Question

A physician asks you to evaluate a patients overall status of electrolyte balance. You would use the following set of electrolytes to calculate the anion gap:

-Na, Ca, Cl, HCO3

-Na, H, Cl, k

-Na, Cl, k

-Na, Cl, HCO3

Answer 1

Electrolytes are minerals that are found in body tissues and blood in the form of dissolved salts. As electrically charged particles, electrolytes help move nutrients into and wastes out of the body's cells, maintain a healthy water balance, and help stabilize the body's acid/base (pH) level.

The electrolyte panel measures the blood levels of the main electrolytes in the body:

• Sodium—most of the body's sodium is found in the fluid outside of the body's cells, where it helps to regulate the amount of water in the body.
• Potassium—this electrolyte is found mainly inside the body's cells. A small but vital amount of potassium is found in the plasma, the liquid portion of the blood. Potassium plays an important role in regulating muscle contraction. Monitoring potassium is important as small changes in the potassium level can affect the heart's rhythm and ability to contract.
• Chloride—this electrolyte moves in and out of the cells to help maintain electrical neutrality (concentrations of positively charged cations and negatively charged anions must be equal) and its level usually mirrors that of sodium. Due to its close association with sodium, chloride also helps to regulate the distribution of water in the body.
• Bicarbonate—the main job of bicarbonate (or total CO₂, an estimate of bicarbonate), which is released and reabsorbed by the kidneys, is to help maintain a stable pH level (acid-base balance) and, secondarily, to help maintain electrical neutrality. Bicarbonate also plays an important role in the transport of CO₂: much of the CO₂ produced by the body's tissues is transported in the blood as bicarbonate to the lungs, where it is exhaled.

The foods you eat and the fluids you drink provide the sodium, potassium, and chloride your body needs. The kidneys help maintain proper levels by reabsorption or by elimination into the urine. The lungs provide oxygen and regulate CO₂. The CO₂ is produced by the body and is in balance with bicarbonate. The overall balance of these chemicals is an indication of the functional well-being of several basic body functions. They are important in maintaining a wide range of body functions, including heart and skeletal muscle contraction and nerve signaling.

Any disease or condition that affects the amount of fluid in the body, such as dehydration, or affects the lungs, kidneys, metabolism, or breathing has the potential to cause a fluid, electrolyte, or pH imbalance (acidosis or alkalosis). Normal pH must be maintained within a narrow range of 7.35-7.45 and electrolytes must be in balance to ensure the proper functioning of metabolic processes and the delivery of the right amount of oxygen to tissues. (For more on this, see the condition articles on Acidosis and Alkalosis and Dehydration.)

A related "test" is the anion gap, which is a value calculated using the results of an electrolyte panel. It reflects the difference between the positively charged ions (called cations) and the negatively charged ions (called anions). An abnormal anion gap is non-specific—it does not diagnose a specific disease or illness—but it can suggest certain kinds of metabolic or respiratory disorders or the presence of toxic substances.

While sodium, potassium, chloride, and bicarbonate are commonly measured together as the electrolyte panel, they can also each be ordered individually for diagnosis/monitoring of conditions that affect specific electrolytes. The body also contains other electrolytes that are not part of the "electrolyte panel" but may also be ordered by your healthcare practitioner. These include: calcium (Ca²⁺), magnesium (Mg²⁺), and phosphate (PO₄^3-).

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