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MODULE 10
Electrolytes
Overview

Electrolytes are essential for basic life functioning such as maintaining electrical neutrality in the
cells, generation, and conduction of action potentials in the nerves and muscles. Sodium, potassium, and
chloride are the significant electrolytes along with magnesium, calcium, phosphate, and bicarbonates.
Electrolytes come from our food and fluids. These electrolytes can have an imbalance, leading to either
high or low levels. A high or a low level of electrolytes disrupts the normal bodily functions and can lead
to even life-threatening complications.
Learning Outcomes
At the end of this module, you will be able to:
1. Define what electrolytes are.
2. Identify the different important electrolytes.
3. Determine the functions of the different electrolytes.
4. Correlate the importance of Electrolytes in Medicine.

TRIVIA TIME (ENGAGE)

DID YOU KNOW?

Natural coconut water contains five key electrolytes: sodium, potassium,

calcium, magnesium, and phosphorus. Coconut water is packed with
potassium, more than found in one banana or 15 sport drinks.

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 Learning Experience (EXPLORE)

Electrolytes are minerals in your body that have an electric charge. They are in your blood, urine, tissues,
and other body fluids. Electrolytes are important because they help:
 Balance the amount of water in your body
 Balance your body's acid/base (pH) level
 Move nutrients into your cells
 Move wastes out of your cells
 Make sure that your nerves, muscles, the heart, and the brain work the way they should.
IMPORTANT NOTES TO CONSIDER:
 Extracellular fluid (ECF) is 1/3 of the total body water (16 liters)
 Intracellular fluid (ICF) is 2/3 of the total body water (24 liters); 60% of the body ’s water
 Water content of plasma is 12% higher than that of whole blood
 Retention of 3L of fluid in the tissue will result to edema
 SALT CONTENT of the body is the MAIN DETERMINANT of the EXTRACELLULAR VOLUME

MAJOR CLINICALLY SIGNIFICANT ELECTROLYTES

- It is the major cation of extracellular fluid; major contributor of OSMOLALITY

- Plasma concentration depends greatly on intake and excretion of water
- Reference value : 135-145 mmol/L
- Threshold critical values: HYPERNATEMIA: 160 mmol/L
HYPONATREMIA: 120 mmol/L

HORMONES AFFECTING SODIUM LEVELS

A. ) Aldoseterone (↑Na, ↓K)
- promotes Na absoprtion in the distal tubules of kidneys; Na retention and K excretion

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 B. ) Atrial Natriuretic Factor (ANF)
- endogenous antihypertensive agent secreted by the heart
- blocks aldosterone and renin secretion; inhibits angiotensin II and vasopressin action
- promotes natriuresis (removal of Na via diuresis)

OVERVIEW OF THE Renin-Angiotensin-Aldosterone System (RAAS)

DIAGNOSTIC SIGNIFICANCE of SODIUM

1. Hypernatremia (↑Na concentration in the plasma)
- usually results from excessive water loss
- Thirst is the major defense mechanism against hyperosmolality and hypernatremia
- CHRONIC HYPERNATREMIA in an alert patient is indicative of HYPOTHALAMIC DISEASE

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2. Hyponatremia
- most common electrolyte disorder
- For every 100mg/dL increase in blood glucose, serum sodium decreases by 1.6 mmol/L
- Serum sodium level of <125 mmol/L may result to severe neuropsychiatric symptoms
- Potassium deficiency causes loss of sodium (Inverse relationship in renal tubules)

3. Pseudohyponatremia
-systematic error in measurement
- most common cause is in vitro hemolysis- also causes pseudohyperkalemia (REMEMBER PISO -
Potassium inside, Sodium outside)

- major intacellular cation; important in heart contraction

- single most important analyte ; abnormality is immediately life-threatening
- concentration in the red blood cells is 105 mmol/L (23x its concentration in plasma)
- Reference value: 3.5-5.2 mmol/L
- Threshold critical value: 6.5 mmol/L (Hyperkalemia)
2.5 mmol/L (Hypokalemia)

DIAGNOSTIC SIGNIFICANCE
1. Hyperkalemia
- almost always due to impaired renal excretion
- 3 mechanisms of Impaired renal K excretion: Reduced aldosterone, Renal Failure and Reduced distal
delivery of Na
- SEVERE HYPERKALEMIA CAUSES LACK OF MUSCLE EXCITABILITY (8mmol/L) ---> CARDIAC ARREST
- Therapeutic K administration is the most common cause of hyperkalemia among hospitalized patients

2. Pseudohyperkalemia
- Hemolysis, prolonged tourniquet , fist clenching and recentrifugation of SST
- Thrombocytosis and severe leukocytosis cause K release from the platelets and white blood
cells ,respectively, during blood clotting.

