Urine electrolyte

Blood pressure, edema, urine output, ECG (if hyperkalemia exists), urine electrolytes, BUN, creatinine, gynecomastia, impotence... 

Today the determination of blood gases (p02, pC02) is performed using electrochemical GSSs, while major blood electrolytes (Na+, K+, Cl as well as Ca2+, Mg2+, Li+ as a therapeutic ion and pH) and main urine electrolytes (Na+, K+) are predominantly determined by electrochemical ISSs or ISEs. Some important metabolites (glucose, lactate, urea, creatinine) are often determined with electrochemical biosensors. 

Since one of the kidney s primary functions is maintaining electrolyte and mineral homeostasis in the face of fluctuating dietary intake and body needs, examination of plasma and urine electrolyte levels will provide some insight into renal function. Because of the large functional mass of the kidney, decrements in plasma electrolyte levels are usually not detected until the amount of renal functional diminution is significant. In contrast, urine electrolyte levels examined with knowledge of plasma levels and dietary intake can serve as an extremely sensitive index to the effect of drugs or chemicals on the functional state of the kidney. 

The most useful way to utilize urine electrolyte information is to calculate the fractional excretion (FE), which is the proportion of the filtered load that is excreted from the plasma. If both tubular function and plasma electrolyte values are normal, increases in electrolyte FE values clearly reflect a decrement in GFR. With tubular malfunction, the direction of the change in FE values depends on the net direction of electrolyte transport (i.e., FE will increase for electrolytes that are primarily reabsorbed and will decrease for secreted electrolytes) (Finco 1997 Stockham and Scott 2002). 

Plasma and urine electrolytes and creatinine are determined by standard methods (Durst and Siggard-... 

E649 Lesick, D., Field, K., Todd, J.K. and Lane, A. (1990). Performance of urine electrolytes on the Hitachi 717, using a ten-day NCCLS protocol. Patient correlations against the Kodak 700 for Na/K and the DuPont ACA III for chlorides. Clin. Chem. 36, 1196, Abstr. 1138. 

Hepatorenal Eliminate concurrent nephrotoxins Serum and urine electrolytes. Prevent progressive renal injury by... 

The urinary concentrations of these cations are highly variable because they are dependent on diet, and samples are subject to the effects of fecal contamination. The data are also highly variable when urinary output is affected by dehydration or excessive fluid losses via the gastrointestinal tract. Urine electrolyte values vary in intravenous studies due to rate of administration, tonicity, and electrolyte concentration of the vehicle. 

Clinical Applications Perhaps the area in which ion-selective electrodes receive the widest use is in clinical analysis, where their selectivity for the analyte in a complex matrix provides a significant advantage over many other analytical methods. The most common analytes are electrolytes, such as Na+, K+, Ca +, H+, and Ch, and dissolved gases, such as CO2. For extracellular fluids, such as blood and urine, the analysis can be made in vitro with conventional electrodes, provided that sufficient sample is available. Some clinical analyzers place a series of ion-selective electrodes in a flow... 

Table 1 Hsts several of the chemical deterrninations and the corresponding reactions uti1i2ed, which are available on automated clinical analy2ers. With the exception of assays for various electrolytes, eg, Na", K", Cl , and CO2, deterrnination is normally done by photometric means at wavelengths in the ultraviolet and visible regions. Other means of assay include fluorescence, radioisotopic assay, electrochemistry, etc. However, such detection methods are normally required only for the more difficult assays, particularly those of semm or urine constituents at concentrations below )Tg/L. These latter assays are discussed more fully in the Hterature (3,4).

If vomiting is severe the nurse observes the patient for signs and symptoms of electrolyte imbalance. The nurse monitors the blood pressure, pulse, and respiratory rate every 2 to 4 hours or as ordered by the primary health care provider. The nurse carefully measures the intake and output (urine, emesis) until vomiting ceases and the patient is able to take oral fluids in sufficient quantity. The nurse documents in the patient s chart each time the patient has an emesis. The nurse notifies the primary health care provider if there is blood in the emesis or if vomiting suddenly becomes more severe... 

