Extracellular

Notes
Major Intra and Extra cellular Electrolytes
1. Enlist the major anions and cation found in body fluids. Explain how
physiological acid-base balance is maintained.
Major cation-
Sodium
• Potassium
• Calcium
• Magnesium
Major anions-
• Chloride
• Sulphate
• Phosphate
• Bicarbonate
Physiological acid-base balance-
The acid base balance in the body is well regulated by intricate mechanism.
A number of chemical reactions takes place in the cell and the reactions
occurring inside is greatly influenced by pH or hydrogen ion concentration.
Acids are being constantly produced in process of metabolism. E.g. carbonic
acid, lactic acid.
Acids or alkalis produced in the body may cause change in pH. Most of
metabolic reactions occur between body pH 7.38-7.42.
Required pH (7.38-7.42) of plasma is maintained by:
1) Buffering system: Three major systems of buffering system occurring in
the body are:
• HCO3
H2CO3 found in plasma & kidneys
• HPO4
H2PO4
- present in cells & kidneys
• Protein or Hb buffer system
2) Respiratory mechanism
The other important pH control is through the control of respiratory centre.
When this is stimulated, it alters the rate of breathing. Through the rate, the
removal of CO2 from body fluid leads to the changes in pH of blood.
Retention of CO2 in the body due to decrease in ventilation as a result of
mechanical/muscular impairment, lung disease, pneumonia, CNS depression
due to narcotic drugs, CHF etc. induces respiratory acidosis This can be
overcome by renal mechanism by :
• Increase in acid excretion by Na+- H+ exchange
• Increase in ammonia (NH3) formation
• Increase in reabsorption of HCO3
In respiratory alkalosis, there is excess loss of CO2 from body due to over
breathing or hyperventilation as a result of emotional factors, fever, hypoxia,
loss of appetite, salicylates poisoning etc.
This can be overcome by renal mechanism by:
• Increase in bicarbonate (HCO3
• -) excretion
• Decrease in ammonia (NH3) formation
• Decrease in reabsorption of HCO3
- (bicarbonate)
3) Renal mechanism
The third mechanism is via elimination of some ions through urine by
kidney.
Absorption of certain ions and elimination of other ions control the acid-base
balance of blood and thus of body fluids.
2. Define mEq/L. Calculate the mEq of sodium chloride in one

litre of 0.90% w/v Solution
3. Explain metabolic acidosis and alkalosis. Write the uses of
potassium citrate.
Due to variety of causes, the body’s acid levels may increase and /
or alkali level decreases below normal causing metabolic acidosis.
Similarly, if the acid level decreases and / or alkali level increases
above normal it causes metabolic alkalosis. Thus metabolic acidosis
is pH dropping slightly below 7.38 and metabolic alkalosis is PH
increasing slightly above 7.42
4. Discuss the term ORS with example.
ORS is an example of electrolyte combination therapy.
• When there is a heavy loss of water and electrolytes e.g. in
excessive vomiting, diarrhea, or prolonged fever, electrolyte
combinations are used as electrolyte replacement therapy.
Various electrolyte combinations in varying concentrations
are commercially available as dry powders to be dissolved in
specified amount of water or in the form of prepared solutions
as “oral electrolyte solutions” or “oral rehydration salts”.
• If equimolar solution of glucose & sodium is given orally, it is
gets absorbed in GIT & restores Na+, Cl- or other ions in the
body. ORS with concentration of 90 mEq/lit. Of Na+ is used
in all types of dehydration in all ages. Once hydration has
been achieved, low concentration of ORS is sufficient to
maintain fluid & electrolyte balance.
• ORS solution is administered in small sips with teaspoon to
prevent dehydration due to vomiting, diarrhea. It should be
freshly prepared to avoid contamination. But severe
dehydration should be treated under medical supervision.
• A large number of formulations of oral rehydration
preparations are available in the market, which contains
anhydrous glucose, sodium chloride, potassium chloride, and
either sodium bicarbonate or sodium citrate.
• These dry powder preparations are to be mixed in specific
amount of water and are used for oral rehydration therapy.
5. Explain electrolyte combination therapy with reference to oral
rehydration therapy. Give composition of ORS recommended
by WHO and UNICEF
Electrolyte combination therapy:
• Usually when patient is unable to take normal diet before or

