Exam 3 Flashcards
(139 cards)
1
Q
pH reference range
A
normal: 7.35
acidosis: <7.35
Alkalosis: >7.35
2
Q
pCO2 reference range
A
normal: 35-45 mmHg
3
Q
pO2 reference range
A
80-100 mmHg
4
Q
HCO3 reference range
A
22-26 mmol/L
5
Q
HCO3 : H2O2
A
20:1
6
Q
pH/HCO3/H2CO3 equation (HH)
A
ph=pka + log (HCO3/pCO2*0.0301)
7
Q
pH measurement
A
Glass membrane
H+ exchange causing potential to develop
8
Q
pCO2 measurement
A
Serveringhaus electrode
pH buffer lowered in presence of CO2 (proportional)
9
Q
pO2 measurement
A
Clark electrode
change in electrical current occurs as O2 diffuses from blood
10
Q
HCO3/H2CO3 buffer
A
CO2 + H2O are converted into H2CO3 by carbonic anhydrase which is broken down into H+ and HCO3-
11
Q
HCO3 decrease (pH)
A
pH decreases
12
Q
HCO3 increase (pH)
A
pH increase
13
Q
Hyperventilation
A
CO2 removed, pH increase
14
Q
Hypoventilation
A
CO2 retained, pH decrease
15
Q
Metabolic acidosis
A
Decreased pH
Decreased pCO2
Decreased HCO3
Diabetes
16
Q
Metabolic alkalosis
A
pH increased
pCO2 increased
HCO3 increased
Vomiting
17
Q
Respiratory acidosis
A
Decreased pH
Increased pCO2
Increased HCO3
Emphysema
18
Q
Respiratory alkalosis
A
Increased pH
Decreased pCO2
Decreased HCO3
Hyperventilation
19
Q
Metabolic Acidosis (increased AG)
A
Ketoacidosis
Lactic acid
Toxic ingestion of aspirin
ethylene glycol
20
Q
Metabolic Acidosis (normal AG)
A
renal diseases
21
Q
Metabolic Acidosis (MUDPILES)
A
Methanol Uremia Diabetes Paraldehyde Isoniazid Lactic acidosis Ethylene glycol Salicylate toxicity
22
Q
metabolic alkalosis causes
A
base excess
cushing’s disease
vomitting
23
Q
full compensation
A
20:1 balance bicarb/carbo
pH normal
24
Q
partial compensation
A
balance off
pH normal or approaching
25
uncompensated
pH off
| compensatory mechanism is still normal
26
specimen collection (ABG)
arterial blood
radial
STAT
heparin syringe
27
bubbles in syringe (ABG)
increased pH
decreased pCO2
increased pO2
28
Syringe at room temp (ABG)
decreased pH
increased pCO2
decreased pO2
29
glycolysis (ABG)
decreased pH, pO2
| increased pCO2
30
pH and temperature
per 1 degree rise pH decreased 0.015
31
Amount of O2 bound to Hemoglobin
availability of O2
fever
type of hemoglobin
pH
32
Alkalosis (Hemoglobin)
O2 readily bound to hemoglobin
33
Acidosis (hemoglobin)
O2 will not bind to hemoglobin
34
Function of Lipids
energy
hormone precursors
cell membranes
insulators
35
fatty acids
linear chain of C-H bonds
| part of triglycerides/phospholipids
36
Saturated fatty acids
contain CH3 without double bonded C-C atoms
37
Monounsaturated fatty acids
one double bond
38
polyunsaturated fatty acids
more than one double bond
39
triglycerides
3 fatty acids and glycerol
synthesized by body
hydrophobic
40
phospholipids
2 fatty acids
hydrophillic/hydrophobic
cell membranes
synthesized in liver
41
cholesterol
produced in liver from acetyl-CoA (500-1000mg)
42
dietary cholesterol recommendation
<300 mg / day
43
cholesterol functions
cell membranes
precursor to steroids
conversion of bile acids
not a fuel source
44
cholesteryl esters
hydrophobic
| center of lipid drops/lipoproteins
45
lipoproteins
lipids+proteins
| Transportation of insoluble fats through blood
