01 - serum chem

Question 1

(BUN)

1. 3 causes of increase?

Answer 1

1. ↓ GFR
2. ^protein diet/GI hemorrhage
3. ^protein catabolism

Question 2

(BUN)

1. 4 causes of ↓ BUN

Answer 2

1. liver failure/shunts
2. low protein diets
3. PU/PD (cause and effect)
4. young animals

Question 3

(creatinine)

1. two causes of increase?

Answer 3

1. ↓ GFR
2. high protein diet

Question 4

(creatinine)

decrease not significant

Question 5

(Calcium)

1. 6 causes of decrease

Answer 5

1. ↓albumin
2. renal failure

3-4. GI (pancreatitis, malabsorption)

5-6. (endocrine) 1° hypoparathyroidism, malabsorption (PLE)

Question 6

(Calcium)

1. 6 causes of ^?

Answer 6

1. ^albumin
2. vitamin D
3. cancer (lymphoma, anal sac, thymoma)
4. renal failure
5. Addison’s
6. 1° hyperparathyroidism

Question 7

3 causes of ↓Ca, normal P

Answer 7

1. ↓ albumin
2. acute pancreatitis
3. drugs (glucocorticoids)

Question 8

2 causes of ↓Ca, ^P

Answer 8

1. 1° hypoparathyroidism
2. ethylene glycol

Question 9

1 cause of ↓Ca, ↓P

Answer 9

1. decreased intestinal absorption

Question 10

two causes of ^Ca, ↓ to normal P

Answer 10

1. 1° hyperparathyroidism
2. hypercalcemia of malignancy (lymphoma, multiple myeloma, anal sac)

Question 11

two causes of ^Ca, ^ P

Answer 11

1. ^ vitamin D
2. addison’s (^intestinal/renal absorption)

Question 12

1 cause of normal Ca, ^P

Answer 12

1. DECREASED GFR most common

Question 13

1 cause of normal Ca, ↓P

Answer 13

1. shift into cells with hyperglycemia and ^insulin

(rarely significant)

Question 14

1 cause of ^Mg

Answer 14

decreased GFR

Question 15

(↓albumin/↓globulin)

1. 5 causes

Answer 15

1. overhydration

(non-selective loss)

2. third space
3. GI disease (esp PLE)
4. burns
5. external hemorrhage

Question 16

↓albumin/normal globulins

2 causes

Answer 16

1. non-selective loss + inflammation balancing globulin loss

(third space, GI, cutaneous, external hemorrhage + inflam)

2. selective loss from kidney

Question 17

(↓albumin/^globulins)

1. 5 causes

Answer 17

1. inflammation
2. hematopoeitic malignancy (lymphoma, multiple myeloma)
3. liver failure
4. PLE
5. starvation

Question 18

(^globulins/normal albumin)

2 causes?

Answer 18

1. inflammation
2. paraneoplastic

Question 19

(^globulin/^albumin)

1 cause

Answer 19

dehydration (or dehydration + inflammation)

Question 20

5 dilutional causes of ↓Na

Answer 20

1. preg/neonate
2. CHF
3. postrenal azotemia/uroabdomen
4. cirrhotic liver dz
5. DM

Question 21

(↓Na)

1. 4 causes when loss of Na > water

Answer 21

1. diarrhea
2. renal dz (diuresis)
3. ketonuria
4. addisons

Question 22

↓ Na

4 causes when loss of Na = water, replaced by water

Answer 22

1. hemorrhage
2. 3rd space loss
3. burns
4. diarrhea

Question 23

two causes of ^Na

Answer 23

1. decreased water intake
2. loss of water > Na: panting, some renal/GI

Question 24

(↓ chloride)

1. if proportional to Na, see sodium
2. if disproportionate, what two causes?

Answer 24

1. with ^bicarb: upper GI fluid loss/stasis
2. with normal/dec bicarb: probably mixed acid/base disorder

Question 25

(^chloride) 1. if disproportionate to Na what two causes?

