Pharmacology Quiz on Electrolytes and pH Balance

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Questions and Answers

What is the pH range of Calcium Chloride injection?

6.5 - 8.0

4.5 - 6.0

5.0 - 7.5 (correct)

3.5 - 5.5

Which statement about Sodium Chloride and Dextrose injection is NOT true?

It contains not less than 95% of the stated amount.

It contains antimicrobial agents. (correct)

It is a clear colorless or faintly straw colored solution.

It has a pH range of 3.5 - 6.5.

What is the minimum percentage of calcium chloride required in Calcium Lactate?

97% (correct)

95%

99%

93%

In which condition is Potassium Chloride NOT typically used?

Acute dehydration Signup and view all the answers

What describes acedemia?

Abnormal decrease in blood pH Signup and view all the answers

Which of the following compounds is less soluble in water than sodium chloride?

Potassium chloride Signup and view all the answers

What is the molecular weight of Potassium Chloride?

74.56 Signup and view all the answers

What is NOT a typical use of Calcium Lactate?

Potassium deficiency treatment Signup and view all the answers

What is the primary characteristic of metabolic alkalosis?

Inability to excrete alkali due to renal damage Signup and view all the answers

What results from respiratory alkalosis?

Decrease in arterial pCO2 Signup and view all the answers

Which drug interaction is caused by mixing with sodium bicarbonate?

Formation of insoluble precipitates Signup and view all the answers

Which of the following is NOT a use of sodium bicarbonate?

As a laxative Signup and view all the answers

Which factor does NOT contribute to respiratory alkalosis?

Excessive vomiting Signup and view all the answers

Which solution is recommended for treating acute poisoning from acidic drugs?

Sodium bicarbonate Signup and view all the answers

In which condition is contraction alkalosis seen?

Excessive Cl– and sodium loss due to diuretics Signup and view all the answers

What happens to the solubility of sodium bicarbonate upon standing or heating?

Increases Signup and view all the answers

What role does the bicarbonate-carbonic acid buffer system play in extracellular fluid?

It helps maintain the extracellular pH within a narrow range. Signup and view all the answers

Why is the hemoglobin buffer system considered the most effective?

It removes more protons for each millimole of oxygen dissociated. Signup and view all the answers

What process occurs during the chloride shift?

An exchange of bicarbonate for chloride ions. Signup and view all the answers

What is the normal HCO3-/H2CO3 ratio corresponding to a pH of 7.4?

27/1.35 meq/lt Signup and view all the answers

What happens to carbon dioxide when it enters the erythrocytes?

It reacts with water to form carbonic acid. Signup and view all the answers

What physiological mechanism helps control the bicarbonate-carbonic acid ratio?

Breathing regulation influences the levels of carbon dioxide and bicarbonate. Signup and view all the answers

Why is a continuous supply of carbon dioxide essential for the buffering system?

It provides a sufficient concentration to maintain buffering. Signup and view all the answers

What triggers the dissociation of carbonic acid in the lungs?

An abundance of oxygen combining with deoxyhemoglobin. Signup and view all the answers

What is the primary objective of replacement therapy?

To restore the volume and composition of body fluids to normal Signup and view all the answers

In a severe volume depletion scenario, what is the recommended intravenous therapy rate for the first 1000 ml?

100 ml per minute Signup and view all the answers

What is the common use of isotonic sodium chloride solutions?

Irrigating body cavities or tissues Signup and view all the answers

What is the acceptable w/v percentage range for Sodium Chloride Injection?

0.85% to 0.95% Signup and view all the answers

What distinguishes hypertonic sodium chloride injection from isotonic sodium chloride injection?

Higher sodium concentration Signup and view all the answers

In which situation are hypotonic solutions typically administered?

During maintenance therapy when oral intake is not possible Signup and view all the answers

What is the pH range for Sodium Chloride Hypertonic Injection?

5.0 to 7.5 Signup and view all the answers

What is typically included in Compound Sodium Chloride Injection apart from sodium chloride?

