Glucose, magnesium, phosphate and proteins Flashcards

(41 cards)

1
Q

Glucose draw, range, location and general function

A

Glucose concentration in extracellular fluid is closely regulated so that a source of energy is readily available to tissues.

Draw tube: SST (as part of chem -7 panel), PPT, gray (if drawing only glucose)

Normal range: 60–110 mg/dL
Panic values: < 40 or > 500 mg/dL

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2
Q

Conditions and drugs causing Hyperglycemia

A

Diabetes mellitus, Cushing syndrome (10–15%), chronic pancreatitis (30%)

corticosteroids,phenytoin, estrogen, thiazides

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3
Q

Conditions and drugs causing Hypoglycemia

A

Hypoglycemia seen with insulinoma, adrenocortical insufficiency, hypopituitarism, diffuse liver disease, enzyme deficiency diseases (eg, galactosemia).

Drugs:insulin, ethanol,propranolol; sulfonylureas,tolbutamide, and other oral hypoglycemic agents.

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4
Q

DIABETES MELLITUS Diagnosis components

A

Diagnosis of diabetes mellitus requires:

A fasting plasma glucose of > 126 mg/dL on two or more occasions

Spot plasma glucose level ≥200 mg/dL

HbA1c≥ 6.5% along with symptoms of diabetes.

Patients with fasting blood glucose levels 110 mg/dL to 126 mg/dL are considered to have impaired fasting glucose.

Glycosylated hemoglobin levels (HbA1c ) are favored to monitor glycemic control in patients with diabetes mellitus.

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5
Q

Calcium function skeletally

A

CA PROVIDES STRENGTH & STABILITY FOR THE COLLAGEN & GROUND SUBSTANCES THAT FORMS THE STRUCTURAL MATRIX OF THE SKELETAL SYSTEM & IS A HUGE RESERVOIR FOR MAINTAINING BLOOD LEVELS OF CALCIUM

Bulk of Ca++ is stored in the skeleton

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6
Q

Anion Calcium integration

A

ANIONS (BICARBONATE, LACTATE, & CITRATE)
CA USED IN MUSCULAR CONTRACTIONS, CARDIAC FUNCTION, TRANSMISSION OF NERVE IMPULSES, & BLOOD CLOTTING

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7
Q

Albumin influence on calcium

A

DECREASES OR INCREASES IN ALBUMIN WILL AFFECT THE TOTAL CALCIUM LEVEL, BUT WILL NOT AFFECT THE IONIZED PORTION

Amount of protein in blood will affect Ca++ levels

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8
Q

Muscular system, cardiac, nervous and heme calcium roles

A

CA USED IN MUSCULAR CONTRACTIONS, CARDIAC FUNCTION, TRANSMISSION OF NERVE IMPULSES, & BLOOD CLOTTING

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9
Q

Total Ca++ is made up of 3 fractions

A

Protein bound (∼40%)
Anion bound (∼10%)
Ionized “free” (∼50%) (metabolically active)

Only the ionized Ca++ can be used by the body for vital cellular processes

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10
Q

Calcium regulation

A

controlled by PTH, calcitonin, vitamin D & renal reabsorption

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11
Q

Ionized calcium functions

A

Participates in enzyme reactions
Important intracellular second messenger for “amplification”

Contributes to membrane potentials & neuronal excitability

Exocytosis of neurotransmitters at NMJ & CNS
Muscle contraction (skeletal, smooth, cardiac)

Participates in hormone release
Influences cardiac automaticity
Required for coagulation in intrinsic pathway

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12
Q

SERUM CALCIUM uses

A

Evaluating pts with known or suspected hyper/hypocalcemia

Evaluating electrolyte status in pts receiving IV fluids

Procedure:
Obtain 5ml of venous blood collected in red, yellow or speckled top tube

Reference range:
Varies considerably throughout adolescent years
Normal adult values: 8.9-10.1 mg/dl

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13
Q

Interfering factor in calcium

A

Thiazide diuretics
Large amount of blood transfusions
Pts undergoing dialysis

Excessive laxative use
Acid base disorders
Increased or decreased protein levels

Calcium levels are inversely related to phosphate levels

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14
Q

HYPERCALCEMIA

A

total Ca++ >12 mg/dl

Etiology:
Hyperparathyroidism
Malignancy (PTHrP producing tumors)
Granulomatous diseases

Thyrotoxicosis
Paget’s disease of bone
Bone fractures

Prolonged immobilization
Excessive intake of vitamin D

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15
Q

Clinical Manifestations of Hypercalcemia

A

Increased thirst
Polyuria, flank pain, signs of kidney stones or renal insufficiency

