electrolytes used for replacement therapy , combination of oral electrolyte powder & solution

1. Major electrolytes
Pt. L R College of Pharmacy
faridabad

2. Electrolytes used in acid-base
therapy( inorganic compounds)
• Sodium acetate
• Potassium acetate
• Sodium bicarbonate
• Sodium citrate
• Potassium citrate
• Sodium lactate
• Ammonium chloride
• Potassium bicarbonate

3. • Body of human beings contains both body
fluid & electrolytes
• The body fluids are divided into followings
• Intracellular fluid:- (intra means inside
the cell) fluid present inside the cell or as
cytoplasmic fluid. It’s about 45-50% of
body wt.
• Extra cellular fluid:- fluid present outside
the cells i.e. it is about 12-15% of body wt.

4. Prolonged fever, sever vomiting or
diarrhea cause the dis-balancing of
physiological ions in the human body
instead in the normal situation body
mechanism itself maintains the
physiological ions conc” & maintain the
electrolytes in the body but whenever body
fails to do that mechanism we needs to
replace the ions from out side of body.

5. • Diarrhea:- passage of loose , liquid or
watery stool
Clinical types of diarrheal disease
• Acute watery diarrhea
• Acute bloody diarrhea
• Persistent diarrhea
• Diarrhea with severe malnutrition
( marasmus & kwashiorkor )

6. Control of diarrheal diseases
• Short term
(a.) Appropriate clinical management
• ORS
• Intravenous rehydration
• Maintenance therapy
• Appropriate feeding
• Chemotherapy
• Zinc supplementation

7. ( b.) better MCH care practices
Maternal nutrition
Child nutrition
( c.) preventive strategies
Sanitation
Health education
immunization

8. What is replacement therapy ?
Under the deficiency of physiological ions
in the body they are supplemented with
more ions this therapy is called
supplemented or replacement therapy
the basic objective
of replacement
therapy is to restore
the volume &
composition of body
fluid to normal

9. It is further divided into following
1. Sodium replacement
2. Potassium replacement
3. Calcium replacement

10. Sodium replacement
• Sodium chloride, sodium chloride dextrose
injection, sodium chloride fructose
injection, compound sodium chloride
dextrose inj. NaCl hypertonic inj.,
compound NaCl sol”, NaCl irrigation sol”
Sodium chloride
NaCl
mw. 58.45 gm/mol

11. Industrially prepared by
1. Evaporating purified
saline (sea water )
deposits & further
purification
2. By purifying rock salt
Storage
It is stored in tightly closed
containers in dry place as it
absorbs moisture

12. Physical properties
• Colorless cubic crystals
• Saline taste & odorless
• Soluble in water, glycerin
• Slightly soluble in alcohol

13. Uses
• It is salt extra cellular fluid
• Used for replacement therapy & manufacturing
of isotonic sol” (0.9% w/w)
• Isotonic solution used as wet dressing for
irrigating body cavities
• Tissue hypertonic sol” are administered for
maintenance therapy when patient is unable to
take fluid orally for 1-3 days
• Hypertonic inj. used in loss of sodium
• orally administered hypertonic sol” induces
vomiting so used in poisoning accidents

14. Potassium replacement
• Potassium chloride, KCl & dextrose inj.
Potassium citrate
Potassium chloride
KCl mw. 74.56 gm/mol
Storage
It is stored in tightly closed containers in
dry place as it absorbs moisture

15. Physical properties
• Colorless, odourless
• Elongated, prismatic or cubical crystals
• Saline taste
• Soluble in water
• Insoluble in alcohol, ether

16. Uses
• Drug of choice for
oral replacement of
potassium
• Used in digitalis
poisoning

17. Sodium acetate
CH3COONa MW. 82.034 g/mol
Synonym :- Hot ice,
• sodium acetate tri-hydrate is prepared by
reacting acetic acid with sodium
hydroxide using water as the solvent.
CH3COOH + NaOH → CH3COONa + H2O

18. Physical properties
• White deliquescent powder
• Vinegar (acetic acid) odor when heated to
decomposition
• Soluble in water, alcohol, hydrazine, SO2
• Monoclinic crystal structure
• Slightly saline & bitter taste

19. Uses
• It is a ingredient of peritoneal dialysis fluid
• Acts as alkalizing agent & also causes diuretic
action
• used as the carbon source for culturing bacteria
• used to give potato chips a salt and
vinegar flavor
• act as a buffer to keep a relatively constant pH
level
• It is also used in heating pads, hand warmers,
and hot ice