after surgery, the electrolyte combination therapy is used.
• Infusions containing glucose and normal saline are used.
• But when the patient is deficient or in protracted illness, other
electrolytes are also needed and in such cases the combination
of electrolytes are prepared and given as per the need of the
patient.
• Various combinations of electrolytes, varying in concentration
are available commercially.
Electrolyte combination products are divided in two categories:-
o Fluid maintenance therapy.
o Electrolyte replacement therapy.
o Fluid maintenance therapy.
▪ In the fluid maintenance therapy, the fluid or solutions of

electrolytes are administered intravenously which provides
the normal requirement of water and electrolytes to patients
who cannot take food orally.
▪ All the fluid maintenance electrolyte infusions contain at least
5.0% glucose, which helps to reduce formation of certain
metabolites like urea, ketone bodies and phosphate, which are
usually associated with starvation.
▪ When there is a heavy loss of water and electrolytes e.g. in
excessive vomiting, diarrhea, or prolonged fever, electrolyte
combinations are used as electrolyte replacement therapy.
▪ Various electrolyte combinations in varying concentrations
are commercially available as dry powders to be dissolved in
specified amount of water or in the form of prepared solutions
as “oral electrolyte solutions” or “oral rehydration salts”.
❖ Some important products used in electrolyte combination
therapy are as follows:
➢ Sodium Lactate Injection (I.P., BP.): (Sodium lactate

intravenous infusion)
➢ Compound Sodium Chloride Injection (I.P.): (Ringers
injection)
➢ Compound Sodium Lactate Injection (IP)/ Compound
Sodium Lactate Intravenous Infusion (B.P.)
➢ (Ringer lactate solution for injection, Hartmann's
solution for injection)
➢ Oral Rehydration Salts (ORS).
Composition of ORS recommended by WHO
And UNICEF.
Ingredients Formula I (WHO) Formula II (UNICEF)
Sodium chloride 3.5 gm 3.5 gm
Sodium bicarbonate 2.5 gm -----

-----
Sodium Citrate 2.9 gm
Potassium Chloride 1.5 gm 1.5 gm
Dextrose or Glucose 20 gm 20 gm
Water To 1 liter 1 liter

Prepare
6. Which salt is commonly used in Sodium Replacement Therapy?

Mention various
Preparations containing it.
Sodium chloride is used commonly in Sodium Replacement
Therapy.
Various preparations containing it are-
• Sodium Chloride Eye Lotion (B.P.)
• Sodium Chloride Solution (B.P.)
• Sodium Chloride Injection (I.P., B.P.): (Sodium chloride
intravenous infusion)
• Sodium Chloride Hypertonic Injection (I.P.) :( Hypertonic saline)
• Sodium Chloride Tablets (B.P.)
• Sodium Chloride and Dextrose Injection (I.P.)
(Sodium chloride and dextrose intravenous infusion)
• Mannitol and Sodium Chloride Injection (U.S.P.)
7. Write molecular formula and uses of ammonium chloride and
sodium bicarbonate
Molecular formula: - NH4Cl
Properties of Ammonium chloride:
• It occurs as white crystals, odorless, cooling or saline taste
• Slightly hygroscopic, soluble in water, sparingly soluble in
alcohol but freely soluble in
• Glycerin.
• It sublimes on heating.
• Its aqueous solution is acidic to litmus.
• It shows reactions of ammonium and chloride radicals.
Uses of Ammonium chloride:
• Expectorant
• Replaces chloride lost during vomiting
• Systemic acidifier (treatment of metabolic alkalosis)
• It is also used in the treatment of urinary tract infections .
• Sodium bicarbonate
Molecular formula-NaHCO3
Uses of Sodium bicarbonate:
• It is used as Antacid.
• It is used as systemic antacid in treatment of systemic
acidosis.
• It is used as electrolyte replenisher.
• 3 to5% solutions in warm water are used as eye lotion.
• It is used as an ingredient of compound NaHCO3 tablets.

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Notes

Major Intra and Extra cellular Electrolytes

2. Define mEq/L. Calculate the mEq of sodium chloride in one

• Usually when patient is unable to take normal diet before or

▪ In the fluid maintenance therapy, the fluid or solutions of

➢ Sodium Lactate Injection (I.P., BP.): (Sodium lactate

Ingredients Formula I (WHO) Formula II (UNICEF)

Sodium chloride 3.5 gm 3.5 gm

Sodium bicarbonate 2.5 gm -----

Potassium Chloride 1.5 gm 1.5 gm

Water To 1 liter 1 liter

6. Which salt is commonly used in Sodium Replacement Therapy?

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