Electrolytes
Electrolytes
INTRACELLULAR
ELECTROLYTES.
ELECTROLYTES
Substance when dissolved in solution separates into ions & is able to carry an
electrical current
Cation - positively charged electrolyte e.g. Ca++
Anion - negatively charged electrolyte e.g. Cl
No of Cations must equal to no of Anions for homeostasis to exist in each
fluid compartment
ELECTROLYTES IN BODY FLUID COMPARTMENTS:
Intracellular: K, Mg, P
Extracellular: Na, Cl, HCO3
The term ‘extracellular fluid’ includes both interstitial and vascular fluids.
These three compartments are separated from each other by membranes that are
permeable to water and many organic and inorganic solutes.
They are nearly impermeable to macromolecules such as proteins and are selectively
permeable to certain ions such as Na +, K+, Mg2+
Functions of Electrolytes:
To facilitate specific metabolic functions by supplying the specific ion to the body fluids
associated with the concerning cell or organ.
Our heart, muscles and nerve cells use electrolytes to maintain voltage across their cell
membranes and to carry electrical impulses to other cells.
A muscle contraction needs calcium (Ca++), sodium (Na+), and potassium (K+) to be
present.
Deficiency and excess of electrolyte level lead to either weak muscles, or muscles that contract
too severely
Electrolytic Imbalance and its
causes:
Body have capacity to adjust slight variation in concentration of electrolytes in fluid
compartments. Mainly electrolytic level is kept constant by our kidneys and other hormones.
Whenever there is a change in concentration of ions in any compartment, water will migrate
across the cell membrane to re-establish osmotic equilibrium. If body is unable to adjust the
concentration of fluid electrolytes then externally “electrolytic replacement therapy” is used.
Body electrolytic levels tend to alter when water levels in the body changes- when our level
of hydration goes up or down
Several other causes include:
Kidney disease
Vomiting or prolong periods
Poor diet
severe dehydration
Diarrhoea
Congestive heart failure
Edema (fluid get accumulated in intestinal space between cell due to low osmotic pressure)
Acid-Base imbalance
Symptoms of electrolytic
Imbalance:
The symptoms will depend on which electrolyte is out of balance, and whether that level is
too high or too low.
An altered level of magnesium, sodium, potassium, or calcium may produce one or more
of the following symptoms:
Major Food Source: Milk and milk products, eggs, green vegetables and some fishes
Major Food Source: Milk and milk products, oatmeal, whole grains, legumes, nuts, egg yolk,
meat especially in liver and kidney.
Absorption From GIT and Fate in Body (Metabolism): Easily absorbed by intestine, excretion
is mainly through urine via kidney (unlike calcium) only small amount are excreted in faces.
Major Food Source: Green vegetables, legumes, whole grain, nuts, beans, meat, milk.
Absorption From GIT and Fate in Body (Metabolism): Not readily absorbed from GIT,
absorption retarded by alkaline media, unabsorbed Mg2+ is excreted through urine, bile and
intestinal secretion.
Major Food Source: Milk and milk products, oatmeal, whole grains, legumes, nuts, egg yolk,
meat especially in liver and kidney.
Absorption From GIT and Fate in Body (Metabolism): Easily absorbed by intestine,
excretion is mainly through urine via kidney (unlike calcium) only small amount are excreted
in faces.
Excessive Presence:
Hyperphosphatemia may be associated with hypervitaminsois D, renal failure,
hypoparathyroidism, it may lead to formation of kidney stone with possible kidney damage.
ELECTROLYTE REPLACEMENT THERAPY
It is also called as electrolyte replenisher. Due to serious symptoms of the loss of
electrolytes, it is essential to maintain the normal level by external supply of
electrolytes, this therapy is called as electrolyte replacement therapy.
There are two types of electrolyte solutions are used in replacement therapy-
I) Electrolyte solution for rapid initial replacement- solutions contains
electrolyte with concentration resemble with the electrolyte concentration found in
extracellular fluids.
