Biochemical Assessment Flashcards by Sydney Perry

Used to
◦Diagnose diseases/illness
◦Evaluate hydration status, organ function
◦Diagnose nutritional deficiencies
◦Monitor effectiveness of nutrition interventions

Biochemical Assessment

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Biochemical Assessment involves __________

Comprehensive Metabolic Panel (CMP)

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Comprehensive Metabolic Panel (CMP) includes ??

Serum Electrolytes:
◦ Sodium (Na+)
◦ Potassium (K+)
◦ Chloride (Cl-)
◦ C02 (total carbon dioxide; bicarbonate)

Glucose
Blood Urea Nitrogen (BUN)
Creatinine (Cr)
Total Calcium
Albumin
Total Protein

Liver function tests:
◦ ALP
◦ ALT
◦ AST
◦ Bilirubin

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Total body water (TBW) comprises _____%
of body weight

Comprised of intracellular & extracellular fluid
Water moves in & out of the intracellular & extracellular spaces based on osmolarity to obtain equilibrium

50-60

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Intracellular Fluid (ICF) ~ ______ of TBW
Extracellular fluid (ECF) ~_____ of TBW
Transcellular fluid (GIT secretions, cerebrospinal
fluid, pericardial fluid, etc. ) ~ ____% of TBW

2/3
1/3
3

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ECF Compartments:
o Interstitial fluid (____ of ECF)
o Intravascular fluid (____ of ECF)

3/4
1/4

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What is interstitial fluid

in between cells and interstitial space
lymphatic system gets it back into cells slowly

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what is intravascular

lymphatic cells and blood

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TBW ________ with age
* Varies depending on amount of body fat & muscle mass, more fat means _____ water

decreases
less

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Average adult:
- Male: ___% of body wt is water
- Female: _____% of body wt is water

Older adult (>60 yo): Male ____%; Female ____%
Adult with obesity: Male ____%; Female ____%

60
50

52
46

50
45

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Large plasma proteins cause an osmotic gradient which promotes movement of water into the ______ space

Decreased serum ______=> decreased _______ pressure=> fluid moves from _________ to the________ space (“__________”) => edema

intravascular

albumin
oncotic
intravascular
interstitial
third spacing

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Pressure exerted by fluid on the capillary walls is ________

Increased by _____ and _____ retention (CHF, HTN, renal failure)

Increased pressure=> movement of fluid into _______space (“________”)=>edema

hydrostatic pressure

Na & water

interstitial
third spacing

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Accumulation of fluid within the interstitial space is ______

Problem of fluid distribution
Does not necessarily indicate __________fluid excess

edema

total body or intravascular

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Causes of edema

Decrease in colloidal oncotic pressure
Increase in hydrostatic pressure
Increase in capillary permeability
Lymphatic obstruction

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_________ AKA: volume depletion
Excessive fluid loss (water & solutes)
Caused by:
*GIT losses=> diarrhea, vomiting, bleeding
*Excessive urinary losses=> _______ therapy
*Skin losses (e.g., fever, burns, wounds)

Hypovolemia

diuretic

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Deficit of water only is _______
Caused by:
◦Decreased ______
◦Excessive ________ (watery diarrhea, prolonged fever, hyperglycemia, diabetes insipidus)

dehydration

fluid intake
water loss

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Symptoms of Dehydration

Thirst
Dry inelastic skin
Dry mucus membranes
Rapid weight loss
Decreased urine output; dark urine
Tachycardia (fast ♡ rate)
Orthostatic hypotension (blood not getting to brain fast enough)
Headaches

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Biochemical Data Indicating Dehydration

Increase in serum Na
Increase in serum osmolality
Increase in serum Blood Urea Nitrogen (BUN)

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Volume overload is _________
Excessive gain of fluid (water & solute such as sodium) Caused by:
______

Hypervolemia

◦Renal failure
◦Congestive Heart Failure (CHF)
◦Excessive fluid or Na intake

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Symptoms of hypervolemia

Rapid weight gain
Elevated blood pressure
Jugular venous distention (JVD)
Peripheral edema
Dyspnea

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Biochemical Data Indicating Hypervolemia

Decreased Na (enough in blood, just so much water)
Decreased Osmolality
Decreased BUN

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what is serum osmolality ?

