Electrolyte replenishers in Inorganic chemistry / Body therapy

Electrolyte replenishers

1. ELECTROLYTE REPLENISHERS

3. BODY FLUID:
Contains various inorganic and organic ions, water, proteins, carbohydrates,
amino-acids (essential, non-essential) etc.
3-main compartment of body
Intracellular (40-45%of body weight)
Interstitial fluid (12-15%of body weight)
Plasma/vascular fluid (3-5%of body weight)
In ordered to maintain the homeostasis ,each compartment are ionically
balanced.
Important function serves by electrolyte are:
To control osmosis of water between body compartment
To maintain acid-base balance needed for normal cellular activities.
To generate action potential and graded potential
Control secretion of hormones and neurotransmitters
Anionic electrolytes:
HCO
3, Cl
-
, SO
4 , HPO
4
Cationic electrolytes:
Na
+
K
+
, Ca
+2
, Mg
+2
.

4. Ions Extracellular
concentration
Intra cellular
concentration
Plasma
concentration
mEq/L mEq/L mEq/L
Cations
Na
+
K
+
Ca
++
Mg
++
142
4
3
2
10
160
--
35
142
4
5
3
Anions
Cl
-
SO
4
--
HCO
3
-
PO
4
-
115
1
30
2
2
0
8
140
103
1
27
2
Organic Acids
5 -- 5
Proteins 1 55 16
Various concentration of important Electrolyte

5. . Role of major physiological cations and anions:
Important function serves by electrolyte are:
To control osmosis of water between body compartment
To maintain acid-base balance needed for normal cellular activities.
To generate action potential and graded potential
Control secretion of hormones and neurotransmitters.
Sodium ion (Na
+
)
Source:Marine foods like fish, water etc
Role:
Most important extracellular ion.
Plasma concentration 136-142 mEq/L.
Normal intake varies from 5-20gm per day
excess quantities get excreted through urine.
The Na
+
level in the blood is controlled by
Aldosterone and antidiuretic(ADH) hormones
Normally in kidney, it plays important role in
excretion of sodium which is reabsorbs from
Glomerularfiltration.
With chloride and bicarbonates it play
important role in acid base equilibrium.
Maintains osmotic pressure and excessive
fluid loss.
Plays important role in transmission of nerve
impulse.

6. Deficiency:
Hyponatremia:
Causeduetolowserumsodiumlevel/concentration.
Excessiveurinationincaseofdiabetesinsipidusresultsinlossofsodiumionconcentration.
Excessiveexcretionin“metabolicacidosis”,diarrhoeaandvomiting.
In“Addison’sdisease”inwhichthereoccuradecreasedexcretionofhormonesAldosteronewhichis
anti-diuretic.
Hypernatremia
Causeduetohighserumsodiumconcentration.
Severedehydration
HyperAdrelanism(cushingsyndrome)
Braindamage.
Excessivetreatmentwithsodiumsalt.

7. Potassiumion(K
+)
Source:Milk,vegetables,meatandwhole
grains.
Role:
Most important intracellular electrolyte.
Plasma concentration 3.8-5 mEq/L.
Normal intake varies from 5-7gm per day.
Daily requirement is 1.5-4.5 gm.
Mainly important in contraction of muscle
(Cardiac muscle).
Transmission of nerve impulses.
Many biochemical activities are maintained
inside the cell.
It rapidly get absorbed from diet from GIT
and is rapidly get excreted through kidney.
That result in changes in acid-base balance
and activity of adrenal cortex.
Hyperkalemia:
Increase serum potassium level. ( renal failure,
dehydration, shock.)
In “Addison disease”-increases the serum K
+
level.
Causes Cardiac and CNS depression, bradycardia,
poor heart sound, peripheral vascular collapse and
cardiac arrest.
Increase level of K
+
brings about metal confusion,
weakness of respiratory muscles.
Hypokalemia:
Result due to low serum K
+
Post-operative treatment which includes I.V.
administration of solution not having K
+
for prolong
period.
Associated with malnutrition, gastrointestinal
losses, as in diarrhoea and in metabolic alkalosis.
In certain diuretics like acetazolamide,
chlorothiazide the K
+
excretion increase.

8. Calcium ion (Ca
++
)
Source:Milk, cheese, green vegetables, eggs and fish.
Role:
Most important extracellular ion. The total plasma Ca
++
has been 2.2-2.6 mEq/L.
Daily requirement in body is 0.8gm. minimum req. is 0.4g.
Ca
++
associated with Vit.D and phosphorous in hardening of bones.
Also involve in coagulation of blood and in impulse propagation and in muscle contraction.
Important in release of AcH from preganglionic nerve terminal.
Greater amount needed during pregnancy and lactation. For child growt.
Deficiency:
Level of Ca
++
is maintained by parathyroid hormone and calcitonin.
Under the condition like Vit. D. deficiency, renal failure and intestinal mal-absorbtion. Ca
++
Absorption gets reduced.
If the ionized concentration becomes low, tetanic spasms or convulsion may take place.
If the ionized Ca
++
is high, cardiac function are disturbed.

