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Semester 2 > Labs: Glucose, Calcium, Phosphate, Magnesium, Proteins > Flashcards

Labs: Glucose, Calcium, Phosphate, Magnesium, Proteins Flashcards

1
Q

Normal glucose

A

60-110 mg/dL

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2
Q

Panic values glucose

A

<40 OR >500 mg/dL

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3
Q

Where do we see hyperglycemia?

A
  • DM
  • Cushings (10-15%)
  • Chronic pancreatitis (30%)
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4
Q

What drugs cause hyperglycemia?

A
  • corticosteroids
  • phenytoin
  • estrogen
  • thiazides
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5
Q

Where do we see hypoglycemia?

A
  • insulinoma
  • adrenocortical insufficiency
  • hypopituitarism
  • diffuse liver disease
  • enzyme deficiency diseases (e.g. galactosemia)
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6
Q

What drugs cause hypoglycemia?

A
  • insulin
  • ethanol
  • propranolol
  • sulfonylureas, tulbutamide, and other oral hypoglycemic agents
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7
Q

What needs to be done to Dx DM?

A

EITHER
1. fasting plasma glucose >126 mg/dL on 2+ occasions
2. spot plasma glucose level >200 mg/dL
3. HbA1C >6.5%

+ symptoms of DM

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8
Q

Patients with fasting blood glucose levels of ______ to ______ are considered to have impaired fasting glucose

A

110-126 mg/dL

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9
Q

What lab is favored to monitor glycemic control in pts with DM?

A

HbA1C
AKA glycosylated hemoglobin

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10
Q

What is total Ca++ made up of?

A
  • protein-bound (~40%)
  • anion-bound (~10%)
  • ionized “free” (~50%) = metabolically active
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11
Q

Which is the only type of calcium that is used by the body for vital cellular processes?

A

ionized Ca++

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12
Q

The amount of __________ in the blood will affect Ca++ levels

A

protein

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13
Q

Ca++ regulation is controlled by

A

PTH, calcitonin, vitamin D, renal absorption

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14
Q

Function of ionized calcium

A
  • enzyme rxns
  • intracellular secondary messenger (amplification)
  • membrane potential + neuronal excitability
  • exocytosis of neurotransmitters at NMJ & CNS
  • muscle contraction (skeletal, smooth, cardiac)
  • hormone release
  • influence cardiac automaticity
  • required for coagulation in intrinsic pathway
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15
Q

Total serum calcium is useful for evaluating

A
  • pts with known or suspected hyper/hypocalcemia
  • electrolyte status in pts receiving IV fluids
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16
Q

Tube for total serum calcium

A

red, yellow, or speckled top tube

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17
Q

Normal total serum calcium level

A

8.9-10.1 mg/dL

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18
Q

Factors that interfere with total serum calcium

A
  • thiazide diuretics
  • large amount of blood transfusions
  • dialysis
  • excessive laxative use
  • acid base disorders
  • ↑ or ↓ protein levels
  • calcium levels are inversely related to phosphate levels
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19
Q

Hypercalcemia level

A

total Ca++ >12 mg/dL

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20
Q

Etiology of hypercalcemia

A
  • 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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21
Q

Clinical manifestations of hypercalcemia

A
  • ↑ thirst
  • polyuria, flank pain, signs of kidney stones, or renal insufficiency
  • anorexia, nausea, vomiting, constipation
  • muscle weakness, atrophy, ataxia, and loss of muscle tone
  • HTN, shortening of QT interval and possible AV block
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22
Q

Hypocalcemia level

A

total Ca++ <8.5

TRUE hypocalcemia is ionized Ca++ <4.0 mg/dL

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23
Q

Etiology of hypocalcemia

A
  • pseudohypocalcemia
  • hypoparathyroidism
  • hyperphosphatemia
  • malabsorption syndromes & malnutrition
  • pancreatitis
  • alkalosis
  • Vit D deficiency (rickets or osteomalacia)
  • alcoholism & cirrhosis
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24
Q

Clinical manifestations of hypocalcemia

A
  • parathesias
  • 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, and fractures
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25
Q

