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USA Acute Care Courses > AHN 568 - Unit 4 - Fluid, Electrolytes, Acid/Base Balance, & Anemias > Flashcards

AHN 568 - Unit 4 - Fluid, Electrolytes, Acid/Base Balance, & Anemias Flashcards

1
Q

The osmolarity of a solution is equal to…

…whereas osmolality equals…

A

…the number of milliosmoles per liter of solution, or think of it as the concentration of molecules per VOLUME of solution.

…the number of milliosmoles per kilogram of solvent, or think of it as the concentration of molecules per WEIGHT of solvent.

(McCance & Huether, Pathophysiology, p. 30)

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2
Q

When solute is added to water, the volume is expanded and includes the ________ _____ __ _____ plus the volume occupied by the solute particles. In measuring osmolarity, the volume of water is therefore reduced by an amount equal to the volume of added solute.

The difference between osmolarity and osmolality when talking about plasma is more significant than in the salt water example. In plasma, less of the plasma weight is water and the overall concentration of particles is therefore greater. The osmolality will be greater than the osmolarity because of the smaller proportion of water. __________ is thus the preferred measure of osmotic activity in clinical assessment of individuals.

A

original liter of water

Osmolality

(McCance & Huether, Pathophysiology, p. 30)

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3
Q

What is the formula for FENa?

A

(urinary Na x plasma creatinine)/(plasma sodium x urinary creatinine).
Multiply by 100 to get a percentage answer.

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4
Q

What are the 4 major causes of hypomagnesemia?

A 
Renal magnesium loss
GI magnesium loss
Deficient magnesium intake
Increased cellular uptake
[Dr. Bouzigard, F & E powerpoint voice-over]
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5
Q

Severe hypermagnesemia is almost always caused by…

A

…renal failure.

[Dr. Bouzigard, F & E powerpoint voice-over]

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6
Q

Iron deficiency anemia is present if serum ferritin is less than __ ____ or less than __ ____ if also anemic.

A

12 ng/mL
30 ng/mL
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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7
Q

What are the essentials of diagnosis of iron deficiency anemia?

A

–30 ng/mL or less serum ferritin
–Caused by bleeding unless proved otherwise
–Responds to iron therapy
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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8
Q

What is hepcidin and when is it increasingly produced?

A

It is a hormone made in the liver, which negatively regulates iron transport by promoting the degradation of ferroportin. It is increasingly produced during inflammation.
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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9
Q

What is ferroportin?

A

The major transporter of iron across the intestinal lumen.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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10
Q

Approximately 1 mg of iron per day is lost through…

A

…exfoliation of skin and mucosal cells.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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11
Q

The most important cause of iron deficiency anemia in adults is _______ _____ ____, especially _________ and ________________ blood loss.

A

chronic blood loss
menstrual
gastrointestinal
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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12
Q

In general, iron metabolism is balanced between…

A

…absorption of 1 mg/ day and loss of 1 mg/ day.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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13
Q

During pregnancy and lactation, the daily requirement of iron increases to…

A

…2 - 5 mg of iron per day.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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14
Q

Prolonged aspirin or NSAID use may cause chronic GI bleeding even without….

A

….a documented structural lesion.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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15
Q

Thalassemia produces a greater degree of ____________ for any given level of anemia than does iron deficiency.
And, unlike virtually every other cause of anemia, has a ______ or ________ (rather than ___) RBC count as well as a reticulocytosis.

A

microcytosis

normal or elevated (rather than low)

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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16
Q

In thalassemia, red blood cell morphology on the peripheral smear resembles…

A

…severe iron deficiency.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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17
Q

The most important part of anemia management is…

A

…identifying the cause, especially a source of occult blood loss. (Occult means hidden or secret.)
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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18
Q

What is the most basic approach to treating iron-deficiency besides finding the source?

A

Ferrous sulfate, 325 mg PO, one to three times daily.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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19
Q

What is Triferic?

A

Ferric pyrophosphate citrate. It’s a drug that was approved by the FDA in 2015 to be added to the dialysate during HD.
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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20
Q

How much iron do CKD patients lose per session of HD?

A

5 - 7 mg

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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21
Q

How do you calculate the needed parenteral iron dosage?

A

Using the example of a 50 kg woman:
0.25 x (27 ml/kg for women OR 30 ml/kg for men) x patient’s weight in kg = 337.5. Take this value and add 1 extra gram to replenish iron stores and anticipate further iron losses.
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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22
Q

What are the essentials of diagnosis for anemia of chronic disease?

