Blake Exam C flashcards
How many miligrams per deciliter are contained in 145mEq/L of Na+
1.) convert miliqulivalence per liter to equivalence per liter = (145mEq/1.00L)( 1Eq/110^3L)= .145Eq/1L
2.) .145Eq/L= X g of NA/ (22.99AW of NA/ 1 Val)/ 1L of sol
3.) .145= (X g of Na/ 22.99)
4.) .14522.99= 3.33g/L or X
5.) convert g/L to miligrams/dl
3.33g/L( 1L/10dl)( 1000mg/g)= 333mg/dl
How do you to convert from mg/dl to meq/L. if sodium MW is 23 and the concentration of NA is 350mg/dl
1.) convert Mg/dl to g/dl=350mg/dl( 1g/1000mg)(10dl/1L)=3.5g/l
2.) Plug-in g/L into your equation ( g/L of Na/ AW of Na/1VA)= 3.5/ (22.99/1Val)= .1522eq/L
3.) .1522Eq/L( 1000mEq/1Eq)= 152.2mEq/L
Pseudohyponatremia and pseudohypocalcemia occur with what methodology to detect lithium( Red color), K+ ( violet color), and Na( yellow color) occur with
Flame emmision spectroscopy
Is calcium low with hypoalbuminemia and Ionized calcium is not affected
True
What is slightly higher in Heperinzed plasma then in serum
K+
The normal range for K+
3.5-5.0mEq/L
Sodium normal range
135-145 mEq/L
Calcium normal range is
9.2-11.0 mEq/L
Magnesium normal range is
1.3-2.1mEq/L
Bicarb normal range is
21-28mEq/L
Chloride normal range is
95-103mEq/L
phosphorous normal range is
2.3-4.7 mg/dL
Iron normal range is
60-150ug/dl
therapeutic lithium normal range is
0.5-1.4 mEq/L
1.0-1.6mEq/L
what is the main regulator of ADH
is Osmolality, neurons within the hypothalamus respond to change in blood osmolality
what are the intracellular electrolytes and what will falsely elevate theses
K+, Mg2+, Phosphorous, Fe. so hemolysis will falsely elevate these
what are the extracellular electrolytes
Cl-, bicarb, Na, and Ca2+
Hyponatremia- A low sodium concentration
conditions
vomiting and diarrhea
excessive sweating and burns
Renal reabsorption disease ( PCT, ALOT, and DCT)
hypoaldosteronism
Polyuria and osmotic diuresis
results in GI leakage and neural problems
Hypernatremia causes a high sodium concentration
caused by
CHF
liver disease–> low protien–> low oncotic pressure–> excrete more water–> high NA
renal disease
Hyperaldosteronism
severe dehydration
nasogastric feeding of high protein concentration w/o sufficient fluid intake
high protein
Hypothalamic injury to thirst mechanism (Ex. adipsia)
excessive intake of NA with therapy aka Na Herparin is used when patient has a bleeding problem
Pregnancy
Hypokalemia
Vomiting, diarrhea
Cushing’s Syndrome - hyperaldosteronism
Renal reabsorptive disease - renal tubular necrosis (PCT, ALOH, DCT)
Metabolic alkalosis
H+ shift
Insulin excess
Diuretic therapy - high urine → K follows water
Low intake over a long period of time
results in
K depletion
Hyperkalemia- There is a high potassium concentration.
Hypoaldosterone - Addison’s Disease
Renal failure
Acidosis
High H+ (low pH) → H+ exchange with intracellular K
Insulin deficiency
High glu plasma → high filtration → high water in tubule → dehydration → high K
Translocation of K
Excess intake
Cellular breakdown
Exercise - physical stress stimulate muscle cells to release K
Hospital administration of infusion solutions containing K if patient cannot excrete
Anoxia, shock
Very low oxygen → low ATP → no Na/K ATPase activity → K permeability → K leakage
Continued metabolism → high CO2 → acidosis → damage membrane → release K
Artificial False Elevation
Elevated platelet, WBC counts - high clot → cells squished → K leak
Tourniquet left on too long - hypoxia due to low blood → sicked shape RBC → squished → K leak
Results in:
Interference with heart electrical impulses
Dehydration will cause elevated levels of
Na+
Urinary blockage causes elevated levels of
Na+
High potassium is associated with Cushings or Addisons
Addisons disease( hypoaldosteronism)
H+ will enter the cell in _______ will leave the cell causing hyperkalemia and vice versa
K+
Chloride will enter the cell and Bicarb will exit in states of
Acidosis
A high amount of insulin will cause a low ____
Potassium
High bicarb is associated with
metabolic alkalosis
High CO2 is associated with
Respiratory acidosis
Hypochloremic metabolic alkalosis occurs when
There is a loss of chloride ions and occurs due to a loss of gastric fluid.