20. Potassium acetate
CH3COOK MW. 98.14 gm/mol
Preparation
CH3COOH + KOH → CH3COOK + H2O
• This type of rxs is called acid-base
neutralization

21. Physical properties
• White deliquescent crystalline powder
• Soluble in alcohol, liquid ammonia
• Insoluble in ether, acetone
• Monoclinic crystal structure

22. Uses
• Deicing
• Potassium acetate is the extinguishing
agent used in Class K fire extinguishers
• used as a food additive as
a preservative and acidity regulator
• Drug of choice for oral replacement of
potassium

23. Sodium citrate
MW. 258.06 g/mol (anhydrous)
Synonym:- Tri-sodium citrate , Citrosodine
Citric acid, tri-sodium salt, Sodium citrate
E331

24. Physical properties
●White crystalline powder
●slightly deliquescent in
moist air
●Freely soluble in water
●salt effloresces on exposure
to dry air
●Practically insoluble in
Alcohol & ether
●Like citric acid, it has a sour taste

25. Uses
• used as a food additive, usually for flavor or as
a preservative
• buffering agent or acidity regulator from the medical
point of view, it is used as alkalinizing agent
• sodium citrate as an anticoagulant in blood transfusions
• Sodium citrate is used to relieve discomfort in urinary-
tract infections, such as cystitis
• used as an osmotic laxative
• agent for removal of carbonate scale from boilers without
removing them from operation
• Good sequestering properties

26. Sodium bicarbonate
NaHCO3 MW. 84.00 gm/mol
• Synonym:- Baking soda, bicarb (laboratory
slang), bicarbonate of soda, nahcolite,
bread soda, cooking soda.
• Preparation:- solvay’s process

27. Physical properties
• White crystalline powder
• Freely soluble in water
• odourless
• Insoluble in alcohol & ether
• Saline taste
• Monoclinic crystal structure
• Salt effloresces on the exposure to dry air
thus stored in air tight container

28. uses
• primarily used in baking as a leavening agent
• Baking soda is used to soften pulses (peas,
beans) before and during cooking
• Fungicide and pest control
• has weak disinfectant properties
• Pyrotechnics
• used to neutralize unwanted acid to treat acid
indigestion and heartburn i.e. stomach
acid produces salt, water, and carbon dioxide

29. NaHCO3 + HCl → NaCl + H2O + CO2(g)
• It is added to local anesthetics, to speed
up the onset of their effects and make their
injection less painful
• component of Moffett's solution, used
in nasal surgery
• Toothpaste containing sodium bicarbonate
have better whitening & plaque removal
effect
• used in a process for removing paint and
corrosion called soda-blasting

30. Potassium citrate
K3C6H5O7 MW.306.395 g/mol
• Synonym:- tri-potassium citrate
• Preparation:- add potassium bicarbonate
or potassium carbonate to citric acid untill
effervescence stops followed by filtration,
evaporation
K2CO3 + C6H8O7 K3C6H5O7

31. Physical properties
• White crystalline hygroscopic powder
• Freely soluble in water
• odour-less
• Insoluble in ethanol
• Saline taste
• Soluble in glycerin

32. uses
• to treat/manage gout and arrhythmia
• used as an alkalizing agent in the treatment of
mild urinary tract infections such as cystitis
• used in many soft drinks as a buffering agent
• used to treat urinary calculi (kidney stones)
• Long standing diarrhea causes the hypo-kalemia

33. Sodium lactate inj.
C3H5O3Na MW. 112.O3 gm/mol
Synonym:- Sodium DL-lactate; Lactic acid sodium salt;
E325, Sodium 2-hydroxypropanoate, RL BOTTLE
Preparation
By fermentation of sugar sources like
corn beet then neutralize to obtain lactic
acid

34. Sodium lactate injection, I.P.
• It is sterile sol” of sodium lactate which
contain not less than 1.75% & not more
than 1.95% sodium lactate
Formula:-
Lactic acid 14 ml
NaOH 6.7 gm
Dil HCl q.s.
WFI q.s. 1000ml

