Basic Lab Data Flashcards
Which organ is responsible for the production of the following enzymes?
How are these enzymes transported?
(ALT) - Alanine Transaminase
(AST) - Aspartate Transaminase
(ALP) - Alkaline Phosphatase
The liver is responsible for the creation of:
(ALT) - Alanine Transaminase
(AST) - Aspartate Transaminase
(ALP) - Alkaline Phosphatase
Albumin, a plasma protein made by the liver, is necessary for the transport of those enzymes
What are the major causes of acidosis?
Use MUDPILES:
M: Methanol U: Uremia D: DKA P: Paraldehyde I: Iron L: Lactic Acid E: Ethylene Glycol S: Salicylates (ASA products)
After analyzing your patient’s CBC, you note a significant WBC right shift. What is a right shift indicative of?
A right shift on the White Blood Cell count is indicative of a VIRAL infection.
How do the kidneys influence pH (per Hydrogen)?
The kidneys influence pH (per Hydrogen) by retaining or secreting bicarb (HCO3).
Which acid - base system reacts faster?
- Respiratory
- Metabolic
The Respiratory (lungs) system can change the acid - base factor significantly faster then the metabolic (kidneys) system.
What measures the effectiveness of coumadin-type anticoagulant medications?
Prothrombin time (PT) measures the effectiveness of coumadin-type anticoagulant medications (Warfarin).
What is a left shift?
What is a left shift indicative of?
A left shift is an increased number of neutrophil bands (immature) and is common with acute infections.
Left shift is primarily bacterial
What is the normal value range of Calcium (Ca++)?
9 - 11 mg/dL is the normal value range of Calcium (Ca++).
What is characterized by the following lab values?
Increase in pH
No Change PaCO2
Increase in HCO3
Uncompensated metabolic alkalosis is characterized by the following lab values:
Increase in pH
No Change PaCO2
Increase in HCO3
How is uncompensated metabolic alkalosis characterized?
Metabolic alkalosis is characterized as:
pH increased
PaCO2 no change
HCO3 increased
How long do elevated cTnI levels remain detectable at an elevated range, suggestive of myocardial specific injury?
Troponin (cTnI) levels stay elevated for approximately 5 - 10 days post infarction.
** this time can be extended for patients with renal injury due to the increased workload of the kidneys to get rid of the myoglobin **
Normal Range Value: < 0.05 ng/mL
______ is a crystalline product when the body breaks down purines (certain types of food).
Uric Acid
Standard Value Range: 2 - 8 mg/dL
If a patient has normal renal function, what is the normal time frame that the Creatine Phosphokinase (CPK) levels will return to baseline, subsequent to an Acute Myocardial Infarction (AMI)
3 - 4 days is the approximate time for the Creatine Phosphokinase (CPK) levels to return to baseline, subsequent to an Acute Myocardial Infarction (AMI), If a patient has normal renal function.
This WBC is predominately a viral killer?
The Lymphocyte White Blood Cell (WBC) is predominately a viral killer.
What is the normal Arterial Blood Gas (ABG) range for partial pressure of oxygen (PaO2)?
The normal Arterial Blood Gas (ABG) range for partial pressure of oxygen (PaO2) is:
35 - 45 mmHg
What is the International Normalized Ratio (INR)?
International Normalized Ratio (INR) is a standardized control used to compare the PT, regarding anticoagulant effectiveness of coumadin-type medications (Warfarin).
What is the normal value range of Creatinine (Cr) when examining the Basic Metabolic Panel (BMP)?
- 6 - 1.4 mg/dL (M):
- 6 - 1.1 mg/dL (F):
:is the normal value range of Creatinine (Cr) when examining the Basic Metabolic Panel (BMP)
What does the Partial Thromboplastin (PTT) measure?
Partial Thromboplastin (PTT) measures the effectiveness of heparin therapy.
A common problem of specimen collection associated with the breakdown of Red Blood Cells (RBC) and subsequent release of hemoglobin (Hgb) is known as:
- Hemoglobinuria
- Hematocrit
- Hemolysis
- Hemodialysis
- Hemolysis
A common problem of specimen collection associated with the breakdown of Red Blood Cells (RBC) and subsequent release of hemoglobin (Hgb) is known as Hemolysis.
