lab med test 2 lecture 7 and 8

pCO2

there is a correlation with ABG and VBG but the confidence intervals are large

- ph

- HCO3

- Base deficit

Correlation in theses specific values for ABG and VBG

PaO2

what value has no correlation and only can look at ABG to get the value

ABG

Is ABG or VBG the gold standard, more difficult and painful to access

- arterial punction increased risk

- hypoxemia pt

- pt in shock

What are some key characteristics to ABG

VBG

Can be used for ph, screening for hypercarbia, and lactate trending

- obtained as a nurse obtains IV access

- decreased risk with no arterial injury

what are some key characteristic for VBG

7.35- 7.45

Normal ph

PaCO2

what value is effected based off lung function

HCO3-

what value is effected based off kidney function

respiratory acidosis

decreased ph, increased PaCO2, increased HCO3

respiratory acidosis

retaining co2

respiratory alkalosis

increased ph, decreased PaCO2, decreased HCO3

Metabolic Acidosis

decreased ph, PaCO2, and HCO3

Respiratory Alkalosis

blowing odd to much CO2

Metabolic Acidosis

gain of H+ or loss of HCO3

metabolic alkalosis

increased ph, PaCO2, and HCO3

metabolic alkalosis

loss of H+ or gain of HCO3

chemical buffer

on the scene in seconds, already present in tissues and will handle minor changed in acid base balance

respiratoy

retention of elimination of CO2 within minutes, can handle mild to moderate acid base shifts

renal

regulates bicard to combat hydrogen loss and gain, starts within hours, but more permanent, when the other two mechanisms fail this system slowly gets to work and requires 5 days to complete

metabolic alkalosis

loss of H+ or increase production/ingestion of HCO3-

- vomiting or nasogastric suction

- hypovolemia

- loop/thiazide diuretics

common causes of chloride responsive metabolic alkalosis

- hyperaldosteronism

- cushing syndrome

common causes of chloride resistive metabolic alkalosis

- Na

-K

Cations

- Cl

-HCO3

anions

k

not always used for anion gap

[(Na)+ (K)]-[(Cl)+(HCO3)]

formula for anion gap with k

(Na)-[(Cl)+(HCO3)]

formula for anion gap without k

- albumin

- also contains phosphate, sulfate, and other anions

what is the anion gap primarily composed of

high anion gap metabolic acidosis

HAGMA

anion gap metabolic acidosis

AGMA

normal anion gap metabolic acidosis

non-anion gap metabolic acidosis

NAGMA

Methonal

Uremia

Diabetic ketoacidosis

Propylene glycol

Isoniazid/iron

Lactic acid

Ethonal/ ethylene glycol

Salicylates (aspirin)

