BMP & LFTs

Albumin and liver function tests (LFT's) are added

How is a comprehensive metabolic panel (CMP) different than a BMP?

Dehydration, a patient of diuretics, potassium, checking glucose, evaluating kidney function, etc

When is BMP done?

Electrolytes

Minerals in your blood and other body fluids that either carry a positive charge (cation) or negative charge (anion)

Sodium

Main extracellular cation

water

Physiologically, sodium is closely related to ____________

Maintain water balance between blood and body tissue cells, transmitting nerve impulses (excitability), and acid-base equilibrium

What are the major roles of sodium?

False; sodium

T/F? Potassium is the most common electrolyte abnormality in hospitalized patients

kidneys; blood

Sodium is excreted by the ______________, which serves to regulate its content in the _____________ after ingesting it

Hypernatremia

Term for too much sodium

"water problem"; sodium homeostasis

Hypernatremia is indicative of a ________________ not a problem with ___________________

Dehydration

What is the most common cause of hypernatremia?

Iatrogenic (excessive Na in IV)

What is a common cause of hypernatremia (besides dehydration)?

Neurologic and dehydration symptoms

What are two broad categories for signs and symptoms of hypernatremia?

Hyperreflexia, ataxia, tremor, delirium, mania, convulsions, and coma

What are some neurologic signs and symptoms of hypernatremia?

Increased thirst, orthostatic hypotension, and oliguria

What are some dehydration symptoms of hypernatremia?

Fluid resuscitation (but not too quickly)

What is the most common treatment for hypernatremia?

Central pontine myelinosis (degradation of myelin sheaths)

What can occur if fluid resuscitation for hypernatremia occurs too rapidly?

Hyponatremia

Too little sodium

Fluid overload (dilutes electrolyte)

Main cause of hyponatremia

True

T/F? Hyponatremia is the most common electrolyte disorder seen in the general hospital population

Decreased sodium intake, increased sodium loss, and increased free body water

What can cause hyponatremia?

Deficient sodium in IVF

What is a common cause for decreased sodium uptake leading to hyponatremia?

Neurologic symptom of weakness

Most common symptom of hyponatremia

volume status; water imbalance

It is important to assess ______________ in the treatment of hyponatremia because most cases are due to _______________

IV saline (different amount/concentration for different patients)

Common treatment for hyponatremia

central pontine myelinolysis

It is important to not administer IV saline too quickly for hyponatremia because it could cause...

Potassium

Main intracellular cation

Potassium

What is the most closely watched electrolyte?

1. Regulating muscle/nerve excitability

2. Control rate and force of heart contraction (cardiac output)

3. Acid-base balance and osmotic pressure

What are the major roles of potassium?

Adverse affects on electrical activity of heart

What is the most serious morbidity associated with potassium?

Kidneys do not conserve it, so deficiencies can occur

Why is it important to replenish potassium daily?

Hyperkalemia

Too much potassium

Renal failure due to kidney disease, hemolysis, medications, and diet

What are some etiologies of hyperkalemia?

Weakness or paralysis and cardiac arrhythmias

What are sign and symptoms of hyperkalemia?

Changes in EKG

What is a common symptom of hyperkalemia associated with cardiac arrythmias?

Peaked T-waves and flattened P-waves

How does an EKG change in an individual with hyperkalemia?

Withhold potassium and treat with calcium chloride or gluconate via IV to restore a normal K+ gradient (no direct effect on K+)

What is the first step in treatment of hyperkalemia?

Insulin and dextrose, sodium bicarbonate, sodium polystyrene sulfonate (SPS) (Kayexalate), and dialysis

What are other treatments for hyperkalemia following calcium chloride or gluconate treatment?

Hypokalemia

Too little potassium

Medications, gastrointestinal (GI), endocrine, and renal

What are some etiologies of hypokalemia?

Diuretics

What medication commonly serves as an etiology for hypokalemia?

Weakness and paralysis, hyporeflexia, and cardiac arrythmias

What are signs and symptoms of hypokalemia?

Depressed T waves

How does an EKG change for a person with hypokalemia?

Oral (mild) or IV (severe) potassium replacement

What is the most common treatment for hypokalemia?

Chloride

Major extracellular anion and least important electrolyte

Acid-bae balance and water balance

Primary functions of chloride

sodium

Chloride changes parallel to...

cations (sodium)

Chloride is excreted with...

sodium

The signs, symptoms, and treatment for hypochloremia and hyperchloremia follow those of...

sodium

Basically to treat chloride, treat...

