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CCP 223 Laboratory and Diagnostic Medicine 🧪 Flashcards

1
Q

what is the 5 step CCP process to ABG interpretation

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. State the ‘emia’. Is it acidemia or alkalemia?
  2. State the ‘osis’. What is the driver? Metabolic vs Respiratory
  3. Calculate the AG. Na - (HCO3- + Cl) = x (corrected for albumin)
  4. Expected compensation? Does the patient have appropriate compensation?
  5. Is there a superimposition present?
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2
Q

Expected compensation ratio (pCO2:HCO3-) for metabolic acidosis

A

1:1

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3
Q

Expected compensation ratio (HCO3- : pCO2) for metabolic alkalosis

A

1:0.7

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4
Q

Expected compensation ratio (pCO2:HCO3-) for respiratory alkalosis

A

1:0.5

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5
Q

Expected compensation ratio (pCO2:HCO3-) for respiratory acidosis

A

1:0.3

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6
Q

“Norm setting” value for pH

A

7.40

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7
Q

“Norm setting” value for pCO2

A

40 mmHg

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8
Q

“Norm setting” value for pO2

A

100 mmHg

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9
Q

“Norm setting” value for HCO3-

A

24

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10
Q

Appropriate AG adjustment for albumin

A

Add +3 to your AG for every 10 point drop in albumin below your baseline value of 40. rounding up or down as needed.

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11
Q

“Norm setting” value for AG

A

12

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12
Q

What are the causes of a low AG?

A
  1. Decreased albumin
  2. GI ingestion (tums)
  3. Lab error
  4. Math error
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13
Q

Define the KULT acronym for metabolic acidosis

A
  1. KETOACIDOSIS
  2. UREMIA
  3. LACTIC ACIDOSIS
  4. TOXINS (includes medications)
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14
Q

Treatment pathway for NAGMA ?

A

Bicarb bicarb bicarb

this is because typically the patients have decreased bicarb d/t either RTA or insensible losses (GI)

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15
Q

Components of the CBC

what constitutes the complete blood count

A
  1. WBC
  2. Hematocrit
  3. Platelets
  4. Hemoglobin
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16
Q

Components of the Chem 7

A
  1. Na+
  2. K+
  3. Cl-
  4. HCO3- (or CO2)
  5. BUN
  6. Glucose
  7. Creatinine (sometimes includes eGFR)
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17
Q

Components of the “extended lytes”

A
  1. Calcium
  2. Magnesium
  3. Phosphate
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18
Q

WBC “differential”

A
  1. Neutrophils (+ Bands)
  2. Eosinophils
  3. Basophils
  4. Monocytes
  5. Lymphocytes
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19
Q

Pancreatic enzymes

A
  1. Amylase

2. Lipase

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20
Q

Components of the “coag panel”

A
  1. INR
  2. PT
  3. aPTT
  4. Fibrinogen
  5. D-Dimer
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21
Q

Components of the “arterial blood gas” in shorthand order

A

pH/paCO2/paO2/HCO3-

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22
Q

Liver function tests

A
  1. Bilirubin
  2. Glucose
  3. Albumin
  4. INR
  5. PT
23
Q

Liver enzymes

A
  1. AST
  2. ALT
  3. GGT
  4. Alkaline phosphatase (ALP)
24
Q

Normal serum sodium (Na+)

A

135 – 145 mmol/L

25
Q

Normal serum chloride (Cl-)

A

98 – 106 mmol/L

26
Q

Normal serum ionized calcium (Ca+)

A

1.05 – 1.3 mmol/L

27
Q

What is the expected compensation ratios for the various types of metabolic/resp acidosis/alkalosis?

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Met Acid 1:1 (CO2:HCO3)
  2. Met Alk 1:0.7 (HCO3:CO2)
  3. Resp Alk 1:0.5 (CO2:HCO3)
  4. Resp Acid 1:0.3 (CO2:HCO3)
28
Q

Define “anion gap”

A

The difference between the sum of routinely measured anions (ie. Na+ and K+) and routinely measured cations (ie. Cl- and HCO3-)

29
Q

Anion gap calculation

A

AG = Na - (Cl + HCO3)

30
Q

Causes of NAGMA

A
  1. RTA (failure of kidneys to Reabsorb all of the filtered bicarbonate and/or failure of kidneys to Synthesize new bicarbonate to
    replace bicarbonate lost to metabolism
  2. GI losses (puking/shitting out all your bicarb)
  3. Hyperchloremia (too much NS)
31
Q

Causes of metabolic alkalosis

A

1) Iatrogenic (exogenous alkalization with HCO3 or putting patient in a prolonged state of respiratory acidosis as seen with permissive hypercapnia in ARDS/severe asthma)
2) Alkaline ingestion (ie. Tums)

32
Q

How do you adjust the AG to account for changes in albumin levels?

