Electrochemistry and Hormonal Regulation Quiz
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Questions and Answers

In diabetes insipidus, what is a typical characteristic related to fluid balance?

  • Water intake exceeds water output
  • Decreased thirst
  • Decreased urine output
  • Water intake equals water output (correct)
  • What is the primary function of Angiotensin II in response to decreased blood volume?

  • Decreases sodium retention
  • Causes vasoconstriction (correct)
  • Decreases blood pressure
  • Causes vasodilation
  • During an oxidation reaction within an electrochemical cell, what process occurs at the anode?

  • Gain of electrons
  • No electron transfer
  • Loss of electrons (correct)
  • Reduction
  • Electrolytes have several functions, but which of the following is NOT a key role of electrolytes?

    <p>Producing glucose (D)</p> Signup and view all the answers

    What does potentiometry measure in an electrochemical cell?

    <p>Voltage at zero current (B)</p> Signup and view all the answers

    What is the function of the reference electrode in an ion-selective electrode (ISE) system?

    <p>To provide a constant potential (C)</p> Signup and view all the answers

    What best describes the relationship between ion activity and ion concentration?

    <p>Directly related (C)</p> Signup and view all the answers

    In the Renin-angiotensin system, what enzyme converts Angiotensin I into Angiotensin II?

    <p>Angiotensin-Converting Enzyme (ACE) (A)</p> Signup and view all the answers

    What is the primary reason for avoiding the use of EDTA tubes when measuring potassium levels?

    <p>EDTA contains potassium, leading to falsely elevated results. (C)</p> Signup and view all the answers

    Why can falsely high potassium results occur if plasma or serum are not separated from cells in a timely fashion?

    <p>Red blood cell breakdown releases potassium into the fluid. (B)</p> Signup and view all the answers

    What is the role of valinomycin in the ion-selective electrode used to measure potassium?

    <p>It selectively binds with potassium ions. (B)</p> Signup and view all the answers

    What is a critical level of potassium that would require immediate medical intervention?

    <p>$6.0$ mmol/L (D)</p> Signup and view all the answers

    In which fluid compartment is chloride the most abundant anion?

    <p>Extracellular fluid (B)</p> Signup and view all the answers

    How does the body primarily regulate chloride levels, which is unlike sodium or potassium?

    <p>By shifting due to changes in sodium or bicarbonate. (D)</p> Signup and view all the answers

    How does the body primarily absorb chloride from the diet?

    <p>Passive reabsorption with sodium in the proximal tubules. (A)</p> Signup and view all the answers

    What is the primary reason fist pumping during venipuncture can cause falsely high potassium levels?

    <p>It causes muscle cells to release potassium. (C)</p> Signup and view all the answers

    Which of the following is the primary function of sodium in the extracellular fluid (ECF)?

    <p>Maintaining water distribution and osmotic pressure (C)</p> Signup and view all the answers

    How does the Na+/K+-ATPase pump contribute to maintaining cell volume?

    <p>By moving 3 Na+ ions out of the cell for every 2 K+ ions that move in, which is then followed by water (D)</p> Signup and view all the answers

    Which of the following is NOT directly involved in the regulation of sodium levels in the body?

    <p>Thyroid-stimulating hormone (TSH) (A)</p> Signup and view all the answers

    Which type of specimen is NOT suitable for testing sodium levels?

    <p>EDTA plasma (A)</p> Signup and view all the answers

    What is the primary function of a reference electrode in potentiometry?

    <p>To provide a stable and constant potential for comparison. (D)</p> Signup and view all the answers

    Which of the following is the most commonly used method for sodium analysis in clinical laboratories?

    <p>Ion-selective electrodes (ISEs) (D)</p> Signup and view all the answers

    According to the Nernst equation, what is the relationship between the measured potential (E) and the activity (a) of an ion?

    <p>E is proportional to the logarithm of a. (A)</p> Signup and view all the answers

    What is the principle behind sodium measurement with ion-selective electrodes (ISEs)?

    <p>Measuring the potential difference across a membrane due to sodium concentration (D)</p> Signup and view all the answers

    What does it mean for an ion-selective electrode to be 'selective but not specific'?

    <p>It measures the target ion and may also show some response to other ions. (A)</p> Signup and view all the answers

    What is a key difference between direct and indirect methods of sodium measurement using ISEs?