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3. Hypokalemia
- Impaired renal function/Renal loss is the most common cause
- Hypomagnesemia leads to hypokalemia by promoting urine loss of K.
- Diarrhea is the most common cause of extra renal loss of K--- direct K loss in the stool
- Causes arrythmia and cardiac paralysis ---> Cessation of Contraction

4. Pseudohypokalemia
- Leukocytosis cause falsely decreased K levels - WBC takes up K if sample is left at room temperature

IMPORTANT NOTE TO REMEMBER

*HEPARINIZED PLASMA is preferred over serum due to potassium release during blood clotting

- major extracellular anion ; chief counter ion of Na in ECF

- only anion to serve as an enzyme activator
- maintains osmolality and electric neutrality
- Reference value: 98-107 mmol/L

DIAGNOSTIC SIGNIFICANCE
- SWEAT CHLORIDE TEST is a very sensitive screening test in diagnosing CYSTIC FIBROSIS; Sweat is induced
via PILOCARPINE IONTOPHORESIS
- CF is a disease that causes mucus build-up in the lungs and other organs. It damages the lungs and
makes it hard to breathe. It can also lead to frequent infections and malnutrition. CF is an inherited
disease, which means it is passed down from your parents, through genes.
- People with CF have a high level of chloride in their sweat

- present almost exclusively in the plasma

- maximally absorbed in the duodenum favored at an acidic pH
- 99% is part of the bones and 1 % is in the blood and ECF
- involved in blood coagulation, enzyme activity, muscle excitability and maintenace of blood pressure
- Reference Values
TOTAL CALCIUM- Adult: 8.6-10 mg/dL ; Child: 8.8-10.8 mg/dL
Ionized Calcium- Adult: 4.6-5.3 mg/dL ; Child: 4.8-5.5 mg/dL

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FORMS:
1. ) Ionized (Active) Calcium - 50%
- sensitive and specific marker for Calcium disorders
2. ) Protein-bound - 40%
3. ) Complxed with anions - 10%

FACTORS AFFECTING PLASMA CALCIUM LEVELS

1. 1,25-dihydroxycholecalciferol (Calcitriol/Vitamin D3)

- increases plasma levels by: ↑ intestinal absorption, renal reabsorption and bone resorption

2. Parathyroid Hormone (PTH)

- increases plasma levels by : ↑ renal reabsorption and bone resorption; prevents urinary loss of Ca
- stimultes the conversion of inactive vitamin D to active vitamin D3 in the kidney

3. Calcitonin
- secreted by the parafollicular C cels of the thyroid gland
- inhibits PTH and vitamin D3 thereby inhibiting bone resorption
- promotes urinary excretion

DIAGNSOTIC SIGNIFICANCE
- Main cause of Hypercalcemia is PRIMARY HYPERPARATHYROIDISM
- Alkalosis causes plasma proteins to have greater negative charge which binds more ionized calcium
resulting to hypocalcemia
- RATE OF FALL in IONIZED CALCIUM initiates TETANY
- Estrogen deficiency reduces formation of active vitamin D
- TRUE HYPOCALCEMIA develops as a serious medical emergency in pancreatitis due to sequestration of
ionized calcium in the damaged tissue and surrounding fluid

IMPORTANT NOTE TO REMEMBER:

 Serum is the specimen of choice

-inversely related to calcium

- maximally absorbed in the jejunum
- Phosphate is esential for the insulin-mediated entry of glucose into cells

-Reference value: ADULT- 2.7-4.5 mg/dL ; CHILD - 4.5-5.5 mg/dL

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DIAGNOSTIC SIGNIFICANCE
- ALCOHOL ABUSE is the most common cause of Hypophosphatemia
-Phosphate deficiency can lead to ATP depletion
-Hyperphosphatemia and hypocalcemia, with elevated BUN and creatinine, is indicative of renal disease
(strongly suggestive of tubular faiure)
- Increased serum phosphate causes serum calcium to diminish

NOTES TO REMEMBER
 Fasting is required - high carbohydrate diet can result to decrease levels
 Blood collection is affected by circadian rhythm - high levels in late morning and low levels in the
evening