Ionized calcium level is useful for

A
  • any surgical procedure that requires rapid & multiple whole blood transfusions
  • second order test in the eval of pts with abnormal Ca++ levels
  • neonatal calcium measurement
  • assessing Ca++ levels in critically ill pts
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26
Q

Normal ionized calcium level

A

4.75-5.20 mg/dL

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27
Q

Panic values of ionized calcium

A

<2.0 mg/dL - may produce tetany or life-threatening complications

> 7.0 mg/dL - may cause coma

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28
Q

Increased levels of ionized calcium are due to

A
  • hyperparathyroidism
  • ectopic PTHrP tumors
  • ↑ vitamin D intake
29
Q

Decreased ionized calcium levels are due to

A
  • hypoparathyroidism
  • vitamin D deficiency
  • pts receiving bicarb (to control metabolic acidosis)
  • acute pancreatitis
  • hyperventilation (to control increased ICP)
  • magnesium deficiency
  • multiple organ failure
30
Q

Factor that inferes with ionized calcium level

A

improper specimen collection in EDTA

31
Q

Serum phosphate locations

A

85% - combined with Ca++ inside bone
14% - within cells
1% - extra-cellular compartment

32
Q

Functions of Serum Phosphate

A
  • bone formation (bone matrix)
  • essential for certain metabolic processes (ATP formation, building of enzymes for glucose, fat, & protein metabolism)
  • cell structure (nucleic acids, membrane phospholipids)
  • acid-base buffer in ECF + renal excretion of H+ ions
  • O2 delivery by RBCs through organic phosphates & 2,3-diphosphoglycerate
33
Q

Serum phosphate is (PROPORTIONAL/INVERSELY RELATED) to Ca++

A

inversely related

34
Q

How does serum phosphate work?

A

moves into the cells after carbohydrate ingestion → lowered in plasma

35
Q

Serum phosphate is useful for evaluating

A
  • pts with CKD or hyperparathyroidism
  • alcoholic + malnourished pts OR pts receiving TPN
  • status of pts recovering from DKA OR pts receiving IV fluids containing phosphorus
  • pts with hyperthyroidism
36
Q

Normal serum phosphate level

A

2.5-5.0 mg/dL

37
Q

Factor that interferes with serum phosphate

A

hemolysis

38
Q

Hyperphosphatemia level

A

> 5 mg/dL

39
Q

Etiology of hyperphosphatemia

A
  • ↓ excretion due to renal failure
  • hypoparathyroidism
  • adrenal insufficiency + acromegaly
  • ↑ intake + absorption
  • redistribution/cellular release
  • hypocalcemia
  • bone tumors + cancer metastases
40
Q

Clinical manifestations of hyperphosphatemia

A

usually related to hypocalcemia

  • paresthesias, tetany, Chvostek’s, and Trousseau’s signs
  • hypotension + cardiac arrhythmias
  • skeletal muscle cramps, abdominal spasms + cramps
  • bone pain
41
Q

Hypophosphatemia level

A

<2.5 mg/dL

42
Q

Etiology of hypophosphatemia

A
  • hyperparathyroidism
  • DKA
  • antacids
  • severe diarrhea
  • Vit. D deficiency
  • alkalosis
  • alcoholism, malnutrition, TPN
  • renal tubular absorption defects
43
Q

Clinical manifestations of hypophosphatemia

A

usually related to hypercalcemia

  • ataxia, hyporeflexia, muscle weakness, joint + bone pain
  • ↑ thirst, anorexia, N/V, constipation
  • lethargy, personality/behavioral changes, stupor, possible coma
44
Q

Serum magnesium locations

A

50% - bone
49% - cells
1% - serum

45
Q

Purpose of Mg++

A
  • required as a cofactor for the production of cellular energy and function of cellular messenger systems (ATP rxns, replication, DNA transcription, mRNA translation, energy metabolism)
  • regulates neuromuscular irritability + clotting mechanism
  • influences secretion, synthesis, + action of PTH
  • contributes to nerve conduction, ion transport, and calcium channel activity
46
Q

