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Major Intra- and Extracellular Electrolytes

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marion dimayuga

on 15 February 2014

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Transcript of Major Intra- and Extracellular Electrolytes

Major Intra- and Extracellular Electrolytes
BODY FLUIDS - solutions of inorganic and organic solutes
REGULATORY MECHANISMS - maintain internal homeostasis and control pH, ionic balances, osmotic balances, etc.
concentration of electrolytes vary in the different fluid compartments which include:
(a) intracellular fluid
(b) interstitial fluid
(c) plasma and vascular fluid
these compartments are separated from each other by membranes that are permeable to water and many organic and inorganic solutes
nearly impermeable to macromolecules
solution in each compartment is ionically balanced
MAJOR PHYSIOLOGICAL IONS
CHLORIDE
- maintains normal hydration and osmotic pressure, gastric HCl, acid and base balance, electrolyte balance
- Hypochloremic Alkalosis

SODIUM
- buffer constituent, acid-base balance, CO2 transport, osmotic pressure, cell membrane permeability, muscle irritability
- dehydration, acidosis, tissue atrophy
- edema and hypertension
POTASSIUM
- buffer constituent acid-base balance, water balance, CO2 transport, neuromuscular irritability
- acidosis, renal damage
CALCIUM
- formation of apatite in bones and teeth, blood clotting
- rickets, poor growth, osteoporosis
MAGNESIUM
- co-factor for PO4 transferring enzymes, constituent of bones and teeth
- muscular tremor, choreiform movement
PHOSPHOROUS
- constituent of bones and teeth, constituent of buffers ATP, NAD, and FAD
- renal rickets, cardiac arrhythmia, osteomalacia
SODIUM CHLORIDE USP 31
- NaCl
- molecular weight: 58. 44
- table salt, sea salt
OCCURENCE: - in solid state or in solution - often found forming extensive beds - extracted in blocks or masses by mining operations - found in the sea, some lakes, springs and wells
PREPARATION: - obtained from sea water by concentrating in salt pans - must be purified before using for medical purposes which requires NaCl > 99.5% - readily precipitated by adding Na2CO3 to the brine, evaporating, saturating cooled solution with HCl when pure NaCl precipitates - collected by decantation or centrifugation and dried
PROPERTIES: - colorless, cubic crystals - white, crystalline powder - soluble in water and slightly more so in boiling water - soluble in glycerin and slightly soluble in alcohol
USES:
ISOTONIC SOLUTIONS (0.9% w/v) - wet dressings for irritating body cavities or tissues - injections when fluids and electrolytes have been depleted
HYPOTONIC SOLUTIONS - for maintenance therapy - hypertonic injections - when there is loss of sodium in an excess of water
SODIUM CHLORIDE INJECTION USP 26 (0.9% NaCl) AND TABLETS - fluid and electrolyte replenisher - prevent development of cramps - large amounts produce emesis, catharsis and diuresis - antidote to silver poisonings, condiment and preservative
EXAMPLES
injections, electrolyte replenisher, wet dressings, inhalation solutions, preservatives
POTASSIUM CHLORIDE USP 31
- KCl
- molecular weight: 74.56
- Kalium Chloratum, Kali Chloridum
OCCURENCE: - in large deposits in the form of sylvite - in combination with NaCl - in the form of carnallite MgCl2.KCl.6H2O
PROPERTIES: - colorless, elongated, prismatic or cubical crystals or as white granulated powder - freely soluble in water and even more so in boiling water - solutions are neutral to litmus - insoluble in alcohol - irritating to gastrointestinal tract - must be well diluted - tablet must be enteric-coated - produced intestinal ulceration
USES: - component of Ringer's Injection and Solution and Lactated Ringer's Injection - Potassium Chloride Injection - treatment of familial periodic paralysis, Meniere's Syndrome, and antidote to digitalis intoxication - given when adrenal steroids ACTH or Chlorothiazide is administered
EXAMPLES
fertilizer, Ringer's solution, tablet
CALCIUM CHLORIDE USP 31
- CaCl2
- molecular weight: 147
- Cloruro de Calico, Muriate of Lime, Fosforo de Homberg
2
O
1
Properties:
- salt composed of white, slightly translucent, hard fragments or granules
- odorless with a sharp bitter saline taste
- very deliquescent
- insoluble in ether, chloroform, and fixed and volatile oils
- soluble in water

Uses:
- electrolyte replenisher as Ringer’s Injection and Lactated Ringer’s Injection
- used in internal hemorrhages, certain bone diseases, and nervous disorders
- replenishes calcium in the system
- desiccant - de-icing and freezing point depressant
EXAMPLES
Ice melting products, Calcium chloride injection
Physiological Acid-Base Balance

Buffer Systems in the Body:
1. Bicarbonate/Carbonic Acid
2. Monohydrogen phosphate/Dihydrogen phosphate
3. Hemoglobin and proteins
Acidosis – pH below 7.38
Alkalosis – pH above 7.42
Compensatory Mechanisms of the Body

Bicarbonate/Carbonic Acid buffer system:
- Metabolic Acidosis
- Metabolic Alkalosis
- Respiratory Alkalosis
Hemoglobin and proteins buffer system:
- Respiratory Acidosis

