Bicarbonate  It is not reabsorbed in the glomerulus

 To retain the pH  Chloride shift mechanism

- 2nd most abundant anion in the ECF
- Simpler form of carbon dioxide in the body Decrease Levels of Bicarbonate
- Accounts for 90% of total body carbon dioxide at physiologic
 Metabolic acidosis
pH (7.35 – 7.45)
o Increase exogenous or endogenous acids that release
- Diffuses out of the cell for exchange of chloride
Hydrogen ions to combine with bicarbonate to form
- Acts as an essential buffer
formic acid.
- Buffers in the body
o It lowers the bicarbonate levels and pH of the blood
o Bicarbonate
o Carbonic acid dissociates into water and carbon
o Protein
dioxide; then it is breathed out.
o Haemoglobin
- Total Carbon dioxide comprises of Increase Levels of Bicarbonate
o Bicarbonate  predominant
 Metabolic Alkalosis
o Carbonic acid
o Concentration of extracellular bicarbonate must be
o Dissolved carbon dioxide
increased
- Carbon dioxide excretion  Exhalation
o Kidneys cant excrete excess bicarbonate
Reference Values:
Analytical Procedure
1. Normal Value: 21 -28 mmol/L
A. Natelson Microgasometer Method
Functions of Bicarbonate a. Reference method
b. All forms of TCO2 are converted to Carbon dioxide by
 Bicarbonate – carbonic acid buffer system
−¿¿ acidification of the sample.
CO 2+ H 2 O❑ H 2 CO3 ❑ H +¿+ HCO ¿
3

⇔ ⇔ c. The method measures as pressure of carbon dioxide is

 Transport form of Carbon dioxide produced by cellular
respiration
Regulations of Bicarbonate
 PCT : 85 % reabsorption
 DCT : 15 % passive reabsorption
 Bicarbonate is a semi-permeable electrolyte
 It is filtered in the glomerulus
liberated.
B. Colorimetric Method
a. pH indicator: cresol red
b. Cresol red provides the acidic pH
c. A color change is produced from red to yellow
d. As the CO2 gas diffuses across a silicone membrane,
decreasing the pH of the recipient buffer solution.
 C. Enzymatic method
a. Alkalinize the sample to convert all forms of carbon
dioxide to bicarbonate.
b. Bicarbonate used to carboxylate phosphoenolpyruvate
(PEP).
c. In the presence of PEP carboxylase, which catalyzes the
formation of oxaloacetate
P EP+ Bicarbonate PEP Carboxylase oxaloacetate + Phosphate
⇒

O xaloacetate+ NADH + H Malate dehydrogenase malate+ NAD

⇒

d. The rate of change in absorbance of NADH at 340 nm is

proportional to the concentration of bicarbonate
D. ISE
a. Uses silicone membrane