Carbon dioxide

Electrolyte that serve as a reflection of the acid-base balance in the body

bicarbonate in the blood

Carbon dioxide is an indirect measure of...

bicarbonate

Carbon dioxide is sometimes referred to as _____________ on tests

Dehydration and COPD

What are some etiologies for an increase in carbon dioxide?

alkalosis

An increase in carbon dioxide is referred to as...

Severe diarrhea and renal disease

What are some etiologies for a decrease in carbon dioxide?

acidosis

A decrease in carbon dioxide is referred to as...

Arterial blood gas (ABG)

To diagnose a cause for a change in carbon dioxide, what is performed?

Treat underlying condition

How do you treat changes in carbon dioxide?

Blood urea nitrogen (BUN)

Indirect and rough measure of kidney function

metabolic function of liver; secretory function of kidneys

BUN is directly related to ________________ and ____________________

Urea

Byproduct of protein metabolism in the liver that travels through blood to the kidneys to be excreted

Balance between production in the liver, intake of protein, and excretion by kidneys

BUN reflects what?

Protein intake and hydration status

What most directly affect BUN?

higher

If you eat more protein, your BUN will be...

Azotemia or renal failure

What are some etiologies for an increased BUN?

prerenal, renal, or postrenal conditions/complications

Azotemia or renal failure can be caused by...

Dehydration and excessive protein breakdown

What are some prerenal etiologies that increase BUN and cause azotemia (renal failure)?

Kidney disease

What are some renal etiologies that increase BUN and cause azotemia (renal failure)?

Liver failure, low protein diets/malnutrition, celiac disease, and SIADH

What are some etiologies for a decreased BUN?

Creatinine

Byproduct of muscle energy metabolism

renal function

Any disease that affects ____________ affects creatinine

more

Creatinine is a more/less specific test of renal function (in comparison to BUN)

It is not affected by liver function, while BUN is

Why is creatinine better than BUN to assess renal function?

Renal disease, rhabdomyolysis, CHF, and shock

What are etiologies for increased creatinine?

Decrease in muscle mass

What is an etiology for decreased creatinine?

Glucose

The levels of this BMP molecule is controlled by insulin and glucagon

Diabetes mellitus, drugs such as corticosteroids and diuretics, and stress

What are some etiologies for hyperglycemia (high glucose)?

Polyuria, polydipsia, fatigue, blurry vision, and unexplained weight loss

What are some signs and symptoms of hyperglycemia?

Insulinoma, decrease in carb ingestion, drugs, and liver disease

What are some etiologies of hypoglycemia?

"Strange feeling", diaphoresis, and palpitations

What are some symptoms of hypoglycemia?

Calcium

Stored in teeth and bones

Parathyroid hormone (PTH)

What causes the release of calcium from reservoirs into the blood?

Ionized calcium and protein bound calcium

What is total calcium made up of?

True

T/F? Both types of calcium, ionized and protein bound, can be measured, and total and/or ionized are typically reported

Albumin

What protein is calcium often bound to (half of calcium, other half is free)?

phosphate

Calcium is inversely related to...

Ionized form

What form of calcium is unaffected by albumin levels?

albumin levels

Total calcium must be corrected for ________________ if high or low

Hyperparathyroidism, malignancy, increase in vitamin D, and milk alkali syndrome

What are some etiologies of hypercalcemia (lots of calcium)?

Hyperparathyroidism

What is the most common cause of hypercalcemia?

PTH; bone

Malignancy can cause hypercalcemia by secreting _________ or destroying ______________

Simultaneous administration of saline for hydration, calcitonin, and bisphosphates

What are treatments for hypercalcemia?

Chronic renal failure, hypoalbuminemia, hypoparathyroidism, hyperphosphatemia, and rickets

What are some etiologies of hypocalcemia (low calcium)?

Can be asymptomatic, or it can cause neurologic symptoms such as trousseau sign and chvostek sign, as well as skin and cardiac symptoms

What are some signs and symptoms of hypocalcemia?

Treat underlying condition (supplement vitamin D and calcium)

How do you treat hypocalcemia?

Phosphate

Found in the body mostly has organic compounds

Contributes to electrical and acid-base homeostasis

What is a function of phosphorus?

Calcium metabolism and vitamin D because they have an inverse relationship

What primarily determines phosphorus levels?

hypocalcemia

The signs and symptoms of hyperphosphatemia (high phosphate) mirror those of...