Serum magnesium is useful for evaluating

A
  • renal function + electrolyte status in hospitalized pts
  • pt with hypocalcemia or hypokalemia not responding to electrolyte correction
  • identification of malabsorption disorders
  • monitoring Tx of pre-eclampsia
47
Q

Normal serum magnesium level

A

1.5-3.0 mEq/L

48
Q

Factors that interfere with serum magnesium

A

hemolysis, lithium, or salicylate use

49
Q

Hypermagnesemia level

A

> 3.0 mEq/L

50
Q

Etiology of hypermenesemia

A
  • renal failure or dehydration
  • treatment of pre-eclampsia
  • rhabdo
  • excessive use of antacids
51
Q

Clinical manifestations of hypermagnesemia

A
  • lethargy, hyporeflexia, muscle weakness
  • depressed respiration, apnea, confusion
52
Q

Hypomagnesemia level

A

<1.5 mEq/L

53
Q

Etiology of hypomagnesemia

A
  • alcoholism, malnutrition, malabsorption, + STARVATION
  • parenteral nutrition
  • pancreatitis
  • hypoparathyroidism
54
Q

Clinical manifestations of hypomagnesemia

A
  • personality changes, tetany, nystagmus, Chvostek’s + Trousseau’s sign
  • altered PTH secretion/action may occur
55
Q

Functions of serum proteins

A
  • source of nutrition
  • buffer system
  • immune function
  • carrier proteins
  • metabolic function
  • chromosomal + DNA components
  • cell membrane structure
  • colloidal osmotic pressure
  • antiprotease
56
Q

Purpose of serum albumin

A
  • part of a diverse microenvironment which primarily maintains colloidal osmotic pressure
  • source of nutrition + also part of complex buffer system
  • “negative” acute phase reactant
57
Q

Serum albumin is useful for evaluating

A
  • nutritional status, albumin loss in acute illness
  • pts with liver or renal disease, hemorrhage, burns, or leaks in GI tract
58
Q

Normal serum albumin

A

3.5-4.8 g/dL

59
Q

Increased levels of serum albumin is due to

A

volume depletion or dehydration

60
Q

Decreased levels of serum albumin is due to

A
  • acute/chronic inflammation + infection
  • cirrhosis, liver disease, + alcoholism
  • nephrotic syndrome
  • Crohn’s, colitis, malabsorption
  • Burns + severe skin disease
61
Q

Factors that interfere with serum albumin

A
  • pregnancy
  • oral contraceptives + estrogen replacement
  • prolonged bed rest
  • IV fluids, rapid hydration, or overhydration
62
Q

Is serum albumin a good indicator of recent changes in nutrition?

A

NO - NOT a good indicator of recent changes in nutrition due to prolong half-life in serum

63
Q

Serum protein electrophoresis (SPEP)

A

separates albumin + globulins with an electric field to differentiate the proteins according to size, shape, + electrical charge into 5 distinct fractions

  • ablumin, alpha-1 globulin, alpha-2 globulin, beta-globulin, gamma-globulin
64
Q

Serum protein electrophoresis (SPEP)

A

separates albumin + globulins with an electric field to differentiate the proteins according to size, shape, + electrical charge into 5 distinct fractions

  • ablumin, alpha-1 globulin, alpha-2 globulin, beta-globulin, gamma-globulin
65
Q

Serum protein electrophoresis (SPEP) is useful for evaluating

A
  • detection of monoclonal protein
  • monitoring size of monoclonal peak in multiple myeloma pts
66
Q

When evaluating myeloma with SPEP, you would expect what distribution of proteins

A

↓ albumin, alpha-1, alpha-2, beta

↑ gamma

67
Q

↑ in total serum protein can be due to

A
  • volume depletion or dehydration
  • multiple myeloma
  • sarcoidosis & other granulomatous diseases
  • any inflammatory state
68
Q

↓ in total serum protein can be due to

A
  • poor nutritional status, liver disease, alcoholism, burns, severe skin disease
  • renal disease, Crohn’s, UC

Semester 2 (5 decks)

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