    <p>Direct methods eliminate interference from lipids and proteins; indirect methods are susceptible to interference from lipids and proteins (D)</p> Signup and view all the answers

    Which factor is accounted for by using the Nernst equation in ion-selective electrode measurements?

    <p>The temperature of the solution. (A)</p> Signup and view all the answers

    What is the expected outcome on sodium level measurement when using indirect ISE in samples with increased lipids or proteins?

    <p>The measured sodium level will be falsely decreased. (C)</p> Signup and view all the answers

    How does modifying a solid material (glass) electrode with a gas-permeable membrane expand its applicability?

    <p>It allows the measurement of gases like CO2. (A)</p> Signup and view all the answers

    Which type of electrode relies on the ion-exchange process of insoluble inorganic salts for its potential generation?

    <p>Solid state electrodes (B)</p> Signup and view all the answers

    In the context of ion-selective electrodes, what is a selectivity factor?

    <p>The degree to which the electrode is affected by interfering ions. (C)</p> Signup and view all the answers

    What is the primary purpose of a solution with a constant composition surrounding a reference electrode?

    <p>To maintain a stable and consistent electrical potential. (C)</p> Signup and view all the answers

    In the chloride shift, which ion diffuses out of the red blood cells and into the plasma?

    <p>HCO3- (D)</p> Signup and view all the answers

    What is the primary purpose of the chloride shift?

    <p>To maintain electrical neutrality across the red blood cell membrane (D)</p> Signup and view all the answers

    Which anticoagulant is best for chloride specimen collection in plasma?

    <p>Lithium Heparin (C)</p> Signup and view all the answers

    Which of the following conditions is associated with a decreased level of chloride in cerebrospinal fluid (CSF)?

    <p>Bacterial Meningitis (D)</p> Signup and view all the answers

    In the amperometric-coulometric titration method for chloride analysis, what is the role of silver ions (Ag+)?

    <p>To bind with chloride ions to form a precipitate (A)</p> Signup and view all the answers

    Which method of chloride analysis uses an ion-exchange membrane to selectively bind chloride ions?

    <p>Ion-selective electrodes (ISEs) (D)</p> Signup and view all the answers

    A sweat chloride test result of 70 mmol/L is indicative of which condition?

    <p>Cystic Fibrosis (A)</p> Signup and view all the answers

    What is the relationship between sodium (Na+) and chloride (Cl-) in the body, as described in the content?

    <p>Cl passively follows the concentration of Na+ (C)</p> Signup and view all the answers

    What is the primary mechanism by which the proximal tubules reabsorb bicarbonate?

    <p>Combination of HCO3- with H+ to form H2CO3, which then dissociates into H2O and CO2, followed by CO2 diffusion into the ECF (B)</p> Signup and view all the answers

    What is the relationship, if any, between total CO2 and bicarbonate (HCO3-) levels in the blood?

    <p>Total CO2 is roughly equal to the bicarbonate level, because bicarbonate constitutes about 90% of total CO2 (C)</p> Signup and view all the answers

    In metabolic alkalosis, how do the kidneys contribute to restoring acid-base balance?

    <p>By increasing the excretion of bicarbonate (HCO3-) in the urine (C)</p> Signup and view all the answers

    Which condition would likely lead to hypochloremia based on the given information?

    <p>Prolonged vomiting (D)</p> Signup and view all the answers

    What is the effect of aldosterone deficiency on chloride (Cl-) levels in the blood?

    <p>Leads to a decrease in both sodium and chloride levels (C)</p> Signup and view all the answers

    What is the role of the ‘chloride shift’ in maintaining proper physiological function?

    <p>To maintain electroneutrality across cell membranes (A)</p> Signup and view all the answers

    How does the body attempt to restore proper pH levels in a state of metabolic acidosis?

    <p>By reabsorbing bicarbonate (HCO3-) via proximal and distal tubules (D)</p> Signup and view all the answers

    Which of the following conditions is MOST likely to cause hyperchloremia?

    <p>Renal tubular acidosis (RTA) (B)</p> Signup and view all the answers

    Flashcards

    Diabetes Insipidus

    A condition caused by the body's inability to produce or respond to Antidiuretic Hormone (ADH), leading to excessive urination and thirst.

    Regulation of Blood Volume

    The process by which the body regulates blood volume, typically involving the secretion of renin, the conversion of angiotensinogen, and vasoconstriction.