Concentration of particles in the blood

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As the amount of free water in the blood increases or the amount of particles decrease=> osmolality ______

As the amount of free water in the blood decreases or the amount of particles increases=> osmolality ______

decreases
increases

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Increased levels of Serum Osmolality may be caused by…

Dehydration
Hypernatremia
Hyperglycemia
Azotemia (nitrogenous waste products)
Ketosis

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Decreased levels of Serum Osmolality may be caused by…

Overhydration Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Hyponatremia

Increased Serum Osmolality will cause… * Secretion of __________ ◦ _______ water reabsorption ◦ __________ urine * _______ thirst * Results in _______ fluid volume and_______ serum osmolality

antidiuretic hormone (ADH) - Increased - Concentrated Increased increased decreased

Decreased Serum Osmolality will… * Suppress the ________ ◦ ________ water reabsorption ◦ Large amounts of _______ urine * Results in ________ fluid volume and the serum osmolality will then ______

release of ADH - Decrease - dilute decreased increase

electrolytes consist of _____ and ______

cations and anions

examples of cations

Na+ K+ Ca2+ Mg2+

examples of anions

Chloride Cl- Phosphate PO4 3-

Principle cation in the ECF space is _____ ; therefore, is a major determinant of serum osmolality and regulator of water balance Serum level is the result of a balance between ______ intake and ________ * Regulated by=> ________ ; _____ function Normal serum level: 136-145 mEq/L

Na dietary Na renal excretion aldosterone(keep Na) renal

Clinical Manifestations of Hyponatremia

N/V Headache Lethargy Muscle cramps Confusion Severe: Seizures; Coma

Causes of Hyponatremia ________ or ________ Syndrome ______________ Increased loss of sodium=> diarrhea, vomiting, NG suction Medications: diuretics Third-space losses=> peripheral edema, _____ (fluid in tummy) Decreased sodium intake - Deficient content in _____ - Deficient dietary intake - rare

Hypervolemia overhydration of Inappropriate Antidiuretic Hormone (SIADH) ascites IVF

Clinical Manifestations of Hypernatremia

Dry mucous membranes Thirst Headache Dizziness Confusion Severe=> seizures; coma

Causes of Hypernatremia Excessive free body water loss (GI, renal) Decreased sodium loss: ________(make too much cortisol which retains sodium); _____________ Medications: __________ Increased sodium intake - Excessive content in _____ - Excessive dietary intake is rarely the cause

Cushing syndrome Hyperaldosteronism corticosteroids IVF

Major intracellular cation is ______ Normal serum K +: 3.5 – 5.0 mEq/L Functions: ◦ Conduction of ________ ◦ Muscle _________ ◦ Cell _______ Regulation of serum K+=> balance of intake and output (renal; _________ increases urinary excretion)

Serum Potassium (K+) nerve impulses contraction metabolism aldosterone

Clinical Manifestations of Hypokalemia

Skeletal muscle weakness Lethargy GI: Constipation; N/V; Ileus (lack of peristalsis) Severe: paralysis, cardiac dysrhythmias, & death (less than 2.5)

Causes of Hypokalemia Excessive ____ loss ◦ GI=> diarrhea, vomiting, gastric drainage ◦ Urinary losses Drugs: _____________ Shift to intracellular space ◦ Insulin ◦ ______ syndrome ◦ Metabolic ______ Inadequate dietary intake

K+ diuretics, insulin, amphotericin B Refeeding alkalosis

Clinical Manifestations of Hyperkalemia

Muscle twitching, cramping, weakness Irritability; restlessness Diarrhea, intestinal cramping Severe=>paralysis; cardiac dysrhythmias