You need to evaluate the functionality of your patient’s liver. Can this be done with a BMP
No, the Basic Metabolic Panel (BMP) does not assess liver functions.
The Comprehensive Metabolic Panel (CMP) is utilized to evaluate liver function.
What is occurring if the pH and the HCO3 are elevated?
Metabolic Alkalosis has occurred if the pH and the HCO3 are elevated.
_______ is an isoenzyme in the skeletal muscles, brain, and cardiac muscles. If this lab value is elevated, it could be indicative of myocardial insult.
Creatine Phosphokinase (CPK)
Normal Range Value: 5 - 35 mcg/dL
What is specificity?
Specificity is the probability that a test will be negative in the absence of a disease.
What is the normal average value for hemoglobin (Hgb)?
15 g/dL is the normal average value for hemoglobin (Hgb).
Male: 14 - 18 g/dL
Female: 12 - 16 g/dL
_____ is defined as an elevation of HCO3- above the normal value.
Metabolic Alkalosis is defined as an elevation of HCO3- (bicarb) above the normal value.
For every _____ mEq of bicarbonate (HCO3), the pH will change _____ in the same direction.
For every 10 mEq of bicarbonate (HCO3), the pH will change 0.15 in the same direction.
How do the lungs regulate acidity in the body?
The lungs regulate acidity in the body by increasing or decreasing the amount of CO2 present.
What does a Base Excess (BE) of > -10 mmol/L indicate?
> -10 mmol/L indicates severe shock
What are the main purposes of lab data analysis?
The main purposes of lab data analysis is:
- Establish baseline data
- Observe trends and changes over time
What is the normal Arterial Blood Gas (ABG) range for serum bicarbonate (HCO3)?
The normal Arterial Blood Gas (ABG) range for serum bicarbonate (HCO3) is:
22 - 26 mEq/L
Which lab value is significant in the determination of dehydration or over-hydration?
Serum Osmolality is significant in the determination of dehydration or over-hydration.
Normal Range Value: 282 - 295 mOsm
What is an acceptable International Normalized Ratio (INR) in persons receiving coumadin-type medications (Warfarin)?
International Normalized Ratio (INR) should be 2-3 in persons receiving coumadin-type medications (Warfarin).
What is released into the blood stream subsequent to a muscle injury?
Myoglobin is released into the blood stream subsequent to a muscle injury.
An elevated myoglobin level may be suggestive of cardiac muscle injury
Myoglobin is NOT sensitive
Normal Value Range: 9 - 12 mcg/mL
What labs can be analyzed via a BMP?
Basic Metabolic Panel:
Sodium (Na+): 135 - 145 mEq/L Potassium (K+): 3.5 - 5 mEq/L Chloride (Cl-): 96 - 106 mEq/L Calcium (Ca++): 9 - 11 mg/dL Glucose (Glu): 60 - 89 mg/dL BUN: 7 - 21 mg/dL Creatinine (Cr): 0.9 mg/dL (M/F average) Bicarbonate (HCO3): 22 - 26 mEq/L (serum)
** Bicarb is usually assessed via ABG **
What is considered a normal anion gap?
8 - 16 mEq/L is considered a normal anion gap.
[Na+ + K+] - [Cl- + HCO3-] = Anion Gap (AG)
What is the “Rule of Three” to determine a certain value via the Complete Blood Count (CBC)?
The “Rule of Three” to determine a certain value via the Complete Blood Count (CBC) is:
RBC x 3 = Hemoglobin (Hgb)
Hgb x 3 = Hematocrit (Hct)
(ex: RBC 5 x 3 = Hgb 15; Hgb 15 x 3 = Hct 45)
What is the time frame you would expect to see a rise in Creatine Phosphokinase (CPK) subsequent to an Acute Myocardial Infarction (AMI)?
Within 4 - 6 hours is the time frame you would expect to see a rise in Creatine Phosphokinase (CPK) subsequent to an Acute Myocardial Infarction (AMI).
How does the body off gas carbonic acid (H2CO3)?
The body off gases carbonic acid (H2CO3) by combining the H+ ion with deoxygenated hemoglobin (Hgb) which is called isohydric buffering and released from the lungs to form exhaled CO2.