    Electrolytes

    The chemical substances dissolved in a solution, including positively and negatively charged ions like sodium, potassium, and chloride.

    Ion-Selective Electrode (ISE)

    A type of electrochemical cell used to measure the concentration of specific ions in a solution by measuring the voltage generated.

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    Potentiometry

    A measurement technique that measures the voltage generated by an electrochemical cell at zero current.

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    Oxidation

    The process of losing electrons at the anode, resulting in oxidation.

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    Reduction

    The process of gaining electrons at the cathode, resulting in reduction.

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    Anode

    The positive electrode where oxidation occurs.

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    Indicator (ISE) Electrode

    A type of electrode that measures the concentration of a specific ion in a solution by generating an electrical potential proportional to the ion's activity (concentration).

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    Reference Electrode

    An electrode with a constant, stable potential that serves as a reference point for measuring potential differences in potentiometry. Common examples include silver/silver chloride (Ag/AgCl) and calomel (mercury/mercury chloride) Hg/HgCl.

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    Potentiometry Principle

    The difference in electrical potential between the indicator electrode and the reference electrode, measured in millivolts, directly corresponds to the concentration of the ion being measured.

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    Nernst Equation

    A mathematical equation that describes the relationship between the electrical potential generated by an electrode and the concentration (activity) of an ion in solution.

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    Selectivity Factor

    A measure of the degree to which an ISE is affected by the presence of other ions in the solution. A low selectivity factor indicates less interference.

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    Solid Material ISE (e.g., Glass Electrode)

    A type of ISE made from a solid material, like a specific type of glass, that is sensitive to certain ions like Hydrogen (H+) or Sodium (Na+). Some can be modified to measure gases like CO2.

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    Liquid (Ion-exchange) ISE

    A type of ISE with a liquid membrane containing ion-exchange material that binds to the specific ion being measured, such as Potassium (K+).

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    Solid State ISE

    A type of ISE with a membrane made of insoluble inorganic salts that generate potential through ion exchange, used for measuring ions like chloride (Cl-).

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    Exercise and Potassium

    Potassium is released from muscle cells during physical activity, leading to increased potassium levels in the blood.

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    Cellular Breakdown and Potassium

    Damage to red blood cells (RBCs) releases potassium into the extracellular fluid (ECF), potentially raising potassium levels.

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    Potassium Sample Collection

    The preferred sample type for potassium measurement is plasma, collected using heparin tubes.

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    EDTA and Potassium Testing

    EDTA anticoagulant contains potassium, so its use in potassium testing can lead to falsely elevated results.

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    Hemolysis and Potassium Testing

    Minimizing hemolysis, the breakdown of red blood cells, is crucial to ensure accurate potassium measurements. Hemolysis can lead to falsely high potassium levels.

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    Clinical Significance of Potassium

    Maintaining normal serum potassium levels is vital for proper muscle function and preventing cardiac irregularities.

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    Critical Potassium Levels

    Potassium levels outside the normal range can cause cardiac arrhythmias and even cardiac arrest, highlighting the importance of accurate potassium monitoring.

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    Chloride: Major ECF Anion

    Chloride is the most abundant anion in the extracellular fluid (ECF), contributing significantly to osmotic pressure and maintaining fluid balance.

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    Sodium (Na+)

    The major cation found in the extracellular fluid (ECF), making up about 90% of its total cation concentration.

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    Na+/K+-ATPase Pump

    The process by which the Na+/K+-ATPase pumps 3 sodium ions (Na+) out of the cell in exchange for 2 potassium ions (K+) using energy from ATP. This helps maintain the cell's osmotic balance and prevents it from swelling.

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    Sodium (Na+) Regulation

    The regulation of sodium (Na+) in the body involves controlling water intake, water excretion, and sodium excretion. This is important for maintaining blood volume and osmolality.

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    Water Intake Regulation

    The process of water intake in response to thirst, which is triggered by changes in plasma osmolality. The higher the osmolality, the greater the thirst.

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    Water Excretion Regulation

    The process of water excretion through urine, controlled by the release of Anti-Diuretic Hormone (ADH) in response to changes in blood volume or osmolality.

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    Sodium (Na+) Excretion Regulation

    The process of sodium (Na+) excretion in response to changes in blood volume. This is regulated by hormones like aldosterone, angiotensin II, and atrial natriuretic peptide (ANP).