Causes of Hyperkalemia Decreased K+ excretion=> ________ Meds: ____________ Shift from intracellular to intravascular space o Tissue destruction o Hemolysis o Metabolic acidosis Dehydration Excessive K+ intake - rare (common in _____)

kidney failure K +-sparing diuretics (e.g., spironolactone) ACE-inhibitors (e.g., lisinopril) salt substitutes made with potassium (nusalt, mortin salt)

Serum Calcium (Ca2+) Serum calcium: (only __ % in the blood) ◦ ____% ionized/free Ca2+ ◦ ____% bound to albumin ◦ _____% complexed with phosphate, bicarbonate, etc. Regulated by=> __________ * Normal Total Calcium: 9-10.5 mg/dL * Normal Ionized Calcium: 4.5-5.6 mg/dL which one is better to look at ?

1% 47 (active calcium) 40 (albumin in transfer protein) 13 (bound = not active) (usually permanently bound) intestine, vitamin D, kidneys, parathyroid hormone(raises calcium from bones) , calcitonin(send ca back to bone) ionized

Symptoms of Hypocalcemia

Irritability Paresthesia Muscle cramps; Tetany Intestinal cramping & diarrhea Cardiac dysrhythmias Seizures

Causes of Hypocalcemia Decreased Ca2+ ________ ________________ (dont make enough parathyroid) ________________ (high phosphate) ________ failure (vit D won't work) Medications: ________________

absorption Hypoparathyroidism Hyperphosphatemia Kidney corticosteroids, Dilantin, cisplatin

____________ decreases total serum Ca2+ by decreasing the amount of bound Ca2+ - Causes a false____ serum total calcium Correction of total serum Ca2+: ([4 – albumin(g/dL)] x 0.8) + Total Ca2+(mg/dL) Alternative=> request an ____________

Hypoalbuminemia low ionized serum Ca2+

Correction of total serum Ca2+:

([4 – albumin(g/dL)] x 0.8) + Total Ca2+(mg/dL)

Symptoms of Hypercalcemia

Fatigue, muscle weakness N/V, constipation Anorexia Confusion Bone pain; pathologic fractures Cardiac dysrhythmias Impaired renal function; kidney stones

Causes of Hypercalcemia _______________ (more this hormone) ______ cancer or _______ Prolonged ______________ Excessive intake of _____ or _____ supplements

Hyperparathyroidism Bone ... metastases immobilization Ca or vitamin D

what is positive acute phase reactants markers of ? produced by _______

Serum levels increase with inflammation o Considered markers of inflammation liver

examples of positive acute phase reactants

C-reactive protein (CRP) Fibrinogen Ferritin (storage form of iron) (will make more from inflammation and hide iron deficiency so be careful)

Negative Acute-Phase Reactants Serum levels ______ with _______ Produced by the _____ Examples: ◦Albumin ◦Prealbumin ◦Retinol-Binding Protein ◦Transferrin

decrease inflammation liver

Examples of negative acute phase reactants

◦Albumin ◦Prealbumin ◦Retinol-Binding Protein ◦Transferrin (carries iron)

serum albumin maintains ______ transport protein for many smaller molecules like ______ half life _____

colloidal oncotic pressure calcium, medications 18 days (doesn't change fast)

serum albumin is a Good indicator of _______ and _________-

inflammatory response and severity of illness

Factors that Affect Serum Albumin Concentrations: Levels decreased by: ◦__________ disease ◦____________ ◦_________ disease ◦ Hyper_________and________ Malnutrition Levels increased by=> _______

Inflammatory disease Metabolic stress response Liver Hypervolemia & overhydration dehydration

Serum Prealbumin Function: ___________=> e.g., thyroid hormones Normal Value: 15-36 mg/dL Half-life: ______

Transport protein 2 days (changes faster)

Factors that Affect Serum Prealbumin Levels decreased by:

◦Inflammation ◦Metabolic stress ◦Liver disease ◦Zinc deficiency ◦Malnutrition many many things

Blood Urea Nitrogen (BUN) - Measures amount of _____ in the ____ path of urea Used to assess excretory function of the _____ and metabolic function of the _____ Also varies with the state of ______

urea in the blood Amino acids=> ammonia=> urea=> bloodstream=>kidneys for excretion kidneys liver hydration

