SODIUM, POTASSIUM & CHLORIDE

Dr. Humaira Aman Ali

Electrolyte concentration of body fluid Gamblegrams showing composition of fluid
compartments compartments
SODIUM (Na+)
Sodium is the chief electrolyte which is found in
large conc. in extracellular fluid compartment and is
one of the most abundant element on Earth.

The sodium is found in the body mainly associated

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with chloride as NaCl and NaHCO3.

Sources: Sodium is widely distributed in food

material. However, major source is table-salt used
in cooking or seasoning. It is also found in cheese,
butter, processed food, salted nuts, sauces and
olives.
Daily Requirement:

According to U.S. Food and Drug

Administration (FDA), the daily value for
sodium is less than 2,300 milligrams (mg) per
day for a healthy adult.
The American Heart Association (AHA)
recommends no more than 2,300 milligrams
(mg) a day and moving toward an ideal limit
of no more than 1,500 mg per day for most
adults.
Reducing to 1,000 milligrams a day can
significantly improve blood pressure and heart
health.
SODIUM PUMP
This is also called as Na+-K+ ATPase. Na-pump is an enzyme, Na+-K+-ATPase.
The enzyme hydrolyses a high energy phosphate bond of ATP and uses the energy thus
released to transport three Na+ ions outside and simultaneously two K+ ions inside across
the cell membrane.
It is a glycoprotein composed of α and β chains. Its activity depends on presence of Na+

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and K+ and requires ATP and Mg++ ions as cofactor.
The Na-pump is very active in those cells where activities depend largely on
transmembrane Na+ fluxes, e.g. nervous, muscle fibers, renal tubules cells, intestinal
mucosal cells.
Renal sodium reabsorption and Excretion
of Na:
Every 24 hours approximately, 25000 mmol of sodium are filtered
by the kidneys.
However, due to tubular reabsorption less than 1 per cent of this
sodium appears in the urine (100-200 mM/day).
Approximately 70 per cent of the filtered sodium is reabsorbed in
proximal tubule. Further 20–30 per cent of filtered Na+ is
reabsorbed by ascending loop of Henle.
Renal sodium reabsorption uses Na-H antiport, Na-glucose
symport, sodium ion channels (minor). It is stimulated
by angiotensin II and aldosterone.
FUNCTIONS
Maintenance of osmotic pressure and
fluid balance: Sodium maintains
osmotic pressure of extracellular
fluids and helps in retaining water in
ECF.
Neuromuscular excitability.
Regulates acid-base balance in
association with chloride and
bicarbonates.
Role in Action Potential: A local
depolarization of nerve or muscle fiber
is observed in stimulation. This
rapidly increases its permeability to
Na+ causing considerable
transmembrane influx of Na+.
 Hypernatraemia
Hypernatremia is defined as a rise in serum sodium concentration to a value exceeding 145
mmol/L.
Causes:
▪ Primary hyperaldosteronism (Conn’s syndrome): e:g aldosterone producing adenoma

▪ Cushing's disease

▪ Prolonged steroid therapy

▪ Excessive intake of salt

▪ In dehydration, when water is predominantly lost, blood volume is decreased with apparent
increased concentration of sodium
 cont..

▪ Elderly patients with poor water intake, and inability to express thirst

▪ Drugs: Anabolic steroids Oral contraceptives, Loop diuretics and Osmotic

diuretics

▪ In pregnancy, steroid hormones cause sodium retention in the body

▪ Diabetes insipidus: These diseases are characterized by lack of antidiuretic

hormone (ADH) or failure of the hormone to act on its target cells.
 Hyponatraemia
Decreased sodium level in blood is called hyponatremia.
Causes:
▪ Vomiting, diarrhea and excessive sweating

▪ Burns result in the loss of both water and sodium

▪
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Addison's disease (adrenal insufficiency)

▪ Renal tubular acidosis (tubular reabsorption of sodium is defective)