II) Electrolyte solution for subsequent replacement- lower concentration of
electrolyte in solution.
1. Sodium replacement-
The depletion of sodium cause various forms of hyponatremias. A patient who
suffers severe symptoms cause by hyponatremia should receive either 3% or 0.9%
sodium chloride solution, until severe symptoms resolve
The main objective of replacement to raise the serum sodium concentration to 120
mEq/L. there are various sodium chloride preparations are available.
1. Sodium chloride:
Chemical properties:
Identifications: It gives reactions characteristics of sodium and chloride.
Test of purity: It has tested for acidity and alkalinity, Ba, Ca and Mg, Fe and heavy
metals, bromide, iodide, sulphate and loss on drying.
Assay: The 0.1 g of substance is dissolved in 50ml of water in a glass stoppered
flask. To it, 50ml of 0.1 N silver nitrate solution, 3ml of nitric acid, 5ml of
nitrobenzene & 2ml of ferric ammonium sulphate solution are added. Now the
solution is shaken well and is then titrated with 0.1 N ammonium thiocyanate
solution until the water becomes reddish- yellow.
Each ml of 0.1 N AgNO3 = 0.005844 g of NaCl.
Storage: It is stored in tightly closed container in dry place as it absorb moisture.
Uses: 1. it can be used as electrolyte replenisher, as it is isotonic solution.
2. In combination with other electrolyte & dextrose, it is used as dialysis solution in
renal failure.
3. It is used as a saline diuretic in the form of enteric coated tablet.
Sodium chloride preparations:
1. sodium chloride injection I.P ( normal saline)
It contains 0.9% sodium chloride without any antimicrobial agent (PH 4.5- 7.0)
2. Sodium chloride hypertonic injection I.P-
It contains 1.6% w/v sodium chloride (PH 5- 7.5)
3. Compound sodium chloride injection ( ringer solution)
It contain following ingredients:
Sodium chloride- 0.869 g
Potassium chloride- 0.030 g
Calcium chloride- 0.048 g
Water for injection q. s.
100ml
4. Bacteriostatic sodium
chloride injection USP.
It is sterile solution of sodium
chloride (0.9% w/v) in water
for injection containing
suitable
antimicrobial agent. It is used
6. sodium chloride tablet I.P
It contain 95.0 to 105 % w/v of sodium chloride and is available in strength of 180,
300 & 500 mg of sodium chloride. It is used as an electrolyte replenisher.
7. Sodium chloride and mannitol injection.
Standard: potassium chloride contains not less 99.0% and not more than 100.5 % of
KCl, calculated with reference to the dried substance.
Preparation:
1. It is prepared from natural mineral, carnallite (KCl, MgCl2.6H2O). The raw
mineral is ground and then treated with hot water. The less soluble KCl
precipitate out. The process is repeated till all the KCl is recovered from liquid.
2. On laboratory scale, it is prepared by action of HCl on potassium carbonate
or bicarbonate.
K2CO3 + 2HCl 2KCl + H2O + CO2
KHCO3 + HCl KCl + H2O + CO2
3. It can also be prepared in the laboratory in small scales by reacting
potassium hydroxide (KOH) with hydrochloric acid (HCl).
KOH + HCl KCl + H2O
Properties:
It is colorless crystalline, or white crystalline powder; odorless. It has a saline taste. It
melts
at 772 C. the 10% aqueous solution is neutral to litmus.
It is freely soluble in water; practically insoluble in ethanol and ether.
Uses:
It is used in prevention and treatment of potassium depletion and hypokalemia
and diuretic-induced hypokalemia.
Potassium chloride is sometimes used as an excipient in pharmaceutical
formulations.
It is used in diabetic ketoacidosis.
It is used in hypertension, potassium supplementation results in reduction of both
systolic and diastolic blood pressure.