Normal Findings Adult: 10-20 mg/dL Elderly: May be slightly higher CRITICAL VALUE: >______ mg/dL indicates serious impairment of _____ function

100 renal

Causes of Increased BUN ______ disease _________ GI _______ Excessive ___________ _________ obstruction Excessive ______________

Kidney disease Dehydration GI bleeding excessive protein catabolism Urinary tract obstruction protein ingestion

Causes of Decreased BUN

Overhydration Liver failure Negative nitrogen balance

Serum Creatinine (Cr) - Daily production depends on ________ - Excreted entirely by the ________ - Used to assess ___________ function

muscle mass kidneys renal excretory

Serum Creatinine (Cr) Normal Findings ◦Adult male: 0.6-1.2 mg/dL ◦Adult female: 0.5-1.1 mg/dL ◦Elderly: may have decreased values ◦Critical Values: >_______ mg/dL indicates serious impairment in renal function

Causes of Increased Serum Creatinine _______ failure ________: glomerulonephritis, acute tubular necrosis, diabetic nephropathy Reduced _____________ ___________ obstruction Meds: _____________

Renal Kidney disease Reduced renal blood flow Urinary tract obstruction gentamicin, cisplatin

Decreased Serum Creatinine

Decreased muscle mass

Fasting Plasma Glucose (FPG) AKA: Fasting Blood Sugar (FBS) or Fasting Blood Glucose (FBG) Used to diagnose and evaluate _____ and other causes of ____________ Controlled by _______ and _______

DM hyperglycemia insulin & glucagon

Fasting Plasma Glucose (FPG) * Normal Findings: 70-110 mg/dL * Fasting=> no caloric intake for at least ____ hrs * Note: serum glucose levels must be evaluated according to _______________

8 the time of day (meal status)

Causes of Hyperglycemia ____________ Metabolic response to _______ Meds: _____________ __________ syndrome

Diabetes mellitus stress (physical) corticosteroids, diuretics Cushing's (too much cortisol)

Causes of Hypoglycemia Excessive ____________ administration Extensive______ disease __________ __________ disease

insulin liver Starvation Addison's (deficiency of cortisol)

Hemoglobin (Hgb) An index of the blood’s _________ capacity Used to diagnose _______ Normal levels: ◦ Men: 14-18 g/dL ◦ Women: 12-16 g/dL

oxygen carrying anemia

Causes of Decreased Hgb levels *______ due to ◦Hemorrhage ◦Hemolysis ◦Nutritional deficiencies ◦Kidney disease (make erythropoietin that tells to make RBC) ◦Meds: ____________ ◦Genetic disorders (e.g., _____________)

Anemia antineoplastic drugs thalassemia, sickle cell anemia

Causes of Elevated Hgb levels

Dehydration CHF COPD Polycythemia vera

Hematocrit (Hct) ___________________ Normal levels: ◦ Men: 42-52% ◦ Females: 37-47%

Percentage of the total blood volume that is made up by RBC

Causes of Decreased Hct levels * _______ caused by Hemorrhage Hemolysis Nutritional deficiency Bone marrow failure Genetic disorders Leukemia Hypervolemia

Anemia

Causes of Elevated Hct levels

Dehydration COPD Polycythemia vera

Mean Corpuscular Volume (MCV) is ________________________ Normal values: 80-95 fL

A measure of the average volume or size of a RBC

Decreased MCV=> small RBC=> _____________ ◦_________________, thalassemia, copper deficiency can cause it * Increased MCV=> large RBC=> __________ ◦_________________, _______________, cytotoxic chemotherapy can cause it

microcytic anemia iron deficiency macrocytic anemia B12, folate

Decreased Hgb & Hct=> anemia Then check ______: If decreased=> microcytic anemia=> possible ____ If increased=> macrocytic anemia=> possible ___________ deficiency anemia If nutritional anemia suggested by MCV=> check micronutrient levels to confirm deficiency deficiency anemia

MCV iron vitamin B12 or folate