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Functions
Sodium: determines osmolality of plasma
Potassium – regulation of neuromuscular excitability, contraction of the heart, ICF volume, and H+
concentration.
Chloride maintaining osmolality, blood volume, and electric neutrality
Magnesium – cofactor, important in glycolysis; transcellular ion transport; neuromuscular transmission;
synthesis of carbohydrates, proteins, lipids, and nucleic acids; and the release of and response to certain
hormones, significant in cardiovascular, metabolic, and neuromuscular disorders
Specimen
Osmolality – serum or urine
Sodium – serum, plasma, and urine (24 hour), sweat
Potassium – serum, plasma, and urine (24 hour)
Chloride – serum or plasma, urine (24 hour), sweat
Bicarbonate - venous serum or plasma
Magnesium - Nonhemolyzed serum or lithium heparin plasma, 24 hour urine with HCl
Calcium - heparinized whole blood, serum or lithium heparin plasma without venous stasis, urine
acidified 5mol/L HCl (1mL per 100mL urine)
Phosphate - Serum or lithium heparin plasma, 24 hour urine
Lactate – heparin with Iodoacetate and fluoride
Anticoagulant of choice
Sodium - lithium heparin, ammonium heparin, and lithium oxalate
Potassium – heparin
Chloride – lithium heparin
Bicarbonate – lithium heparin
Magnesium - lithium heparin
Calcium – dry heparin
Hemolysis
Sodium – does not cause significant change
Potassium – false increase
Chloride – does not cause significant change
Magnesium – should be avoided
Phosphate - higher concentrations inside the red cells
Method
Sodium – ISE
Potassium – ISE – valinomycin membrane
Chloride – ISE*, amperometric-coulometric titration (Ag+)
Bicarbonate – ISE ( acid reagent to convert all the forms of CO2 to CO2 gas and is measured by a pco2
electrode and an enzymatic method (phosphoenolpyruvate carboxylase then MDH)
Magnesium – AAS*, colorimetric
Calcium – AAS*, ortho-cresolphthalein complexone (CPC) with 8-hydroxyquinoline or arsenazo III dye
Phosphate - ammonium phosphomolybdate – colorless, if reduced, molybdenum blue complex
Lactate – Enzymatic - lactate oxidase to produce pyruvate and H2O2, also Peroxidase
Source of error
Sodium – protein buildup – less sensitivity
Potassium – clotting – hyperkalemia
Bicarbonate - uncapped before analysis, CO2 escapes. Levels can decrease by 6 mmol/L/h
Calcium – liquid heparin can lower Ca
Phosphate - venous stasis will increase lactate levels
Principles
↓ K+, hypoxia
↓ K+, ↓ resting membrane potential, ↑ cell excitability (cell more negative), hyperpolarize cannot
contract then muscle weakness
↑K+, ↑ resting membrane potential, depolarize but then cannot repolarize thus cannot contract
↑HCO3- ↓Cl-
Catecholamine – uptake
Na goes, Cl follows
↓Cl- - respiratory acidosis (HCO3 out Cl in), diabetic ketoacidosis (low insulin, high ketones thus acidic),
aldosterone deficiency
Mg – parathyroid hormone
↓ Mg ↓ intracellular K
Hypokalemia, hypomagnesemic
Mg – vasodilator
Pesudohypermagnesemia – dehydration
↑ PO4, ↓ Ca
Mg and Ca
Hormones
AVP is secreted by the posterior pituitary gland
PTH – bone
Thyroxine and GH deficiency (increase reabsorption Mg) - ↑ Mg
Anion Gap
Questions