Anorexia, nausea, vomiting, constipation
Muscle weakness, atrophy, ataxia & loss of muscle tone

Lethargy, personality/behavioral changes, stupor or possible coma

HTN, shortening of QT interval & possible AV block

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16
Q

HYPOCALCEMIA

A

total Ca++ <8.5 but true hypocalcemia is ionized Ca++ <4.0 mg/dl

Etiology:
Pseudohypocalcemia
0.8 (nl alb - measured alb) + reported Ca
Hypoparathyroidism

Hyperphosphatemia
Malabsorption syndromes & malnutrition
Pancreatitis

Alkalosis
Vit D deficiency (rickets or osteomalacia)
Alcoholism & cirrhosis

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17
Q

Clinical Manifestations of Hypocalcemia

A

Paresthesias
Skeletal muscle cramps, abdominal spasms & cramps
Hyperactive reflexes, + Chvostek’s & Trousseau’s signs, tetany & laryngeal spasm

Hypotension, cardiac insufficiency, no response to drugs with Ca-mediated mechanism
Osteomalacia, bone pain, deformities & fractures

18
Q

IONIZED CALCIUM uses and procedure

A

Particularly helpful during any surgical procedure that requires rapid & multiple whole blood transfusions

Second order test in the evaluation of pts with abnormal Ca++ levels

Neonatal calcium measurement

Assessing Ca++ levels in critically ill pts

Procedure:
5ml of venous blood in red, yellow, or speckled top tube

19
Q

IONIZED CALCIUM LEVEL

A

Reference range:
Normal: 4.75-5.20 mg/dl
Panic values: <2.0 mg/dl may produce tetany or life-threatening complications, levels >7.0 mg/dl may cause coma

Increased levels:
Hyperparathyroidism
Ectopic PTHrP tumors
Increased vitamin D intake

20
Q

Ionized calcium decreased levels and Interfering factors

A

Decreased levels:
Hypoparathyroidism
Vitamin D deficiency

Pts receiving bicarbonate to control metabolic acidosis
Acute pancreatitis

Hyperventilation to control increased ICP
Magnesium deficiency
Multiple organ failure

Interfering factors:
Improper specimen collection in EDTA

21
Q

SERUM PHOSPHATE functions

A

85% of the body’s total phosphorus is combined with Ca+ inside bone; 14% resides within cells; 1% is the the extra-cellular compartment

Multiple functions – bones, glucose, lipids, acid-base balance, storage & energy transfer

Moves into cells after carbohydrate ingestion & therefore is lowered in the plasma
Inversely related to Ca++

22
Q

SERUM PHOSPHATE functions 2

A

Major role in bone formation (bone matrix)
Essential for certain metabolic processes (ATP formation, building of enzymes for glucose, fat, & protein metabolism)

Cell structure (nucleic acids of DNA/RNA, membrane phospholipids

Serves as a acid-base buffer in the ECF & in the renal excretion of H+ ions

O2 delivery by RBCs through organic phosphates & 2,3 diphosphoglycerate

23
Q

Serum phosphate uses

A

Evaluating pts with CKD or hyperparathyroidism
Evaluating alcoholic & malnourished pts or pts receiving TPN

Evaluating status of pts recovering from diabetic ketoacidosis or pts receiving IV fluids containing phosphorus

Evaluating pts with hyperparathyroidism
Procedure: same as other electrolytes

Reference range: 2.5-5.0 mg/dl
Interfering factors: hemolysis

24
Q

HYPERPHOSPHATEMIA

A

Definition: >5 mg/dl

Etiology:
Decreased excretion due to renal failure
Hypoparathyroidism
Adrenal insufficiency & acromegaly
Increased intake & absorption
Redistribution/cellular release
Hypocalcemia
Bone tumors & cancer metastases

