CCP 223 Laboratory and Diagnostic Medicine 🧪 Flashcards
1
Q
what is the 5 step CCP process to ABG interpretation
💵💵💵💵 MONEY SLIDE 💵💵💵💵
A
- State the ‘emia’. Is it acidemia or alkalemia?
- State the ‘osis’. What is the driver? Metabolic vs Respiratory
- Calculate the AG. Na - (HCO3- + Cl) = x (corrected for albumin)
- Expected compensation? Does the patient have appropriate compensation?
- Is there a superimposition present?
2
Q
Expected compensation ratio (pCO2:HCO3-) for metabolic acidosis
A
1:1
3
Q
Expected compensation ratio (HCO3- : pCO2) for metabolic alkalosis
A
1:0.7
4
Q
Expected compensation ratio (pCO2:HCO3-) for respiratory alkalosis
A
1:0.5
5
Q
Expected compensation ratio (pCO2:HCO3-) for respiratory acidosis
A
1:0.3
6
Q
“Norm setting” value for pH
A
7.40
7
Q
“Norm setting” value for pCO2
A
40 mmHg
8
Q
“Norm setting” value for pO2
A
100 mmHg
9
Q
“Norm setting” value for HCO3-
A
24
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.
11
Q
“Norm setting” value for AG
A
12
12
Q
What are the causes of a low AG?
A
- Decreased albumin
- GI ingestion (tums)
- Lab error
- Math error
13
Q
Define the KULT acronym for metabolic acidosis
A
- KETOACIDOSIS
- UREMIA
- LACTIC ACIDOSIS
- TOXINS (includes medications)
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)
15
Q
Components of the CBC
what constitutes the complete blood count
A
- WBC
- Hematocrit
- Platelets
- Hemoglobin
16
Q
Components of the Chem 7
A
- Na+
- K+
- Cl-
- HCO3- (or CO2)
- BUN
- Glucose
- Creatinine (sometimes includes eGFR)
17
Q
Components of the “extended lytes”
A
- Calcium
- Magnesium
- Phosphate
18
Q
WBC “differential”
A
- Neutrophils (+ Bands)
- Eosinophils
- Basophils
- Monocytes
- Lymphocytes
19
Q
Pancreatic enzymes
A
- Amylase
2. Lipase
20
Q
Components of the “coag panel”
A
- INR
- PT
- aPTT
- Fibrinogen
- D-Dimer
21
Q
Components of the “arterial blood gas” in shorthand order
A
pH/paCO2/paO2/HCO3-
22
Q
Liver function tests
A
- Bilirubin
- Glucose
- Albumin
- INR
- PT
23
Q
Liver enzymes
A
- AST
- ALT
- GGT
- Alkaline phosphatase (ALP)
24
Q
Normal serum sodium (Na+)
A
135 – 145 mmol/L
25
Normal serum chloride (Cl-)
98 – 106 mmol/L
26
Normal serum ionized calcium (Ca+)
1.05 – 1.3 mmol/L
27
What is the expected compensation ratios for the various types of metabolic/resp acidosis/alkalosis?
💵💵💵💵 MONEY SLIDE 💵💵💵💵
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
Define "anion gap"
The difference between the sum of routinely measured anions (ie. Na+ and K+) and routinely measured cations (ie. Cl- and HCO3-)
29
Anion gap calculation
AG = Na - (Cl + HCO3)
30
Causes of NAGMA
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
Causes of metabolic alkalosis
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
How do you adjust the AG to account for changes in albumin levels?
Normal albumin = 40
For every 10pt drop in albumin, add +3 to your calculated AG
33
anions vs cations
1. cations are positively charged
| 2. anions are negatively charged
34
"KULT" approach to metabolic acidosis
1. Ketones
2. Uremia
3. Lactate
4. Toxins
35
What are the causes of a low/narrow AG?
1. Decreased albumin
2. GI ingestion (tums)
3. Lab error/Math error
36
Causes of NAGMA
1. GI losses (shitting/puking out your bicarb)
2. RTA (renal tubular acidosis)
3. Elevated Cl- (hyperchloremic metabolic acidosis)
37
Five step process for ABG's
💵💵💵💵 MONEY SLIDE 💵💵💵💵
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
Appropriate compensation ratios for ABG's
💵💵💵💵 MONEY SLIDE 💵💵💵💵
1. Metabolic Acidosis 1:1
2. Metabolic Alkalosis 1:0.7
3. Respiratory Alkalosis 1:0.5
4. Respiratory Acidosis 1:0.3
39
golden rule of treating acid-base disturbances
identify and treat the underlying cause
40
define Serum pH
measurement of the activity of free protons in the plasma
pH = −log10[H+]
41
what are the 3 components that determine the pH of the body
1. Strong ions (eg, Na+, Cl−, lactate)
2. Weak acids (albumin, phosphate)
3. CO2
42
carbonic acid equation
CO2 + H2O ⇄ H2CO3 ⇄ H+ + HCO3−
43
Law of conservation of electroneutrality
All positive charges must equal all negative charges
44
The determinants of acid-base status
the differences in strong anions, weak anions, and pCO2
45
Cations present in the human regulation of acid-base
1. Na+
2. K+
3. Ca2+
4. Mg2+
46
anions present in the human regulation of acid-base
1. Cl−
| 2. HCO3−
47
normal components of the anion gap (like the actual gap. what shit comprises the actual gap)
1. albumin
2. inorganic phosphate
3. sulfate
4. lactate
48
metabolic acidosis can occur in one of these two mechanisms
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
metabolic alkalosis can occur in one of these two mechanisms
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
most common cause of a low AG
decrease in albumin
51
what is measured on macroscopic urinalysis (there are your macroscopic piss strips. the analysis test strips)
1. general appearance
2. pH
3. specific gravity
4. leukocyte esterase
5. blood
6. protein
7. glucose
8. ketones
9. urobilinogen
10. nitrite
52
what is measured on microscopic urinalysis (piss under a microscope)
1. WBCs
2. red blood cells
3. bacteria
4. epithelial cells
5. crystals/casts/mucus
6. other sediment
53
MUDPILES CAT
💵💵💵💵 MONEY SLIDE 💵💵💵💵
```
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
