast 5% dextrose
- minimizes build-up of metabolites associated with starvation (urea, phosphate and ketone bodies)
- intravenously
- composed generally of Na+, Cl-, HCO3-, Mg+2, HPO4-2 & Glucose

2. Electrolyte Replacement
- loss is severe

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy