Extracellular

Chapter III: Major Intra- and Extracellular Electrolytes

The concentrations of electrolytes vary in the different fluid compartments:
a. Intracellular fluid
b. Interstitial fluid
c. plasma and vascular fluid

- separated from each other by membranes permeable to water and many organic and inorganic solutes.
- impermeable to macromolecules such as proteins
- selectively permeable to sodium, potassium and magnesium

SODIUM & CHLORIDE
- found in plasma and interstitial fluids(extracellular)
POTASSIUM, MAGNESIUM & PHOSPHATE
- found in intracellular fluid

Major Physiological Ions Principal Metabolic Functions Clinical Manifestation of
Deficiency
CHLORIDE Maintains normal hydration,
osmotic pressure,
gastric HCl,
acid-base balance,
electrolyte balance
Hypochloremic Alkalosis
(pernicious vomiting)
SODIUM
Buffer constituent acid-base balance,
water balance,
CO
2
transport,
osmotic pressure,
cell membrane permeability,
muscle irritability
Dehydration
acidosis
tissue atrophy
edema
hypertension
POTASSIUM
Buffer constituent acid-base balance,
water balance,
CO
2
transport,
neuromuscular irritability
Acidosis
Renal Damage
CALCIUM Formation of apatite in bones
and teeth
Blood clotting
Poor growth
Osteoporosis
Rickets
MAGNESIUM
Co-factor for PO4 transferring enzymes
constituent of bones and teeth
muscular tremor
chloreiform movement
PHOSPHOROUS
(as HPO
4
2-
)
Constituent of bones and teeth,
of buffers ATP, NAD and FAD

Renal rickets
Cardiac Arrhythmia
Osteomalacia












Electrolytes Used for Replacement Therapy

SODIUM CHLORIDE
- Table salt, Sea salt, Sal gemme
- colorless, cubic crystals/white crystalline powder having saline taste
- soluble in glycerin and slightly in alcohol
- occurs in solid states called rock salt, halite, fossil salts, and sal gemme
- prepared under the heat of the sun using salt pans (Mg
+2
& Ca
+2
present as impurities)
o impurities readily precipitated by adding sodium carbonate to the brine (NaCl solution), crystals are
collected by decantation or centrifugation
- must be purified for medical purposes (100%)

USES:
Isotonic Solutions for physiological fluids tonicity (0.9%w/v, NSS)
- dressings for irritating body cavities/tissues
- as injections when fluids and electrolytes are depleted
**build up of extensive extracellular fluid due to administration of isotonic sodium chloride may
lead to both pulmonary and peripheral edema

Hypotonic solutions for maintenance therapy when patients are unable to take fluids and
nutrients orally
- dextrose (glucose) is the caloric source

Hypertonic injections used when there is loss of sodium in an excess of water

Sodium Chloride injection fluid and electrolyte replenisher

Antidote to silver poisoning, condiment and preservative

POTASSIUM CHLORIDE (KCl)
- Kalium Chloratum, Kali Chloridum
- colorless, elongated prismatic/cubical crystals OR as white granular powder
- odorless, with saline taste
- neutral to litmus, solutions
- found in large deposits in the form of silvite and carnalite; sometimes in combination with NaCl
- drug of choice for ORAL REPLACEMENT OF K
+

- irritating to the gastrointestinal tract, must be enteric-coated

USES:
drug of choice for ORAL REPLACEMENT OF K
+

component of Ringers injection and Solution & Lactated Ringers Injection
o injection - fluid and electrolyte replenisher
- patients with severe hypopotassemia*
*defiency of K
+
, resulting to muscle weakness
o solution topical purposes
treatment of:
familial periodic paralysis
Menieres Syndrome
- inbalance, noise in the inner ear
antidote to Digitalis intoxification

CALCIUM CHLORIDE (CaCl
2
2H
2
O)
- Muriate of Lime
- white, odorless, slightly translucent granules with slightly saline taste
- colligative property less than zero freezing point
- very deliquescent, mixed with lactose to reduce deliquescence
- irritating to the veins
USES:
electrolyte replenisher
in internal hemorrhages
certain bone diseases
nervous disorders
deficiency of Calcium in the system
osteomalacia softening of the bones



BUFFER SYSTEMS IN THE BODY

1. Bicarbonate/Carbonic Acid (HCO
3
-
/H
2
CO
3
)
- found in plasma and kidneys
2. Monohydrogen/Dihydrogen phosphate (HPO
4
-2
/H
2
PO
4
-
)
- found in cells and kidneys
3. Hemoglobin and proteins
- found in red blood cells
- buffer for carbonic acid

Acidosis bodys acid levels increase, decrease alkali below normal
Alkalosis alkali levels increase, decreasing acid below normal
() ()


