Unit 5 Electrolytes

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vertopia
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266368
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Unit 5 Electrolytes
Updated:
2014-03-18 17:14:18
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Exam3 Analytical Chemistry
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Electrolytes for the third exam.
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  1. What is the reference range for Sodium?
    Adult Plasma 136 - 146 mMol/L
  2. What is the reference range for Potassium?
    • Adult 3.5 - 5.1 mMol/L
    • Newborn 3.7 - 5.9 mMol/L
  3. What is the reference range for Chloride?
    • Serum 98 - 106 mMol/L
    • Sweat Up to 35 mMol/L
  4. What is the reference range for Total CO2?
    • Venous 23 - 30 mMol/L
    • Arterial 22 - 29 mMol/L
    • Capillary 22 - 29 mMol/L
  5. What is the reference range for Bicarbonate?
    • Venous 22 - 29 mMol/L
    • Arterial 21 - 28 mMol/L
    • Capillary 21 - 28 mMol/L
  6. What is the reference range for Blood pH?
    • Venous 7.32 - 7.42
    • Arterial 7.35 - 7.45
    • Capillary 7.35 - 7.45
  7. What is the reference range for the Anion Gap?
    7 - 16 mMol/L

    Method: Anion Gap = Na - (Cl + Bicarb)
  8. What is the reference range for Serum Calcium?
    • Total 8.4 - 10.2 mg/dL
    •   (2.1 - 2.6 mMol/L)

    Ionized 1.11 - 1.30 mMol/L
  9. What is the reference range for serum Inorganic Phophorous?
    • Adults 3.0 - 4.5 mg/dL
    • Children 4.5 - 6.5 mg/dL
  10. What is the reference range for serum Magnesium?
    • 1.5 - 2.3 mg/dL
    • 0.65 - 1.05 mMol/L
  11. What is the reference range for serum Iron?
    • Males 50 - 170 ug/dL
    • Female 30 - 160 ug/dL
  12. What is the reference range for serum TIBC (total iron blood capacity)?
    250 - 460 ug/dL
  13. What is the reference range for Transferrin Iron Saturation?
    25 - 55%  (mid of about 37%)
  14. What chemical is used for stimulating sweat in the diagnoses of Cystic Fibrosis?
    Pilocarpine Iontophoresis
  15. What electrolytes are in great abundance within cells and will therefore affect assays if sample is hemolyzed?
    Inorganic Phosphorous, Magnesium, Potassium, and Iron
  16. How does pH change the plasma/serum potassium levels?
    0.1 pH drop causes a 0.6 mMol/L increase in K+. Potassium is leaving cells as H+ goes into cells.

    0.1 pH increase causes a 0.6 mMol/L decrease in K+

  17. Explain the relationship of calcium to inorganic phosphorous (or phosphate). (5 relationships... or 6)
    • 1. Anion phosphorous shows an inverse relationship with calcium.
    • 2. Hyperparathyroid Disease:
    • Calcium High
    • Phosphate Low (or low end of normal)
    • 3. Hypoparathyroid Disease or Renal Disease:
    • Calcium Low
    • Phosphate High
    • 4. Osteolytic bone tumor (dissolving bone), Hypervitiminosis D, excessive intake of Calcium (all have calcium and phosphate):
    • Calcium High
    • Phosphate High
    • 5. Osteoporosis (dissolving bone):
    • Calcium Slightly High
    • Phosphate Normal
    • 6. Osteomalacia (geriatric ricketts) and Ricketts (deficiency of vitamin D).
    • Calcium Low
    • Phosphates Normal
  18. Effect of protein concentration on Na and Ca:
    • Hyperproteinemia: Na+ will decrease to compensate for change in blood pressure.  Total Ca2+ will elevate because more will be bound to the proteins.
    • Hypoproteinemia: Na+ will increase to compensate for resulting decrease in blood pressure.  Total Ca2+ will decrease a little because there will be less proteins to bind it.
  19. What is the Chloride Shift?
    A balance of Chloride with Bicarbonate.  When one decreases, the other normally increases.  This is the case for a normal Anion Gap.  When it does not work, that means there are abnormal anions present in significant amounts.
  20. How do you calculate the Anion Gap and what is its normal range?
    Anion Gap = Na - (Bicarb or TCO2 + Chloride)

    • Normal gap: 7 - 16
    • It should be positive except in Addison's Disease.


    Causes of increased gap: lactic acid, diabetes (ketoacidosis), methanol, antifreeze, drugs...
  21. What are the electrolyte panel discrepancies for Addison's Disease?
    Addison's disease – Adrenal cortex failure: no Cortisol or Aldosterone

    • Sodium: low
    • Potassium: high 
    • Glucose: low (due to low Cortisol)
    • = 60 – due to low Cortisol

    Remember that Aldosterone favors saving sodium and secreting potassium.