- 2nd most abundant intracellular cation

- important in maintaining the structures of DNA, RNA and ribosomes as well as synthesis of Biomolecules.
It regulates the movement of K across the myocardium and acts as an enzyme activator
- Reference value: 1.2-2.1 mEq/L

FACTORS AFFECTING PLASMA MAGNESIUM LEVEL

 Parathyroid hormone inceases intestinal absorption and renal reabsorption of Mg
 Aldosterone and Thyroxine increase renal excreation of Mg
DIAGNOSTIC SIGNIFICANCE
- It is a vasodilator and cause decrease uterine hyperactivity in eclamptic states
- Life threatening symptoms occur if the serum level reach 5 mmol/L
- Mg loss leads to decreased intracellular K levels
- Hypermagnesemia is seen in diabetic coma and hypomagnesemia in sprue (malabsorption syndrome)

- 2nd most abundant anion in the ECF

- it buffers excess Hydrogen ion by combining with acid; MAJOR COMPONENT OF THE BUFFERING SYSTEM
OF BLOOD
- Reference value : 21-28 mEq/L

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DIAGNOSTIC SIGNIFICANCE
- Anion Gap (AG)
> DIFFERENCE BETWEEN THE UNMEASURED CATIONS (Na and K) AND UNMEASURED ANIONS (Cl and
HCO3)
> used to monitor recovery from DIABETIC KETOACIDOCIS
>abnormal anion gaps in sera of healthy person indicate an instrument problem
FORMULA: AG= Na - (Cl + HCO3) reference value: 8-16 mmol/L
AG= (Na + K) - (Cl + HCO3) reference value: 10-20 mmol/L

NOTES TO REMEMBER:
- A change in serum Na usually does not cause a change in AG because serum Cl usually changes in the
same direction
- Increased AG is most often due to accumulation of anions of acids whle decreased AG is most commonly
due to REDUCTION in SERUM ALBUMIN concentration

Self-Assessment Activity (EXPLAIN)

Can electrolytes be considered as specific indicators of a disease?
Why or why not?

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permission in writing from the author.
 End of Module Assessment (EVALUATION)

Name: _______________________________________________ Score: __________

Year & Section:__________________ Date: __________
Instruction: Write your answer in the space provided. If for instance the space is not enough, you can use
extra papers which you will attach here.
1. Why would tubes of serum samples opened for a long time cause falsely decreased ionized calcium? (5 points)

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2. List some electrolytes that are mostly affected by hormones. (3 points)

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3. Why is Potassium laboratory result considered the most critical? (5 points).

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4. Justify why sodium and potassium considered as having an inverse relationship. (5 points)

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5. Give one food or drink that has high electrolyte content and enumerate the electrolytes present in the said
food or drink. (2 points)

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permission in writing from the author.
 References
Book:

Rodriguez, M,T. (2018). Clinical Chemistry Review Handbook for Medical Technologists. Cattleya Star Copy Center
and Book Binding
Online Sources:

[Link]
[Link]
Water-on-Electrolyte-and-Carbohydrate-
Replacement#:~:text=Natural%20coconut%20water%20contains%20five,banana%20or%2015%20sport%20drinks.
[Link]
[Link]

Looking Ahead
For our next module, we will be discussing Lipids. You can reread your previous lessons about
carbohydrates and lipids to prepare you for the next module. You can contact me through my email or
mobile number if there are certain parts of this module that you do not understand. Thank you and Good
luck!

Module Evaluation

Circle the number corresponding to your rating for each indicator. Please refer to the following rating scale.

4 - Strongly Agree 3- Agree 2 - Disagree 1 - Strongly Disagree

Indicators Rating
1. Provides a brief yet compelling overview of the topic. 4 3 2 1
2. States learning outcomes following the SMART principles. 4 3 2 1
3. Discusses contents logically and clearly. 4 3 2 1
4. Presents contents in an engaging manner through effective 4 3 2 1
use of narration, examples or illustrations.
5. Provides opportunities for self-checking of understanding. 4 3 2 1
6. Provides a summary of the key concepts of the lesson. 4 3 2 1
7. States specific instructions all throughout the module. 4 3 2 1

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permission in writing from the author.
 8. Conducts assessment that are well-aligned to the learning 4 3 2 1
outcomes.
9. Develops independent learning and higher order thinking 4 3 2 1
skills of the learner.
10. Indicates necessary citations and references. 4 3 2 1

CONGRATULATIONS for finishing this first module!

Keep going! We’ll do this together

_______________________________________ , RMT
Batch 2023

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permission in writing from the author.