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MATERIALS REQUIRED BUT NOT SUPPLIED
no interference was observed by the presence of: Current laboratory instrumentation. Spectrophotometer UV/VIS with thermostatic cuvette holder. Automatic micro- pipettes. Glass or high quality polystyrene cuvettes. Deio- Precision
SUMMARY OF TEST
intra-assay (n=10) mean (mEq/l) SD (mEq/l) Chloride is the major extracellular anion. Sodium and chlo- ride together represent the majority of the osmotically Stability: up to expiration date on labels at 15-25°C.
active constituents of plasma. Chloride is therefore signifi- Stability since first opening of vials: preferably within 60 inter-assay (n=20) mean (mEq/l) SD (mEq/l) cantly involved in maintenance of water distribution, osmo- tic pressure and anion-cation balance in the extracellular fluid compartment. In both gastric and small and large inte- PRECAUTIONS
stinal secretions, Cl- is the most abundant anion.
Reagent may contain some non-reactive and preservative Methods comparison
Chloride ions in food are almost completely absorbed from components. It is suggested to handle carefully it, avoiding a comparison between Chema and a commercially availa- the intestinal tract. They are filtered from plasma at the glo- meruli and passively reabsorbed, along with Na+, in the Perform the test according to the general “Good Labora- proximal tubules. In the thick ascending limb of the loop of Henle, Cl- is actively reabsorbed by the so-called “chlo- ride pump,” whose action promotes reabsorption of Na+ SPECIMEN
as well. Loop diuretics such as furosemide and ethacrynic acid inhibit the chloride pump. Surplus Cl- is excreted in Serum, plasma heparinate. Separation of cells from plasma the urine and is also lost in the sweat. Excessive losses in should be prompt. Sweat is a suitable sample.
sweat, as can occur in hot weather, are normally minimized WASTE DISPOSAL
by the action of aldosterone, which is secreted by the adre- Dilute sample urine 1:2 with redistilled water and multiply nal cortex in response to decrease in plasma Na+ and Cl-.
This product is made to be used in professional laborato- Hypochloremia is observed in salt-losing nephritis as asso- TEST PROCEDURE
ries. Please consult local regulations for a correct waste ciated with chronic pyelonephritis. In Addison’s disease, Cl- levels are usually maintained close to normal except in S56: dispose of this material and its container at hazar- Addisonian crisis, when Cl- as well as Na+ levels may drop dous or special waste collection point.
significantly. Hypochloremia may also be seen in those S57: use appropriate container to avoid environmental types of metabolic acidoses that are caused by increased production or diminished excretion of organic acids (e.g., S61: avoid release in environment. Refer to special instruc- diabetic ketoacidosis and renal failure). Persistent gastric secretion and prolonged vomiting, whatever the cause, REFERENCES
result in significant loss of Cl-, and ultimately in hypochlore- mia and depletion of total body Cl-. Other conditions asso- Levinson S.S., Direct determination of serum chloride with ciated with hypochloremia include aldosteronism, bromide a semiautomated discrete analyzer, Clin.Chem. 22:273- intoxication, cerebral salt-wasting after head injury, SIADH, and conditions associated with expansion of extracellular Tietz Textbook of Clinical Chemistry, Second Edition, Mix, incubate at 25, 30 or 37°C for 5 minutes.
fluid volume. In metabolic alkalosis, plasma levels of Cl- Read absorbances of standard (As) and samples (Ax) tend to fall while HCO - levels increase.
Hyperchloremia occurs with dehydration, renal tubular aci- MANUFACTURER
dosis, acute renal failure, metabolic acidosis associated with prolonged diarrhea and loss of sodium bicarbonate, RESULTS CALCULATION
in diabetes insipidus, in adrenocortical hyperfunction, and in salicylate intoxication. A slight rise in Cl- level is seen in respiratory alkalosis. Hyperchloremic acidosis may be a chloride mEq/l = Ax/As x 100 (standard value) sign of severe renal tubular pathology. Extremely high die- tary intake of salt and overtreatment with saline solutions In a study of individuals with hypercalcemia due to either chloride mEq/l = Ax/As x 100 x 2 (standard value and dilu- primary hyperparathyroidism or other causes, plasma Cl- concentrations were 106 ± 5 mmol/l for cases of primary hyperparathyroidism compared with 103 ± 3 mmol/l for the other group. The difference in Cl- levels was believed to be due to the effect of parathyroid hormone on distal tubular chloride mEq/24h = Ax/As x 100 x 2 x urine volume (standard value, dilution factor and diuresis in decilitres) Urinary excretion of Cl- normally approximates dietary intake; physiological increase occurs with postmenstrual EXPECTED VALUES
diuresis and decrease with premenstrual salt and water retention, in parallel with increase and decrease of urinary Na+ level. Massive diuresis of any cause is accompanied by increased Cl- excretion, as is K+ depletion and adrenocor- tical insufficiency. Urinary excretion of Cl- decreases when losses by other routes are increased, as well as in adre- nocortical hyperfunction and in postoperative stress syn- Each laboratory should establish appropriate reference intervals related to its population.
Spectrophotometric methods based on the reaction of chloride ions with HgCNS have been implemented on a QUALITY CONTROL AND CALIBRATION
It is suggested to perform an internal quality control. For this purpose the following human based control sera are PRINCIPLE OF THE METHOD
Chloride ions react with mercuric ions, giving available an QN 0050 CH
QUANTINORM CHEMA 10 x 5 ml
equal quantity of tiocyanate ions. Tiocyanate ions react with normal or close to normal control values with trivalent ferric ions present in solution to form a red QP 0050 CH
QUANTIPATH CHEMA 10 x 5 ml
colored complex with an absorbance peak at 480 nm.
If required, a multiparametric, human based calibrator is KIT COMPONENTS
AT 0030 CH
For in vitro diagnostic use only.
The components of the kit are stable until expiration date Please contact Customer Care for further information.
Keep away from direct light sources.
0100: 2 x 50 ml (liquid) blue cap
0500: 4 x 125 ml (liquid) blue cap
If the limit value is exceeded, it is suggested to dilute Composition: mercury(II) tiocyanate 2.2 mM, mercury(II) sample 1+9 with distilled water and to repeat the test, mul- chloride 0.7 mM, iron (III) nitrate 19 mM.
chloride solution 100 mEq/l - 5 ml
Sensitivity/limit of detection (LOD)
the limit of detection is 1.5 mEq/l.
Dr. Joaquín M. Jiménez Ferrer HUMA3022 (Manifestaciones culturales) La moral—como ya hemos señalado—se da en un doble plano: el normativo y el fáctico. Por un lado, encontramos en ella normas y principios que tienden a regular la conducta de los hombres, y, por otro, un conjunto de actos humanos que se ajustan a ellos, cumpliendo así su exigencia de realización. La esencia de la mora