Potassium chloride Signup and view all the answers

What is the typical HPO4-2/H2PO4- ratio at physiological pH of 7.4?

4:1 Signup and view all the answers

Which process involves the preferential removal of sodium in the kidneys?

Sodium hydrogen exchange Signup and view all the answers

What characterizes metabolic acidosis?

Excess production of protons Signup and view all the answers

Which treatment is used for metabolic acidosis due to bicarbonate deficit?

Administration of sodium salts of bicarbonate Signup and view all the answers

Respiratory acidosis is primarily caused by which of the following?

Retention of carbon dioxide Signup and view all the answers

Which condition is NOT a cause of renal acidosis?

Increased dietary bicarbonate Signup and view all the answers

What may cause metabolic acidosis due to excessive loss of alkaline fluid?

Diarrhea Signup and view all the answers

What ions are typically used to treat metabolic acidosis?

Lactate and acetate Signup and view all the answers

What is the primary use of potassium acetate?

As a buffer in metabolic acidosis Signup and view all the answers

What physical form does sodium citrate typically occur in?

Granular crystals Signup and view all the answers

In which circumstance is sodium citrate particularly utilized?

Anticoagulation of blood Signup and view all the answers

What is the solubility characteristic of potassium citrate in alcohol?

Practically insoluble Signup and view all the answers

What kind of effect does ammonium chloride have on the body?

Diuretic effect Signup and view all the answers

What is the pH range of a 5% potassium acetate solution in water?

7.5 to 9.2 Signup and view all the answers

How should potassium acetate be stored?

In airtight containers Signup and view all the answers

What is sodium citrate's solubility characteristic in ethanol?

Practically insoluble Signup and view all the answers

Study Notes

Replacement Therapy

The main goal of replacement therapy is to restore the volume and composition of bodily fluids to normal levels.
Volume contraction is life-threatening because it hinders circulation, decreases blood volume, lowers cardiac output, and compromises microcirculation.
In cases of severe volume depletion, a rapid infusion of isotonic sodium chloride solution is necessary.
In critical situations, intravenous therapy at 100ml per minute for the first 1000ml is considered crucial for treating cholera.
A common guideline is to replace half of the estimated volume loss during the first 12-24 hours of treatment.

Sodium Replacement

Sodium Chloride (NaCl) has a molecular weight (MW) of 58.44.
It exists as colorless cubic crystals or white crystalline powder, with a saline taste.
It's highly soluble in water and, to a lesser degree, in boiling water, glycerin, and alcohol.

Sodium Chloride Uses

Used as a fluid and electrolyte replenisher.
Utilized in preparing isotonic solutions.
Provides flavor enhancement.
Used in wet dressings.
Used for irrigating cavities and tissues..

Sodium Chloride Injection

A sterile isotonic sodium chloride solution in water for injection.
Contains a minimum of 0.85% and a maximum of 0.95% w/v sodium chloride.
Does not contain any antimicrobial agents.
The pH of the solution ranges between 4.5 and 7.0.

Sodium Chloride Hypertonic Injection

A sterile sodium chloride solution for injection.
Contains a minimum of 1.52% and a maximum of 1.68% w/v sodium chloride.
Free of antimicrobial agents.
Has a pH between 5 and 7.5.
Meets pyrogen testing requirements.

Compound Sodium Chloride Injection (Ringer Injection)

Contains:
- Minimum 0.82%, maximum 0.9% w/v sodium chloride.
- Minimum 0.0285%, maximum 0.0315% w/v potassium chloride.
- Minimum 0.03%, maximum 0.036% w/v calcium chloride in water for injection.
Free of antimicrobial agents.
pH between 5 and 7.5.

Sodium Chloride and Dextrose Injection

A sterile solution of sodium chloride and dextrose in water for injection.
It appears clear, colorless, or faintly straw-colored.
The pH ranges between 3.5 and 6.5.
Contains a specified percentage (95% to 105%) of sodium chloride and dextrose.