25
Clinical Manifestations of Hyperphosphatemia
Manifestations are usually related to the reciprocal changes that are seen in calcium (hypocalcemia) Paresthesia's, tetany, Chvostek’s and Trousseau’s signs Hypotension and cardiac dysrhythmias Skeletal muscle cramps, abdominal spasms & cramps Bone pain
26
HYPOPHOSPHATEMIA
Definition: <2.5 mg/dl Etiology: Hyperparathyroidism Diabetic ketoacidosis Antacids Severe diarrhea Vitamin D deficiency Alkalosis Alcoholism, malnutrition, and TPN Renal tubular absorption defects
27
Clinical Manifestations og Hypophosphatemia
Manifestations usually related to reciprocal calcium changes (hypercalcemia) Ataxia, hyporeflexia, muscle weakness, joint & bone pain Increased thirst, anorexia, N/V, & constipation Lethargy, personality/behavioral changes, stupor or possible coma POLYURIA, FLANK PAIN, SIGNS OF KIDNEY STONES OR RENAL INSUFFICIENCY HTN, SHORTENING OF QT INTERVAL & POSSIBLE AV BLOCK
28
SERUM MAGNESIUM
50% in bone, 49% in body cells, & 1% is dispersed within the serum Mg is required as a cofactor for the production of cellular energy and function of cellular messenger systems Along with Na, K, & Ca ions, Mg also regulates neuromuscular irritability and the clotting mechanism The secretion, synthesis, & action of PTH is influenced by Mg Mg & Ca are intimately linked in their body functions
29
Serum Magnesium further functions
Cofactor for intracellular enzyme reactions (transfers phosphate groups) Essential for all ATP reactions Essential for every step related to replication & transcription of DNA & for translation of messenger RNA Required for cellular energy metabolism, function of the Na+/K+/ATPase pump Stabilizes membranes Contributes to nerve conduction, ion transport, & calcium channel activity
30
Serum Magnesium uses, procedure and Interfering factors
Evaluating renal function & electrolyte status in hospitalized patients Pts with hypocalcemia or hypokalemia not responding to electrolyte correction Identification of malabsorption disorders Monitoring tx of pre/eclampsia Procedure: same as other electrolytes Reference range: 1.5-3.0 mEq/L Interfering factors: Hemolysis, lithium or salicylates use
31
HYPERMAGNESEMIA
Definition: >3.0 mEq/L Etiology: Renal failure or dehydration Treatment of pre/eclampsia Rhabdomyolysis Excessive use of antacids
32
Clinical manifestations of Hypermagnesmia
Lethargy, hyporeflexia, muscle weakness Depressed respiration, apnea, confusion
33
HYPOMAGNESEMIA
Definition: <1.5 mEq/L Etiology: Alcoholism, malnutrition, malabsorption & starvation Parenteral nutrition Pancreatitis Hypoparathyroidism
34
Clinical Manifestations of Hypomagnesmia
Personality changes, tetany, nystagmus, Chvostek’s & Trousseau’s sign, TACHYCARDIA, HYPERTENSION, and CARDIAC ARRHYTHMIAS Altered PTH secretion/action may occur
35
SERUM PROTEINS functions
Source of nutrition Buffer system Immune function Carrier proteins Metabolic function Chromosomal & DNA components Cell membrane structure colloidal osmotic pressure Antiprotease
36
Serum Albumin
Part of a diverse microenvironment which primarily maintains colloidal osmotic pressure Source of nutrition & also part of a complex buffer system. It is a “negative” acute phase reactant Useful for: Evaluation of nutritional status, albumin loss in acute illness Evaluation of pts with liver or renal disease, hemorrhage, burns or leaks in GI tract
37
Serum Albumin
Reference range: Normal: 3.5-4.8 g/dl Increased levels: Volume depletion or dehydration Decreased levels: Acute/chronic inflammation & infection Cirrhosis, liver disease & alcoholism Nephrotic syndrome Crohn’s, colitis, malabsorption Burns & severe skin disease Procedure: same as electrolytes (red, yellow SST tube or plain red tube )
38
Serum Albumin interferring factors
Pregnancy Oral contraceptives (OCP) & estrogen replacement Prolonged bed rest IV fluids, rapid hydration or overhydration Is not a good indicator of recent changes in nutrition due to prolonged half-life in serum
39
SERUM PROTEIN ELECTROPHORESIS (SPEP)
Separates albumin & globulins with an electric field to differentiate the proteins according to size, shape & electric charge into 5 distinct fractions [Albumin, alpha-1-globulin, alpha-2-globulin, beta-globulin, gamma-globulin] Useful for: Detection of monoclonal protein or monitoring size of monoclonal peak in multiple myeloma pts
40
SPEP Interpretation
↑ & ↓ albumin ↑ in total serum protein Volume depletion or dehydration Multiple myeloma Sarcoidosis & other granulomatous diseases Any inflammatory state ↓ in total serum protein Poor nutritional status, liver disease, alcoholism, burns, severe skin disease Renal disease, Crohn’s, UC
41
SPEP more interpretation
Increases in gamma-globulin protein Multiple myeloma, leukemia & other cancers Autoimmune disease, chronic infections Decreases in gamma-globulin protein Nephrotic syndrome Hereditary aggamaglobulinemia Increases in beta-globulin protein Multiple myeloma, biliary cirrhosis, obstructive jaundice Decreases in beta-globulin protein Nephrosis