Preparations of Potassium chloride:
Chemical properties:
When treated with dil. HCl, it is decomposed into gluconic acid
and calcium chloride.
Method of Preparation:
It is prepared by boiling a solution of gluconic acid with
Calcium carbonate.
Product is filtered and dried.
Assay:
Principles: Complexometric titration.
-0.5 g sample is dissolved in warm water, cool and add 5 ml of 0.05 M MgSO4
and 10 ml of strong ammonia solution.
-Titrant: 0.05 M Disodium EDTA
-Indicator: Mordant Black II mixture.
- End point: until deep blue color develops.
-From the volume of 0.05 M disodium EDTA required, subtract the volume of the
MgSO4 solution added for actual reading.
- Factor: 1 ml 0.05 M disodium EDTA= 0.02242 g of Calcium gluconate.
Uses: It is used in management of hypocalcemia and calcium deficiency state.
In insect bite: calcium gluconate 10 % solution, is given intravenously as an
alternative to the use of conventional muscle relaxant, for the management of
pain and muscle spasm associated with insect bite.
In severe acute hypocalcemia.
Preparations of calcium gluconate:
1. Calcium gluconate injection:
As the stability of ORS containing sodium bicarbonate under tropical condition is very
poor, formulations containing sodium bicarbonate are less suitable; sodium bicarbonate may
be packaged separately in such cases to improve storage stability. ORS may contain suitable
flavoring agent and, where necessary, suitable flow agent, in the minimum quantity,
required to achieve a satisfactory product. But may not contain artificial sweetening agent
like mono or polysaccharide, saccharin or aspartate.
Usual strength of ORS
Formula (gm/L) ORS- A ORS- Citrate
Sodium chloride 1.25 3.5
Potassium chloride 1.5 1.5
Sodium citrate 2.9 2.9
Anhydrous Dextrose 2.9 2.9
Dextrose 29.7 22.0
monohydrate
ORS- A , commonly used in India for treatment of non-choleraic diarrhea &
ORS- Citrate, recommended by Diarrheal Disease Control Programmed of the
World
Health Organization (WHO).
Our body fluids are having a balanced quantity of acids and bases. It becomes essential to
maintain normal PH range because the biochemical reaction which take place in the
living system are very sensitive to even small changes in acidity or basicity.
Generally acidic metabolites are formed in higher quantity then basic metabolites
because CO2, protein and amino acids contributes to acidic metabolites generation.
These are then neutralize by bicarbonate ions.
PH of blood remains constant around 7.3- 7.4 because of the mechanism of controlling
PH by buffering system. An optimum PH is required by every system of body to perform
various physiological functions and reactions.
Most of metabolic reaction occurs in narrow range of PH. The required PH of plasma is
maintained by the three regulatory mechanism.
The buffer system may consist of weak acid and the salt of that acids. Buffer system of
body does not allow rapid and drastic changes in the PH of a body fluid by converting
strong acids & bases into weak acids & bases. Buffers are thus able to remove the
excess Hydrogen from the body fluids but not from the body.
1. Buffer system/ buffering mechanism
While if there occurs shortage of hydrogen, the carbonic acid (another component
of
buffer system) ionize to release more hydrogen ion & maintain the PH.
In lungs, for example, oxygen reacts with the protonated deoxyhemoglobin,
releasing protons. Theses protons combine with bicarbonate, forming carbonic acids,
which then dissociates to yield carbon dioxide and water. Then the carbon dioxide
gets exhaled out.
Normal metabolism gives rise to more acids than bases, but the blood is made more
acidic. Therefore the body needs more bicarbonate salt than it needs carbonic acid.
