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Q3 Clin LAB Test 1 (UA, Na, K, CMP) > CMP (lec 4) > Flashcards

CMP (lec 4) Flashcards

1
Q

Components of CMP for renal fxn?

A

BUN

Creatinine

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2
Q

Components of CMP for liver fxn?

A

Alk Phos
ALT (alanine aminotransferase)
AST (aspartate aminotransferase)
Total Bilirubin

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3
Q

Components of CMP for Serum Protein Electrophoresis (SPEP)?

A 
(components separated based on charge)
Na+
K+
Cl-
Ca+
CO2
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4
Q

Remaining components of CMP?

A

Glu
Total Protein
Albumin

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5
Q

Total Protein = ?

Tells us?

A

prealbumin + albumin (60%) + globulins

Dx/monitoring:
CA, immun, liver dz, edema, impaired nutrition

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6
Q

Albumin is?

Tells us?

A

liver-produced protein,
transports molecules thru blood,
maintains osmotic pressure (keeps fluid in blood)

Hepatic fxn, nutritional status

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7
Q

Low albumin caused by? (5)

A

1) poor nutrition,
2) protein-losing entero- or nephropathy,
3) liver dz,
4) third-spacing (fluid leak -e.g. burns/ascites),
5) inflamm dz

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8
Q

High albumin caused by?

A

dehydration

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9
Q

Globulins are?

Made where?

A

proteins used in making antibodies, acute reactants

bone marrow, lymph tissue

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10
Q

High globulins caused by?

A

(U) high when ablumin is low

actue rxns
chronic inflamm dz
advanced cirrhosis (ascites = low albumin)

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11
Q

Total Ca2+ = ?

Simultaneously measures?

A

free (ionized) + protein-bound

albumin

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12
Q

Ca2+ tells us?

Monitors?

A

parathyroid fxn

renal fail,
hyperparathroid,
CA

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13
Q

Ca2+ critical values are?

A

< 6 or > 13

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14
Q

Ca2+ distribution?

A

99% bone

  1. 8% cells
  2. 1% ECF

ECF:
50% free
10% complexed
40% protein-bound

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15
Q

Free Ca2+ important for?

A

nm activity
enzyme rxn
blood clotting

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16
Q

Ca2+ absorbed?

Stored?

Excreted?

A

from intestines via Vit D

bone

kidney

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17
Q

Serum Ca2+ regulated by?

A

PTH (parathyroid hormone)

Vit D

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18
Q

Physio response to↓ Ca2+?

A

PTH secretion -> ↑ Vit D activation -> ↑ Ca2+ by:
absorb from gut,
release from bone,
conservation by kidneys

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19
Q

Hypercalcemia (U) caused by?

A

Decreased bone reab from hyperparathyroidism,
Bone destruction from CA

Ca2+ > 10.5

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20
Q

Hypercalcemia sxs:

Neuromuscular?

CV?

Renal?

GI?

A

Neuromm:
↓ excitability -> mm weakness -> lethargy

CV:
HTN, short QT Int

Renal:
polyuria, ↑ thirst, stone

GI:
anorexia, N/V/C

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21
Q

Hyperparathyroidism (HPT) is?

Leads to?

A

excess PTH secretion -> hyperCa2+ -> parathyroid adenoma

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22
Q

HPT epidemiology?

A

F>M

>50yo

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23
Q

HPT presentation?

A

(U) asymp

Bones, Stones, Abd Groans, Psychic Moans, Fatigue Overtones

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24
Q

HPT X-Ray findings?

A

Osteitis Fibrosa Cystica:

eroded, lace-like phalanges from subperiosteal reab

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25
Q

HPT diagnostics?

A

HyperCa2+/Hypophosphatemia (reciprocally regulated)

↑ PTH

Parathroid scan/bx

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26
Q

HPT tx?

A

Parathyroidectomy

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27
Q

Malignancy-caused hyperCa2+: what kinds of CA?

A

solid tumors:
breast, lung, kidney

hemo:
multiple myeloma,
lymphoma,
leukemia

28
Q

HypoCa2+ caused by? (3)

A

Ca2+ < 9

1) ↓ ability to use Ca2+ stores (↓ PTH, ↓ Mg)
2) ↑ loss thru kidney (failure -> phosphate-retention)
3) ↑ protein-binding (↓ free Ca2+)

29
Q

Hypoalbuminemia and HypoCa2+?

A

↓ albumin -> 2º ↓ Ca2+

NOT true hypoCa2+

30
Q

Adjusting Ca2+ for low albumin?

A

Serum Ca2+ - Serum Albumin + 4

Serum Ca2+ needs to be ↑ by 1 for every 1 albumin is below 4

31
Q

Other causes of HypoCa2+?

A 
Hypoparathyroidism,
Mg deficiency (↓ PTH)
Renal fail
Vit D deficiency
Osteomalacia (soft bones)
32
Q

HypoCa2+ sxs:

Neuromuscular?

