CHLORIDE

CHLORIDE
• major extracellular anion
• involved in maintaining osmolality, blood volume, and electric neutrality
• almost completely absorbed by the intestinal tract, then filtered out by
the glomerulus and passively reabsorbed by the proximal tubules
• Excess Cl¯ is excreted in the urine and sweat
• maintains electrical neutrality in two ways:
1. Cl¯ acts as the rate-limiting component, in that Na+ reabsorption is limited by the
amount of Cl¯ available
2. Through the “Chloride Shift”
CHLORIDE
SHIFT
CLINICAL APPLICATIONS
1. Hyperchloremia
Occur when there is an excess loss of HCO3¯ as a result of GI losses,
RTA, or metabolic acidosis
2. Hypochloremia
Occur with excessive loss of Cl¯ from prolonged vomiting, diabetic
ketoacidosis, aldosterone deficiency, or salt-losing renal diseases such as
pyelonephritis

NORMAL ADULT VALUE: 97-107 mEq/L

 DETERMINATION OF
CHLORIDE
• SPECIMENS:
a. Serum or plasma (98–107 mmol/L)
b. Whole blood samples
c. Urine (24-hour collection) (110–250 mmol/d)
d. Sweat
• METHODS:
1. ISE (Ion-Selective Electrode) = an ion-exchange membrane is used to selectively bind Cl¯
ions
2. Amperometric-coulometric titration = generates silver ions (Ag+), which combine with
Cl¯ to quantitate the Cl¯ concentration
BICARBONAT
E
BICARBONATE
• Second most abundant anion in the ECF
• Total CO2 measurement is indicative of HCO3¯ measurement
• Total CO2 comprises the bicarbonate ion (HCO3¯), H2CO3, and dissolved CO2
• Major component of the buffering system in the blood

 This process converts potentially toxic CO2 in the plasma to an effective buffer:
HCO3¯.
 HCO3¯ buffers excess H+ by combining with acid, then eventually dissociating into
H2O and CO2 in the lungs where the acidic gas CO2 is eliminated.
REGULATION
• Most of the HCO3¯ in the kidneys (85%) is
reabsorbed by the proximal tubules, with 15% being
reabsorbed by the distal tubules
• The tubular reabsorption process transports substances
out of the tubular fluid and back into the blood of the
peritubular capillary
• Usually reabsorbed as CO2
• H+ + HCO3− → H2CO3 → CO2 + H2O
• All excess HCO3¯ flows into the urine
• Alkalosis: relative increase in HCO3¯ results to
kidneys increase excretion of HCO3¯ into the urine
• Acidosis: increased excretion of H+ into the urine
and HCO3¯ reabsorption
DETERMINATION OF CO2
• SPECIMEN:
• Serum or lithium heparin plasma
• METHODS:
1. ISE = One type of ISE for measuring total CO2 uses an acid reagent
to convert all the forms of CO2 to CO2 gas and is measured by a
pco2 electrode
2. Enzymatic method = alkalinizes the sample to convert all forms of
CO2 to HCO3¯