Hence at physiological PH 7.4, the plasma is having about 24 mEq/L of
bicarbonate in comparison to about 1.2 mEq/L of carbonic acid. (ratio of 20: 1)
2. Phosphate buffer system
It is also able to maintain physiological PH at 7.4. as the phosphate concentration is
highest in intra-cellular fluid, the phosphate buffer system is considered to be an
important regulator of PH. This system occurs in the cells and kidneys. The system
consist of monohydrogen phosphate/ dihydrogen phosphate (HPO4/H2PO4). It is
known to act in the same manner as the carbonic acid- bicarbonate buffer system
acts.
If there occurs an excess of hydrogen, the monohydrogen phosphate ion acts as
the weak base by accepting the proton.
While the dihydrogen phosphate ion can act as the weak acid and is able to
neutralize
the alkaline condition, as
For example, in kidney, NaH2PO4 gets formed if excess hydrogen ion in the
kidney tubules combines with Na2HPO4. the sodium ion released in this reaction
forms sodium bicarbonate by accepting bicarbonate ion.
The NaHCO3 then enters the blood. The kidney are also able to synthesize new
HCO3 and reabsorb bicarbonate ion that have been filtered so this important
buffer does not get lost in the urine.
The hydrogen ion that replaces sodium ion become part of the NaH2PO4 that goes
into the urine. Thus, kidney are able to maintain pH by the acidification of urine. At
physiological pH, the HPO4/H2PO4 ratio in the intracellular fluid is about 4:1.
while in the kidney it is nearly 1:100 because the urine pH is in acidic (4.5- 4.8)
range.
3. Protein (Hemoglobin) buffers system
It is considered to be the most abundant buffer in body cells and plasma. Proteins are composed of amino acids
that are having at least one carboxyl group (COOH) and at least one amino (NH2) group. When there occurs
an excess of hydrogen ions, the amino group act as a base and accepts the proton.
While the free carboxyl group can release protons so as to neutralize an alkaline
condition.
Thus, protein is able to serve both the function of acid and base components of a buffer system because of
its amphoteric nature.
2. Respiratory mechanism:
The body's second best defense against acid-base disturbance is control of
extracellular fluid CO2 concentration by the lungs.
When respiration get decreased, the accumulation of CO combines with
2
water present in blood to form carbonic acid (H2CO3) which further dissociates
to give Hydrogen ion and give rise to acidosis.
Similarly in case of over breathing, excess of CO2 excreted by lung, which give rise
to alkalosis.
3. Renal mechanism:
Kidney perform a major task to remove the excess of acid present in the body that is why PH of urine
usually found to be acidic. Kidney is able to generate ammonia (NH3) which neutralize the acidic
product of protein metabolism, these products are then excreted out from the body in urine. Fixed
acids like sulphuric, phosphoric and hydrochloric acids are generally excreted out by kidney while
unstable carbonic acid is removed mainly by respiratory mechanism.
Stability of buffers (From acids, bases & buffer chapter)
It is required to make up and treat buffer solutions with care. A typical shelf life for
commercial technical buffers is 2 years unopened and 3- 6 months open. However, this is not
valid for alkaline buffers (PH of buffer is 10 or higher). Alkaline solution will change their
PH when they come into contact with carbon dioxide in air. The typical shelf-life for alkaline
buffers is 1 month open.
So to maintain the stability of buffer solutions, following points must be taken care of;
Check any expiration date on commercial buffer solution before using it.
During making a buffer solution, put a date on label and also an expiration date.
Keep the buffer solutions in closed plastic container or within stoppered flask.
Store the buffers at room temperature, 15 to 25C.
For alkaline buffers, it is recommended to put the bottles in the refrigerator.
The temperature of buffers is important because it is a function of its PH. At lower
temperature, the evaporation of the water in the buffers is slower than a higher temperature,
which help to maintain the concentration of the buffer constant for a longer period of time.
Storage: store the buffers;
At room temperature, 15 to 30 C or
Refrigerated, 2 to 8 C
Store the prepared buffer solutions in chemically resistant, tight container such
as type I glassbottles. Use these solutions within 3 months.