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    Electrolytes: M. Zaharna Clin. Chem. 2009

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    Ahmed Gaber
    1) Bicarbonate is the second most abundant anion in extracellular fluid and acts as a transport form for carbon dioxide in plasma. It is regulated by the kidneys and lungs and helps maintain acid-base balance. 2) Magnesium is essential for many enzyme reactions and cardiac and muscle function. It is regulated by dietary intake and kidney excretion. Abnormal levels can cause cardiovascular and neuromuscular issues. 3) Calcium is critical for heart function and bone health. Its levels are tightly controlled by parathyroid hormone, vitamin D, and kidney absorption and excretion. Imbalances can cause disorders.

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    Electrolytes: M. Zaharna Clin. Chem. 2009

    Uploaded by

    Ahmed Gaber
    58 views20 pages
    1) Bicarbonate is the second most abundant anion in extracellular fluid and acts as a transport form for carbon dioxide in plasma. It is regulated by the kidneys and lungs and helps maintain acid-base balance. 2) Magnesium is essential for many enzyme reactions and cardiac and muscle function. It is regulated by dietary intake and kidney excretion. Abnormal levels can cause cardiovascular and neuromuscular issues. 3) Calcium is critical for heart function and bone health. Its levels are tightly controlled by parathyroid hormone, vitamin D, and kidney absorption and excretion. Imbalances can cause disorders.

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    ELetrolytes--------mazen----2

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    1) Bicarbonate is the second most abundant anion in extracellular fluid and acts as a transport form for carbon dioxide in plasma. It is regulated by the kidneys and lungs and helps maintain acid-base balance. 2) Magnesium is essential for many enzyme reactions and cardiac and muscle function. It is regulated by dietary intake and kidney excretion. Abnormal levels can cause cardiovascular and neuromuscular issues. 3) Calcium is critical for heart function and bone health. Its levels are tightly controlled by parathyroid hormone, vitamin D, and kidney absorption and excretion. Imbalances can cause disorders.

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    © All Rights Reserved
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    Download as ppt, pdf, or txt
    58 views20 pages

    Electrolytes: M. Zaharna Clin. Chem. 2009

    Uploaded by

    Ahmed Gaber
    1) Bicarbonate is the second most abundant anion in extracellular fluid and acts as a transport form for carbon dioxide in plasma. It is regulated by the kidneys and lungs and helps maintain acid-base balance. 2) Magnesium is essential for many enzyme reactions and cardiac and muscle function. It is regulated by dietary intake and kidney excretion. Abnormal levels can cause cardiovascular and neuromuscular issues. 3) Calcium is critical for heart function and bone health. Its levels are tightly controlled by parathyroid hormone, vitamin D, and kidney absorption and excretion. Imbalances can cause disorders.

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    Electrolytes

    Part 2

    M. Zaharna Clin. Chem. 2009 1


    Bicarbonate
    • 2nd most abundant anion of ECF.
    • The major form of CO2 in plasma
    • Major component of the HCO3- /H2CO3
    buffering system.
    • Serves as a transport form for CO2
    produced from metabolic processes in
    tissues

    M. Zaharna Clin. Chem. 2009 2


    Regulation
    • Bicarbonate conc. is regulated both in:
    – Kidneys through increased or decreased
    tubular reabsorption
    – And in lungs through exhalation of gaseous
    CO2 and H2O
    • Decreased levels of HCO3- in plasma
    result in acid-base disorder (acidosis)
    • Increased levels result in alkalosis

    M. Zaharna Clin. Chem. 2009 3


    Assay
    • Two common methods:
    1. Ion selective electrode
    2. Enzymatic:
    • converts all forms of CO2 to HCO3;
    • HCO3 is used to caboxylate
    phosphoenolpyruvate.
    • Coupled enzyme reaction that measures the
    amount of NADH consumed.
    • The rate of absorbance change is proportional to
    amount of CO2 present.

    M. Zaharna Clin. Chem. 2009 4


    Anion Gap
    • Body water compartments exist in a state of
    electroneutrality (anions=cations)
    • Routine measurements: Na, K, Cl & HCO3 levels
    • Anion Gap is the difference between
    unmeasured anions and unmeasured cations.
    • Formula: AG=(Na + K)- (Cl + HCO3)
    • The "real" balance is given by the equation:
        [Na]+ [K] + [other cations] = [Cl] + [HCO3] + [other anions]
    ([Na]+ [K]) - ([Cl] + [HCO3])= [other anions] - [other cations]
    = "Anion Gap“
    M. Zaharna Clin. Chem. 2009 5
    Anion Gap
    • Some of the unmeasured cations (~7Mmol/L)
    include calcium, magnesium, and most other
    minerals.
    • Unmeasured anions (~24 Mmol/L) include
    proteins like albumin, and phosphates, sulfates,
    etc.
    • There are always more unmeasured anions than
    cations, and thus the "anion gap" equation is
    always greater than zero.