36. Physical properties
• White crystalline powder
• Water soluble
• Odourless
• Mild saline taste

37. uses
• as a preservative, acidity regulator, and bulking
agent
• used in shampoo products and other similar
items such as liquid soaps, as it is an
effective humectant and moisturizer
• used to treat arrhythmias caused by overdosing
of class I antiarrythmics, as well as
presser sympathomimetics resulting in
hypertension
• Fluid & electrolyte re-plenisher used in a
strength of 1/6 molar
• Given i.v. in treatment of metabolic acidosis in
patients of limited oral intake of sod’ bicarbonate

38. Ammonium chloride inj.
NH4Cl MW. 53.49 gm/mol
Synonym:- ammonium muriate
• MOP:- neutralizing hydrochloric acid with
ammonia & evaporating sol” to dryness
NH3 + HCl NH4Cl

39. Physical properties
• White crystalline powder
• Cool, saline & hygroscopic
• Freely soluble in water & glycerin
• Sparingly soluble in alcohol

40. Ammonium chloride injection U.S.P
• It is 100 m-eq, sterile, non-pyrogenic sol”
of NH4Cl in WFI used i.v.
– Ammonium chloride increases acidity by
increasing the amount of hydrogen ion
concentrations.
– Ammonium chloride can be used as an
expectorant due to its irritative action on the
bronchial mucosa. This effect causes the
production of respiratory tract fluid which in
order facilitates the effective cough.

41. uses
• Expectorant in cough syrups
• diuretic & systemic acidifier
• The ammonium ion (NH4+) in the body plays an
important role in the maintenance of acid-base
balance. The kidney uses ammonium (NH4+) in place of
sodium (Na+) to combine with fixed anions in
maintaining acid-base balance, especially as a
homeostatic compensatory mechanism in metabolic
acidosis. The therapeutic effects of Ammonium Chloride
depend upon the ability of the kidney to utilize ammonia
in the excretion of an excess of fixed anions and the
conversion of ammonia to urea by the liver, thereby
liberating hydrogen (H+) and chloride (Cl–) ions into the
extracellular fluid.
• Ammonium Chloride Injection, USP, after dilution in
isotonic sodium chloride injection, may be indicated in
the treatment of patients with: (1) hypochloremic states
and (2) metabolic alkalosis

42. Combination of oral electrolyte
powder & solution

43. Types of oral electrolyte powder & solutions
1. sodium carbonate based
2. tri-sodium citrate based
3. reduced osmolarity based
4. zinc containing ors

44. At first the composition of ORS
recommended by WHO was sodium
carbonate based but product was not more
stable

45. Tri-sodium citrate based ors is more stable,
longer shelf life & less stool output
especially in high output diarrhea as in cholera
because sodium citrate directly increases the
intestinal absorption of sodium & water

46. • In 2003, WHO and UNICEF recommended
that the osmolarity of ORS be reduced from
311 to 245 mosm/L. This recommendation
was based on multiple clinical trials showing
that the reduced osmolarity solution reduces
stool volume in children with diarrhea by
about 25% and the need for IV therapy by
about 30% when compared to standard
ORS.
• Since january 2004, only new ORS
formulation is procured by UNICEF & india
was first country in the world to launch this
ORS formulation since june 2004.

47. • “Soft drinks, plain glucose water,
sweetened fruit juices & sweetened tea
should not be used because they have
high osmolarity & leads to worsening of
dehydration”
So use
oral rehydration solution
or home available fluids
(HAF)

48. New WHO recommended:- reduced
osmolarity ORS ( low Na ORS)
Composition (gm) Osmolar conc” (mmol/l)
Sodium
chloride
2.6 Sodium 75 45
Potassium
chloride
1.5 Potassium 20 40
Sodium
citrate
2.9 Chloride
Mg++,Zn++,Cu++
65 70
04
glucose 13.5 Citrate 10 7
Glucose 75 125
Total 20.5 Total 245 300

49. Zinc based ORS reduces
the duration of diarrhea in
pediatric patients

50. • Rice based ORS glucose replaced with starch or oligosaccharides
• The Benefits of Rice-Based Oral
Rehydration Therapy
• Cost Effective (IV vs. Oral)
• Lack of Complications
• Lack of Pain
• Provides calories from complex carbohydrates
• Less worry when mixing because rice-based ORS has a lower osmolarity then glucose-
based ORS
• Lower osmolarity also means better absorption
• Always works as well as glucose-based ORS and is even more effective in severe cases of
dehydration
• Sustained hydration (larger molecule, more substrate)
• Tastes better