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Medical Diagnostics > BMP > Flashcards

BMP Flashcards

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USMLE® Step 1 flashcards
1
Q

What are the main components of a BMP?

A
  • Sodium (Na)
  • Potassium (K)
  • Chloride (Cl)
  • Bicarbonate (HCO3)
  • Creatinine (Cr)
  • Blood Urea Nitrogen (BUN)
  • Calcium (Ca)
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2
Q

What main information does a BMP provide?

A
  • Fluid and electrolyte status
  • Renal function
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3
Q

What is the normal value of Potassium (K)?

A

3.5-5.0 mEq/L

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4
Q

What is the main role of potassium?

A

-Body’s major intracellular cation
-Main determinate of resting cell membrane potential
*important for cardiac b/c action potentials

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5
Q

What is hypokalemia?

A

-Low potassium
<3.5

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6
Q

What are signs and symptoms of hypokalemia?

A

-Typically vague –> generalized weakness, malaise, paresthesias (pins and needles sensation)

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7
Q

What is the most common cause of hypokalemia?

A

Diuretic induced renal or diarrheal induced gastrointestinal losses of potassium

(AKA fluid loss or being on a diuretic)

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8
Q

What is the treatment for hypokalemia?

A 
\<3.2 = supplement with oral potassium
\<3.0 = supplement with IV potassium (this is very painful)
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9
Q

What is hyperkalemia?

A

High potassium
>5.5

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10
Q

What are the signs and symptoms of hyperkalemia?

A
  • Typically vague –> generalized weakness, muscle fatigue, nausea
  • More significant with moderate to severe hyperkalemia (>6.0) –> palpitations, chest pain
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11
Q

What are the causes of hyperkalemia?

A
  • Decreased excretion (renal failure, addison’s disease)
  • Increased production (aka tissue injury) (burns, rhabdomyolysis, crush injury)
  • Transcellular shift (metabolic acidosis, hyperglycemia)
  • Fictitious (pseudohyperkalemia)
  • Drugs (digoxin)
  • Rarely ever from increased K intake
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12
Q

What patient population would be at an increased risk for hyperkalemia?

A

Patients on dialysis (specifically patients who skip dialysis can have severe hyperkalemia)

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13
Q

What is the normal range of Sodium (Na) and what is the role of sodium?

A
  • 135-145 mg/L
  • Predominant extracellular cation
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14
Q

What is the role of ASH and aldosterone?

A
  • ADH (pituitary) → H2O retention
  • Aldosterone (kidneys) → sodium reabsorption
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15
Q

What is hyponatremia?

A

Sodium <135

-Disorders of ECF volume (volume status, serum osmolality)

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16
Q

What are signs and symptoms of hyponatremia?

A

Headache, fatigue, difficulty concentrating, cramping, confusion, lethargy, agitation, N/V, seizures, dehydration, tachycardia, dry mucous membranes, sunken fontanelles

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17
Q

What are the causes of hyponatremia?

A
  • Hypertonic (hyperglycemic) increased solute
  • Isotonic (hyperlipidemia, hyperproteinemia)
  • Hypotonic (diuretic use, GI loss, renal failure, CHF, nephrotic syndrome, cirrhosis)
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18
Q

What is hypernatremia?

A

High sodium

>145

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19
Q

What are the signs and symptoms of hypernatremia?

A

Lethargy, irritability, restlessness, spasticity, seizure, tachycardia, orthostasis, dry mucous membranes, diminished skin turgor, oliguria

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20
Q

What are some causes of hypernatremia?

A
  • Hypervolemia (glucocorticoid excess, cushing syndrome)
  • Hypovolemia (volume loss, GI, renal, diabetes indipidus)
21
Q

What is the role of chloride (Cl) and what is the normal range?

A

Anion involved in acid-base regulation and fluid balance

95-100

22
Q

What is hypochloremia and what are the signs and symptoms?

A

Cl <95

  • Rarely occurs in absence of other metabolic abnormalities
  • Vomiting, diarrhea, dehydration (tachycardia, poor skin turgor, dry mucous membranes, sunken fontanelles)
23
Q

What are the causes of hypochloremia?

A
  • Primarily volume contraction
  • Vomiting, diarrhea, NG tube, diuretic overuse, CF
24
Q

What is hyperchloremia and what are signs and symptoms?

A

Cl >105

-Often asymptomatic, may have signs of hypernatremia

25
Q

What are some causes of hyperchloremia?

A
  • Advanced dehydration
  • Kidney disease
  • Carbonic anhydrase inhibitors
  • Over agressive IVF’s
26
Q

What is bicarbonate (HCO3) and what are the normal values?

A

22-28 (24 is good)

  • Anion involved in acid-base regulation and fluid balance
  • Important part of buffering system
  • BASIC
  • Regulated by renal tubules of kidneys and lungs
27
Q

What is hypobicarbonemia and what are signs and symptoms?

A

Bicarb <22

*Sx not caused by hypobicarbonemia, but but the acid-base imbalance

-N/V, abdominal pain, weakness, dizziness, AMS, tachycardia, orthostasis, poor skin turgor, Kussmaul respirations, fruity odor

28
Q

What are the causes of hypobicarbonemia?

