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Clin Lab Med Unit 1 > CMP & Electrolyte Abnormalities > Flashcards

CMP & Electrolyte Abnormalities Flashcards

(92 cards)

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1
Q

Tests that make up the CMP

A
  • Glucose
  • Renal function: BUN, Creatinine, BUN/Cr ratio
  • Electrolytes: Na, K, Cl, CO2

Total protein

Albumin

Ca

Liver: ALP, ALT, AST, Total bilirubin

(* indicates test that are part of the Basic Metabolic Panel)

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2
Q

________ is involved in energy metabolism

A

Glucose

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3
Q

Glucose is regulated by ________ hormones

A

Pancreatic hormones:

Insulin released in response to HIGH blood glucose

Glucagon released in response to LOW blood glucose

Glucose levels are influenced by multiple factors

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4
Q

DDx for HYPERglycemia

A 
Diabetes
Gestational diabetes
IV Dextrose infusion
Drugs (steroids, etc)
Stress (trauma, illness, infection etc)
Endocrine disorders (Cushings, Acromegaly)
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5
Q

Why does stress lead to hyperglycemia?

A

Trauma, illness, infection, burns etc lead to increased catecholamine release by the adrenal gland, which raises blood glucose

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6
Q

DDx for HYPOglycemia

A

Drugs (insulin overdose)

Starvation

Endocrine disorders (Addison Disease, Hypopituitarism)

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7
Q

In evaluating blood glucose for diabetics, correlate levels according to …

A

Time of day obtained (fasting, casual, post-prandial, etc)

Note: post-prandial = 2 hours after a meal

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8
Q

What does BUN measure?

A

Blood Urea Nitrogen measures the amount of Urea formed in the liver as a by-product of protein metabolism

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9
Q

Urea is made in the ______ and excreted by ________.

A

Made in the liver, excreted by the kidneys

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10
Q

BUN is an indirect measurement of _________________ and ______________.

A

Metabolic function of the liver and excretory function of the kidney

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11
Q

Severe primary liver diseases _________ BUN

A

Decrease

2˚ decreased urea synthesis

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12
Q

Nearly all primary renal diseases will _______ BUN

A

Increase

2˚ reduced urea excretion

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13
Q

How does hydration status affect BUN?

A

Dehydration concentrates BUN, thus RAISING it

Overhydration dilutes BUN, thus LOWERING it

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14
Q

An upper GI bleed will _______ BUN levels

A

Increase

Blood overloads the gut with protein, thus the BUN goes up

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15
Q

How does protein intake affect BUN?

A

Low protein diets lower BUN

High protein diets raise BUN

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16
Q

Catabolic product of creatine phosphate

A

Creatinine (Cr)

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17
Q

Because it is excreted entirely by the kidneys, ______ is a measurement of renal function

A

Creatinine

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18
Q

Creatinine is interpreted in conjunction with…

A

BUN

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19
Q

Creatinine can be used as an approximation of …

A

Glomerular filtration rate (GFR)

Inverse relationship between Cr and GFR

Generally, a doubling of Cr suggests a 50% reduction in GFR

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20
Q

Why must we interpret Creatinine with regards to GFR with caution?

A

Serum CR levels are influenced by muscle mass, protein intake, certain drugs, and unstable critically ill patients

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21
Q

Factors increasing levels of Creatinine (Cr)

A

Acute Kidney Injury (multiple etiologies)
Chronic Kidney Disease
Rhabdomyolysis
Dehydration

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22
Q

Factors decreasing levels of Creatinine (Cr)

A

Debilitation
Muscular Dystrophy
Myasthenia Gravis

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23
Q

The BUN/Cr ratio is helpful in determining cause of ____________.

A

Acute Kidney Injury

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24
Q

Normal BUN/Cr ratio

A

~10-20/1 (if BUN = 10, Cr=~1)