What does a positive Base Excess (BE) indicate?
A positive Base Excess (BE) indicates the patient has metabolic alkalosis.
______ measures the degradation products of cross-linked fibrin created during fibrinolysis.
D-dimer Assey measures the degradation products of cross-linked fibrin created during fibrinolysis.
Normal Range Value: < 0.5 - 1 mcg/mL
< 500 - 1000 mcg/L
What is an elevated CPK suggestive of?
Creatine Phosphokinase (CPK) is suggestive of:
Myocardial injury: CPK-MB
Renal Failure
Tongue Injury
Normal Range Values: 5 - 35 mcg/dL
What does a negative Base Excess (BE) indicate?
A negative Base Excess (BE) indicates the patient has metabolic acidosis.
What is the formula to determine a patient’s anion gap (AG)?
[Na+ + K+] - [Cl- + HCO3-] = AG
[Sodium + Potassium] - [Chloride + Bicarb] = AG
Creatinine (Cr) aids in the diagnosis of _______.
Creatinine (Cr) aids in the diagnosis of renal dysfunction.
What is the proper sequence for interpreting Arterial Blood Gases (ABGs)?
The proper sequence for interpreting Arterial Blood Gases (ABGs) is:
- pH
- PaCO2
- HCO3
- PaO2
- Assess the anion gap (AG)
What is the normal value range of Creatine Phosphokinase (CPK)?
5 - 35 mcg/mL is the normal value range of Creatine Phosphokinase (CPK).
What is a normal value for prothrombin time (PT)?
11.2 - 13.2 seconds is a normal value for prothrombin time (PT).
______ is defined as a reduction of HCO3 below normal.
Metabolic acidosis is defined as a reduction of HCO3 below normal.
What does the Blood Urea Nitrogen (BUN) panel evaluate?
The Blood Urea Nitrogen (BUN) panel evaluates renal function and hydration status.
________ is a hormone produced by the cardiac ventricles when stretched. When elevated, this hormone is indicative of heart failure.
What are the normal value ranges?
B-type Natriuretic Peptide (BNP)
< 100 pg/ml - Low likelihood of heart failure
100 - 400 pg/mL - Interment likelihood of heart failure
> 400 pg/mL - High likelihood of heart failure
________ is the probability that a test will be negative in the absence of a disease.
Specificity is the probability that a test will be negative in the absence of a disease.
True or False:
Your patient has a myoglobin lab value of 19 mcg/mL? This is immediately suggestive of myocardial insult/damage?
False.
Myoglobin is NOT sensitive! Increased myoglobin levels are suggestive of muscular injury anywhere in the body.
Normal Range Value: 9 - 12 mcg/mL
What is the normal average value for hematocrit (Hct)?
45% is the normal average value for hematocrit.
Male: 40 - 54%
Female: 36 - 46%
Hematocrit (Hct) is displayed as a percentage: it is the percentage of chemicals suspended in the blood
If you note an elevated BNP level on your patient’s lab work, what does this tell you?
BNP lab values greater then 100 pg/mL suggest the likelihood of heart failure.
< 100 pg/ml - Low likelihood of heart failure
100 - 400 pg/mL - Interment likelihood of heart failure
> 400 pg/mL - High likelihood of heart failure
What is occurring if the pH is elevated and the PaCO2 is down?
Respiratory alkalosis has occurred if the pH is elevated and the PaCO2 is down.
Think seesaw
______ is a waste product of protein metabolism found in urine.
Creatinine (Cr) is a waste product of protein metabolism found in urine.
You note that your patient has elevated myoglobin levels. Approximately how long ago should you expect the muscular insult occurred?
Myoglobin levels increase 2 - 6 hours post injury
** Myoglobin peaks 8 - 12 hours after injury **
Normal Range Value: 9 - 12 mcg/mL
What is the “distance” between cations (+) and anions (-) called?
Anion gap is the the “distance” between cations (+) and anions (-).
______ is a standardized control used to compare the PT, regarding anticoagulant effectiveness of coumadin-type medications (Warfarin).