Potassium Replacement (Potassium Chloride)

Potassium Chloride (KCl) has a molecular weight (MW) of 74.56.
Contains a minimum of 99% of dried substance.
Exists as a white crystalline solid, cubic crystals.
Less soluble in water than sodium chloride, slightly more soluble in boiling water; soluble in glycerin, and insoluble in alcohol.

Potassium Chloride Injection (Ringer Injection) Uses

Replenishes electrolytes in potassium deficiency.
Treats familial periodic paralysis, Meniere's syndrome, and digitalis intoxication.
Treats myasthenia gravis.
Contraindicated in renal impairment and acute dehydration.

Calcium Replacement (Calcium Lactate)

Calcium lactate has a molecular weight (MW) of 308.30.
Potassium chloride must be between 97% and 103% of Calcium Chloride dihydrate.
Occurs as a white odourless powder.
Soluble in water, virtually insoluble in alcohol.
Used for oral calcium deficiency treatment.

Physiological Acid-Base Balance

Variations in blood pH are significant clinically.
Acidaemia and alkalaemia denote abnormal decreases or increases in blood pH, respectively.
Acidosis and alkalosis are clinical conditions that can result in acidaemia or alkalaemia.
The degree of pH change often depends on compensation mechanisms, which vary between conditions. A common technique to assess is through bicarbonate-carbonic acid (HCO3- - H2CO3) system.

Extracellular Fluid Buffer System

Bicarbonate is the most abundant buffer component in extracellular fluid.
Carbon dioxide supply is unlimited.
Physiological processes maintain extracellular pH by controlling fluid.
The bicarbonate-carbonic acid buffer system coexists with hemoglobin.

Acid Production and Buffering

Metabolisms produce acids continuously.
Most metabolic processes occur in a narrow pH range (7.38-7.42).
The body uses buffer systems (Bicarbonate/carbonic acid and monohydrogen phosphate/dihydrogen phosphate) in plasma, kidneys, and cells.
Red blood cells (RBCs) use hemoglobin's buffering system to neutralize carbonic acid.

Carbon Dioxide Buffering in Blood

Carbon dioxide (CO2) produces carbonic acid in the cells which diffuses into the blood and reacts with water.
Increased carbonic acid is buffered by plasma proteins in blood.
CO2 enters RBCs where it reacts with water to form carbonic acid (H2CO3)via carbonic anhydrase; or it combines with hemoglobin (Hb).
To prevent a drop in blood pH, the bicarbonate anion leaves, and chloride enters red blood cell, a "chloride shift".
In the air, the reverse process happens, and CO2 is released in the lungs.

Phosphate Buffer System

The phosphate buffer system is an important component in regulating physiological pH.
Buffer effectiveness peaks at pH 7.4.
It involves the HPO4-2/H2PO4- ratio; with a 4:1 ratio being ideal for pH 7.4
In the kidneys, the pH of urine can vary between 4.5-4.8, corresponding to a HPO4-2/H2PO4- ratio between 1:99 and 1:100

Acid Excretion by Kidneys

Acids (mineral or organic) are excreted from the kidneys by removing their sodium salts during glomerular filtration.
Sodium is removed from the renal filtrate or tubular fluid in the tubular cells via sodium hydrogen exchange.
Bicarbonate is returned to plasma and removed by the lungs as CO2.
Protons enter the fluid, forming acids from original sodium salts.

Acidosis

A rise in either potential and/or non-volatile hydrogen ion (H+) content in the body is called acidosis.
Increased H+ concentration in plasma is known as acidaemia, visible as a decrease in blood pH.
If the concentration of H+ stays constant despite acidosis, it's called a compensated acidosis.

Metabolic Acidosis Types and Causes

Elevated proton production, such as an overactive metabolism (e.g., in fever)
Intake of substances that produce protons (e.g., salicylates and chlorides)
Excessive alkali loss from the intestines (e.g., diarrhea)
Introduction of high quantities of saline.

