MNT I Lab Values

Over hydration, as evidenced by edema will do what to lab values?

Dilute

Dehydration, due to vomiting or diarrhea makes lab values appear_______

Higher

What is the best way to get dehydration or over hydration under control?

Restore fluid balance

______ _________ can help assess hydration statues as well.

Serum osmolality

Inflammation can be both ________ and _______

acute (post-surgery)
chronic (obesity)

Some labs will ________ with inflammation for positive acute phase respondents

increase

Some labs will ________ with inflammation for negative acute phase respondents

decrease

Hyponatremia

Low sodium serum may be caused by vomiting, diarrhea, continuous IV 5% dextrose; low sodium diet, inflammatory reactions

Factitious Hyponatremia

Caused by high glucose

Pseudohyponatremia

Caused by high triglyceride and/or protein levels

Severe hyponatremia

<120mEq/L can lead to seizure, coma, and death

Hypernatremia

Dehydration, severe vomiting and diarrhea, high-sodium diet

What's the difference between dehydration and hypovolemia?

Patients with dehydration are always hypernatremic- only losing water, not sodium

What are signs of hypervolemia?

edema, pulmonary crackles- should limit free water

What are signs of hypovolemia?

thirst, dry throat, hypotension, tachycardia- increase free water and sodium

Hypernatremia

replace free water and watch potassium

What can abnormal potassium values cause?

Hypokalemia- caused by decreased intake, protracted vomiting, nasogastric aspiration, renal failure, infection and hemolyzed blood.

How are sodium and chloride values related?

When sodium is normal, chloride is normal.

Alkalosis

When blood pH is too high

Acidosis

When blood pH is too low

BUN- blood urea nitrogen

If someone is dehydrated then their BUN is going to be HIGH

BUN

Elevated in kidney disease and protein catabolism, decreased in liver failure, negative nitrogen balance

Creatinine

Excreted by the kidneys- reflects kidney function. Renal problems indicated when high. High-dose of Vitamin C and dehydration can raise values

Glucose

High in diabetes, also high during stress

Albumin

Important for maintaining oncotic pressure (the force keeping fluid in the capillaries). Marker of inflammation

Low Albumin

Frequently seen in patients with edema

Total Protein

Measurement of both albumin and globulins, if Tprot is low it suggests liver or kidney issues (not specific)

Alkaline phosphatase ALP

produced in liver and bone, derived from kidney, intestine and placenta. Found in bone tissue

AST and ALT

Indicative of LIVER disease.

Total Bilirubin (T-bili)

Increased serum bilirubin levels indicate obstructive disease of the liver, hemolysis or actual liver cell damage

High T-bili

Jaundice occurs

Total Calcium

Low hypocalcemia in cases of kidney failure, pancreatitis, high phos, low mag, low vit D, VERY low Ca diet.

Total Cholesterol

Risk of CHD and CVD when high

LDL cholesterol

Risk of CHD and CVD when HIGH

HDL cholesterol

Risk of CHD and CVD when LOW

Triglycerides

Risk of CHD when HIGH, elevated in uncontrolled diabetes

Prothrombin Time (PTT)

Reduced when vitamin K is low or when on anticoagulant therapy (Coumadin/Warfarin)

High-Sensitivity C-reactive Protein Hs-CRP

Measures presence of inflammation

Alb, PAB, retinol binding protein and transferrin

Hepatic transport proteins and negative acute phase reactants. All will decrease during stress, injury, and illness.

If CRP is elevated albumin is likely to be _____

low

Albumin

An indicator of what was going on pre-hospitalization

Pre-albumin

What is going on right now

Stress

Do not overfeed patients when they are stressed. Once in an anabolic phase, more aggressive therapy can be started.

CRP proteins

Levels go up sharply when stressed and decrease when stress subsides