Specimens

1. Serum
2. Plasma (Lithium Heparin)
a. Should be done in closed evacuated tube system
b. When exposed to air, it loses approximately 4 – 6
mmol/L of CO2/hour
Magnesium - Overall regulation is controlled by the kidneys majorly in the
Loop of Henle.
- 2nd most abundant cation in ICF
- Ascending Loop of Henle : 50 – 60%
- In the cell – it has 10x greater than in plasma
- PCT : 23 %
- 4th most abundant cation in the body
- DCT : 2 – 5%
- Serum levels may not reflect total body stores of Magnesium
- Analysed for the prevention and treatment of cardiovascular Hormones affecting magnesium levels
disease
 Parathyroid hormone
Distribution o Parathyroid gland
o Increase renal reabsorption of Magnesium
- 53% : bone
o Enhance its absorption at small intestines
- 46% : muscles and soft tissues
- 1 % : serum and RBC  Aldosterone and Thyroxine
o Increase renal excretion of magnesium
Forms o Stopping the reabsorption of magnesium
- Free or ionized : 55% Hypomagnesemia
- Protein bound : 30%
- Complexed with ions : 15% - Plasma Magnesium level : < 0.63 mmol/L
- Can be caused by decrease renal reabsorption of Magnesium
Reference Values: - Magnesium deficit diet
 Serum : 0.63 – 1.0 mmol/L o Starving
o 1.26 – 2.10 mEq/L o Chronic alcoholism
- Common in ICU (intensive care unit) patients
Regulation of Magnesium
- Caused by several drugs
- Found in: o Diuretic
o Gentamycin
o Raw nuts o Meat
o Digoxin
o Dry cereal o Fish
- Can be caused by:
o Vegetables o Fruit
o Hyperaldosteronism
o Chronic alcoholism
- The small intestines may absorbed 20 – 65% dietary
- Symptoms are
Magnesium.
o Psychiatric
 o Neurologic of magnesium – phosphate compound which is not
measured.
Symptoms of Hypomagnesemia S.T.A.R.V.E.D
2. Fluorometric methods
1. Seizures a. Use of calcein, a fluorescent dye that removes calcium
2. Tetany to prevent interference.
3. Anorexia and Arryhytmias b. 8 – hydroxyquinoline : binds with magnesium
4. Rapid heart rate c. Separate serum ASAP to prevent leakage of
5. Vomiting magnesium into the serum
6. Emotional liability 3. Colorimetric Methods – most commonly used
7. Deep tendon reflex increases a. Calagmite
i. Forms a reddish violet complex
Hypermagnesemia
ii. Measured spectrophotometrically at 532 nm
- Plasma Magnesium value @ > 1.0 mmol/L iii. EGTA (ethylene glycol tetra acetic acid)
- Decrease renal function 1. Prevents calcium interference
- Increase intake b. Formazan dye
- Most common cause: Renal Failure i. Forms a colored complex
- Most susceptible: Nursing homes ii. Measured at 660 nm
c. Methylthymol blue
Symptoms of Hypomagnesemia
Specimens
1. Cardiovascular
a. Hypotension 1. Serum
b. Bradycardia 2. 24 hour urine
2. Neuromuscular
Notes
a. Decreased reflexes
b. Paralysis - Plasma is unacceptable because of the chelating action of
c. Respiratory depression anticoagulants
Analytical Procedures - Hemolysis is unacceptable

1. AAS (Atomic Absorption Spectrophotometer)

a. Standard reference method
b. Lanthanum and Strontium are contained in the
diluents to bind with phosphate to prevent formation
 b. PTH secretion in the blood is stimulated by negative
feedback mechanism
Calcium
c. It will act on the bone to activate bone resorption
- 99% : bones d. And the kidneys to increase phosphate excretion and
- 1% : mostly in blood and other ECF calcium reabsorption returning to iCa back to normal
- Essential for myocardial contraction e. PTH will also activate vitamin D for maximal
- Ionized calcium is closely monitored during surgery reabsorption of calcium in the small intestines
f. Vitamin enhances the effects of PTH on bone
Forms
resorption
- Free or ionized – 45%
3 major effects of PTH
o Routinely quantitated
- Protein bound – 40%  Activates bone resorption
- Bound to anions – 15% o Breakdown of osteoclast with subsequent release of
calcium into the ECF
Reference Value
 In the kidneys, PTH conserves calcium by increasing tubular
1. Total Calcium reabsorption of calcium ions
a. Child : 2.2 – 2.7 mmol/L  PTH stimulates renal production of Vitamin D
b. Adult : 2.15 – 2.50 mmol/L
2. Ionized Calcium 2. 1, 25 Dihydroxycholecalciferol (1, 25 – (OH) – D3)
a. Child : 1.2 – 1.38 mmol/L a. Active form of Vitamin D
b. Adult : 1.16 – 1.32 mmol/L b. Increase calcium absorption in the small intestines
Functions c. Enhances the effect of PTH on bone resorption
3. Calcitonin
 Myocardial function a. Synthesized in the medullary cells of the thyroid gland
 Blood coagulation b. Secreted when concentration of calcium inn blood
 Skeletal mineralization increases
 Synthesis and regulation of endocrine and exocrine glands c. It has a calcium lowering effect by inhibiting the action
of both PTH and vitamin D
Regulations of Serum Calcium

1. Parathyroid hormone (PTH)

a. Parathyroiod gland – principal organ in maintaining
calcium homeostasis