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    Sodium Electrode

    A method for measuring sodium (Na+) in samples using a glass ion-exchange membrane. This membrane interacts with Na+ ions in the sample, generating a potential difference that is proportional to the concentration of Na+.

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    Direct Measurement (ISE)

    A type of sodium (Na+) measurement where the undiluted sample is directly tested on the ISE membrane. This approach is more accurate, especially for samples with elevated lipids or proteins.

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    Chloride Shift

    The movement of chloride ions (Cl-) across the red blood cell membrane in response to bicarbonate ions (HCO3-) movement. It maintains electrical neutrality during carbon dioxide transport in the blood.

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    What happens during the Chloride Shift in tissues?

    In the tissues, carbon dioxide (CO2) enters red blood cells (RBCs) and forms carbonic acid (H2CO3), which dissociates into hydrogen ions (H+) and bicarbonate ions (HCO3-). Deoxyhemoglobin buffers the H+ ions, while HCO3- diffuses out of the RBC into the plasma. To maintain electrical neutrality, chloride ions (Cl-) move into the RBC.

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    What happens during the Chloride Shift in the lungs?

    The reverse of the chloride shift occurs in the lungs. Bicarbonate ions (HCO3-) move from the plasma into the RBC, chloride ions (Cl-) move out, and carbon dioxide (CO2) is released from the RBC to be exhaled.

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    What is a chloride serum/plasma specimen?

    A type of blood sample used to measure chloride levels. It's separated from the red blood cells.

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    What is the best anticoagulant for chloride specimen collection?

    Lithium heparin is the preferred anticoagulant for collecting blood samples for chloride analysis.

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    What is the best sample for measuring total chloride excretion?

    A 24-hour urine collection is the most accurate method for measuring total chloride excretion.

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    What is the clinical significance of Chloride in CSF?

    A test performed on cerebrospinal fluid (CSF) that can indicate bacterial meningitis. Reduced chloride levels in CSF are suggestive of bacterial meningitis.

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    What is the clinical significance of Chloride in sweat?

    A screening test for cystic fibrosis (CF). A sweat chloride level greater than 60 mmol/L is considered positive for CF.

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    Hypochloremia

    Condition characterized by low chloride levels in the blood, often caused by prolonged vomiting, diabetic ketoacidosis, or aldosterone deficiency.

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    Hyperchloremia

    Condition characterized by high chloride levels in the blood, often caused by increased chloride intake, excess loss of bicarbonate, or metabolic acidosis.

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    Bicarbonate - ECF

    Bicarbonate (HCO3-) is the second most abundant anion in the extracellular fluid (ECF).

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    Total CO2 (TCO2)

    Total CO2 (TCO2) is comprised of dissolved CO2, carbonic acid (H2CO3), and bicarbonate. Bicarbonate accounts for 90% of TCO2, making TCO2 a good indicator of bicarbonate levels.

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    Bicarbonate as Blood Buffer

    Bicarbonate is a key component of buffer systems in the blood, particularly the bicarbonate-carbonic acid buffer system (NaHCO3-/H2CO3).

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    Bicarbonate and Chloride Shift

    Bicarbonate is involved in the 'chloride shift' that maintains electroneutrality across cell membranes. HCO3- moves in/out of cells, while Cl- moves out/in to balance the charge.

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    Kidney Regulation of Bicarbonate

    The kidneys play a crucial role in bicarbonate regulation by reabsorbing the majority (85%) in the proximal tubules and the remainder (15%) in the distal tubules. In alkalosis, the kidneys increase bicarbonate excretion to lower pH. In acidosis, the kidneys reabsorb bicarbonate to raise pH.

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    Bicarbonate and Acid-Base Balance

    Bicarbonate is a vital component of the body's acid-base balance, playing a crucial role in neutralizing excess acids and maintaining pH within a narrow range.

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    Study Notes

    Electrolytes - Part 1

    • CHEM2010 course.
    • Covers electrolytes and their role in water balance.
    • Textbook chapters 16 (8th ed.) and 11 (9th ed).

    Water Balance

    • Water intake should equal water output.
    • Excess intake leads to edema (fluid in tissues).
    • Excess output leads to dehydration.
    • Examples of conditions causing dehydration: severe vomiting and diarrhea.
    • Kidneys regulate water in the body, adjusting levels as needed.
    • High water intake results in dilute urine.
    • Low water intake results in concentrated urine.