Observations for fluid and electrolyte disturbances are particularly important in the aged or chronically ill patient in whom severe dehydration may develop in a short time. The nurse must immediately report symptoms of dehydration, such as dry mucous membranes decreased urinary output, concentrated urine, restlessness or confusion in the older adult. 

A diuretic is a drug that increases die secretion of urine (ie, water, electrolytes, and waste products) by die kidneys. Many conditions or diseases, such as heart failure, endocrine disturbances, and kidney and liver diseases can cause retention of excess fluid (edema). When die patient shows signs of excess fluid retention, die primary healdi care provider may order a diuretic. There are various types of diuretic drugs, and the primary healdi care provider selects the one that best suits die patient s needs and effectively reduces the amount of excess fluid in body tissues. 

To prevent a fluid volume deficit, the nurse encourages oral fluids at frequent intervals during waking hours. A balanced diet may help prevent electrolyte imbalances. The nurse encourages patients to eat and drink all food and fluids served at mealtime The nurse encourages all patients, especially the elderly, to eat or drink between meals and in the evening (when allowed). The nurse monitors the fluid intake and output and notifies the primary health care provider if the patient fails to drink an adequate amount of fluid, if the urinary output is low, if the urine appears concentrated, if tiie patient appears dehydrated, or if signs and symptoms of an electrolyte imbalance are apparent. 

In the ED setting, the diagnosis of ketamine intoxication is a clinical one. Ketamine is not routinely detected by urine toxicology tests, although it can be detected with high-performance liquid chromatography (Koesters et al. 2002). As with MDMA, the initial assessment for ketamine intoxication includes the use of routine laboratory tests to detect electrolyte abnormalities and to evaluate renal and hepatic functioning (Koesters et al. 2002). 

There are no special problems with the reconstitution or handling of these kinds of materials for electrolytes. The concentration of electrolytes is high, and no contamination problems are to be expected. Many commercial suppliers deliver reference materials for electrolytes in serum and urine. 

Goals of therapy are to maintain a state of euvolemia with good urine output (at least 1 ml/kg per hour), to return serum creatinine and BUN to baseline, and to correct electrolyte and acid-base abnormalities. Vital signs, weight, fluid intake, urine output, BUN, creatinine, and electrolytes should be assessed daily in the unstable patient. 

Develop a plan to provide symptomatic care of complications associated with ARF, such as diuretic therapy to treat volume overload. Monitor the patient s weight, urine output, electrolytes (such as potassium), and blood pressure to assess efficacy of the diuretic regimen. 

Electrolytes, complete blood count normal. Urine hCG negative. TSH less than 0.5 milliunit/L (normal 0.5-2.5 milliunits/L) FT4 3.1 ng/dL (39.9 pmol/L normal 0.7-1.9 ng/dL, or 9.0-24.5 pmol/L) +TSHR-SAbs... 

The posterior pituitary is innervated by direct nervous stimulation from the hypothalamus, resulting in the release of specific hormones. The hypothalamus synthesizes two hormones, oxytocin and vasopressin. These hormones are stored in and released from the posterior pituitary lobe. Oxytocin exerts two actions (1) it promotes uterine contractions during labor, and (2) it contracts the smooth muscles in the breast to stimulate the release of milk from the mammary gland during lactation. Vasopressin is an antidiuretic hormone (ADH) essential for proper fluid and electrolyte balance in the body. Specifically, vasopressin increases the permeability of the distal convoluted tubules and collecting ducts of the nephrons to water. This causes the kidney to excrete less water in the urine. Consequently, the urine becomes more concentrated as water is conserved. 

Prevention of tumor lysis syndrome generally is achieved by increasing the urine output and preventing accumulation of uric acid. Prophylactic strategies should begin immediately on presentation, preferably 48 hours prior to cytotoxic therapy. Treatment modalities primarily increase uric acid solubility, address electrolyte disturbances, and support renal output. 

Acute renal failure Sudden loss of the kidney s ability to excrete wastes, concentrate urine, and remove electrolytes. 

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