46
apolipoprotein
outer layer of proteins around lipid drop
47
large lipoprotein
increased lipid
| decreased density
48
small lipoprotein
increased protein
| increased density
49
chylomicron
largest/least dense lipoprotein
high % triglycerides
produced in intestines
VLDL, LDL, HDL
50
chylomicron function
transport dietary fat to adipose/muscle cells
51
chylomicron specimen
creamy layer upon plasma
reflect light
cause turbidity
52
VLDL
-Very Low Density Lipoproteins
53
LDL
-Low Density Lipoprotein
54
VLDL function
endogenous triglycerides to adipose tissue
| made by liver
55
LDL function
transport cholesterol from liver to cells
| bad cholesterol
56
few LDL receptors
blood cholesterol rises, excess deposited into arteries
57
HDL
High Density Lipoprotein
58
HDL function
transport cholesterol from peripheral tissue TO the liver, to be incorporated into bile salts
"scavenger of excess cholesterol"
59
Friedwald
LDL=Tot - HDL - (tri/5)
60
HDL reference range
good: >60 mg/dl
okay: 40-59 mg/dl
bad: <40 mg/dl
61
Cholesterol range
140-200 mg/dl
62
LDL range
50-130 mg/dl
63
triglyceride range
60-150 mg/dl
64
Non-HDL calculation
130 mg/dl
good predictor of heart disease
no fasting
counts LDL and VLDL
65
Apo A-I
Major protein on HDL
66
Apo B
protein on LDL, VLDL, chylomicrons
100: LDL, associated with CVD
48: chylomicrons
67
Apo C
Breakdown triglycerides
68
Lipid absorption
Micelles contact membranes of intestinal cells, enter circulation, picked up by albumin and taken to liver
69
micelles
lipid aggregates with bile acids
70
pancreatic lipase
cuts off fatty acids and converts to more polar compounds (amphipathic)
form micells
71
exogenous pathway
transport of dietary lipids
| Chylomicron remnants taken up by liver, broken down by lysosomal enzymes
72
released from exogenous pathways
fatty acids, free cholesterol, amino acids
73
endogenous pathway
transport of hepatic derived lipids
74
VLDL endogenous pathway
loses core lipids, converts to remnants, half are converted to LDL, half are taken in by liver
75
Reverse cholesterol transport
HDL
excess cholesterol transported to liver. Cholesteryl esters to chylomicrons. VLDL to liver.
Conversion of cholesterol into bile acids
76
Thyroxine/Cholesterol
Hypothyroid: hyper cholesterol
Hyperthyroid: hypocholesterol
77
Estrogen/Cholesterol
Post-menopausal: increased LDL
78
Pregnancy/cholesterol
Increased cholesterol
79
Arteriosclerosis
Deposition of lipids in artery walls
80
Hyperlipoproteinemia
Elevated lipoproteins
81
Hypercholesterolemia
Linked to heart disease
| Lacking/deficient LDL receptors (LDL build up)
82
Hypercholesterolemia symptoms
heart attacks
xanthomas
300-1000mg/dl
83
Hypertriglyceridemia
imbalance between synthesis and clearance of VLDL.
deficience of apo-C and LPL
can cause pancreatitis
84
Hypertriglyceridemia/hormones
hormones trigger lipase
| insulin, glucagon, GH, ACTH, thyrotropin, epinephrine, norepinephrine
85
Hypolipoproteinemia
Low lipoproteins,
| decrease in HDL
86
Disease/Hypolipoproteinemia
Tangier disease
87
Metabolic syndrome
```
increased trig.
obesity.
high blood pressure.
low HDL.
Glucose intolerance.