Three mechanisms of acid-base balance:
a. Buffers
b. Pulmonary excretion of CO2
c. Renal excretion of acid or base
SODIUM ACETATE USP 31
- CH3COONa.3H2O
- molecular weight: 136
- Acetate of Soda, Acetado de Sosa
- occurs as colorless, transparent crystals
-as a white granular crystalline powder or white flake
-odorless or has a faint acetous odor
-efflorescent in warm dry air
- very soluble on water and alcohol
1
1
O
Electrolytes in Acid-Base Therapy
Metabolic Acidosis- treated with the sodium salts of bicarbonate, lactate, acetate, and citrate
Metabolic Alkalosis- treated with ammonium salts
USES:
- metabolized to carbon dioxide then to bicarbonate (used as an effective buffer in metabollic acidosis of acute cholera)
- uremic acidosis (acidic urine) has been corrected by infusion of sodium acetate
-as diuretic, diaphoretic, aperient and system alkalizer
EXAMPLES
buffering agent in cosmetics, food additive, heating pads, cold packs
POTASSIUM ACETATE USP 31
- CH3COOK
- molecular weight: 98.15
- diuretic salt
-colorless monoclinic crystals or as a white crystalline powder
-saline and alkaline taste
-deliquesces on exposure to moist air
-very soluble in water and alcohol
1
1
1
USES:
- given at 1-4 g, it is used as diaphoretuc and diuretic
-given at 16-30 g, it is used as a cathartic
-never prescribed in dry state but always in solution
-categorized as an alkalizer
-found in Potassium Triplex
SODIUM BICARBONATE USP 31
- NaHCO3
- molecular weight: 64.01
- Baking Soda, Soda Saleratus, Sal de Vichy, Soda Acid Carbonate, Sodium Hydrogen Carbonate, Bicarbonate of Soda
- white crystalline powder
-stable in dry air, but slowly decompose in moist air
-its solutions, when freshly prepared with cold water without shaking, are alkaline to litmus
-alkalinity increases as the solutions stand, are agitated or are heated
-soluble in water and insoluble in alcohol
1
O
O
When heated, the salt loses water and carbon dioxide and is converted to normal carbonate. Since the sodium carbonate which remains is much more alkaline than the carbonate solution and consequently is dangerous to use parenterally.

WAYS OF STERILIZING SODIUM BICARBONATE
1. Bacteriological filtration
2. Autoclaving
3. Heating the bicarbonate solution in an open vessel and then resaturating the cooled solution with sterile carbon dioxide

USES
-serve as guide to consideration of other bicarbonates
Sodium Bicarbonate may be considered from the standpoint of two relationships:
A. ITS RELATIONSHIP TO THE BODY ECONOMY AS A BUFFER COMPONENT
- most important plasma buffer
B. THERAPEUTIC AND MISCELLANEOUS USES
-used in medicine
-for its acid-neutralizing properties
-combat gastric hyperactivity
-combat systemic acidosis
-oral administration can lessen the acidity of the urine or may even produce alkalinization
-used in the treatment of certain types of urinary tract infections
-treatment of methyl alcohol poisoning
-manufacture of effervescent salts, baking powders, fire extinguishers, carbonated drinks and cleaning products
EXAMPLES
injections, antacids, baking soda, toothpaste
POTASSIUM BICARBONATE USP 31
- KHCO3
- molecular weight: 100.12
- Potassium Acid Carbonate, Salaeratus

PROPERTIES:
- Colorless, Transparent, Monoclinic prisms
- Or white granular powder
- Odorless
- Stable in air
- Solutions are neutral or alkaline to litmus.
- Freely soluble in water and insoluble in alcohol.

USES:
- Electrolyte replenisher
- Component of K-Lyte
- Antacid
EXAMPLES
SODIUM CITRATE USP 31
- C6H5Na3O7
- molecular weight: 258.07
- citric acid trisodium salt dihydrate, trisodium citrate dihydrate
PROPERTIES:
- Colorless crystals, or white, crystalline powder.
- May be anhydrous or contains two moles of water of hydration
- Freely soluble in water, very soluble in boiling water, and soluble in alcohol

USES:
- Anticoagulant for whole blood
- Buffering agents
- Used in chronic acidosis to restore bicarbonate reserve
- Has diuretic effect
EXAMPLES
soda, in food, vacutainer for coagulation
POTASSIUM CITRATE
- C6H5K3O7.H2O
- molecular weight: 342
- citric acid tripotassium salt, tripotassium citrate
PROPERTIES:
-Transparent crystals, or white granular powder
-Odorless
-Has a cooling saline taste
-Deliquescent when exposed to moist air.
-Freely soluble in water and almost insoluble in alcohol

USES:
-Systemic alkalizer
-Diuretic antacid
-Diaphoretic antacid
-Expectorant antacid
-Laxative anatacid
-Gastric antacid
Electrolyte Combination Therapy
- following surgery, it is the infusion of standard glucose and saline solution.
-when deficits are severe, solutions containing additional electrolytes are required

These combination products can be divided into two groups:
1. Fluid Maintenance
2. Electrolyte Replacement

*Maintenance therapy with intravenous fluids is intended to supply normal requirements for water and electrolytes to patients who cannot take them orally
Official Combination Electrolyte Infusions
Ringer's Injection USP XX
Lactated Ringer's Injection USP XX
Oral electrolyte solutions are used to supply water and electrolytes in amounts needed for maintenance as soon as intake of usual foods and liquids is discontinued and before serious fluid looses or deficits occur
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