When does hyperchloremia occur
in chronic metabolic acidosis; aka chloride ions need to take up H ions.
Anion gap calculations
(Na + K) - (Cl + HCO3) = 15 mmol/L (10-20)
Na - (Cl + HCO3) = 12 mmol/L (7-16)
two methods to determine Na and K
FEP and ion selective electrode potentiometry
Total CO2 exists as
dissolved CO2( 3%), Carbamino ( 33%) and bicarb ( 64%)
what is the major form of CO2 transported in blood
most of the CO2 in blood exists as Bicarb and is formed from the reaction of CO2 + H20–> HCO3 by carbonic anhydrase.
administration of insulin on K+ levels
Lowers the amount of serum K because glucose and K are both taken up into the cell.
Acidosis cause elevated or decreased K + levels in the serum
Elevated because of K+ and H+ shift in the cell
Alkalosis will cause an increase or decrease in K+ in the serum
Decrease in the serum potassium as K+ into the cell H+ moved out. As K+ is moved in it stimulates the distal cells of the nephron to secrete more K+.
as pH is decreased, Ca2+ _________
H+ disrupts Ca2+ from binding to binding sites and causes an increase in ICa2+.
high free calcium, high divalent pH.
As the pH is Increased Albumin becomes more
negatively charged and binds with calcium therefore decreasing the amount of ICa2+.
low free calcium and high monovalent pH
What is a cause of low Calcium, low PTH, and high phosphate
Pseudohypoparathyrosm
what is a cause of a of low Ca, low PTH, and high pH
PseudohypoPh because you will have a low calcium, low PTH, and high phosphate, which will cause phosphate to bind with H+ to become Phosphorous.
how is alkaline phosphatase inhibited
By serum calcium levels, if alkaline phosphatase comes into contact with serum calcium, then it will crystalized.
Where is alkaline phosphatase secreted?
in bone formation from osteoblast which is regulated by PTH and PTH stimulates the release of ALP from bone It also stimulates phosphorous excretion into the urine and calcium reabsorption from the gut
when there is low Mg2+, there is low what
Calcium and PTH, Mg2+ is required for enzymes that cause PTH to be released and if there is a decrease in Mg2+ then there will be a decrease in Calcium.
what condition will cause a low absorption and high excretion of Mg2+
Alcoholism and intestinal sprue.
Magnesium blocks ______ entry into the cell
Calcium
What conditions cause a decrease in mg2+ and calcium secondarily
intestinal reabsorptions issues, alcoholism, magnesium sulfate therapy, secondary hypoparathyroidism
what is the most widely used method for phosphate
what Is the reducing agent
Molybdenum blue method
Phosphate + molybdenum –> complex structures
after reduction, molybdenum+ phos is converted to molybdenum blue at 660nm.
ANS is the reducing agent
Why is EGTA added to magnesium studies?
to act as a chelator and chelate calcium to remove interferences
why is hydroxyquinoline added to calcium studies
To chelate Magnesium and to remove interferences
Why is KCN added to both calcium and magnesium studies?
to avoid heavy metal interferences and to stabilize the product
Anemia of chronic infection has what Iron level, % T,< TIBC, and Ferritin
Decreased Iron, TIBC, % T, but an increase in ferritin
IDA has a
Decreased Iron level, Decrease %T, Increased TIBC, and an decrease Ferritin.
What causes does an acidic medium have on IRON.
it will cause the % transferrin to lower because iron will be removed from transferrin, thereby increasing the TIBC
What causes does an alkali medium have on IRON.
it will cause Iron to be stay on transferrin and will decrease the TIBC
What increases ammonia and question gave us normal creatinine and BUN so renal is normal
Liver disease
why is serum osmolality compared to calculated osmolality
In order to detect the presense of unmeasured cosmetically active substances, mainly volatile substances, that only contribute to the measured osmolality
Osmolality equations
2NA + glucose + urea= mmol/L
2NA + glucose/18 + Urea/2.8= Mg/dL
What is used to treat bipolar disorders
Lithium
lactic acid tube anticoagulant
sodium flouride
what anticoagulant should not be used in lactic acid test
Flouride oxalate because it inhibits LDH activity
what electrode measures H+ and uses Bicarb as a buffer
PCO2 electrode
[CO2]=
a* PCO2 where a is bunsen coefficient and = .0301 mmol* L
Respiratory Acidosis
([HCO3-]/ high αpCO2) < 20
(low [HCO3-] / αpCO2)< 20 in
Metabolic acidosis
why is EDTA not used in blood gas analysis
because it can chelate divalent cations
Given the following information calculate the total CO2 in Meq/L. HCO3= 24 mEq/L and pCO2=40 mmHg
Hint: You do not need the pH just the solubility coefficient of pCO2.