metabolic acidosis HAGMA or AGMA characteristics

Hyperalimentation

Acetazolamide use

Renal tubular acidosis

Diarrhea

Uretosigmoid fistula

Pancreatic fistulas

metabolic acidosis NAGMA characteristics

because of alkali loss of the pancrease secretes a bicarbonate-rich fluid

why does Pancreatic fistulas cause NAGMA

because the colon will waste bicard

why does uretosigmoid fistula cause NAGMA

- Type 1= distal

- type 2= proximal

- type 3= hyporeninemic hypoaldosteronism

what are the types of renal acidossi

<40 and >450

what are critical levels of serum glucose for women

<50 and >450

what are critical levels of serum glucose for men

- food injestion

- glucagon

- stress

- acute pancreatitis

- cushing syndrome

- pregnancy

- medications

what increases glucose levels

- iv fluid contain dextrose

- antidepressants

- antiphychotics

- corticosteriods

- duiretics

- estrogen

- statin

what medications increase glucose

- exercise/ actvity

- hypopituitarism

- addison disease

- extensive live disease

- starvation

- drugs

what decrease glucose levels

- insulin

- acetmainophen

- gemfibrozil

- propranolol

- sulfonylureas

what drugs decrease glucose levels

- blood glucose monitoring uses capillary beds in home or clinic

- continuous glucose monitor with use of interstitial fluid

how do we measure serum glucose levels with a glucometer

- increased thirst

- frequent urination

- extreme hunger

- blurred vision

- slow healing cuts

- fatigue

what are some symptoms of hyperglycemia

- shaking or trembling

- fast heart rate

- extreme hunger

- sweating

- confusion/difficulty concentration

- dizziness

what are some symptoms of hypoglycemia

abnormal

glucose levels of 130 fasting means

normal if meal was ingested in the last hour

glucose levels of 130 non fasting means

annual physical

diabetes suspicion

diabetic follow up

when to get serum gloces checked

greater than or equal to 6.5

diabetic diagnosis

- poorly controlled diabetes

- stress

- cushing syndrome

- splenectomy

- steriods

- pregnancy

- acromagly

what can increase your A1C

- hemolytic anemia

- chronic blood loss

- chronic kidney failure

what decreases your A1C

- hemoglobinopathies- quality of HbA is affected

- RBC lifespan is increased

- Abnormally chronic low levels of proteins

- ascorbic acid can falsely cause low levels

what are interfering factors for A1C

Insulin C peptide

what is a C peptide that correlates with endogenous insulin production by the pancreas

c peptide

what determines the severity to insulin deficiency

c peptide

what is a by product of insulin synthesis into the body of the pancreas and it used to distinguish between endogenous and exogenous insulin

c peptide

what aids in distinguishing between type one and type two DM

c peptide

what determine insulin protein function in an insulin dependent diabetic

GAD65 antibodies

against glutamic acid decaroxylase enzyme produced in pancreatic beta cells

- GAD65

- insulin antibodies

- islet cell autoantibodies

- zinc transport 8 autoantibodies

- insulinoma- associated antigen 2 autoantibodies

what are the types of autoantibodies in type one DM

2

how many autoantibiodies do you have to order to diagnose DM type 1

GAD65

what is one autoantibodies that has to be ordered when diagnosis type 1 DM

Cholestrol and triglycerides

what are two lipids in the blood

cholestrol

element of all animal cell membrans, form the backbone of steriod hormones and bile acid

triglycerides

important for transferring energy from food into cells

no they need a lipoprotein that has a water soluble outside and insoluble lipid core

can lipids travel through the blood

apoproteins

what guides lipoproteins

how dense they are

how are lipoproteins classified

VLDLS

most triglycerides are transported in chylomicrons or

LDLs and HDLs

most cholestrol is carried as cholestrol ester in

Triglycerides

what makes lipoproteins less dense

apoproteins

what makes lipoproteins more dense

chylomicrons

VLDL

ILD

LGL

HDL

what is the list of least to most dense for lipoproteins

LDL cholestrol

the higher the level the Greater the risk of ASCVD and deposits cholestrol into the blood vessels

HDL cholestrol

the higher the level the lower the risk of ASCVD and takes cholestrol away from the blood vessels to the liver

lipoprotein

what is a subfraction of LDL

elevated levels considered RF and ASCVD

levels are largely genetically determined

hyperlipidemia

more broad term for elevated lipids

Hypercholesterolemia

elevation of LDL-C

Hypertriglyceridemia

elevation of TGs

Mixed Hyperlipidemia

elevated TG and LDL-C

Dyslipidemia

imbalance of lipids

total cholesterol, TG, LDL, HDL, VLDL and often non-HDL

what does a lipid panel include

with patient fasting for 8-12 hours

how are lipid panels often obtained

steroids, OCP, beta-blockers, phenytoin, thiazide diuretics, vitamin D

what can increase a lipid profile

allopurinol, bile salts, colchicine, erythromycin, niacin, nitrates, statins

what can decrease a lipid profile

12-18 hrs. FAST

Needs _______; only water can be consumed

increase

Pregnancy/postmenopausal/oophorectomy can ____ levels

decrease

Recumbent position can ____ levels

Determine risk for coronary heart disease; evaluation of hyperlipidemias

why would you use a lipid panel

"protein-fat" molecule; carries cholesterol through the bloodstream

Lipoprotein

> 400

what is a critical value for triglycerides

pancreatitis

with high Levels over 500 of triglycerides you have an increase risk for

can mask

High TG levels ________ LDLs levels

starch

Fatty meal ingestion, high ______ consumption, alcohol, and pregnancy can elevate TG levels

from

LDL carries cholesterol ____ the liver to cells that need it; can accumulate on arterial walls; determines coronary heart disease (CHD) risk

to

HDL (high density lipoprotein) – carries excess cholesterol _____ the liver; more protective and reduces CHD risk

at higher levels

HDL + LDL + 20% triglycerides

total cholesterol

age and sex while smoking and alcohol can decrease them

what is HDL dependent on

negative

HDL >= 60 mg/dL is a ______risk factor for CHD