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IPAP > Clin Lab 2: Lect 1-3 > Flashcards

Clin Lab 2: Lect 1-3 Flashcards

1
Q

What are the three functions of the kidneys?

A

Excretion- selective clearance
Homeostasis- water/E+, A-/B+ balance
Endocrine- erythropoeitin, prostaglandin/thromboxanes, renin synthesis

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2
Q

How is glomerular filtration rate maintained?

A

Myogenic control related to degree of stretch on afferent arteriole
Stress induced inhibit filtration, constrict afferent
RAAS increases SBP

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3
Q

Tubular reabsorption begins when filtrate enters ? and involves ? two processes?

A

PCT
Near total reabsorption of organic nutrients
Hormonal reabsorption of water

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4
Q

Virtually all nutrients and lipids are reabsorbed where in the kidney?

A

PCT

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5
Q

Where is Mg reabsorbed?

Where is urea reabsorbed?

A

DLoH

PCT and CD

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6
Q

How do substances move from peri-tubular capillaries into tubular filtrate?

A

Active transport

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7
Q

What are the two functions tubular secretion completes?

A

Eliminates non-organics not found in blood

Acid-base regulation via secretion of H/NH4

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8
Q

Where does final urine concentration begin?

How is this process controlled?

A

Late DCT and CD

Regulated by ADH

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9
Q

What would be the effect if there was NO ADH in the body?

A

Low osmolality of ECF
Low number of aquaporins
Low water reabsorbed from CD
Large vol of diluted urine

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10
Q

What type of urine is excreted from a DM PT?

What type of urine is excreted from a DI PT?

A

Looks dilute, high osmolality

Truly dilute, low SpecGrav

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11
Q

When is Polyuria seen?
When is Oliguria seen?
When is Anuria seen?

A

DM/DI
Dehydration
Kidney damage, decreased blood flow

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12
Q

What five characteristics of a urine sample will change with time and why?

A 
Color- darkens, RedOx of metabolites
Odor- inc, urea->ammonia
pH- inc, loss of CO2
Nitrite- inc number of nitrate reducing bacteria
Bacteria- increased numbers
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13
Q

What are the three parts to urinalysis?

A

Physical exam
Chemical analysis
Microscopic exam

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14
Q

What gives urine the yellow color?

A

Urochrome

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15
Q

What causes urine to be dark amber/orange?

A

Presence of conjugated bilirubin

Photo-oxidation of urobilinogen to urobilin causes color change to yellow/orange

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16
Q

What causes pink/red/brown urine?

A

RBCs in an acidic urine x hrs= brown urine from Hgb oxidation to methemoglobin

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17
Q

Intact RBCs in a urine samples will give the sample a ___ appearance
What if Hbg/Mgb is present?

A

Hematuria- Cloudy

Specimen is red and clear

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18
Q

What causes urine samples to turn brown/black?

A

Methemoglobin: Standing-> Hbg Fe in acidic urine is oxidized to methemoglobin= brown urine
Melanin: neutral pH urine->black w/ melanin present

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19
Q

Define Homogentisic Acid and when is it seen

A

Inborn error of metabolism

Increased excretion occurs in alkaptonuria (metabolic defect) causing urine to appear brown if it’s more acidic

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20
Q

When/why would melanin be present in a urine sample turning it brown/black?

A

Metastatic malignant melanoma

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21
Q

What causes a urine sample to turn dark orange?

What causes urine to turn blue/green?

A

Pyridium from cystitis Rxs (Rifampicin)

UTI w/ Pseudomonas
Intestinal tract infection= inc urinary indican

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22
Q

What are the non-pathological reasons for hazy urine?

A 
Amorphous crystals
Squamous epithelial cells
Seminal fluid
Fecal contamination
Mucus
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23
Q

What are the pathological reasons urine samples can be hazy?

A

R/WBCs
Bacteria
Renal epithelial cells
Lipids

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24
Q

What conditions can cause urine samples to smell more noxious/unusual?

A

Bacteria infection
Ketones- fruity
MSUD- syrup/burnt sugar
Foods- asparagus

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25
Q

Clinitests are often performed on Peds until what age and for what reason?

A

2y/o

Detect presence of: galactose, fructose, pentose or lactose

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26
Q

Glucosuria normally appears when the renal threshold of glucose exceeds what limit?