A

Metabolic acidosis, chronic diarrhea, kidney disease, adrenal insufficiency

29
Q

What is hyperbicarbonemia and what are signs and symptoms?

A

Bicarb >28

-Very rare, seen when the body has lost volume so the bicarb appears high

-N/V, diarrhea, SOB, dehydration

30
Q

What are some causes of hyperbicarbonemia?

A

-Metabolic alkalosis

  • Chronic respiratory acidosis
  • Conn’s syndrome
  • Cushing’s syndrome
31
Q

What is creatinine and what are the normal values?

A

Male = 0.5-1.5

Female = 0.6-1.2

  • Byproduct of creatine phosphate
  • Primarily used to determine renal function
32
Q

What is hypocreatinemia, signs and symptoms and causes?

A

Creatinine <0.5 (not really a problem)

  • Possibly signs of starvation, muscle atrophy
  • Causes: decreased muscle mass, inadequate protein intake
33
Q

What is hypercreatinemia, signs and symptoms and causes?

A

Creatinine >1.2 (females) >1.5 (males)

  • Fatigue, vomiting, diarrhea, dry mucous membranes, shortness of breath, edema, confusion
  • Beginning of kidney failure!!
  • Causes = kidney disease (look at BUN:Cr ratio)
34
Q

What is BUN and what is the normal range?

A

8-20 mg/dL

Blood Urea Nitrogen

  • Liver makes urea, kidneys excrete it
  • Primarily used to determine renal function
35
Q

What are signs and symptoms of decreased BUN and causes?

A

BUN <8

  • Possibly signs of starvation, muscle atrophy
  • Causes: decreased muscle mass, inadequate protein intake, liver disease, aggressive IVF
36
Q

What are signs and symptoms of increased BUN and causes?

A

BUN >20

  • Vomiting, diarrhea, melen/hemtochezia, dehydration, uremic “frost”
  • Causes: kidney disease, hypovolemia, GI hemorrhage, CHF

*Increased BUN means liver is working but kidneys are NOT (because liver makes urea and kidneys excrete it)

37
Q

What are the normal ranges of the BUN:Cr ratio?

A

10:1-20:1

38
Q

How do you calculate BUN:Cr ratio?

A

(BUN #) / (Cr #) :1

39
Q

What is a BUN:Cr ratio >20:1 indicative of?

A

PRERENAL - before the kidneys

→ renal artery stenosis

→ dehydration

→ Blood loss (not enough blood to the kidneys, usually a ratio of 30:1 or greater)

-Azotemia (buildup of waste products in the blood), hypoperfusion/dehydration, GI bleed, CHF

40
Q

What is BUN:Cr ratio 10-20:1 indicative of?

A

Postrenal or normal

→ Stone (anything blocking)

→ BPH (do a bladder scan)

41
Q

What is a BUN:Cr ratio <10:1 indicative of?

A

INTRINSIC (in the kidney’s)

→ kidney failure

→ Medications (NSAIDs)

→ Renal tubular acidosis

→ Nephritis

42
Q

BUN = 42

Cr = 1.5

What is the BUN:Cr ratio and what might this indicate?

A

42/1.5 = 28

28:1 (increased BUN:Cr)

GI BLEED

43
Q

What is the function and normal range of calcium?

A
  1. 5-10.5 mEq/dL
    - Important cation → comprises main mineral component of bone
    - Parathyroid hormone → key controller of serum calcium concentration
    - Vitamin D → stimulates calcium absorption in gut
44
Q

How do albumin levels affect calcium levels?

A
  • 50% of blood calcium is bound by protein (mostly albumin)
  • Decrease in albumin → decrease in total serum calcium

(decrease of 0.8mg serum Ca for every 1g decrease in albumin)

-Does NOT affect the ionized (free form) calcium concentration

45
Q

What is the value and signs/symptoms of hypocalcemia?

A

Ca <9

-Neuromuscular irritability (hallmark of hypocalcemia)

-Acute symptoms seen <7

-Severe hypocalcemia = prolonged QT interval leading to Torsades

-tetany, paresthesias, muscle cramps, spasms, seizures, hyperreflexia, Chovestek’s sign and Trousseau’s sign

46
Q

What is Chvostek’s sign?

A

Twitching of the facial muscles in response to tapping over the area of the facial nerve

47
Q

What is Trousseau’s sign?

A

Hand muscle spasm caused by inflating the BP cuff to level over systolic pressure for 3 minutes

48
Q

What is the value and signs/symptoms of hypercalcemia?

A

Ca > 10.5

-Symptoms appear with Ca >12

-Stones, bones, groans and moans

→ Bones = Ca pulled from bones (aches, pains, fractures)

→ Moans = GI complaints (constipation, nausea, decreased appetite)

→ Stones = kidney, flank pain, frequency (extra Ca can form kidney stones)

→ Groans = psych (confusion, dementia, memory loss, depression)

49
Q

What are some causes of hypercalcemia?

A

-Hyperparathyroidism

-Malignancy

  • Medications
  • Adrenal insufficiency

Medical Diagnostics (10 decks)

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