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25
BUN/Cr ratio > 20:1 suggests...
Prerenal cause of AKI
26
BUN/Cr ratio ~10:1 suggests...
Intrinsic renal AKI
27
What BUN/Cr ratio might we expect for postrenal AKIs?
Varies! Variations in ratio are due to the extent and overlap of etiologies Hx and Phys Ex are important
28
How is the Chloride (Cl) test used?
In the evaluation of electrolyte and acid-base disturbances. Hypo- and hyperchloremia rarely occur alone - usually accompany shifts in sodium and bicarbonate
29
How is the CO2 test used?
In the evaluation of electrolyte and acid-base disturbances CO2 is an indirect measurement of bicarbonate (HCO3), which indicates pH.
30
HCO3 is regulated by the _________
Kidneys! Excretion or retention of bicarbonate pending acid-base disturbance
31
The total protein is a combination of what?
Albumin + Globulin
32
Fractionation of total protein is used to diagnose, evaluate, and monitor:
Liver disease, edematous states, protein-losing conditions, nutrition status, immune disorders, and cancer
33
Albumin is synthesized in the ________
Liver Measurement reflects synthetic function of the liver
34
Albumin helps maintain ____________
Osmotic pressure Keeps fluid within the vascular space Transports hormones, enzymes, and drugs
35
Increased albumin is associated with ....
Dehydration
36
Globulin represents non-albumin proteins, produced mainly in ...
Bone marrow and lymph tissues They are the building blocks for antibodies, acute-phase reactants, transport
37
The three groups of globulins
Alpha Beta Gamma
38
________ is often elevated when albumin is low to maintain normal total protein levels
Globulin
39
DDx for Hypoalbuminemia
Liver Disease Protein-losing enteropathies (Crohn’s, Celiac) Protein-losing nephropathies (Nephrotic Syndrome) Burns Malnutrition/malabsorption Inflammatory diseases (globulins increase causing albumin to decrease)
40
Normal total protein with low albumin and normal/increased globulin
Chronic liver disease | Collagen vascular disease (Lupus)
41
Increased Total Protein with increased globulin fraction
Multiple Myeloma SPEP (Serum protein electrophoresis) will demonstrate “M-spike” and you’ll see Bence-Jones proteins in urine
42
Hepatocellular injury will effect...
AST and ALT
43
Cholestatic injury (to bile ducts and/or bile flow) will effect...
ALP and Total billirubin
44
Enzyme found in liver, cardiac and skeletal muscle, as well as kidney and brain
Aspartame Aminotransferase (AST) Injury or disease affecting these tissues release AST into the bloodstream with resultant rise in AST
45
Enzyme found predominantly in the LIVER; lesser quantities in kidneys, cardiac, and skeletal muscle
Alanine Aminotransferase (ALT) Injury or disease affecting the liver will release ALT into the bloodstream with resultant rise in ALT
46
______ is more specific to the liver than ______
ALT more specific than AST | Because it’s got an L. Duh
47
Enzyme predominantly found in liver, biliary tract, and bone
Alkaline Phosphatase (ALP) Excreted in Bile, therefore conditions that obstruct the flow of bile can increase ALP
48
______ is used primarily to detect hepatobiliary and bone disorders
ALP
49
AST & ALT > ALP reflective of ...
Hepatocellular injury
50
ALP > AST & ALT reflective of...
Cholestatic injury
51
________ is the most frequent extrahepatic source of ALP
Bone
52
An isolated elevated ALP in the absence of other liver test abnormalities or H/P to suggest live disease) should raise suspicion for ...
Extrahepatic cause, especially conditions with high bone turnover Physiologic growth in children/adolescents Healing fractures Bone metastasis
53
The 3rd trimester of pregnancy can also give rise to ...
Isolated elevated ALP
54
Total bilirubin =
Unconjugated (indirect) and Conjugated (direct) bilirubin
55
Excess hemolysis will ...
Increase unconjugated bilirubin
56
Steps in the Bilirubin process
1) Hemolysis in the spleen (RBC —> Heme —> Unconjugated bilirubin) 2) Unconjugated bilirubin, bound to albumin, is transported to the liver for uptake 3) In the liver, unconjugated bilirubin is conjugated via enzymes 4) Conjugated bilirubin is excreted through the biliary ducts into the duodenum
57
Discoloration of body tissues caused by abnormally high levels of bilirubin
Jaundice Can result in a defect in any stage of bilirubin metabolism
58
Bilirubin is interpreted in conjunction with ...
AST, ALT, ALP
59
DDx for unconjugated hyperbilirubinemia