9. Phosphate ion (PO
4
¯):
Source: milk, milk product, whole grain legumes, nuts.
Role:
•Ions like H
2
PO
4
¯, HPO
¯4
are main anion of intracellular fluids.
•Normal plasma concentration is 1.7-2.6mEq/L
•Total body phosphate is present in teeth and bones along with calcium. Mostly found in
phospholipids, ATP, DNA-RNA
•Play important role in buffer systems. Mainly occur as monohydrogenphosphate and
dihydrogenphosphate.
•Mainly involve in phosphorylation that involve the conversion of organic compound to phosphate
ester.
•Deficiency:
Phosphate deficiency associated with patient with calcium deficiency.
Phosphate depletion occurs as a result of renal tubular disordered or in patients consuming large
amount of antacid, specifically aluminum hydroxide

10. Electrolyte use for replacement therapy:
ReplacementTherapy:Objective
Torestorethevolumeandcompositionofbodyfluid.
Volumecontractionislifethreateningcondition.Inextremecase(Accidentorduring
surgery)100mlperminutefor1000mlhasbeenconsidernecessary.
Ageneralruleistoreplaceonehalfoftheestimatedvolumelossinthefirst12-24hours
oftreatment.
Duringthediseaseconditionlikediarrhoea,vomiting,dysenterythefluidlosscause
disturbanceofelectrolytebalance

11. PotassiumReplacement
PotassiumChloride:KCl(MW74.56)
•I.P.Limit.Potassiumchloridecontainsnotlessthan99%calculatedwithreferencetodried
substance.Itoccursassylvine(KCl)andCarnallite(KCl,MgCl
2
)6H
2
Ocontaminatedwithmagnesium
sulphateandchlorides.Itoccursaswhitecrystallinesolid,cubiccrystals.Itislesssolubleinwaterthan
sodiumchloride,andslightlymoresolubleinboilingwater,solubleinglycerinandinsolubleinalcohol
•Preparation:
1.ItispreparedbyfusingCarnallitewherebyliquefiedmagnesiumchloridehexahydrate
isseparatedfromthesolidpotassiumchloride.
2.ThecrushedCarnalliteisdissolvedbyboilingwithliquorleavingotherimpurities
undissolved.Thesearefilteredoffandthefiltrateiscrystallizestogetcubiccrystalsof
potassiumchloride.
3.ItisalsopreparedinlaboratorybyreactingHClwithpotassiumcarbonateor
bicarbonate
K
2
CO
3
+ 2HCl KCl + H
2
O +CO
2
KHCO
3
+ HCl KCl + H
2
O +CO
2

12. •Use:
•Electrolytereplenisherinpotassiumdeficiency,familialperiodicparalysis,Meniere’ssyndrome
(diseaseofinnerear),
•antidoteindigitalisintoxication,myastheniagravis.
•Contraindication:renalimpairmentwitholigouria,acutedehydration.
PotassiumChlorideinjection:Ringerinjection
Calcium Replacement
Calcium Lactate: C
6
H
10
CaO
6
xH
2
O (MW 308.30)
•I.P. Limit. Potassium chloride contains not less than 97% and not less than 103% of Calcium Chloride
dihydrate. It occurs as white odorless powder. The pentahydrate effloresces and becomes anhydrous at
120°. Aqueous solutions are prone to become moldy. It is soluble in water, practically insoluble in
alcohol.
•Preparation:
It is obtained by neutralizing a hot solution of lactic acid with calcium carbonate in slight excess. The
hot liquid is filtered and filtrate is evaporated to crystalline product

13. 2. It is also obtained by fermenting hydrolyzed starch with a suitable mold in the presence
of calcium carbonate
3. Or by fermentation of mother liquor resulting from the production of milk sugar and
chalk. The mixture is digested for a week at about 30°. The product is purified by
crystallization.
Use: An excellent source of calcium in oral treatment of calcium deficiency
•Physiological acid-Base balance
Objective:
Acid-baseconcentrationmaintenance.
Essentialbecausethebiochemicalreactiontakingplaceinlivingsystemisverysensitive
tosmallchangesofacidityoralkalinity.
The normal concentration of free H+ in the extracellular fluid (ECF) is extremely small,
approximately 40 nmEq/L, which is equivalent to one millionth of a mEq/L concentration
of sodium.
Normal metabolism produces hydrogen in the form of volatile and fixed acids.
To maintain pH within its normal narrow range of 7.35 to 7.45, acids must be buffered or
excreted

14. Buffersystem:
Main function of the buffer system is to prevent drastic changes in pH values in the blood.
Buffers are able to remove the excess H
+
ion from body fluid and not from whole body
pH Regulation:
pH is controlled by two major and related processes
1) pH regulation. 2) pH compensation
Regulation is a function of the buffer systems of the body in combination with the
respiratory and renal systems,
Whereas compensation requires further intervention of the respiratory and/or renal
systems to restore normalcy.
Mostimportantbuffersystemsinourbody
are:
•Carbonic acid-bicarbonate buffer system.
•Phosphate buffer system.
•Haemoglobin buffer system.
Body fluids pH Ranges
Urine 4.5-8.0
Blood 7.4-7.5
Gastric juice 1.5-3.5
Saliva 5.4-7.5
Bile 6.0-8.5
Semen 7.2-7.6