    Abnormal anion gap because sodium is low.  Cl and Bicarb are normal.
  22. What are the electrolyte panel discrepancies for Cushing's Disease?
    Cushing's disease – over producing Cortisol

    • Sodium: high
    • Potassium: low
    • Glucose: slightly high (due to low Cortisol)

    Cortisol is the brother of Aldosterone.
  23. What are the electrolyte panel discrepancies for Renal Failure (early and late)?
    Early renal failure:

    • Sodium: slightly low (losing ability to reabsorb sodium)
    • Potassium: high
    • BUN: high
    • Creatinine: high
    • Calcium: low (its getting filtered and person is losing ability to reabsorb it)
    • BUN/Creatinine: 14 (consistent with intrarenal disease)

    Normal anion gap.

    •                                             
    • Late Renal Failure Disease:

    • Sodium: slightly low (losing ability to reabsorb sodium)
    • Potassium: high
    • Chloride: low
    • Bicarbonate: low (losing buffering)
    • BUN: high
    • Creatinine: high
    • Calcium: low (its getting filtered and person is losing ability to reabsorb it)
    • BUN/Creatinine = 10 (consistent with intrarenal disease)

    Abnormal anion gap.
  24. What are the electrolyte panel discrepancies for Diabetes Mellitus Type I and Type II?
    Diabetes Mellitus Type I

    • Sodium: low (trying to compensate for increased osmotic pressure from huge amount of glucose)
    • Potassium: high (metabolic acidosis)
    • Chloride: low
    • Bicarbonate: low (lost buffering to ketone bodies)
    • Glucose: way high (like 400s)

    Abnormal anion gap – ketone bodies are there in a significant amount.

    •                                             
    • Diabetes Mellitus Type II

    • Sodium: slightly low (compensating for osmotic pressure from high glucose)
    • Potassium: high (metabolic acidosis)
    • Chloride: low
    • Bicarbonate: low (slight loss to ketone bodies)
    • Glucose: way high (200s)
    • BUN = 17 (normal)
    • Creatinine: 1.4 high
    • BUN/Creatinine: 12.1 (Developed renal disease due to high glucose levels and high blood pressure.)

    Abnormal anion gap – ketones minimal.
  25. What are the electrolyte panel discrepancies for metabolic acidosis due to Salicylate Poisoning (aspirin)?
    • Sodium: high normal (compensating for osmotic pressure from high glucose)
    • Potassium: high (aspirin is converted to Salicylic Acid or SA)
    • Chloride: 85 (we expected it to shift with the decrease in bicarb, but it didn’t due to the SA)
    • Bicarbonate: low (buffering SA) 
    • BUN: 17 (normal, no damage to kidneys yet.)

    Abnormal anion gap
  26. How do you calculate the UIBC (unbound iron binding capacity)?
    TIBC - serum iron = UIBC
  27. Describe the relative expected serum iron, UIBC, and TIBC for:

    Hepatic Necrosis
    Iron Deficiency Anemia
    Hemochromatosis (iron poisoning)
    Hemolytic Anemia due to transfusion reaction
    Anemia of Chronic Infection
    • Hepatic Necrosis (liver cells dying and releasing stores): 
    • High serum iron.  High TIBC.

    • Iron Deficiency Anemia (Liver compensates by making more transferrin)
    • Low serum iron.  High TIBC.

    • Hemochromatosis (iron poisoning - iron is high so liver compensates by making less transferrin):
    • High serum iron.  Low TIBC (unless acute and then it may be high...?)

    • Hemolytic Anemia due to transfusion reaction (sickle cell, spherocytosis...):
    • High serum iron.  Low TIBC.

    • Anemia of Chronic Infection (TB, Diabetes Mellitus, Immunocompromised patients - liver is not making transferrin):
    • Low serum iron.  Low TIBC.
    • This is the same pattern for Chronic Inflamation.
  28. What are the methods of analysis for Sodium, Potassium, and Lithium?
    • Flame Photometry
    • Ion-Selective Electrode
  29. What are the methods of analysis for Chloride?
    • Coulometric (Buchler-Cotlove)
    • Mercuric Thiocyanate
    • Ion-Selective Electrode
  30. What are the methods of analysis for Total CO2?
    • pCO2 Electrode (Severinghaus Electode)
    • PEPC Enzymatic Method (measures bicarb?)
  31. What are the methods of analysis for Calcium?
    • Atomic Absorption
    • OCPC (o-Cresolphthalein Complexone) - a dye that binds calcium and turns a color
    • Ion-Selective Electrode
  32. What are the methods of analysis for Inorganic Phosphorous?
    Molybdenum Blue (Fiske-Subbarow)
  33. What are the methods of analysis for Magnesium?
    • Titan Yellow Dye or Methylthmol Blue Dye
    • Calmagite Dye - changes color when it binds Mg
  34. What are the methods of analysis for Iron, TIBC?
    Ferrozine Dye Binding (Schade method uses Sulfonated Diphenylphenanthroline and is the most common)

    Bathophenanthroline - iron binding dye

    *Reagents are all buffered around pH 6.0 so all iron is released from Transferrin and Ferratin if present.

    These are sensitive to iron contamination because blood amounts are so small.

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