    M. Zaharna Clin. Chem. 2009 6


    Clinical Uses of the Anion Gap
    • To detect the presence of a metabolic acidosis
    • Help differentiate between causes of a metabolic
    acidosis: high anion gap versus normal anion
    gap metabolic acidosis.
    • In an inorganic metabolic acidosis (eg due HCl
    infusion), the infused Cl- replaces HCO3 and the
    anion gap remains normal.
    • In an organic acidosis, the lost bicarbonate is
    replaced by the acid anion which is not normally
    measured.

    M. Zaharna Clin. Chem. 2009 7


    Magnesium
    • 4th most abundant cation in the body and 2nd
    most abundant intracellular cation.
    • 53 % of Mg found in the bone, 46 % in muscle
    and tissue, <1% is present in the serum.
    • The Mg circulating in serum is in the bound form
    (one third-bound to albumin), of the remaining
    two thirds- (61%) is in the free or ionized form, 5
    % bound to phosphate and citrate.
    • Free form is physiologically active.

    M. Zaharna Clin. Chem. 2009 8


    Regulation of Magnesium

    • Regulated by dietary intake, intestine


    may absorb 20-65 % of dietary intake
    and body needs.
    • Kidneys regulate absorption and
    excretion of Mg.
    • PTH increases the renal reabsorption of
    Mg

    M. Zaharna Clin. Chem. 2009 9


    Clinical Significance
    • Roles in the body:
    • Myocardial rhythm and contraction
    • Cofactors in enzyme activation
    • Regulation of ATPase ion pump
    • Abnormal levels related to cardiovascular,
    metabolic, and neuromuscular disorders.

    M. Zaharna Clin. Chem. 2009 10


    Hypo- & Hypermagnesaemia
    • Hypomagnesaemia:
    1. Reduce intake
    2. Decreased absorption
    3. Increased excretion

    • Hypermagnesaemia caused by:


    1. Decreased excretion
    2. Increased intake

    M. Zaharna Clin. Chem. 2009 11


    Assay
    • Methods (colormetric)
    1. Calmagite
    2. Formazan dye
    3. Methylthymol blue

    M. Zaharna Clin. Chem. 2009 12


    Calcium (Ca+2)

    • 99 % of calcium is associated with bone tissue


    • Only 1 % of body calcium is in the plasma

    – 45 % ionized (active form)


    – 40 % protein bound
    – 15 % bound to other compounds

    • Critical component of cardiac function

    M. Zaharna Clin. Chem. 2009 13


    Regulation

    • Decreased plasma ionized Ca stimulates


    release of PTH
    • PTH increases renal reabsorption of
    Calcium
    • PTH stimulates Vitamin D activation
    • Vitamin D increases GI absorption of
    Calcium

    M. Zaharna Clin. Chem. 2009 14


    Regulation

    M. Zaharna Clin. Chem. 2009 15


    • Causes of hypocalcemia
    – Hypoparathyroidism
    – Vitamin D deficiency

    • Causes of hypercalcemia
    – Hyperparathyroidism

    M. Zaharna Clin. Chem. 2009 16


    Phosphate
    • Element found everywhere, participates in
    various biochemical processes.
    – Most significant: ATP, Creatine Phosphate,
    phosphoenolpyruvate reactions.
    – Important compound in the release of O2 from
    Hb (2,3-DPG)
    • Distribution: two forms
    1. Organic
    2. Inorganic

    M. Zaharna Clin. Chem. 2009 17


    Regulation
    • Absorbed in the intestine, regulated by renal
    excretion or reabsorption.
    • Renal regulation is effected by factors such as
    Vit. D (↑), acid-base balance and PTH (↓).

    M. Zaharna Clin. Chem. 2009 18


    Clinical application
    • Hypophosphatemia: decreased level of
    phosphate in blood
    • Hyperphoahatemia: patients with acute
    and chronic renal failure are at the
    greatest risk for condition.

    M. Zaharna Clin. Chem. 2009 19


    Assay
    • Methods:
    • Photometric method:
    – the reaction of phosphate ions with molybdate
    – form complex structures such as ammonium
    phosphomolybdate
    – One can measure phosphomolybdate complexes
    directly or convert them to molybdenum blue using a
    wide variety of reducing agents
    • Enzymatic Method

    M. Zaharna Clin. Chem. 2009 20

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