15. Carbonic acid-bicarbonate buffer system:
Occurs in plasma and kidneys.
Bicarbonate ion act as weak base and accepts H
+
to form carbonic acid.
As CO
2
is produce in large quantity in metabolic reaction and from the environment they
are inhale, the amount of water in body are in plenty of amount hence the reaction between
these two give rise to carbonic acid in presence of enzymecarbonic anhydrase.
CO
2
+H
2
O H
2
CO
3
•WhenH
+
ionconcentrationislessthenthiscarbonicacidget
dissociatedintoH
+
ionandthusmaintainthebalance.
•Normalmetabolismgivesrisetomoreacidthanbases.But
bloodismademoreacidic,thereforethebodyneedsmore
bicarbonatesaltthanitneedscarbonicacid.Hence
physiologicalpH7.4theplasmaishavingabout24mEq/Lof
bicarbonateincomparisontoabout1.2mEq/Lofcarbonic
acid(ratio20:1)

16. Phosphate buffer system:
•Occur in cell and kidney.
•The system consist of monohydrogenphosphate/dihydrogenphosphate anions.
•If there occurs an excess of H
+
ion, the monohydrogen phosphate ion acts as the weak base by
accepting the proton.
HCl + Na
2
HPO
4
NaCl + NaH
2
PO
4
Strong acidweak base Salt + weak acid
•While the dihydrogen phosphate ion act as weak acid and is able to
neutralize the alkaline condition
NaOH + NaH
2
PO
4
H
2
O + Na
2
HPO
4
Strong base + weak acid Water + weak base
•Ex. In kidney if excess H
+
ion in the kidney tubule combines with NaH
2
PO
4.
•The sodium ion release in this reaction forms sodium bicarbonate by accepting
bicarbonate ion.
•The NaHCO
3
then enter in the blood. The H
+
ion that replaces Na+ becomes part of the
NaH
2
PO
4.
That goes into the urine.
•The ratio in intracellular fluid is about 4:1.1

17. Electrolyteusedinacid-
basetherapy:
GenerallyK
+
/Na
+
compoundsuch
asbicarbonate,lactate,acetatecanbe
usedfortreatingmetabolicacidosis.
Whereasmetabolicalkalosiscanbe
tratedwithammoniumsalt,
importantbeingammonium
chloride.
Example.Sodiumacetate,sodium
citrate,potassiumbicarbonate,
sodiumlactate.Ammonium
chloride.(Note:Monographare
attch)

18. Electrolytecombinationtherapy:
Whenpatientundergoesasurgery,heisunabletotakenormaldiettherefore
combinationsofglucoseandsalinesolutionsareusuallysufficientinshortterm
therapyforrestoringelectrolyteloss.Butinseveredeficitofelectrolytesdueto
heavybloodlossorchronicdiarrhea,solutionscontainingadditionalelectrolytes
areusuallyrequired.Thecombinationproductsareoftwotypes:
1.Fluidmaintenancetherapy
2.Electrolytereplacementtherapy
Electrolyte Concentration
mEq/L
Sodium 25-30
Potassium 15-20
Chloride 22
Bicarbonate 20-23
Phosphorous 3
Magnesium 3

19. The electrolyte concentrations in solutions for rapid initial
replacement are almost similar to the electrolyte
concentrations found in extracellular fluids. The electrolyte
concentrations of these solutions are given as.
Twotypesofsolutionsareusedinreplacementtherapy:
i)Solutionforrapidinitialreplacement
ii)Asolutionforsubsequentreplacement
Officialcompoundusedare:
Example.
1.Sodiumchlorideinjection,
2.Compoundsodiumchloride
injection(Ringerinjection),
3.Ringersolutionlactated
(Hartmannssolution).

20. Oral rehydration salt/ therapy
Oralrehydrationtherapyistheuseofmodestamountsofsugarandsaltaddedto
waterinordertopreventand/ortreatdehydration.
Thisdehydrationismostcommonlycausedbydiarrhoeaandalsocausedby
vomiting
•Dehydration: Loss of water and dissolve salts from the body, occurring, for
instance as result of diarrhoea.
•Rehydration:correction of dehydration.
Characteristics of ORS:
1.Dry , homogeneously mix powder containing Dextrose, Sodium Chloride,
Potassium Chloride and either Sodium Bicarbonate or Sodium Citrate
2.May contain flavoring agent, but no artificial sweeteners are added
( saccharin and aspartame)

21. Composition of the formulation in terms of the amount, in g, to be dissolved in
sufficient water to produce 1000 ml.
The molar concentrations of sodium, potassium, chloride and citrate ions in terms
of millimoles per liter are given below:
The total osmolar concentration of the solution in terms of
mOsmol per liter is 245