International Normalized Ratio (INR) is a standardized control used to compare the PT, regarding anticoagulant effectiveness of coumadin-type medications (Warfarin).
What lab value tests are used to determine blood medicated coagulation sufficiency?
Prothrombin Time (PT): 11.2 - 132 secs (12 secs)
Measures Coumadin-type anticoagulation medications.
******
Partial Thromboplastin Time (PTT): 22.1 - 34.1 secs (25)
Measures the effectiveness of clotting factors and heparin efficacy.
*****
International Normalized Ratio (INR): INR 1 is unmedicated
INR 2-3 - normal value for a person on heparin
What is the physiological progress of the creation of bilirubin?
Bilirubin is created when red blood cells (RBCs) are broken down and recycled.
If CO2 is decreased, the kidneys excrete ____ H+ ions and reabsorbs _____ HCO3.
If CO2 is decreased, the kidneys excrete less H+ ions and reabsorbs less HCO3.
Which lab panel represents the physiological metabolic byproduct created from the breakdown of blood, muscle, and protein?
The Blood Urea Nitrogen (BUN) panel physiologically represents the metabolic byproduct created from the breakdown of blood, muscle, and protein.
What does prothrombin time (PT) measure?
Prothrombin time (PT) measures the effectiveness of coumadin-type anticoagulant medications (Warfarin).
________ is the probability that the test will be positive in the presence of a disease.
Sensitivity is the probability that the test will be positive in the presence of a disease.
Your patient has a confirmed pulmonary embolism. What lab value would you expect to be elevated, suggestive of clot formation?
D-dimer
** NOT specific - will NOT indicate the location of the clot **
Normal Range Value: < 0.5 - 1 mcg/mL
< 500 - 1000 mcg/L
Which lab panel evaluates renal function and hydration status?
The Blood Urea Nitrogen (BUN) panel evaluates renal function and hydration status.
What is the normal Arterial Blood Gas (ABG) range for oxygen saturation (SaO2)?
The normal Arterial Blood Gas (ABG) range for oxygen saturation (SaO2) is:
90 - 100%
______ perfusion results in tissue hypoxia and anaerobic metabolism.
Decreased perfusion results in tissue hypoxia and anaerobic metabolism.
A patient with an elevated bilirubin is suggestive of what?
Higher than standard amounts of blood being broken down and metabolized.
Standard Range Value: 1 - 2 mg/dL
What does a Complete Blood Count (CBC) panel consist of?
Complete Blood Count (CBC) panel:
- White Blood Cell (WBC) count = 4500 - 10000 /uL
- White Blood Cell (WBC) differential = 40 - 70%
- Red Blood Cell (RBC) count = 3.5 - 6M /uL
- Hemoglobin (Hgb) = 15 g/dL
- Hematocrit (Hct) = M: 40 -54% / F: 36 - 46%
- Platelet count = 150,000 - 400,000 /mm3
What two organs are the primary acid-excreting organs in healthy people?
The lungs and the kidneys are the primary acid-excreting organs in healthy people.
What is the normal value range of Sodium (Na+)?
135 - 145 mEq/L is the normal value range of Sodium (Na+).
What is the normal value range of Potassium (K+)?
3.5 - 5 mEq/L is the normal value range of Potassium (K+).
What medication can be administered to stem or reverse the effects of Coumadin-type medications?
Vitamin K can be administered to stem or reverse the effects of Coumadin-type medications.
What kind of infection is a “left shift” indicative of?
A left shift is indicative of a bacterial infection.
________ are the contractile proteins of the myofibril.
Troponin T / Troponin I (cTnI) are the contractile proteins of the myofibril.
** Troponin is MORE specific for a myocardial injury than the CPK-MB **
Normal Range Value: < 0.50 ng/mL
What is the root cause of respiratory acidosis?
The root cause of respiratory acidosis is hypercapnia (excessive carbon dioxide).
What is characterized by the following lab values?
Decrease in pH
Increased PaCO2
No Change in HCO3
Uncompensated respiratory acidosis is characterized by the following lab values:
Decrease in pH
Increased PaCO2
No Change in HCO3
Which lab value is displayed as a percentage, which represents the amount of dissolved chemicals within the blood?
