Lab Med Quiz 2

Components of BMP (endocrine)(1)

glucose

Components of BMP (kidney function)(4)

BUN

Creatinine

BUN:Cr

eGFR

Components of BMP (electrolytes)(4)

Calcium

Sodium

Potassium

Chloride

Components of BMP (blood gas/pH of blood)(1)

CO2

CMP (Complete Metabolic Panel)

BMP + LFT's (liver function)

Fishbone Diagram (top)(from left to right)

Na; Cl; BUN

Fishbone Diagram (bottom)(from left to right)

K; CO2; Cr

Fishbone Diagram (tail)

Glucose

Glucose normal range (fasting)

70-100 mg/dL

What is used to assess blood glucose level?

Glucose

What is used for evaluation of diabetes?

Glucose

Critical values of glucose (male)

<50 and >450 mg/dL

Critical values of glucose (female)

<40 and >450 mg/dL

What 2 things can increase glucose?

Stress and caffeine

types of stress listed in powerpoint (3)

trauma

infection

MI

strenuous exercise

shock

What does BUN stand for?

blood urea nitrogen

How is BUN formed?

in liver as product from protein metabolism and digestion

BUN uses (2)

assess kidney function

assess liver function

Term for increase in BUN levels

azotemia

What affects BUN?(3)

dietary protein intake, muscle mass, advanced pregnancy

Where is BUN excreted?

kidneys

Creatinine use?

assess kidney function

Catabolic product of creatinine phosphate (used in muscular contraction)

creatinine

daily production is dependent on muscle mass (should not change much)

creatinine

can be affected by gigantism

creatinine

high dietary meat consumption transiently elevates what?

creatinine

Creatinine is excreted by?

kidneys

Acute increases in what signify reduction in kidney filtration rate?

creatinine

BUN:Cr is used to assess what?

kidney and liver function

BUN:Cr in relation to age and decreasing muscle mass (increases or decreases)

increases

Low protein intake causes a high or low BUN:Cr?

low

Advanced liver disease causes a high or low BUN:Cr?

low

Rhabdomyolysis causes a high or low BUN:Cr?

low

Kidney damage causes a high or low BUN:Cr?

low

Hypothyroidism causes a high or low BUN:Cr?

low

Dehydration causes a high or low BUN:Cr?

high

GI bleed causes a high or low BUN:Cr?

high

CHF causes a high or low BUN:Cr?

high

Kidney disease causes a high or low BUN:Cr?

high

Hyperthyroidism causes a high or low BUN:Cr?

high

eGFR stands for?

estimated glomerular filtration rate

eGFR is used to assess?

kidney function

eGFR is calculated using...(3)

serum Cr

sex

age

Calcium use to assess?(4)

assess electrolyte

evaluate parathyroid function

renal diseases

some malignancies

Hyper or hypo with calcium? (hyperparathyroidism)

hypercalcemia

Hyper or hypo with calcium? (malignancy)

hypercalcemia

Hyper or hypo with calcium? (excessive vitamin D intake)

hypercalcemia

Hyper or hypo with calcium? (hypoalbuminemia in alcoholics)

hypocalcemia

Hyper or hypo with calcium? (chemotherapy)

hypocalcemia

Hyper or hypo with calcium? (certain drugs - bisphosphates)

hypocalcemia

What can affect calcium levels?(2)

excessive milk ingestion

prolonged tourniquet time

Chloride is uses? (2)

electrolyte

extra-cellular anion

Chloride functions (3)

Maintain electrical neutrality as a salt w/ sodium

affects water balance

buffer in acid-base balance

What can increase chloride levels?

excessive saline infusions

CO2 is used to assess?(2)

serum pH

electrolytes

CO2 plays a major role in?

acid-base balance

What can affect CO2 levels?

air (under filling tube with blood)

Venous blood is more accurate for CO2 levels (T/F?)