Metabolic Acidosis Treatment

It's treated by providing sodium salts of bicarbonate, lactate, acetate, or citrate.
Sodium bicarbonate administration helps balance the HCO3-/H2CO3 ratio.
Lactate, acetate, and citrate are normal metabolic components; the TCA cycle degrades them into carbon dioxide and water.

Renal Acidosis

Due to inadequate renal H+ excretion.
Seen in conditions like tubular disorders, Addison's disease.
This can occur due to drugs interfering with H+ tubular secretion, like carbonic anhydrase inhibitors

Respiratory Acidosis

Develops from a buildup of carbon dioxide (CO2). This results in a buildup of carbonic acid.
Occurring in chronic lung disease, respiratory muscle paralysis, and respiratory depressant drugs.

Alkalosis

It represents a decrease in the body's total hydrogen ion (H+) content.
Decrease in hydrogen ion plasma is known as alkalemia.
This leads to an increase in blood pH.
If no associated plasma H+ decrease, the state is compensated.

Metabolic Alkalosis

Caused by renal inability to effectively excrete alkali.
Can occur due to excessive vomiting, leading to loss of H+ and Cl-.
Treated with ammonium salts which acts in the kidneys slowing down the Na+/H+ exchange.
Can occur due to excessive use of mercurial diuretics.

Respiratory Alkalosis

Caused by hyperventilation, leading to a reduced amount of CO2 and thus carbonic acid in the blood.
Characterized by a fall in arterial pCO2 and a reduction in the bicarbonate-to-carbonic acid ratio.
Can result from high altitudes, fever, encephalitis, hypothalamic tumors, or salicylate intake, or a heated environment.

Electrolytes in Acid-Base Balance

Sodium Bicarbonate
- Contains at least 99% sodium bicarbonate.
- Occurs as a white, crystalline powder or granules.
- Soluble in water (1:12).
- Partially soluble in alcohol.
- Stored in air-tight containers (alkalinity increased by standing/heating). -Used in metabolic acidosis treatment, diarrhea, and poisoning from acidic drugs.
Sodium Bicarbonate with Other Compounds
- Reacts with calcium or magnesium salts, cisplatin, dobutamine, and oxytetracycline to form insoluble precipitates.
- Some drugs (adrenaline hydrochloride, benzyl penicillin potassium, carmustine, glycopyrronium bromide, isoprenaline hydrochloride, and suxamethonium chloride) lose their efficacy when mixed with sodium bicarbonate.
- Used in medical applications (eye drops for crust removal in blepharitis, ear drops for softening ear wax, and as a lubricant for contact lenses).
Sodium acetate/ Potassium acetate/ Sodium citrate/ Potassium citrate characteristics. Uses and notes
Ammonium Chloride
- A sterile ammonium chloride solution in water for injection.
- Contains between 99.5% and 105% by weight of the dried substance.
- Hydrochloric acid (HCl) may be added to adjust the pH.
- Pharmacologically active as an acid-base equilibrium factor in the body.
- It has diuretic and expectorant properties.
- Contraindicated for patients with impaired renal or hepatic function.
- Used in acid-base therapy, as a diuretic, and to correct hypochloremic alkalosis.

Electrolyte Combination Therapy

Glucose and saline solutions are sufficient for short-term electrolyte restoration.
For significant electrolyte loss (severe blood loss or chronic diarrhea), additional electrolytes are needed.
Electrolyte combination therapy can fall into categories like fluid maintenance therapy and electrolyte replenishment therapy.
The electrolyte concentrations in the solutions used for quick replacement are similar to extracellular fluids. Maintenance solutions commonly include Sodium, Potassium, Chloride, Bicarbonate, Magnesium, and Phosphorus in specific concentration ranges. The notes state concentrations in mEq/l.

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Description

Test your knowledge on the pH ranges and uses of various electrolyte injections like Calcium Chloride, Sodium Chloride, and Potassium Chloride. This quiz covers metabolic and respiratory alkalosis, and the solubility of different compounds. Assess your understanding of drug interactions and conditions related to electrolyte imbalances.