```
88
Elevated lipid treatment
Treat secondary cause first (i.e diabetes)
treat by exercise/diet
drug treatment (statins)
89
Lipid analysis specimen collection
Serum
| Fasting
90
Cholesterol testing
Cholesterol oxidase coupled reaction
91
NCEP ranges
Tot. Cho: <200 mg/dl
Trig: <150 mg/dl
LDL: <100 mg/dl
HDL: >40 mg/dl
92
3 major renal functions
Glomerular filtration
Tubular reabsorption
Tubular secretion
93
Nonprotein Nitrogen Compounds
Products of catabolism of proteins and nucleic acids
94
Major Non-protein Nitrogen Analytes
Urea
Uric Acid
Creatinine
Ammonia
95
BUN origin
Formed in liver when ammonia is removed and combined with CO2
96
BUN reference range
Plasma/Serum: 6-20 mg/dl
| 24h Urine: 12-20 g/d
97
BUN Clinical sig
Evaluation of renal function
Hydration
Nitrogen balance
Dialysis
98
BUN/Glomerular function
Increased BUN = decreased glom. function
99
Azotemia
elevated urea concentration
100
Uremia
increased urea accompanied by renal failure
101
BUN/Creatinine Ratio
20:1
102
Prerenal azotemia
```
Congestive heart failure
Shock
Burns
Increased protein
Dehydration
```
103
Renal azotemia
Disease of nephron
| ex. glomerulonephritis, nephrotic syndrome
104
Post renal azotemia
Obstruction to urine outflow
| ex. kidney stones
105
Prerenal Azotemia ratio
Elevated BUN
Elevated ratio
Normal creatinine
106
Renal Azotemia ratio
Normal ratio
Elevated BUN
Elevated creatinine
107
Post renal azotemia ratio
Elevated BUN
Elevated ratio
Elevated creatinine
108
Decreased BUN/ low ratio
Decreased protein
Liver disease
Tubular necrosis
Dialysis
109
Specimen collection BUN
Plasma, Serum, Urine
110
BUN methodology
Urease catalyzes urea and produced ammonia
111
Uris Acid formation
Product of catabolism of nucleic acids
| majority reabsorbed by glomerulus
112
Uric Acid clinical significance
```
Gout
Purine metabolism
Renal calculi
Chemotherapy
kidney dysfunction
```
113
Uric acid reference range
Men: 3.5-7.2 mg/dl
Women: 2.6-5.5 mg/dl
Child: 2.0-5.5 mg/dl
114
Gout
Uric acid crystals
older males
Monosodium urate: >6.0 mg/dl
115
Hyperuricemia
Gout
Purine-rich diet
Chronic renal disease
116
Hyperuricemia disease
Lesch-Nyhan syndrome
117
Hypouricemia
Hepatocellular disease
Fanconi syndrome
<2.0 mg/dl
118
Uric Acid specimen collection
- Plasma
- Serum removed ASAP
- Urine
119
Uric Acid Methedology
Uricase method
| Caraway method
120
Uric acid interferences
hemolysis
bilirubin
Vitamin C
Decrease results
121
Creatinine formation
Creatine in muscle loses phosphoric acid and water
122
Creatinine (Plasma)
Inversely related to glomerular filtration rate
123
Creatinine advantages
Formed at constant rate
Identify fluid as urine
kidney function before cat scan
124
Creatinine clinical significance
renal function/kidney damage
| --> increased creatinine = decreased GFR
125
Creatine clinical significance
increased associated with muscle disease
126
Creatinine specimen collection
plasma/serum
| 24 h urine
127
Specimen requirements Creatinine
Avoid hemolysis/icterus
128
Creatinine methedology
Jaffe: creatinine reacts with picric acid (red-orange)
Kinetic Jaffe: picrate
enzymatic: creatinase
129
Creatinine clearance reference ranges
Males: 97-137 ml/min
Females: 88-128 ml/min
130
Creatinine disadvantages
- 24 h collection
- correction
- drugs inhibit secretion
- elevated blood levels increase creatinine
- bacterial breakdown
131
GFR/Creatinine
Decerased GFR = Increased serum creatinine
132
Ammonia formation
Breakdown of amino acids
| Bacterial metabolism
133
Ammonia disease
Reye's syndrome
Renal failure
Liver disease
134
Ammonia reference range
Adult: 19-60 ug/dl
Child: 68-136 ug/dl
135
Ammonia specimen collection
```
Whole blood
-EDTA, Heparin
STAT
no tourniquet
on ice
```
136
Ammonia error
No smoking prior to collection
137
Ammonia methodology
Glutamate dehydrogenase
138
eGFR advantages
indicate impaired renal function
139
eGFR disadvantages
GFR can remain normal until extensive kidney damage has occured