Compensatory Mechanisms of the Body
Condition/Causes Buffer System Respiratory Function Renal Function
Metabolic acidosis
- HCO
3
-
deficit
: diabetic acidosis, renal
failure, diarrhea
HCO
3
-
/H
2
CO
3
carbonic acid
CO2 + H2O
Hyperventilation
increased excretion of H2CO3
as CO2
Increased acid
excretion
by Na
+
-- H
+
exchange
increased NH3 formation
HCO3
-
reabsorption
Metabolic alkalosis
- HCO
3
-
excess
: administration of excess
alkali, vomiting
HCO
3
-
/H
2
CO
3

CO
2
retention,
increased H2CO3 concentration
Decreased
Respiratory Acidosis
- H
2
CO
3
excess
: cardiac disease, lung
damage, drowning
Hemoglobin and
protein
Increased CO
2

excretion
through the lungs
*Metabolic Acidosis
Respiratory Alkalosis
- H
2
CO
3
deficit
: fever, hysteria, anoxia,
salicylate poisoning
*Metabolic Alkalosis *Metabolic Alkalosis *Metabolic Alkalosis






Steps in Kidneys Acid Excretion
1. Glomerular filtration sodium salts of mineral and organic acids are removed from the plasma
2. Sodium-hydrogen exchange sodium is removed from the renal filtrate/tubular fluid and
tubule cells
Na
+
+ H
2
CO
3
----------------> Na
+
+ HCO
3
-
+ H
+
3. Sodium bicarbonate returns to the plasma and removed from the lungs as CO
2


3 Mechanisms Maintaining the Normal Acid-Base Balance of the Plasma:
1. Buffers of the body fluids and red blood cells
2. Pulmonary excretion of excess CO
2

3. Renal excretion of either acid or base, whichever is in excess

Metabolic acidosis is treated with Sodium:
Bicarbonate
Lactate
Acetate
Citrate
Metabolic alkalosis is treated with AMMONIUM SALTS, retards sodium-hydrogen exchange


SODIUM ACETATE (CH
3
COONa3H
2
O)
- Acetate of Soda
- colorless, transparent crystals/white granular powder/white flake
- faint acetous odor
USES:
buffer in metabolic acidosis of acute cholera
treatment for uremic acidosis (by infusion)
Systemic alkalizer
diuretic, diaphoretic, aperients

POTASSIUM ACETATE (CH
3
COOK)
- Diuretic Salt
- colorless monoclinic crystals/white crystalline powder
- has a saline/alkaline taste
- deliquesces on exposure to moist air, never prescribed in dry state
USES:
Diaphoretic and Diuretic (1-4 grams)
Cathartic (16-30 grams)
Alkalizer

SODIUM BICARBONATE (NaHCO
3
)
- Baking Soda
- white crystalline powder
- its alkanility in solutions increases as it stands
- CO
2
is liberated when treated with acids
effervescence (bubbling)






Ways of Sterilizing Sodium Bicarbonate
1. Bacteriological filtration
- use of filterthingy with very small pores impermeable to bacteria
2. Autoclaving
- ensures backward reaction, preserving the sodium bicarbonate
3. Heating the bicarbonate solution in an open vessel
USES:
Combat gastric hyperacidity and systemic acidosis(orally&parenterally)
o drug of choice for systemic acidosis
lessening of the acidity of the urine (orally)
inhibits the activity of other drugs when taken simultaneously with it
treatment of methyl alcohol poisoning
in the manufacture of effervescent salts, baking powder, fire extinguisher, carbonated drinks and cleaning
mixtures

POTASSIUM BICARBONATE (KHCO
3
)
- Salaeratus
- transparent monoclinic prisms/white granular powder, odorless
- solutions: neutral or alkaline to litmus
- presence of carbonate indicated by deliquescence

USES:
electrolyte replenisher
component of Potassium Triplex (Acetate, Citrate, Bicarbonate)
oral effervescent potassium replacement solution
antacid

SODIUM CITRATE (C
6
H
5
Na
3
O
7
)
- colorless crystals/white crystalline powder
USES:
anticoagulant
o chelates serum calcium, removing one of the components of blood clotting
o fibrin - clot
chelation/sequestering of other cations
in chronic acidosis to restore bicarbonate reserve
diuretic effect due to increased body salt concentration

POTASSIUM CITRATE (C
6
H
5
K
3
O
7
H
2
O)
- white granular powder, odorless, cooling saline taste
- deliquescent
USES:
systemic alkalizer
diuretic
diaphoretic
expectorant
laxative
gastric antacid




Electrolyte Combination Therapy
1. Fluid Maintenance
- intended to supply normal requirements for water and electrolytes for patients who cannot take
them orally
- should contain atleast 5% dextrose
- minimizes build-up of metabolites associated with starvation (urea, phosphate and ketone bodies)
- intravenously
- composed generally of Na
+
, Cl
-
, HCO
3
-
, Mg
+2
, HPO
4
-2
& Glucose

2. Electrolyte Replacement
- loss is severe