CV?

A

Neuromm: (↑ excitability)
hyper reflex, spasm, paresthesia, mm cramp

CV:
hypoTN, long QT Int, arrhy

33
Q

Tetany is?

A

↑ mm excitability -> sustained contractions

proceeding numb/tingle of lips, fingers, toes

34
Q

Carpal Spasm characteristics?

A 
wrist flex
MCP flex
PIP/DIP ext
Finger adduction
"obstetrician's hands"
35
Q

Tests for Tetany?

A

Chvostek’s Sign: tap facial n against bone anterior ear = contract of facial mm

Trousseau’s Sign: occlude brachial a 3 min = carpal spasm

36
Q

Phosphate tells us?

Critical value?

A

parathyroid and Ca2+ abn

< 1

37
Q

PO4 absorbed?

Excreted?

A

small intest

renal

38
Q

PO4/Ca2+ relationship?

A

inverse

39
Q

PTH effect on PO4?

A

↓ PO4 reab by kidneys

40
Q

High PO4 caused by?

A

Hypoparathyroidism
Renal fail
↑ diet
Acromegaly

41
Q

Low PO4 caused by?

A

Hyperparathyroidism
TPN (feed tube)
DM ketoacidosis (DKA) tx
Alcohol w/draw

42
Q

Mg distribution?

A

60% bone
49% cells
1% ECF (2nd most common intracell ion)

ECF:
1/3 bound to albumin

43
Q

Mg critical value?

A

< 0.5 or > 3.0

44
Q

Mg regulated by?

Reab ↓ when?

A

kidney

serum Mg ↑ (neg feedback)
serum Ca2+ ↑
loop diuretics

45
Q

HypoMg caused by?

A

< 1.3

conditions that:
limit intake,
↑ GI/renal loss,
movement b/w ECF/ICF (e.g. pH, glu, insulin),
hypoCa2+,
hypoK+
46
Q

HypoMg sxs:

Neuro mm?

CV?

A

NM: (Same as low Ca2+)
hyper reflex, paresthesia, mm weak, tetany

CV: (opposite of hypoCa2+)
HTN, tachy, arrhy

47
Q

HypoMg /HypoCa2+/HypoK+ relationship?

A

Low Mg can cause low Ca2+/K+:

lowers PTH,
impairs kidney reab of K+

HAVE TO FIX Mg to fix Ca2+/K+

48
Q

HypoMg tx?

A

oral or IV replacement

49
Q

HyperMg caused by?

A

> 2.1, rare

kidney Φ excrete

50
Q

HyperMg sxs:

NM?

CV?

A

NM:
hyporeflex, mm weak, confusion, respiratory paralysis

CV: hypoTN, arrhy

51
Q

HyperMg cautions?

A

avoid Mg-containing meds (e.g. maalox, mylanta)

52
Q

BUN tells us?

A

origin of renal issue
glom filtration
liver dz

53
Q

BUN worrisome value?

Critical value?

A

> 50

> 100

54
Q

High BUN (azotemia) caused by?

A

↓ renal excretion
high protein diet
dehydration

55
Q

Low BUN caused by?

A

liver dz (urea formed by liver)
low protein diet
overhydration

56
Q

Creatinine is?

Tells us?

Critical value?

A

byproduct of mm contraction

GFR (best assessment)

> 4

57
Q

High Creatinine caused by?

A

renal dz
rhabdomyolysis (mm destruction)
acromegaly

58
Q

Low Cr caused by?

A

debilitation
MS
myasthenia gravis

59
Q

BUN/Cr ratio tells us?

A

origin of high BUN (azotemia)
(ratio should be 10/1)

Azotemia:
>20/1 = prerenal
10-20/1 = renal
variable = postrenal

60
Q

Prerenal Azotemia caused by?

A

(> 20/1 BUN/Cr)

hypovolemia (trauma, dehydration, diuretics),
sepsis,
low CO (CHF),
hypoTN

61
Q

Prerenal Azotemia tx?

A

stop cause of volume loss,
restore intravascular volume (fluid intake/IV),
closely monitor

62
Q

Renal Azotemia caused by?

A

(10-20/1 BUN and Cr ↑ proportionately)

Acute tubular necrosis
(2ndary to low perfusion/toxins)

Chronic renal dz

Acute glomerulonephritis

63
Q

Renal Azotemia tx?

A

Manage dz
(P) dialysis
closely monitor to min fluid overload

64
Q

Postrenal Azotemia caused by?

A

(↑BUN/variable Cr)

Obstructed urine flow:
clots, stones, sickle cell,
BPH, CA, stricture

**pt is symptomatic

65
Q

Postrenal Azotemia tx?

A

Locate and tx obstruction

66
Q

Cl- tells us?

A

acid/base balance

hydration

67
Q

Cl- abnormalities (U) accompany shifts in what?

A

Na+ and HCO3

Q3 Clin LAB Test 1 (UA, Na, K, CMP) (4 decks)

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