Hematocrit (Hct) is displayed as a percentage, which represents the amount of dissolved chemicals within the blood.
What is the normal range value for Serum Osmolality?
Normal Range Value is 282 - 295 mOsm
** Panic Values: < 240 mOsm; > 321 mOsm **
What is the most common cause of normal anion gap acidosis?
Diarrhea is the most common cause of normal anion gap acidosis.
Your patient has a myoglobin lab value of 6 mcg/dL? You know that the normal lab values are between 9 - 12 mcg/dL. What is a low myoglobin value suggestive of?
Nothing.
Low myoglobin values are not relevant.
Normal Range Value: 9 - 12 mcg/mL
What is characterized by the following lab values?
Decrease in pH
No Change PaCO2
Decrease in HCO3
Uncompensated metabolic acidosis is characterized by the following lab values:
Decrease in pH
No Change PaCO2
Decrease in HCO3
What is a standard value range for Uric Acid?
Uric Acid:
2 - 8 mg/dL
What factors would result in an unmedicated elevation of Prothrombin Time (PT) and/or Partial Thromboplastin Time (PTT)?
Factor V insufficiency
Factor X insufficiency
What is Creatinine (Cr)?
Creatinine (Cr) is a waste product of protein metabolism found in urine.
What organ is responsible for making Albumin?
The liver is responsible for making Albumin.
** albumin is necessary for the transport of hormones and enzymes **
What does a Base Excess (BE) of -3 to -5 mmol/L indicate?
3 to -5 mmol/L indicates mild shock
What additional labs can be analyzed via the CMP that can NOT be analyzed via the BMP
Comprehensive Metabolic Panel:
True or False:
Ammonia is included in the standard CMP?
False.
Ammonia (NH3) is NOT included in the standard Comprehensive Metabolic Panel and must be requested/ran separately.
NH3 Standard Value Range: 15 - 45 mcg/dL
What Arterial Blood Gas (ABG) value indicates the presence of hypercapnia?
Hypercapnia (excessive carbon dioxide) is indicated as a value greater then 45 mmHg on the ABG/PaCO2
> 45 mmHg
What is sensitivity?
Sensitivity is the probability that the test will be positive in the presence of a disease.
How do the kidneys eliminate H+ ions?
The body eliminates H+ ions via urine.
Subsequent to an Acute Myocardial Infarction (AMI), when does the Creatine Phosphokinase (CPK) level usually peak?
Creatine Phosphokinase (CPK) levels usually peak 24 hours subsequent to an Acute Myocardial Infarction (AMI).
What causes metabolic alkalosis?
Metabolic alkalosis is the result of elevated serum bicarb (HCO3) or the loss of H+ ions.
________ can be caused by hyperventilation.
Respiratory alkalosis can be caused by hyperventilation.
What is characterized by the following lab values?
Increase in pH
Decreased PaCO2
No Change in HCO3
Uncompensated respiratory alkalosis is characterized by the following lab values:
Decrease in pH
Increased PaCO2
No Change in HCO3
The liver produces three main enzymes. What are they?
(ALT) - Alanine Transaminase
(AST) - Aspartate Transaminase
(ALP) - Alkaline Phosphatase
** Albumin, a plasma protein made by the liver, is necessary for the transport of those enzymes **
What does a Base Excess (BE) of -6 to -9 mmol/L indicate?
-6 to -9 mmol/L indicates moderate shock
Your patient has an elevated cTnI level. What does this suggest?
What cTnL level is considered normal?
A high Troponin level (cTnI) is suggestive of myocardial insult.
Normal Range Value: < 0.05 ng/mL
What is a normal value for Partial Thromboplastin (PTT)?
22.1 - 34.1 seconds (after heparin is administered) is a normal value for Partial Thromboplastin (PTT)
THINK: Two lower case T’s look like an “H”
What results from hypoventilation?
The pH decreases; acidosis results from hypoventilation; retention of CO2.
Respiratory acidosis
If CO2 is increased, the kidneys excrete ____ H+ ions and reabsorbs _____ HCO3.
If CO2 is increased, the kidneys excrete more H+ ions and reabsorbs more HCO3.
A patient has an elevated Serum Osmolality level of 310 mOsm. What is this indicative?
