11. EMQ on Enzymes and Chemistry Flashcards
Creatine kinase is the protein in your muscle, what is the waste produce that it generates?
Creatinine
As people have a fixed muscle mass, you make creatinine at …
a fixed rate
As people have a fixed muscle mass, you make creatinine at a fixed rate. Therefore, when the kidneys fail…
creatinine goes up
What will happen to AST following an acute MI? Why?
AST will increase following an acute MI because AST is found within the myocytes
When are AST levels increased and for how long?
AST goes up about 3 days after an MI and remains for around 14 days (3-14 days)
Which enzymes increase following an MI?
Troponins, CK (MB), AST, LDH
Why can rhabdomyolysis lead to acute kidney injury?
Because myoglobin is very nephrotoxic
What do you give patients with rhabdomyolysis?
IV bicarbonate
Why do you give IV bicarbonate to patients with rhabdomyolysis?
If patients have a very high CK because of muscle breakdown, it can lead to renal failure. To prevent this from happening, you give them IV bicarbonate which allows them to pee out all the extra CK
ALT and AST in patients with viral hepatitis
ALT will be higher than AST
ALT and AST in patients with chronic alcoholic cirrhosis
AST will be higher than ALT (2:1) in patients with chronic alcoholic cirrhosis
What are the levels of acid phosphatase in prostate cancer?
Acid phosphatase rises
What is the vitamin D level in primary hyperparathyroidism and why?
The vitamin D level is LOW. This is because PTH activates 1-alpha hydroxylase meaning that vitamin D is consumed (i.e. it is activated)
In acute renal failure that is caused by dehydration, what will rise the most?
urea
In chronic renal failure caused by a fall in GFR, what will rise the most?
creatinine
Diabetes, as a cause of CKD, is less rapidly progressive than other causes of renal impairment, true or false
false, it is much more rapidly progressive than other causes of renal impairment
With diabetes, you are likely to reach end-stage renal failure within a year if you have a creatinine ….
> 200 micromol/L
Having a high creatinine does or does not mean that you need dialysis?
Does NOT
What are indications for dialysis?
Hyperkalaemia, acidosis (NOTE: a lot of these patients are given sodium bicarbonate to try and minimise the acidosis) and pulmonary oedema
What is a marker of glucose control over the last 3 weeks?
Fructosamine
Why use fructosamine as a marker of glucose control (over last 3 weeks)?
- It is important to have good diabetic control during pregnancy
- You also cannot wait for 3 months to assess blood glucose control because the pregnancy only lasts 9 months
- It is also important to monitor blood glucose control because as the pregnancy progresses their control will deteriorate (because all the hormones in pregnancy are insulin-resistant)
What is the FreeStyle Libre?
Soon, you will be able to use a FreeStyle Libre (a probe that you can put on your arm and swipe to get a reading)
In Paget’s disease, what is there an increase in activity of?
Both osteoclasts and osteoblasts
What does an increase in osteoblasts and osteoclasts in Paget’s disease lead to?
Increase in ALP and osteocalcin