    Daily Water Balance

    • Liquid intake: 950 ml
    • Oxidation intake: 250 ml
    • Food intake: 800 ml
    • Total intake: 2000 ml
    • Urine output: 1050 ml
    • Evaporation output: 850 ml
    • Feces output: 100 ml
    • Total output: 2000 ml
    • These values represent a daily balance.

    Kidneys

    • Ultimate regulators of water balance.
    • Adjust volume and concentration of urine based on factors like water intake.
    • High water intake → dilute urine
    • Low water intake → concentrated urine
    • Key roles: regulating ADH and aldosterone to manage water and sodium balance.

    Hormones: Antidiuretic Hormone and Aldosterone

    • ADH (Arginine Vasopressin Hormone, AKA AVP)
    • Increases water reabsorption.
    • Secretion stimulated by hypothalamus
    • Aldosterone:
    • Increases sodium reabsorption.
    • Produced by adrenal cortex.
    • Important for Na+ (and Cl) reabsorption by kidneys. Associated with the excretion of K+.

    Water

    • An individual's body weight is 40-75% water.
    • Water percentage decreases with age.
    • More water in female bodies
    • Water is the solvent for processes in the human body.
    • Transports nutrients to cells.
    • Determines cell volume.
    • Removes waste through urine.
    • Acts as body coolant (sweating).
    • Found both intracellularly and extracellularly.

    Body Water Compartments

    • Intracellular fluid (ICF): inside cells (~40-50% body weight)
    • Extracellular fluid (ECF): outside cells, with:
      • Intravascular ECF (plasma): ~5%, the liquid portion of blood.
      • Interstitial fluid: ~15%, surrounding cells and tissues.
    • Transcellular fluid: insignificant but includes specialized compartments (e.g., cerebrospinal fluid, synovial fluid).

    Electrolytes

    • Ions that carry an electrical charge.
    • Two types: anions (negative charge, toward anode) and cations (positive charge, toward cathode).
    • Important in many bodily processes:
      • Volume and osmotic regulation (Na+, Cl–, K+).
      • Myocardial rhythm and contractility (K+, Mg2+, Ca2+).
      • Enzyme activation (Mg2+, Ca2+, Zn2+).
      • Blood coagulation (Ca2+, Mg2+).
      • Acid-base balance (HCO3–, K+, Cl–).
      • Neuromuscular excitability (K+, Ca2+, Mg2+).

    Composition of Body Fluids

    • ECF: main cation is Na+, main anion is Cl–
    • ICF: main cation is K+, main anion is HPO42–

    Electrolyte Distribution

    • [Na+] in ECF is significantly higher than in ICF.
    • [K+] in ICF is significantly higher than in ECF.
    • This difference is maintained by the Na+-K+ ATPase pump.
    • Hemolysis in samples can lead to falsely elevated K+ levels.

    Increase in Anion

    • If one anion increases, another anion or multiple cations must change to maintain electroneutrality.
    • Total anions always equal total cations.

    Osmolality

    • Osmolality is the measure of concentration based solely on the number of solute particles (small particles).
    • It replaced specific gravity for assessing renal concentration
    • 100 mmol Na contributes 100 to osmolality
    • 100 mmol NaCl contributes 200 to osmolality
    • Increased particles decrease the freezing point of a solution.

    Changes in Osmolality

    • Hypothalamus responds to osmolality changes.
    • Increasing osmolality → body fluids concentrate → thirst sensation → ADH secretion.
    • ADH increases water reabsorption by kidneys → diluted urine → decreased plasma osmolality.
    • Conversely, low osmolality leads to lack of thirst and suppressed ADH production.
    • Reference ranges are available for serum and urine osmolality.

    Water Excess

    • Excess water intake (polydipsia) lowers plasma osmolality.
    • Kidneys lower ADH and thirst.
    • Large volume of dilute urine is excreted.
    • Usually does not occur without impairment with renal excretion.

    Water Deficit

    • Thirst prevents water deficit.
    • Water deficit increases plasma osmolality.
    • AVP and thirst activate to increase water reabsorption.
    • Hyper-osmolality and hypernatremia is a concern for infants, unconscious patients, older adults and those with diminished mental status.