A

Normal albumin = 40

For every 10pt drop in albumin, add +3 to your calculated AG

33
Q

anions vs cations

A
  1. cations are positively charged

2. anions are negatively charged

34
Q

“KULT” approach to metabolic acidosis

A
  1. Ketones
  2. Uremia
  3. Lactate
  4. Toxins
35
Q

What are the causes of a low/narrow AG?

A
  1. Decreased albumin
  2. GI ingestion (tums)
  3. Lab error/Math error
36
Q

Causes of NAGMA

A
  1. GI losses (shitting/puking out your bicarb)
  2. RTA (renal tubular acidosis)
  3. Elevated Cl- (hyperchloremic metabolic acidosis)
37
Q

Five step process for ABG’s

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Declare the “emia”. Acidemic vs Alkalemic
  2. Declare the “osis”. Acidosis vs alkalosis
  3. Calculate the AG (Na+ - (Cl- + HCO3-) = 12
  4. Expected compensation? (look at compensatory ratios)
  5. Is there a superimposition present?
38
Q

Appropriate compensation ratios for ABG’s

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A
  1. Metabolic Acidosis 1:1
  2. Metabolic Alkalosis 1:0.7
  3. Respiratory Alkalosis 1:0.5
  4. Respiratory Acidosis 1:0.3
39
Q

golden rule of treating acid-base disturbances

A

identify and treat the underlying cause

40
Q

define Serum pH

A

measurement of the activity of free protons in the plasma

pH = −log10[H+]

41
Q

what are the 3 components that determine the pH of the body

A
  1. Strong ions (eg, Na+, Cl−, lactate)
  2. Weak acids (albumin, phosphate)
  3. CO2
42
Q

carbonic acid equation

A

CO2 + H2O ⇄ H2CO3 ⇄ H+ + HCO3−

43
Q

Law of conservation of electroneutrality

A

All positive charges must equal all negative charges

44
Q

The determinants of acid-base status

A

the differences in strong anions, weak anions, and pCO2

45
Q

Cations present in the human regulation of acid-base

A
  1. Na+
  2. K+
  3. Ca2+
  4. Mg2+
46
Q

anions present in the human regulation of acid-base

A
  1. Cl−

2. HCO3−

47
Q

normal components of the anion gap (like the actual gap. what shit comprises the actual gap)

A
  1. albumin
  2. inorganic phosphate
  3. sulfate
  4. lactate
48
Q

metabolic acidosis can occur in one of these two mechanisms

A
  1. An increase in the chloride anion in relation to the sodium cation (hyperchloremic metabolic acidosis)
  2. An increase in the “unmeasured anions” (anion gap) in relation to sodium
49
Q

metabolic alkalosis can occur in one of these two mechanisms

A
  1. A decrease in the chloride anion in relation to the sodium cation (hypochloremic metabolic acidosis)
  2. A decrease in the “unmeasured anions” in relation to sodium
50
Q

most common cause of a low AG

A

decrease in albumin

51
Q

what is measured on macroscopic urinalysis (there are your macroscopic piss strips. the analysis test strips)

A
  1. general appearance
  2. pH
  3. specific gravity
  4. leukocyte esterase
  5. blood
  6. protein
  7. glucose
  8. ketones
  9. urobilinogen
  10. nitrite
52
Q

what is measured on microscopic urinalysis (piss under a microscope)

A
  1. WBCs
  2. red blood cells
  3. bacteria
  4. epithelial cells
  5. crystals/casts/mucus
  6. other sediment
53
Q

MUDPILES CAT

💵💵💵💵 MONEY SLIDE 💵💵💵💵

A 
M - Methanol, metformin
U - Uraemia
D - Diabetic ketoacidosis
P - paracetamol, paraldehyde, Phenformin, pyroglutamic acid, propylene glycol
I - Iron, isoniazid
L - Lactate (numerous causes)
E - Ethanol, ethylene glycol
S - Salicylates

C - Cyanide, carbon monoxide
A - Alcoholic ketoacidosis
T - Toluene

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