Chapter III: Major Intra- and Extracellular Electrolytes

The concentrations of electrolytes vary in the different fluid compartments:

a. Intracellular fluid
b. Interstitial fluid
Extracellular
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

CHLORIDE

Maintains normal hydration,

osmotic pressure,
gastric HCl,
acid-base balance,
electrolyte balance

SODIUM

Buffer constituent acid-base balance,

water balance,
CO2 transport,
osmotic pressure,
cell membrane permeability,
muscle irritability
POTASSIUM

CALCIUM

MAGNESIUM
PHOSPHOROUS
(as HPO42-)

Buffer constituent acid-base balance,

water balance,
CO2 transport,
neuromuscular irritability
Formation of apatite in bones
and teeth
Blood clotting
Co-factor for PO4 transferring enzymes

constituent of bones and teeth

Constituent of bones and teeth,
of buffers ATP, NAD and FAD

Clinical Manifestation of
Deficiency
Hypochloremic Alkalosis
(pernicious vomiting)

Dehydration
acidosis
tissue atrophy
edema
hypertension
Acidosis
Renal Damage
Poor growth
Osteoporosis
Rickets
muscular tremor
chloreiform movement
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%)

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy

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 (CaCl22H2O)

- 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

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy

BUFFER SYSTEMS IN THE BODY

1. Bicarbonate/Carbonic Acid (HCO3-/H2CO3)
- found in plasma and kidneys
2. Monohydrogen/Dihydrogen phosphate (HPO4-2/H2PO4-)
- 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
Metabolic acidosis
HCO3-/H2CO3
- HCO3- deficit

carbonic acid
CO2 + H2O

: diabetic acidosis, renal

failure, diarrhea

Metabolic alkalosis

HCO3 excess

HCO3-/H2CO3

Respiratory Function
Hyperventilation
increased excretion of H2CO3
as CO2

CO2 retention,

Renal Function
Increased acid
excretion
by Na+ -- H+ exchange
increased NH3 formation
HCO3- reabsorption

Decreased

increased H2CO3 concentration

: administration of excess
alkali, vomiting

Respiratory Acidosis
- H2CO3 excess
: cardiac disease, lung
damage, drowning

Respiratory Alkalosis

Hemoglobin and
protein

Increased CO2
excretion

*Metabolic Acidosis

through the lungs

*Metabolic Alkalosis

*Metabolic Alkalosis

*Metabolic Alkalosis

- H2CO3 deficit
: fever, hysteria, anoxia,
salicylate poisoning

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+ + H2CO3 ----------------> Na+ + HCO3- + H+
3. Sodium bicarbonate returns to the plasma and removed from the lungs as CO2
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 CO2
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 (CH3COONa3H2O)

USES:

Acetate of Soda
colorless, transparent crystals/white granular powder/white flake
faint acetous odor
buffer in metabolic acidosis of acute cholera
treatment for uremic acidosis (by infusion)
Systemic alkalizer
diuretic, diaphoretic, aperients

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy

POTASSIUM ACETATE (CH3COOK)

- 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 (NaHCO3)

- Baking Soda
- white crystalline powder
- its alkanility in solutions increases as it stands
- CO2 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 (KHCO3)

-

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 (C6H5Na3O7)

- 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

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy

POTASSIUM CITRATE (C6H5K3O7H2O)

USES:

white granular powder, odorless, cooling saline taste

deliquescent
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-, HCO3-, Mg+2, HPO4-2 & Glucose
2. Electrolyte Replacement
- loss is severe

Chapter III: Major Intra- and Extracellular Electrolytes | Suzette Pamela G. Santos | 1FPharmacy