Excess hemolysis, impaired hepatic bilirubin uptake (HF), impaired bilirubin conjugation (Gilbert Syndrome)
60
DDx for conjugated hyperbilirubinemia
Hepatitis, drugs/toxins, liver infiltrations (TB), biliary obstruction
61
What test results might you see in hepatocellular damage?
Disproportionate elevation of AST/ALT compared to ALP Serum Bilirubin may be elevated
62
What test results might you see in cholestatic damage?
Disproportionate elevation in ALP compared to AST/ALT Serum bilirubin may be elevated
63
Why do we measure Ca in the blood?
Role in neurotransmission, muscle contraction, and blood clotting
64
There is an inverse relationship between calcium and _______
Phosphorus
65
99% of calcium is in the ______
Bone
66
The remaining 1% of Ca in the ECF is distributed as:
50% free (ionized) - can participate in cellular function 10% complexed 40% protein-bound
67
Which form of Ca in the ECF is physiologically active?
Ionized Ca It is unaffected by serum albumin levels and free to participate in cellular function
68
Complexed calcium can chelate with _________.
Citrate Citrate is added to blood to prevent clotting
69
When serum albumin is low, Calcium level will be...
Also low, because 40% of the ECF calcium is protein bound Must look at the two together.
70
Serum Total Calcium falls _____ for every 1 g/dL decrease in serum albumin
~0.8 mg/dL Patients with hypoalbuminemia will need to have their total serum calcium concentration corrected for the abnormality in albumin
71
Calculating Corrected Ca
Total serum Ca + 0.8(4.0 - serum albumin)
72
Got a low Ca level?
Look at albumin, do a corrected Ca!
73
If you get a high Calcium test, what’s the first thing you do?
Retest! Always confirm a high Ca
74
90% of cases of hypercalcemia are related to ...
Primary hyperparathyroidism and malignancy
75
Mechanism for high Ca in hyperparathyroidism
Bone reabsorption (Ca released from bone into blood) as a result of over production of Parathyroid Hormone (PTH)
76
Second most common cause of hypercalcemia?
Malignancy Mechanism: Tumor metastatic to bone can cause bone destruction and release Ca into bone Mechanism: Cancer can produce PTH-like substance that drives calcium up (ectopic PTH)
77
Clinical presentation of hypercalcemia
Decreased neuromuscular excitability —> muscle weakness, loss of muscle tone, lethargy, stupor, coma CV: HTN, ECG abnormalities (short QT) Renal: Polyuria, polydipsia, nephrolithiasis GI: Anorexia, N/V, constipation
78
DDx for hypocalcemia
Hypoalbuminemia Large blood transfusion (citrate additives bind to Ca) Hypomagnesemia (Mg deficiency inhibits PTH thus can be assoc. with refractory hypocalcemia) Hypoparathyroidism Renal failure (phosphorus retention and reciprocal loss of Ca) Intestinal malabsorption/Vit D deficiency
79
Clinical presentation of hypocalcemia
Increased neuromuscular excitability (tetany) —> parathesias, hyperactive reflexes, carpopedal spasms CV: ECG changes (prolonged QT), arrhythmia, hypotension
80
Carpopedal spasms and parasthesias are signs of ...
Hypocalcemia
81
Tapping facial nerve against the bone just anterior to the ear results in contraction of facial muscles
Chvostek’s sign (hypocalcemia)
82
Occluding brachial artery for 3 minutes with BP cuff induces carpal spasms
Trousseau’s sign (hypocalcemia)
83
Dietary phosphorus is absorbed in _____ and excreted by _____.
Small intestine; Kidneys
84
DDx for hyperphosphatemia
Renal failure (increased b/c not being excreted) Hypoparathyroidism (b/c low Ca means high PO4) Hypocalcemia Exogenous Phosphorus
85
DDx for Hypophosphatemia
Malnutrition/malabsorption Hyperparathyroidism Chronic alcoholism Severe diarrhea Cellular shift (insulin, refeeding syndrome)
86
Clinical presentation of hypophosphatemia
If severe (< 1.0 mg/dL0: muscle weakness and Rhabdomyolysis, seizures
87
Magnesium is excreted by ________
Kidneys
88
DDx Hypermagnesemia
Renal insufficency Large Mg load (ingestion of Mg containing meds, IV Mg infusion for preeclampsia/eclampsia)
89
DDx hypomagnesemia
Malnutrition/malabsorption Severe diarrhea Alcoholism Cellular shift
90
Clinical presentation of hypermagnesemia
Decreased DTRs, bradycardia, hypotension
91
Clinical presentation of hypomagnesemia
Neuromuscular excitability (tetany) Cardiac arrhythmias
92
Mg is intimately tied to _________
Ca and K Hypomagnesemia can contribute to refractory hypocalcemia and hypokalemia Check and correct Mg deficit to fix Ca and K level!

Clin Lab Med Unit 1 (4 decks)

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