False, arterial blood gas more accurate

Sodium critical values

<120 and >160 mEq/L

Na uses (2)

assess fluid

electrolyte balance

Is a major cation and electrolyte in extracellular fluid

Na

How are Na blood levels determined usually?(2)

dietary Na intake

renal excretion

_______ ---> kidneys reabsorb Na ---> decrease renal loss ---> Na conservation

aldosterone

Na blood levels high ---> ______ ---> decreases Na renal absorption ---> increases Na renal loss

Natriuretic hormone

_____ controls water reabsorption in kidneys ---> dilution or concentration affecting Na blood levels

Antidiuretic hormone (ADH/vasopressin)

alcohol and coffee inhibits _____

ADH

Hypernatremia definition and critical value

high levels of Na

>150 mEq/L

Symptoms of hypernatremia (8)

dry mucous membranes

thirst

agitation

restlessness

hyperreflexia

mania

seizures

coma

rapid decrease of cerebral volume ---> cerebral vein rupture ---> hemorrhage

acute hypernatremia

less likely to induce neurological symptoms in adults

chronic hypernatremia

slow correction in infants

chronic hypernatremia

Hypernatremia causes (4)(general)

increased sodium intake

decreased sodium loss

excessive free body water loss

medications

Na intake examples (2)

dietary

IV

decreased Na loss examples (2)

Cushing syndrome

hyperaldosteronism

excessive free body water loss examples (5)

GI loss

excessive sweating

extensive burns

diabetes insipidus - ADH deficiency

osmotic diuresis

medications causing hypernatremia (5)

steroids

estrogens

laxatives

OCP

cough medications

Hyponatremia definition and critical value

low levels of Na

<135 mEq/L

hyponatremia causes (4)(general)

decreased Na intake

increased Na loss

increased Free body water

medications

increased Na loss examples (8)

Addison's disease

diarrhea

vomiting

nasogastric aspiration

intraluminal bowel loss (3rd spacing)

diuretics

chronic renal insufficiency

large volume aspiration of lung or peritoneal fluid

examples of increased free body water (8)

excessive oral/iv H2O intake

hyperglycemia

CHF

peripheral edema

ascites

pleural effusion

intraluminal bowel loss (3rd space losses of Na)

syndrome of innapropriate or ectopic secretion of ADH

medications causing hyponatremia (8)

ACE-I

diuretics

haloperidol

heparin

NSAIDS

sulfonylureas

tricyclic antidepressants (TCA)

vasopressin

potassium critical values

<3 or >6.1 mmol/L

K blood level uses?(3)

cardiac function

evaluated in serious illness

maintenance of membrane electrical potential (neuromuscular issues) affecting heart rate and contractility

What is excreted by kidneys with NO renal absorption?

K

What levels can drop rapidly if not in diet or IV infusion?

K

Common factors affecting K(3)

aldosterone - increases renal losses of K

Na reabsorption - K loss

acid-base balance - alkalotic state DECREASES K, acidotic states INCREASES K

What is hyperkalemia?

high levels of K (>5.5)

Symptoms of hyperkalemia(4)

irritability

nausea/vomiting

GI cramping/colic

diarrhea

Signs of hyperkalemia(4)

ascending muscle weakness

paralysis

cardiac arrhythmias

ECG -> peaked T waves, widened QRS, depressed ST

Hyperkalemia causes(9)

increased K intake

acute/chronic renal failure

Addison's disease

Hypoaldosteronism

acidosis

crush injury

dehydration

insulin deficiency, hyperglycemia, hyperosmolality

medications

medications that cause hyperkalemia(4)

beta-blockers

ACE-inhibitors/ARBs

digitalis overdose

aldosterone-inhibiting diuretics (spironolactone, triamterene)

What is hypokalemia?

low levels of K (<3.5)

Signs of hypokalemia (5)

decreased contractility causing:

ascending muscle weakness

paralysis

arrhythmias

cardiac sensitivity to digoxin

ECG -> U waves, flattened T waves

Causes of hypokalemia (14)

decreased K intake

insulin administration

diuretics

burns

GI (diarrhea,vomiting)

hyperaldosteronism

Cushing's syndrome

renal tubular acidosis

renal artery stenosis

cystic fibrosis

ascites

alkalosis

licorice

medications

What medications cause hypokalemia?(4)

amphotericin B (antifungal)

barium intoxication

chloroquine intoxication

antipsychotics (quetiapine, risperidone)

Acute Kidney Injury is defined as...(3)

increase in serum creatinine by .3 w/in 48 hours or 50% in 7 days

increase in serum creatinine to >.3 or > 50% over 48 hours

urine volume <.5 for 6 hours (NOT NEEDED FOR TESTING PURPOSED)

"Pre-renal" in context to AKI

decreased blood flow to kidneys

BUN:Cr for pre-renal AKI

>20:1

causes of pre-renal AKI (5)

Congestive heart failure (CHF)

shock (sepsis, GI bleed)

acute tubular necrosis

dehydration

vomiting, diarrhea w/ dehydration

"renal" in context to AKI

intrinsic kidney damage