Answer 25

1. w/ dec bicarb: metabolic acidosis 2. with normal/^bicarb: probably mixed acid/base disorder

Question 26

(↓ potassium) 1. two causes?

Answer 26

1. anorexia 2. intracellular shift (^insulin/glucose, alkalosis)

Question 27

(^ potassium) 1. 4 causes

Answer 27

1. failure of elimination (oliguria/anuria/post-renal) 2. addison's 3. insulin/deficiency resistance (DM) 4. metabolic acidosis (translocation)

Question 28

(bicarbonate) 1. 1 cause of increase?

Answer 28

1. loss of acid (GI or renal)

Question 29

↓ bicarb 1. with high anion gap 2. with normal anion gap

Answer 29

1. excessive acid: ketoacidosis, lactic acidosis, uremic acidosis 2. ^ bicarb losses (GI or renal)

Question 30

(decreased anion gap) 2 causes

Answer 30

1. low albumin 2. ^ cationic proteins (rare, gammopathy)

Question 31

(^anion gap) 1. usually due to what?

Answer 31

1. accumulation of anionic acids (lactic, keto, uremic)

Question 32

(^bilirubin) 3 broad causes

Answer 32

pre-hepatic cholestasis hepatic cholestasis post-hepatic cholestasis

Question 33

(^bilirubin) evidence of pre-hepatic cholestasis

Answer 33

1. anemia (usually regen) RBC morph (sphero, heinz, schistocytes)

Question 34

(^bilirubin) 1. 4 causes of hepatic cholestasis

Answer 34

dec liver fx (↓BUN, glucose, albumin, cholesterol, low USG, ^Pt) sepsis (inflam leukogram, hypoglycemia, Cx) lepto (+ renal azotemia) anorexia (+/- cats, not dogs)

Question 35

^bilirubin causes of post hepatic cholestasis

Answer 35

(blockage of bile caniculi or ducts) choleliths, mucocele, neoplasia, inflammation, pancreatitis

Question 36

5 causes of ^ALP

Answer 36

1. post-hepatic cholestasis 2. bone-growth/disease 3. corticosteroids (cushing's) 4. phenobarb 5. metabolic: DM, hyperT4

Question 37

(^GGT) 2 causes

Answer 37

post-hepatic cholestasis or biliary hyperplasia inductino by drugs or hormones (similar to ALP: steroids, phenobarb)

Question 38

(^ALT) 6 causes

Answer 38

1. 1° liver dz (inflam, infectious, neoplastic, toxic, trauma, fatty infiltration) (secondary) 2. ↓perfusion/hypoxia 3. post-hepatic cholestasis 4. intestinal dz 5. pancreatic dz 6. endocrine (DM, hyperT4)

Question 39

(^AST) 1. +^ALT = ? 2. + ^CK = ?

Answer 39

1. hepatocellular dmg 2. skeletal muscle dmg

Question 40

(^amylase) 3 causes

Answer 40

1. ↓GFR 2. intestinal dz 3. pancreatitis/pancreatic neoplasia

Question 41

(↓ glucose) 2 broad causes

Answer 41

↓production excessive use/cellular uptake

Question 42

↓glucose from ↓ production 4 causes

Answer 42

1. liver failure 2. sepsis 3. hypoadrenocorticism 4. young animals/small breed

Question 43

↓glucose from escessive use/cellular uptake 3 causes

Answer 43

1. sepsis 2. insulin overdose 3. paraneoplastic (insulinoma)

Question 44

(^glucose) 1. 6 causes

Answer 44

1. post-prandial 2. stress 3. DM 4. Cushing's 5. hyperT4 (Cats) 6. pancreatitis

Question 45

3 causes of ↓cholesterol

Answer 45

1. liver failure 2. addison's 3. PLE

Question 46

^cholesterol 7 causes

Answer 46

1. post-pradial 2. DM 3. Cushing's 4. pancreatitis 5. hypoT4 6. post-hepatic cholestasis 7. nephrotic syndrome