▪ Chronic renal failure: due to kidney dysfunction, Na+ is not reabsorbed

 cont..
▪ Congestive cardiac failure b/c of Diuretics administration and
in advance stages.
▪ Hyperglycemia and ketoacidosis: Hyperglycemia causes
hyperosmolality, and the water moves from intracellular
space to extracellular space, which in turn produces a
dilutional decrease in serum sodium level
▪ SIADH: Syndrome of inappropriate secretion of anti-diuretic
hormone
▪ Drugs: ACE inhibitors, Vasopressin, use of diuretics.
POTASSIUM (K+)
Potassium is the major intracellular
cation.
Over 98% is in the intracellular
compartment (primarily in the muscle,
subcutaneous tissue, and red blood
cells) and 2% is in the extracellular
compartment.
The intracellular concentration gradient
is maintained by the Na+-K+ ATPase
pump.
REQUIREMENT, SOURCES, NORMAL PLASMA
LEVEL, EXCRETION and REGULATION
Requirement:
Potassium requirement is 3-4 g per day.
Sources:
Sources rich in potassium, but low in sodium are banana, orange, apple,
pineapple, almond, dates, beans, yam and potato. Coconut water is a very
good source of potassium.
Normal plasma level:
The normal conc. of plasma potassium is 3.5-5 mEq/L.
Excretion:
90% of excess potassium is excreted through kidneys in the urine.
The rest 10% potassium is also excreted in gastrointestinal tract, saliva, gastric
juice, bile, pancreatic and intestinal juices.
Regulation
The majority of the filtered K+ is reabsorbed in the proximal tubule.
The control of secretion occurs in the cortical collecting duct. The exchange of
potassium for sodium at the renal tubules is a mechanism to conserve sodium
and excrete potassium.
This is controlled by aldosterone. Aldosterone and corticosteroids increase the
excretion of K+.
On the other hand, K+ depletion will inhibit aldosterone secretion.

Note:
Insulin promotes the entry of K+ into skeletal muscles and hepatic cells.
FUNCTIONS
Many functions of potassium and sodium are carried out in
coordination with each other.
Nerve conduction
Muscular function
Osmotic pressure: regulates intracellular osmolality
Protein synthesis: K+ and Mg2+ both ions contribute to the
stability of various RNA structures
Acid-base balance
It has an important role in cardiac function
Hypokalemia
Hypokalemia is generally defined as a serum potassium level of less than
3.5 mEq/L (3.5 mmol/L).
Causes:
Cushing's syndrome
Hyperaldosteronism
Hyper reninism, renal artery stenosis
17 alpha hydroxylase deficiency and 11 beta hydroxylase deficiency
(genetic disorder of steroid biosynthesis that causes decreased
production of glucocorticoids and increased synthesis of
mineralocorticoid precursors)
cont..

Alkalosis
Insulin therapy
Gastrointestinal loss: Diarrhea, vomiting
Deficient intake or low potassium diet
Malabsorption
Intravenous saline infusion in excess
Drugs Insulin Salbutamide Osmotic diuretics Thiazides,
acetazolamide Corticosteroids
Hyperkalemia
Plasma potassium level above 5.5 mmol/L is known as hyperkalemia.
Since the normal level of K+ is kept at a very narrow margin, even
minor increase is life-threatening.
There is increased membrane excitability, leads to ventricular
arrhythmia and ventricular fibrillation.
Lowering cell-resting action potential and prevention of
repolarization, leading to flaccid muscle paralysis, bradycardia and
cardiac arrest.
ECG shows elevated T wave, widening of QRS complex and
lengthening of PR interval.
Causes
Decreased renal excretion of potassium: Obstruction of urinary tract, renal failure, severe
volume depletion (heart failure)

Entry of potassium to extracellular space: Increased hemolysis, tissue necrosis, burns

tumor lysis after chemotherapy, rhabdomyolysis, crush injury, excess potassium
supplementation

Metabolic acidosis

Insulin deficiency (diabetes mellitus)

cont..
Tissue hypoxia

Improper blood collection (hemolysis)

Thrombocytosis

Leukocytosis

Hyperkalemic periodic paralysis

Drugs Spiranolactone ACE inhibitors Beta blockers

CHLORIDE (Cl–)
Functions:
Chloride is important in the formation of
hydrochloric acid in gastric juice.
Chloride ions are also involved in chloride shift.

Sources:
Table salt
Vegetables and meats have small proportions of
chloride.
It is also available in the ‘chlorinated water’
which is normally supplied as a process of CHLORIDE SHIFT
purification of water for drinking purpose.
Daily Requirement: About 100-200 mmol is taken
in diet as sodium chloride (table salt)
Chloride concentration in plasma is 96-106 mEq/L and in CSF, it is about
125 mEq/L.
Chloride concentration in CSF is higher than any other body fluids.
Distribution:
• Plasma
• CSF
• Cells
• Muscles
Excretion
• Sweat
• Faeces
• Renal

99 per cent of the Cl– in the glomerular filtrate is reabsorbed by renal tubules
mainly in proximal tubule (60-70%) and then in ascending loop of Henle (20-
25%) followed by distal tubule, collecting duct (10-15%).
Regulations:
Similar to that of sodium.
Increase in blood volume decreases reabsorption of chloride and vice-
versa.
Plasma levels of chloride vary with and to a great extent depend on the
plasma conc. of Na and HCO– 3.
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