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Diagnostics Exam 3- CMP, Inflammation, LFTs > CMP > Flashcards

CMP Flashcards

1
Q

What is measured in a BMP?

A 
BUN
Cr
CO2
Glucose
CL
K
Na
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2
Q

Name the electrolytes measures in a chemistry panel?

A

Sodium
Potassium
Chloride
Carbon dioxide

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3
Q

The defining feature of an amino acid is what?

A

its side chain

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4
Q

Total protein measures what? What is it used to diagnose/monitor in patients?

A

prealbumin
albumins- 60%
globulins

CA
immune disorders
impaired nutrition
protein-losing enteropathies
liver disease
edema
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5
Q

What are the functions of proteins?

A
  • makes up tissues, enzymes, hormones
  • transport substances in the serum
  • creates osmotic pressure in the intravascular space (by pulling fluid in/or preventing fluid from leaving)
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6
Q

Functions and indicators of Albumin

A

Functions:
osmotic pressure
transports drugs, hormones, enzymes

Indicator ir nutritional status and liver function (synthesized in liver)

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7
Q

Causes of decreased albumin?

A
  • malnourishment
  • “protein losing enteropathies”
  • nephrotic syndrom
  • liver disease
  • inflammatory disease
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8
Q

Causes of increased albumin?

A

Dehydration

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9
Q

Multiple Myeloma shows what specific pattern in SPEP (serum protein electrophoresis) and what is urine?

A
  • characteristic “M-spike”- (spike in beta or gamma globulin)
  • “monoclonal gammopathy”

-Bence-Jones proteins in urine

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10
Q

ECF consists of what percentage of interstitial and what percentage of plasma?

A

interstitial- 75-80%

plasma- 15-20%

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11
Q

How does TBW change over lifetime?

A

100% fetus
80% baby
70% adult
50% elderly person

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12
Q

What is osmolarity?

A

the solute or particle concentration of a fluid

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13
Q

Abnormal extracellular fluid volume is due to?

A

Sodium control mechanisms

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14
Q

Abnormal extracellular fluid sodium concentration is due to?

A

Problems with water control

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15
Q
  • too little Na= ?

- too much Na= ?

A

Fluid volume deficit

Fluid volume excess

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16
Q
  • Too much water=?

- Too little water=?

A

Hyponatremia

Hypernatremia

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17
Q

Pseudohyponatremia

A

Low Na, but nl osmolarity

-due to hypertriglyceridema or hyerproteinemia

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18
Q

Hyponatremia due to hyperosmolar state

A

increased glucose in ECF causes shift of water from ICF to ECF, thus lowering serum Na

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19
Q

Hyponatremia with Hypervolemia-

Fluid overload conditions

A

CHF
Renal failure
nephrotic syndrom
hepatic cirrhosis

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20
Q

Clinical findings in pt with fluid overload

A
  • pedal edema, pulmonary crackles, JVD
  • anemia
  • other signs of heart, liver, or renal disease
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21
Q

Hyponatremia with Hypovolemia:

  • renal causes
  • non renal causes
A

renal- diuretics

nonrenal- vomiting, fistula

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22
Q

Clinical characteristic of dehydration

A

reduced skin turgor
dry MM
orthostatic BP/pulse changes

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23
Q

Function of Potassium and route of elimination

A
  • The major intracellular cation

- renal excretion

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24
Q

Hypokalemia:

  • value
  • clinical manifestations
A

< 3.5

  • Neuro= weakness, fatigue, paralysis
  • GI= constipation, ileus
  • Nephrogenic -Diabetes Insidius
  • ECG changes: flattened T waves, prominent U waves
  • cardiac arrhythmia
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25
In presence of ____, a low K+ concentration needs to be corrected. Why?
Alkalosis is pH > 7.45 there is 0.3mEq/L K decrease for each 0.1 increase in pH
26
Hyperkalemia: Value Clinical manifestations
> 5.0 - weakness, ascending paralysis - respiratory failure - ECG changes: peaks Ts, flattened Ps, prolonged PR, wide QRS
27
Elevated potassium correction in metabolic acidosis
0.7 mEq/L increase for every 0.1 decrease in pH
28
Elevated potassium correction in respiratory acidosis
0.3 mEq/L increase for every 0.1 decrease in pH
29
What is Ca used to measure?
Parathyroid function
30
10-20% of patients with malignancy have??
Elevated Ca ++
31
A decrease in serum Ca triggers?
PTH secretion = increase in serum Ca
32
Actions of PTH
- Increase vit. D activation (calcitriol)= increase Ca absorption form gut - promotes Ca release from bone - promotes conservation of Ca by kidneys
33
Free (ionized) Ca++ does what?
Cardiac contractility
34
What EKG abnormality will you see with hypercalcemia?
Short QT
35
Most common causes of hypercalcemia? | Other cause?
- #1= hyperparathyroidism - Malignancy (bone destruction or stimulation of osteoclast activity) -Other: Drugs- thiazide diuretics
36
Usual etiology of hyperparathyroidism and sx
Parathyroid adenoma - typically asymptomatic - "Bones, stone, abnormal groans, psychic moans, with fatigue overtones"
37
How would you dx hyperparathyroidism?
- Hypercalemia | - Hypophosphatemia
38
Three main causes of HYPOcalcemia
1. decreased ability to mobilize bone stores 2. excess loss of Ca from kidneys 3. increased protein binding
39
What is the most common cause of reported hypocalcemia?
Hypoalbuminemia- Not true hypocalcemia If serum albumin if low, Ca measurement must be corrected
40
Sx of HYPOcalcemia
Neuromuscular: increased excitability - carpopedal spasms - positive Chovostek and Trousseau signs - Tetany
41
What is Chvostek sign?
tapping facial nerve against the bone just anterior to the ear results in contraction of facial muscles
42
What is Trousseau sign?
occluding brachial artery from 3 min with BP cuff induces carpal spasms
43
Treatment for hypocalcemia: Asymptomatic? Tetany? Chronic?
Asym= oral calcium chloride or calcium gluconate Tetany= IV calcium gluconate or calcium chloride chronic= dietary changes, eval Vit D
44
What is phosphates relationship with Ca?
Inverse relationship with Ca
45
PTH does what to phosphate?
Decreases phosphate reabsorption by the kidneys | = increased urinary PO4 excretion; Increased Ca absorption
46
Causes of increased phosphate?
hypoparathyroidism renal failure increased dietary intake acromegaly
47
Causes of decreased phosphate?
``` decreased intake/malnutrition drugs EtOH hyperparathyroidism increased renal loss ```
48
Where is Magnesium highest in the body?
Bone- 50-60%
49
It is common to see hypocalcemia with hypomagnesemia because?
K, Mg, and Ca are closely related, absorption and excretion are interdependent
50
How is Magnesium regulated? | And how would you increase excretion?
By the kidneys loop diuretics (furosemide)
51
What patients often have hypomagnesemia?
- ICU and ED patients | * *Common in pt's with CHF due to diuretic use**
52
Clinical signs of hypomagnesemia
- Neuromuscular effects, similar to low Ca | - CV effects- HTN, tachy, arrythmias
53
Magnesium deficiency can cause? | And what is needed to correct first?
Hypocalcemia and hypokalemia Need to correct Mg deficits to fix K and Ca level
54
When treating Hypomagnesemia what patients do you need to use caution with?
Patients w/ renal disease
55
Most common cause of HYPERmagnesemia
Renal insufficiency | because kidneys are usually able to excrete excess MG so high Mg is rare
56
What does blood urea nitrogen (BUN) measure?
rough measurement of renal function and globular filtration
57
Increased BUN= ?
AZOTEMIA
58
Almost all renal disease cause ____ excretion of urea, which causes BUN to ____?
inadequate | rise
59
What causes decrease in BUN?
Low protein diet | overhydration
60
What causes increase in BUN?
high protein diets | dehydration
61
Kidney failure= what level of creatinine?
>4 mg/dl= critical value
62
BUN/creatinine ratio: Prerenal Azotemia= Renal azotemia= post renal azotemia=
``` Prerenal= >20/1 (elevated) Renal= ~10-15/1 Post= variable ratio ```
63
Characteristics of prerenal Azotemia
- Elevated BUN/Cr ratio - no inherent kidney disease - hypovolemia - infection - low cardiac output
64
Prerenal azotemia is a sign of?
intravascular volume depletion or hypotension
65
How do you treat prerenal azotemia?
GIVE FLUIDS
66
Most common cause of renal azotemia
acute tubular necrosis chronic renal disease acute glomerulonephritis
67
When BUN and Cr both increase, suspect?
Intrinsic renal disease
68
Most cause of Postrenal Azotemia
obstruction to urine flow - Ureter and renal pelvis: blood clot, stone, sickle cell - Bladder: prostatic hypertrophy or malignancy, neuropathic bladder, blood clot - Urethral stricture

Diagnostics Exam 3- CMP, Inflammation, LFTs (3 decks)

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