Biochemistry Of Sodium, Potassium & Chloride

Introduction to Sodium

  • Total amount of sodium in an average adult is about 3500-4000mEq
  • About 50% is present in bones and 40% in ECF.
  • The remaining 10% is distributed in soft tissues
  • Sodium is the major cation of the extracellular fluids
  • Sodium is present mainly as NaCl or NaHCO3.
  • Plasma sodium level is 310-340 mg/dl or 136-145 mEq/L.
  • Other extracellular fluids are also rich in sodium. The intracellular fluid contains only about 10 mEq/L.

Functions of Sodium

  • Maintenance of osmotic pressure
  • Maintenance of pH
  • Nerve excitability and conduction
  • Active transport

Requirement

  • There has been considerable controversy about the daily requirement of sodium.
  • The requirement depends upon daily loss of sodium from the body which depends upon Climate.
  • The recommended daily allowance is 1-3.5 g/day as common salt. (1gm sodium chloride provides 393 mg of Na+).

Dietary sources

  • Table salt (sodium chloride) is one of the chief source of sodium in our daily diet
  • Baking powder (sodium bicarbonate) can also contribute significant amounts
  • Meat, fish, fowl, eggs, milk, cheese and cereals are rich in sodium
  • Carrot, radish, cauliflower, spinach, turnip, legumes and nuts are also good sources of sodium
  • Low levels are known as hyponatremia and high levels are called hypernatremia.

Hyponatraemia 

  • Very uncommon
  • Can be seen both in situations of dehydration  as well as over hydration due to dilution.

Causes

  • severe diarrhea and vomiting and excessive sweating etc
  • Excessive GIT loss such as in fistula, gastric aspiration etc

Hypernatraemia 

  • Hypernatraemia occurs in adrenocortical hyperactivity and  prolonged steroid therapy
  • Cushing syndrome : Excess of aldosterone causes increased sodium absorption

Consequence and treatment

  • Hypernatremia is accompanied by edema and  hypertension. It may also lead to congestive heart failure.
  • Treatment is by diuretics which cause sodium and water loss.

Potassium

  • Potassium is the chief cation of the intracellular compartment, and is present in all cells
  • The total body potassium is about 3500 mEq and  most of it (75%) Is present in muscles.
  • Serum potassium level is 3.5-5 mEq/L.

Functions

  • Maintenance of osmotic pressure
  • Maintenance of pH
  • Nerve excitability and conduction
  • Cofactor for enzymes
  • Active transport

Dietary sources

  • Potassium is very widely distributed in foodstuffs
  • Meat, fish, fowl, cereals, vegetables, apricots, peaches, oranges and pineapples and banana are rich in potassium

Abnormal serum potassium levels

Hyperkalemia- serum K+level is >5mEq/L 

Causes

  • Renal failure with anuria when there is no or minimal urinary loss of K+ 
  • Addison’s disease: deficiency of aldosterone causes K+retention by decreasing its excretion
  • Drugs toxicity like digitalis and ACE inhibitors overdose
  • Iatrogenic due to excessive and fast intravenous infusion.

Hypokalemia

Serum potassium level of <3.5mEq/L is called hypokalemia

Causes

  • Reduced dietary intake or GIT losses rarely cause hypokalemia.
  • Cushing Syndrome or prolonged steroid treatment can cause hypokalemia.
  • Metabolic alkalosis also causes excessive renal loss of K+  and leads to hypokalemia.

Chloride

  • The total amount of chlorine in an average adult is about 80 gm
  • Chlorine, in the form of chloride ions, is the chief anion of extracellular compartment
  • Normal serum chloride level is 96-106 mEq/L (355-375 mg/dl)
  • Chloride ions help in maintaining the pH of blood by the mechanism of chloride shift
  • Chloride ions are necessary for the formation Hydrochloric acid which is an important constituent of gastric juice

Chloride Requirement

  • Chloride is commonly present in food as sodium chloride.
  • Therefore, sodium and chloride intakes are parallel
  • If daily requirement of sodium is met, so will be that of chloride
  • Dietary intake of salt and renal excretion vary from 5-10g/day.

Dietary sources

  • Table salt is the most abundant source of chloride in our daily diet
  • Foods that provide sodium also provide chloride
  • e.g. meat, fish, fowl, eggs, milk, cheese, cereals etc

Abnormal serum chloride levels

With a few exceptions, changes in serum chloride level are parallel to those in serum sodium level

Hypochloremia

  • Prolonged severe vomiting or gastric fistula is the major cause
  • Excessive severe sweating
  • Addison’s disease

Treatment :- Oral intake of salt- NaCl

Hyperchloremia

  • Dehydration
  • Cushing’s syndrome
  • Severe pancreatic secretion loss or diarrhoea with loss of HCO3 and compensatory Clretention
  • Renal tubular acidosis

Treatment of cause combined with Na+ and K+ supplementation and correction of acidosis.

Other Biochemistry Notes

Biochemistry of Proteins

Carbohydrate Metabolism

VITAMIN PYRIDOXINE AND BIOTIN

Vitamin A

VITAMIN D

Pyrimidine metabolism

Purine Metabolism

Cardiac Biomarkers

. Blood Metabolism (Heme synthesis and breakdown)

Haemoglobinopathies

DNA Repair

Regulation of gene expression

DNA Replication

Transcription

Protein synthesis and genetic code

Detoxification (Xenobiotics)

Liver Function Test

Transamination Deamination & Urea Cycle

METABOLISM OF INDIVIDUAL AMINO ACIDS

Hydroxy amino acids

ACIDIC AMINO ACIDS (Aspartate and Glutamate)

Inborn Error Of Phenyl alanine, Tyrosine Metabolism

Electron Transport Chain & Biological Oxidation

RENAL FUNCTION TEST

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