TCCO2= ApCO2 + HCO3-
( 0.0301 * 40mmHg) + 24 mEq/L = 25.2mEq/L
The impact of the following blood gas sampling errors
-Exposing to air
pH: increases (function of pCO2)
pCO2: decreases since the pCO2 of atmospheric air is lower than blood
pO2: increases since the pO2 of atmospheric air is higher than blood
The impact of the following blood gas sampling errors
- delayed transport time, not exposed to air
pH: decrease, caused by cell glycolysis
pCO2: increases, caused by cell glycolysis
pO2: decrease, caused by cell respiration
The impact of the following blood gas sampling errors
Not collected on ice
pH: decrease
pCO2: increase
pO2: decrease
standard transport time for blood gases
specimens should be placed on ice and analyzed within 10-15min
Glass tubes should be help for up to 2 hours but plastic tubes should be analyzed within 15 minutes
if the sample was out for 2.5 hours then reject it and recollect
what is the anticoagulant of choice for blood gas analysis
Lithium heperin
what is the most common method for Ketones
Enzymatic with beta hydroxybutyrate dehydrogenase
Beta Hydroxybutyrate dehydrogenase is used for catalyzing NAD(+) to give acetoacetate and NADH + H(+) and is the most common method used to determine acetone amounts.
how do you calculate molarity
Moles of solute/ L of solution
what do you use to bind inorganic phosphate
Molybdenum blue
Hypernatremia is associated with what aldosterone disease
Cushings disease
Hyponatremia is associated with what aldosterone disease
Addisons disease
Calcium and magnesium have a _______ relationship
Direct
Chloride and sodium have a _______ relationship.
DIrect
If you have a metabolic acidosis, chloride will move into the cell and bicarb will move ____
out
if you have a metabolic alkalosis Chloride will move out of the cell and Bicarb will move ___
in the cell
Hyperchloremia is indicative of
metabolic acidosis
Hypochloremia is indicative of
metabolic alkalosis
You make a 1:5 dilution. how much diluent do you use
1 sample: 4 part diluent
850mililiter to microliters
850,000 microliters
Validation is used to check if the
QC is good by what the manufacturer says.
Verification is what the MLS must do before
Sending out results
Hypoparathyroidism, hypocalcemia, tetany, malabsorption, and alcoholism are all associated with
Mg2+ deficiency
How does magnesium inhibit calcium?
by allosteric regulation
In IDA and ACI what is the FEP and serum iron and % T
Increased FEP and decreased serum Iron
%T is decreased
In IDA and ACI what is the soluble transferrin receptor %
Increased in IDA and normal in ACI
Primary hyperparathyroidism has
Increased PTH, calcium and a decrease in Phosphate
Secondary hyperparathyroidism has
Increased PTH, low Ca2+ or normal, and low to high phosphate.
Primary hypoparathyroidism has what
Decreased PTH and Ca2+, and increased phosphate
Secondary hypoparathyroidism
Decreased PTH and decreased Ca2+ and increased or decreased phosphate. depends on the severity of the hypomagnesemia. In acute= Increased, in chronic= decreased
If samples were received at 8;30 and not received in the lab until 11 for an arterial sample what should you do
Request a new sample
Calibration is the
functional relationship between measured values and analytical quantities
Defincieny of what is assoicated with poor wound healing
Zinc
How to calculate total CO2
Ph= PK + log( HCO3-)/(apCO2)
If you dont have Bicarb then
HCO3= TCO2- a* pCO2( this is dissolved CO2)
If you dont have PCO2 then pCO2=
(TCO2-[HCO3]) * .03010
what is the purpose of EDTA
to Chelate calcium; decreases interferences
Increased Ammonia is due to what pathology
hepatic encephalitis ( causes neural abnormalities because NH3 can cross the BBB( coma and seizers)
When preparing 10% sulfuric acid to make 100ml of solution. what do you add first
90mL of DI water
remember add acid to base
what is the purpose of the west guard rules
to evaluate controls from multiple runs
The purpose of running controls is to check for
Accuracy
what is the Confidence limit of a sample falling within 2SD of the mean
95%
In QC total range refers to
mean +,- 2SD
How to calculate CV
SD/mean* 100
b-HCG allows for more
Sensitivity/ Specificity
Iron is reduced from 3+ to 2+ in what environment
Acidic
Concentration= %(W/V)
= (mass of solution(g)/ volume of solution(Mg)) * 100
Tech looks at the QC machine and sees 6 linear points out of my mean what is this
Shift
Metabolic acidosis= what Ionized Calcium and phosphorus levels
Increased leading to a stone
How would you make 500mL of a 10% bleach solution
you add 50mL of bleach to 450mL of water
What is the principle of the active calcium measurements
OCPC red complex
How to measure ionized calcium
by ISE
what is caused by a high PTH and high calcium and low Phosphorous level and bone lesions( osteitis fibrosa)
Primary hyperparathyrodism