    Diabetes Insipidus

    • No ADH or ability to respond to ADH.
    • Excessive thirst.
    • High urine output (up to 10 L/day).
    • Water intake = output.
    • Normal plasma osmolality.

    Regulation of Blood Volume

    • Renin, angiotensin I, and angiotensin II control blood volume/pressure by triggering vasoconstriction, increased blood pressure and increased Na+ retention by triggering aldosterone excretion.

    Ion-Selective Electrodes

    • Used in potentiometry.
    • Electrochemical cells of two half cells linked by a salt bridge.
    • Indicator electrode detects the ion of interest.
    • Reference electrode provides constant potential.
    • ISEs combine these components in a single unit.
    • Activity is directly related to concentration

    ISE Potentiometry - Key Words

    • Activity refers to the concentration of an ion.
    • Oxidation is the loss of electrons (at anode)
    • Reduction is the gain of electrons (at cathode)
    • Anodes are positive electrodes and oxidation occurs there.
    • Cathodes are negative electrodes and reduction occurs there.
    • Electrochemical cell combines two half-cells connected via a salt bridge.

    Electrolyte Functions

    • Affect various metabolic processes.
    • Maintain osmotic pressure and water balance.
    • Control pH.
    • Regulate heart and muscle function.
    • Involved in oxidation-reduction reactions.
    • Act as enzyme cofactors.

    Sodium (Na+)

    • Major cation in extracellular fluid (ECF).
    • Crucial in maintaining water distribution/osmotic pressure.
    • Maintains extracellular fluid volume & osmotic pressure.
    • Dietary intake (130-260 mmol/day).
    • Active transport by Na+/K+-ATPase pump.
    • Influences water movement in and out of cells, preventing osmotic rupture.

    Regulation of Sodium (Na+)

    • Regulated by intake (thirst), excretion (ADH and aldosterone, angiotensin II, atrial natriuretic peptide.)
    • Thirst is stimulated by hypothalamus in response to increased osmolality.
    • Increased osmolality → hypothalamus stimulates thirst and ADH release.
    • ADH increases water reabsorption by kidneys.
    • Aldosterone increases Na+ reabsorption.

    Specimen Testing - Sodium

    • Gold-top/red-top tubes for serum blood samples.
    • Special tubes containing heparin for plasma, Random or 24-hour urine collection for testing.
    • Hemolysis not significantly affecting testing outcome.
    • Storage requirements for delayed analysis.

    Methods of Analysis - Sodium

    • Chemical methods are outdated.
    • Flame emission spectrophotometry (older method).
    • Atomic absorption spectrophotometry (older method).
    • Ion-selective electrodes (ISEs) are the most routinely used method

    Sodium Electrode

    • A glass ion-exchange membrane is used for Na+ measurement.
    • Na+ interacts with the membrane, which produces a potential related to Na+ activity.
    • Reference electrode maintains a constant potential, allowing for measuring the potential difference in relation to concentration.

    Measurement Modes for ISEs

    • Direct measurement uses undiluted samples with ISE membranes
    • Elevated lipids/proteins do not interfere with Direct measurement.
    • Indirect measurement uses diluted samples
    • Electrolyte exclusion effect where excess lipids/proteins causes falsely decreased Na+ concentrations in blood samples

    Sodium Electrode - Sources of Error

    • Continuous use buildup of protein on the electrode membranes
    • Causes poor selectivity/ poor reducibility of results -Routine/ regular maintenance is required to resolve the problem of protein buildup

    Hypo/Hypernatremia

    -Conditions related to sodium levels in blood.

    • Causes of low/high sodium are listed

    Potassium (K+)

    • Major cation in intracellular fluid (ICF).
    • Daily dietary requirements (50-150 mmol).
    • Regulates neuromuscular excitability.
    • Regulates heart contraction.

    Regulation of Potassium (K+)

    • Nearly all K+ is reabsorbed in the proximal tubules of the kidney.
    • Additional K+ is secreted into the urine.
    • Excess K+ is excreted in the urine.
    • Accumulates to toxic levels in renal failure
    • Factors impacting K+ distribution: hypoxia, hypomagnesemia, digoxin overdose, insulin, catecholamines, and propranolol.