Dangerously low fluid volume levels.
Can be attributed to:
- Renal Disease
- CHF
- Dehydration
- Diabetes Mellitus
Normal Range Value: 282 - 295 mOsm
What is the normal Arterial Blood Gas (ABG) range for base excess (BE)?
The normal Arterial Blood Gas (ABG) range for base excess is:
-3 to +3 mmol/L
For every ____ mmHg change in CO2, the pH will change ____ in the opposite direction.
For every 10 mmHg change in CO2, the pH will change 0.08 in the opposite direction.
What are the three creatine phosphokinase (CPK) markers?
CPK-MM - Creatine Phosphokinase - Skeletal Muscle
CPK-BB - Creatine Phosphokinase - Brain
CPK-MB - Creatine Phosphokinase - Cardiac
Normal Range Value: 5 - 35 mcg/mL
What does the Blood Urea Nitrogen (BUN) panel represent physiologically?
The Blood Urea Nitrogen (BUN) panel physiologically represents the metabolic byproduct created from the breakdown of blood, muscle, and protein.
You are asked to to run a CBC for a patient. What does the CBC evaluate?
Complete Blood Count - used as a broad screening test to check for a variety of conditions including anemia and infections.
WBC - White Blood Count: 4,500 - 11,000 /mL
WBCd - White Blood Count Differential: 40 - 70%
RBC - Red Blood Cell Count: 3.5 - 6M /mL
HGB - Hemoglobin: 15 g/dL
HCT - Hematocrit: 44%
Platelet Count - 150,000 - 400,000/mm3
How is uncompensated metabolic acidosis characterized?
Metabolic acidosis is characterized as:
pH decreased
PaCO3 no change
HCO3 decreased
What is the normal value range for the Blood Urea Nitrogen (BUN) panel?
The normal value range for the Blood Urea Nitrogen (BUN) panel is:
7 - 21 mg/dL
What is occurring if the pH is down and the PaCO2 is elevated?
Respiratory acidosis has occurred if the pH is down and the PaCO2 is elevated.
Think Seesaw
Your patient has an elevated ammonia (NH3) level. What is this indicative of and why?
Elevated ammonia (NH3) levels are indicative of liver damage/failure.
With liver damage, the liver may be unable to convert ammonia into urea causing an increase of NH3 levels.
NH3 Standard Value Range: 15 - 45 mcg/dL
What are the two main mechanisms leading to hypercapnia?
The two main mechanisms leading to hypercapnia (excessive carbon dioxide) are:
- Hypoventilation
- Ventilation / Perfusion mismatch (V/Q mismatch)
What does a Base Excess (BE) of +3 to -3 mmol/L indicate?
+3 to -3 mmol/L is considered a normal Base Excess (BE).
What is occurring if the pH and the HCO3 are down?
Metabolic acidosis has occurred if the pH and the HCO3 are down.
What is the normal Arterial Blood Gas (ABG) range for pH (per Hydrogen)?
The normal Arterial Blood Gas (ABG) range for pH (per Hydrogen) is:
7.35 - 7.45
What does the D-dimer Assey assess?
D-dimer assesses for clot formation.
** NOT specific - will NOT indicate the location of the clot **
Normal Range Value: < 0.5 - 1 mcg/mL
< 500 - 1000 mcg/L
What is appropriate labeling for patient lab containers?
Appropriate labeling for patient lab containers is:
- Date
- Time
- Patient Name
What is a standard range value of Creatinine (Cr)?
Creatinine (Cr): 0.9 mg/mL
Males: 0.6 - 1.4 mg/mL
Females: 0.6 - 1.1 mg/mL
What results from hyperventilation?
The pH increase; alkalosis results from hyperventilation; blows off excess CO2.
Respiratory alkalosis
What is a standard BUN/Cr ratio?
BUN/Creatinine(Cr) ratio:
≤ 10:1
ex: BUN = 12; Cr = 1.2 is a normal ratio
BUN = 18; Cr of 2.4 is an abnormal ratio
What component of the BMP/CMP is used to specifically evaluate renal and urinary tract function?
Uric Acid (bUn) s used to specifically evaluate renal and urinary tract function.