Electrolytes and Blood Gases

Objectives

• List 4 Major electrolytes

• Discuss the functions and regulation of
sodium, water, potassium and chloride
• Describe the methods routinely used in
measuring sodium, potassium and chloride
• State the principle of the ion selective
electrode method for sodium, potassium and
chloride ions
 Learning Objectives

• Explain what is meant by “fluid balance,”

“electrolyte balance,” and “acid-base balance”
• Compare the compositions of intracellular and
extracellular fluids
• Identify the hormones that play important roles
in regulating fluid and electrolyte balance
• Understand the movement of fluid that takes
place within the ECF, between the ECF and the
ICF, and between the ECF and the environment
 Learning Objectives

• Discuss how sodium, potassium, calcium and

chloride ions are regulated to maintain
electrolyte balance
• Explain the buffering systems that balance the
pH of the intracellular and extracellular fluids
• Describe the compensatory mechanisms
involved in acid-base balance.
 Maintenance of normal fluid
volume and composition is vital

• Extracellular fluid (ECF) includes:

– Interstitial fluid, plasma, lymph and other body fluids
• Intracellular fluid (ICF) includes:
– The cytosol (fluid inside the cell)
– Makes up about two-thirds of the total body water
 Fluid and electrolyte balance
• Fluid balance
– Fluid is in a balance when the amount of water gained (e.g.
through the digestive system) each day equals the amount of
fluid lost (e.g. through urinary system, sweat glands) each day
• Electrolyte balance
– The ion gain each day equals the ion loss
– Electrolytes are ions released through the dissociation of
inorganic compounds
• Acid-base balance
– H+ gain is offset by their loss
– When acid–base balance exists, the pH of body fluids remains
within normal limits (7.35-7.45).
The Composition of the
Human Body
 Regulation of fluids and
electrolytes
• Homeostatic mechanisms respond to changes in ECF
• No receptors directly monitor fluid or electrolyte
balance.
• However fluid and electrolyte can be monitored by
responding to changes in plasma volume or osmotic
concentrations
– All water moves passively in response to osmotic gradients
– Body content of water or electrolytes rises if intake exceeds
outflow
 Cations in Body Fluids

• Major cations inside the cell (ICF) include

• Potassium (K+)
• Magnesium (Mg2+)
• Sodium (Na+)
• Major cations outside the cell (ECF)
include
• Sodium (Na+)
• Potassium (K+)
• Calcium (Ca2+)
• The concentration of cations inside the
cell and outside the cell differs as shown
in figure on the right e.g. there is much
higher concentration of potassium in the
ICF than in the ECF, there is much higher
concentration of sodium in the ECF than
in the ICF.
 Anions in Body Fluids
• Major Anions inside the cell (ICF) include
• Proteins
• Phosphates (HPO42-)
• Bicarbonate (HCO3-)
• SO42-
• Chloride (Cl-)

• Major Anions outside the cell (ECF) include

• Chloride (Cl-)
• Proteins
• Bicarbonate (HCO3-)
• SO42-
• The concentration of anions inside the cell and
outside the cell differs as shown in figure on the
right e.g. there is much higher concentration of
proteins and Phosphate in the ICF than in the ECF..,
There is much higher concentration of chloride in
the ECF than in the ICF.
 Primary regulatory hormones

• Fluid balance and electrolyte balance are

mediated by three hormones:
– Antidiuretic hormone (ADH)
• Stimulates water conservation and the thirst center
– Aldosterone
• Controls Na+ reabsorption and K+ secretion
– Natriuretic peptides (ANP and BNP)
• Reduce thirst and block the release of ADH and
aldosterone
 Fluid movement within the ECF
• Fluid moves freely within ECF compartment
• Water, electrolytes, proteins, fats and other
nutrients and molecules are normally balanced
by gains via
– Eating
– Drinking
– Metabolic generation

• Loss of water and other molecules are by:

– Urination
– Respiratory losses
– Perspiration
– Fecal Loss
Fluid Exchanges
 Major Electrolytes
• Are ionized molecules found throughout the blood, tissues, and cells
• Help to balance pH and acid-base levels in the body
• Facilitate the passage of fluid between and within cells through a
process of osmosis
• Play a part in regulating the function of the neuromuscular, endocrine,
and excretory systems.
• Commonly tested electrolytes in Clinical Labs:
• Sodium (Na+) - A positively charged electrolyte that helps to balance
fluid levels in the body and facilitates nerve & muscle function.
• Potassium (K+) - A main component of cellular fluid, this positive
electrolyte helps to regulate neuromuscular function and osmotic
pressure.
• Chloride (CI-) - An anion, or negative electrolyte, that regulates blood
pressure.
• Bicarbonate (HCO3- )- regulates the body’s pH or acid balance.
 Electrolyte Imbalance

• Could result from loss of body fluids from

prolonged vomiting, diarrhea, sweating
• Inadequate diet e.g.: vitamin deficiency
• Malabsorption e.g. in pancreatic disorders,
bacterial infections
• Hormonal or endocrine disorders
• Kidney disease
• Complication of chemotherapy
• Certain medications such as:
– Chemotherapy drugs
– Diuretics
– Antibiotics (Amphotericin B)
 Sodium imbalance
hypernatremia
• Inadequate water intake
• Excessive fluid loss such as in
diabetes insipidus, kidney
disease, severe burns, and
prolonged vomiting or diarrhea.
• Sodium retention which may
be caused by excessive
sodium intake or
aldosteronism.
• Certain drugs
– including loop diuretics, and
antihypertensive medications
may cause elevated sodium
levels.
hyponatremia
• inadequate dietary intake of
sodium
• excessive perspiration
• water intoxication
• Impairment of adrenal gland or
kidney function.
• Excessive water consumption
• Prolonged diarrhea
• Use of diuretics
• Diseases involving organs that
control sodium or water
regulation
 Potassium imbalance

• may be caused by ketoacidosis (diabetic coma), myocardial

infarction (heart attack), severe burns, kidney failure, fasting,
gastrointestinal bleeding, adrenal insufficiency, or Addison's disease.