    Factors that influence distribution of K+

    • Factors like exercise and hemolysis causing changes in blood K+
    • Exercise releases K+ from muscle cells to the ECF.
    • Fist-pumping can cause elevated blood K+.
    • RBC damage releases K+ into the extracellular fluid (ECF/ plasma)

    Specimen Collection - Potassium

    • Serum/plasma using Gold-top/red-top tubes.
    • Plasma samples use heparin as anticoagulant.
    • EDTA (K2EDTA) should not be used for samples, as it may introduce K+ into the sample, leading to inaccurate results. -Urine samples (random or 24 hour).
    • Hemolysis should be minimized.

    Methods of Measurement - Potassium

    • Flame photometry (an older method).
    • Ion-selective electrodes (ISEs) are the most common approach.

    Potassium Electrode

    • Ion-exchange electrode.
    • Membrane contains valinomycin, which selectively binds with K+.
    • KCl is used for the inner electrolyte solution.
    • Can function in direct or indirect measurement modes
    • Similar outcome between the direct/indirect methods, unlike Na+

    Chloride (Cl–):

    • Major anion in the extracellular fluid (ECF).
    • Major contributor to osmolality.
    • Importance in maintaining proper hydration, blood volume, and electrical neutrality.

    Regulation of Chloride

    • Absorbed by intestinal tract → filtered by glomerulus → passively reabsorbed into the blood by proximal tubules -excess chloride excreted in urine and sweat.

    How Chloride Maintains Electroneutrality

    • Chloride assists in maintaining electroneutrality involving Na+ reabsorption.
    • Processes like bicarbonate shift are crucial to maintaining this balance.

    Chloride Specimen Collection

    • Serum/plasma (separate from cells) using Lithium heparin as an anticoagulant.
    • Urine samples (24hr),
    • CSF samples
    • Sweat as a screening test for Cystic Fibrosis

    Chloride Methods of Analysis

    • Amperometric-coulometric titration.
    • Mercurimetric titration.
    • Colorimetry.
    • Ion-selective electrodes (ISEs)

    Chloride Methods of Analysis

    • Silver ions quantitatively generated for titrating the sample
      • free silver ions indicate the end point of titration which is used to calculate amount of chloride in the sample
    • Example of the method is Cotlove Chloridometer.

    Chloride Methods of Analysis

    • Ion-selective electrodes (ISEs)
    • Use ion-exchange membranes bind to Cl–.
    • Common in clinical chemistry analyzers.

    Chloride - Clinical Significance

    • Chloride disorders often share similar causes as sodium disorders.

    Bicarbonate (HCO3) :

    • Second most abundant anion in ECF.
    • Major component in blood buffer systems
    • Critical to maintaining acid-base balance

    Regulation of Bicarbonate

    • Reabsorbed by proximal tubules in kidneys; and 15% reabsorbed by distal tubules
    • Bicarbonate combines with H+ → H2CO3
    • H2CO3 dissociates into water and CO2
    • CO2 diffuses back into extracellular fluid (ECF)
    • Excess HCO3 excreted in urine in alkalosis
    • HCO3 reabsorbed in acidosis

    Bicarbonate Specimen Collection

    • Serum and lithium heparin plasma. (arterial or whole blood samples)
    • Anaerobic techniques required - Exposure to air will decrease CO2 levels
    • Samples need to be analyzed within a timely manner

    TCO2 Methods of Analysis

    • ISE method (pCO2) (uses a combination pH electrode with gas-permeable membrane and pH-sensitive electrode):
    • Enzyme method to measure TCO2.

    Anion Gap

    • Represents concentration of unmeasured anions (proteins, phosphates, sulfates, organic acids).
    • Calculated by subtracting the sum of commonly measured anions from the sum of commonly measured cations.
    • Useful for identifying metabolic disorders
    • Useful for quality control in electrolyte measurements.

    Anion Gap Calculation

    • Measured cations – measured anions
    • (Na) + (K) - (Cl) - (HCO3)
    • Normal gap is 7–16mmol/L (or 10–20 mmol/L if K+ included, depending on testing protocol).

    Abnormal Anion Gap

    • Low anion gap (rare): multiple myeloma, instrument error
    • High anion gap (MUD PILES): methanol, uremia, diabetic ketoacidosis, paraldehyde, inhalants, ibuprofen, lactic acidosis, ethylene glycol acidosis, salicylates, starvation ketoacidosis

    Summary of Serum/Plasma Reference Ranges

    • Provides a quick overview of normal and critical values for serum/plasma electrolytes.

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