A

–mild or moderate normocytic or microcytic anemia
–normal or increased ferritin and normal or reduced transferrin
–underlying chronic disease
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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23
Q

The anemia of inflammation is associated with inflammatory states such as…
…and is mediated through ________, a negative regulator of ferroportin, resulting in reduced iron ______ in the ___ and reduced iron transfer from ___________ to _________ progenitor cells in the ____ ______.

A

…inflammatory bowel disease, rheumatoid arthritis, chronic infections, and malignancy…

hepcidin, uptake, gut, macrophages, erythroid, bone marrow

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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24
Q

In anemia of inflammation, the serum iron is…

A

…low.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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25
Q

Anemia of organ failure occurs with…

A

…kidney disease, hepatic failure, and endocrine gland failure.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

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26
Q

In anemia of organ failure, the serum iron is…

A

…normal, except in CKD where it is low due to the reduced hepcidin clearance and subsequent enhanced degradation of ferroportin.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

27
Q

In anemia of the elderly, the serum iron is…

A

…normal.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

28
Q

Anemia of the elderly occurs as a result of relative resistance to ___ _________ in response to ______________, a decrease in erythropoietin production relative to the _______ ____, and a negative erythropoietic influence of low levels of chronic ____________ _________ in older adults.

A

RBC production, erythropoietin
nephron mass
inflammatory cytokines

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

29
Q

Is referral to a hematologist necessary for anemia of chronic disease?

A

Nope

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

30
Q

The thalassemias are hereditary disorders characterized by…

A

…reduction in the synthesis of globin chains (either alpha or beta)
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

31
Q

The thalassemias are described as “_____” when there are laboratory features without significant clinical impact, “__________” when there is an occasional RBC transfusion requirement or other moderate clinical impact, and “_____” when the disorder is life-threatening and patient is ___________-dependent.

A 
trait
intermedia
major
transfusion
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]
32
Q

What do most patients with thalassemia major die of?

A

The consequences of iron overload from RBC transfusions.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

33
Q

Alpha-thalassemia is due primarily to ____ _________, while beta-thalassemias are usually caused by _____ _________ rather than _________.

A

gene deletions
point mutations, deletions
[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

34
Q

MCV is measured in fL. What is fL?

A

femtoliters
This is the metric unit of volume equal to 10^-15 liters.
This is one quadrillionth of a liter, and is the same as one cubic micrometer (μm), a.k.a. one micron
1 μm3 = 1 fL
[from Wikipedia]

35
Q

What are the essentials of diagnosis for sideroblastic anemia?

A

Presence of ringed sideroblasts in the bone marrow.
Elevated serum iron levels and transferrin saturation.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

36
Q

What are the essentials of diagnosis for folic acid deficiency?

A

Macrocytic anemia
Megaloblastic blood smear (macro-ovalocytes and hypersegmented neutrophils)
Reduced folic acid levels in red blood cells or serum
Normal serum vitamin B12 level

37
Q

What are the essential of diagnosis for vitamin B12 deficiency?

A

Macrocytic anemia
Megaloblastic blood smear
Low serum vitamin B12 level

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

38
Q

What 3 drugs are known to cause folic acid deficiency by decreasing its absorption?

A

phenytoin
sulfasalazine
trimethoprim-sulfamethoxazole

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

39
Q

What does methotrexate have to do with folic acid?

A

It can cause a folic acid deficiency by inhibition of the reduction of folic acid to its active form

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

40
Q

The bone marrow has the ability to increase _________ __________ up to _________ in response to reduced red cell survival, so anemia will be present only when the ability of the bone marrow to __________ is outstripped.

A

erythroid production
eightfold
compensate

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

41
Q

Reticulocytosis is an important clue to the presence of hemolysis, since in most hemolytic disorders the bone marrow will respond with…

However, hemolysis can be present without reticulocytosis when…

A

…increased red blood cell production and earlier release of young red blood cells into the circulation.

…a second erythropoietic disorder (infection, nutritional deficiency) is superimposed on hemolysis.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

42
Q

Reticulocytosis does not necessarily imply hemolysis, since it also occurs during…

A

…recovery from hypoproliferative anemia (replacement of a missing nutrient) or acute bleeding.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

43
Q

Hemolysis is correctly diagnosed (when acute bleeding and nutrient replacement are excluded) if the hematocrit is…

A

…either falling or stable despite reticulocytosis.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

44
Q

What are the two main classifications of hemolytic anemias?

A

intrinsic and extrinsic

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

45
Q

Name 4 intrinsic causes of hemolytic anemia and give examples of each.