• May also result from use of diuretic drugs, cyclosporine, lithium,

heparin, and trimethoprim as well as heavy exercise
Fictitious hyperkalemia Hyperkalemia due to
increased K+ intake
– Blood transfusion (increasing
– Hemolysis or tissue ischemia
risk with duration of cell
during phlebotomy
storage)
– Thrombocytosis or
– Intravenous (IV) or oral
leukocytosis (affects serum K+
potassium
but not plasma K+)
– Maintenance K+ in IVF or oral
solutions combined with
decreased renal function
Hyperkalemia due to
transcellular K+ shift
– Metabolic acidosis
– Acute tubular necrosis
– Congenital adrenal
hyperplasia
– Head trauma
– Succinylcholine use in a child
with neuromuscular disease,
prolonged bedrest (including
patients in ICUs), or more
than 24 hours after crush or
burn injury.
Hyperkalemia due to
decreased K+ excretion
– Acute renal failure
– Primary adrenal disease
– aldosteronism
– Renal tubular disease
– Medications (e.g., potassium
sparing diuretics, Angiotensin
Converting Enzyme (ACE)
inhibitors, angiotensin II
blockers)
 Hypokalemia
Caused by:
• diarrhea
• excessive alcohol abuse
• chronic kidney disease
• long-term diuretic therapy
• excessive laxative use
• congestive heart failure
• adrenal gland impairments
 Chloride Imbalance

Chloride travels primarily with sodium and

water and helps generate the osmotic
pressure of body fluids. It is an important
constituent of stomach hydrochloric acid
(HCl), the key digestive acid.
 Chloride imbalance
Hyperchloremia
• refers to increased plasma
chloride concentrations and
may be caused by severe
dehydration, kidney failure,
hemodialysis, traumatic brain
injury, and aldosteronism.
• Drugs such as boric acid,
ammonium chloride and the
intravenous (IV) infusion of
sodium chloride can also boost
chloride levels, resulting in
hyperchloremic metabolic
acidosis.
Hypochloremia
• refers to decreased plasma
concentration of chloride and
usually occurs as a result of
sodium and potassium
depletion
• Severe depletion of serum
causes metabolic alkalosis.
• may manifest as; mental
confusion, slowed breathing,
paralysis and muscle tension
or spasm.
 ECF Concentrations of other
electrolytes

• Calcium balance
– Bone reserves, absorption in the digestive tract, and
loss through kidneys
• Magnesium balance
– Absorbed by the convoluted tubule to keep pace
with urinary losses
 Acid-base Balance
The importance of pH control
• The pH of the ECF remains between 7.35 and
7.45
– If plasma levels fall below 7.35 (acidemia), acidosis
results
– If plasma levels rise above 7.45 (alkalemia), alkalosis
results
– Alteration outside these boundaries affects all body
systems e.g. can result in coma, cardiac failure, and
circulatory collapse
 Blood pH control
• Carbonic acid is most important factor affecting pH of
ECF
– CO2 reacts with water to form carbonic acid
– Inverse relationship between pH and concentration of CO2
 Mechanisms of pH control
• Buffer system consists of a weak acid and its
conjugate base.
• Three major buffering systems:
– Protein buffer system
• Amino acid
– Hemoglobin buffer system
• H+ are buffered by hemoglobin
– Carbonic acid-bicarbonate
• Buffers changes caused by organic and fixed acids
 Carbonic Acid-Bicarbonate Buffering
System

• Carbonic acid-bicarbonate buffer system

CO2 + H2O  H2CO3  H+ + CO3–
• Has the following limitations:
– Cannot protect the ECF from pH changes due to
increased or decreased CO2 levels
– Only functions when respiratory system and control
centers are working normally
– It is limited by availability of bicarbonate ions
(bicarbonate reserve)
The Carbonic Acid-Bicarbonate Buffer
System
 Maintenance of acid-base balance

• Lungs help regulate pH through carbonic acid -

bicarbonate buffer system
– Changing respiratory rates changes PCO2
• Respiratory compensation
• Kidneys help regulate pH through renal
compensation
The Central Role of the Carbonic Acid-Bicarbonate
Buffer System in the Regulation of plasma pH
The Central Role of the Carbonic Acid-
Bicarbonate Buffer System in the
Regulation of Plasma pH
 Changes with age include
• Reduced total body water content
• Impaired ability to perform renal compensation
• Increased water demands
– reduced ability to concentrate urine
– reduced sensitivity to ADH/ aldosterone
• Net loss of minerals
• Inability to perform respiratory compensation
• Secondary conditions that affect fluid, electrolyte, acid-base
balance
 Specimen for electrolyte
determination
• Serum obtained from venipunture into Red-
top tube (plain tube).
• Heparinised whole blood arterial or venous
sample obtained for blood gases or pH
determination(only with Direct ISE).
 Methods for electrolyte
analysis and principles
• Ion selective electrodes (ISE)
– An ISE consists of a thin membrane across which
only the intended ion can be transported.
– The transport of ions from a high conc. to a low
one through a selective binding with some sites
within the membrane creates a potential
difference.
• Direct potentiometric methods
– Measurement of electrical potential in electrolyte
analysis
END