A

–Membrane defects: hereditary spherocytosis, hereditary elliptocytosis, paroxysmal nocturnal hemoglobinuria

–Glycolytic defects: pyruvate kinase deficiency, severe hypophosphatemia

–Oxidation vulnerability: glucose-6-phosphate dehydrogenase deficiency, methemoglobinemia

–Hemoglobinopathies: sickle cell syndromes, thalassemia, unstable hemoglobins, methemoglobinemia

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

46
Q

Name 5 extrinsic causes of hemolytic anemia and give examples of each.

A

–Immune: autoimmune, lymphoproliferative disease, drug-induced

–Microangiopathic: thrombotic thrombocytopenic purpura, hemolytic-uremic syndrome, disseminated intravascular coagulation, valve hemolysis, metastatic adenocarcinoma, vasculitis, copper overload
 
–Infection: Plasmodium, Clostridium, Borrelia

–Hypersplenism
 
–Burns

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

47
Q

What are the essentials of diagnosis for hereditary spherocytosis?

A

Positive family history
Splenomegaly
Spherocytes and increased reticulocytes on peripheral blood smear
Hyperchromic red blood cells (elevated mean corpuscular hemoglobin concentration [MCHC])

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

48
Q

Hereditary spherocytosis is a disorder of…

A

…the red blood cell membrane, leading to chronic hemolytic anemia.

[Current Medical Diagnosis and Treatment, Ch 13: Blood Disorders]

49
Q

What is the normal range for urine specific gravity?

A

1.010 - 1.035

[Powerpoint: “Differential Dx and Lab Findings”]

50
Q

What is the normal range for pH of urine?

A

4.5 - 8.0

[Powerpoint: “Differential Dx and Lab Findings”]

51
Q

In a normal urinalysis result, the sample should be negative for…

A

…glucose, ketones, protein, bilirubin, nitrate, and leukocyte esterase.

[Powerpoint: “Differential Dx and Lab Findings”]

52
Q

In a normal urinalysis result, the urobilinogen level should be…

A

…0.1 to 1.0 Ehrlich units/dL
(1 - 4 mg/24 hr)

[Powerpoint: “Differential Dx and Lab Findings”]

53
Q

In a normal urinalysis result, there should be _ to _ RBC’s per high power field (HPF) and _ to _ WBCs.

A

0 to 3
0 to 4

[Powerpoint: “Differential Dx and Lab Findings”]

54
Q

In a normal urinalysis, epithelial cells should be ___, casts are __________ and are _______ or ________. Crystals are also __________ and are made of ____ ____, _____, _________, or _______ _______.

A

few
occasional, hyaline or granular
occasional, uric acid, urate, phosphate, calcium oxalate

[Powerpoint: “Differential Dx and Lab Findings”]

55
Q

Urinalysis should not be run on samples left out at room temperature for more than…

A

…1 hour.

[Powerpoint: “Differential Dx and Lab Findings”]

56
Q

Persistent proteinuria usually indicates _____ or ________ disease.

A

renal or systemic

[Powerpoint: “Differential Dx and Lab Findings”]

57
Q

What is the formula for calculating osmolality?

A

2[Na+] + [glucose/18] + [BUN/2.8] = osmolality

[Dr. Culpepper, Camtasia Video, Part 1]

58
Q

Why does herniation occur with severe hyponatremia?

A

Herniation occurs as a result of cerebral edema secondary to profound hypo-osmolality.

[from “Correcting Severe Hyponatremia” USA handout]

59
Q

The maximal correction via 3% saline should be…

A

…a return to 120.

[from “Correcting Severe Hyponatremia” USA handout]

60
Q

Ease the Sodium up over 120 without exceeding…

A

…a total correction of 10 - 12 mEq/L in the first 24 hours.

[from “Correcting Severe Hyponatremia” USA handout]

61
Q

In cases where neuro compromise is not yet present but sodium is low enough to require less urgent replacement…

A

…correction should not exceed 0.5 mEq/l/hr over 24 hrs.

[from “Correcting Severe Hyponatremia” USA handout]

62
Q

What is the formula for the anion gap?

A

(Na + K) - (Cl + HCO3)
(remember, “the sum of sodium and potassium, minus the sum of chloride and bicarbonate”)

[from powerpoint “Acid Base Imbalances, USA 2015”]

63
Q

What are the 3 main causes of non-anion gap metabolic acidosis?

A

GI loss of bicarbonate
Insufficient renal acid secretion
Hydrogen chloride intake of acidifying salts

[from powerpoint “Acid Base Imbalances, USA 2015”]

64
Q

In metabolic acidosis, testing urine pH can help identify the cause.
If pH is > than 5.5…
If < than 5.5…

A

…suspect renal acidifying defect

…suspect GI bicarbonate loss or AG acidosis

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