A

170 mg/dL

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27
Q

Glucosuria w/out hyperglycemia is related to ? caused by ?

A

Impaired tubular reabsorption

Pregnancy or heavy metal poisoning

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28
Q

What are the Renal-Associated reasons for a positive urine glucose result?

A

Fanconi Syndrome
Advanced Renal Dz
Osteomalacia
Pregnancy

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29
Q

Chemstrips can only test/detect what form of ketone?

A

Acetoacetic acid

Not acetone or hydroxybutyric acid

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30
Q

Acetoacetic acid is slowly and irreversibly decarboxylated into ? and excreted how?

A

Acetone

Skin, lungs, urine

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31
Q

Ketonuria can be caused by what issue?

A

Inability to utilize carbs (DM) forcing body to utilize FAs for fuel

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32
Q

What type of PTs/situations would a positive ketone result be seen?

A 
DM
Starvation
High fat/protein, low carb diet
Exercise
Malabsorption
Frequent vomiting
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33
Q

Explain Hemolytic Jaundice

A

Pre-Hepatic

Excessive RBC breakdown increasing bilirubin levels until overflow into intestines

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34
Q

What will bilirubin and urobilinogen levels be in a pre-hepatic issue PT urine sample?

A

Bilirubin- excretion rate maintained by liver

Urobilinogen- elevated in urine and blood

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35
Q

Explain Hepatic Jaundice

A

Damage/Dz to liver
Heme goes to liver but not enough blirubin is removed
Unconjugated bilirubin increases in the blood to kidney to urine

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36
Q

What will urobilinogen levels be in a Hepatic Jaunidce PT urine sample?

A

Normal or low

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37
Q

Define Bilirubinuria and what causes it

A

Increased conjugated bilirubin in urine due to hepatocellular disease/dec ability of liver to excrete all conjugated bilirubin into common bile duct

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38
Q

Bilirubinuria can be caused by what two issues?

A

Cirrhosis

Hepatitis

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39
Q

Explain Biliary Obstruction/Post Hepatic

A

Bilirubin can’t get to intestines, builds in blood and removed by kidneys

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40
Q

What will urobilinogen levels be in a Biliary Obstruction PT urine sample?

A

Little if any present

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41
Q

What are four reasons bilirubin wouldn’t be able to get into the intestines?

A

Carcinoma in liver or pancreas
Stones
Fibrosis

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42
Q

Where/how is urobilinogen formed?

A

Intestines by bacterial breakdown of conjugated bilirubin

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43
Q

What happens to a urobilinogen test if a urine sample is not delivered to the lab within the time frame/is not stored properly?

A

Urobilinogen will be rapidly oxidized into non-detectable urobilin

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44
Q

If urobilinogen is not/undetectable by a Chemstrip, what is the next sample needed for testing?

A

Stool

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45
Q

What are some prehepatic events that can lead to/cause increased urobilinogen in urine?

A

Increased Hgb breakdown
Hemolysis
Ineffective erthropoiesis

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46
Q

What are some hepatic events that can lead to/cause increased conjugated bilirubin in urine?

A

Hepatocellular disease from:
Hepatitis
Cirrhosis

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47
Q

What can cause a decreased to absent amount of urobilinogen in urine?

A

Intra / extra-hepatic obstruction
Carcinoma
Stones
Fibrosis

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48
Q

Define SpecGrav and what it indicates

A

Density of substance to reagent grade water

Indicates proportions of dissolved solids to total volume of specimen

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49
Q

What is the significance of a high specific gravity result?

A

Dehydration w/ oliguria

In DM Pts, a Solute Diuresis= urine w/ glucose and polyuria PT

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50
Q

What is the significance of a low specific gravity result?

A

Inability of tubules to concentrate

DI PT w/ polyuria and urine has low concentration

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51
Q

Define Isosthenuria

A

Consistent urine samples with SG of 1.010 which implies renal tubular damage and loss of function

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52
Q

What are the three most common causes of isosthenuria?

A

Chronic renal failure from:
Diabetic nephropathy
HTN Renal Dz
Chronic glomerulonephritis

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53
Q

Define Osmolality

A

Number of particles in a fluid sample

A more exact measurement of urine concentration than SpecGrav

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54
Q

What are the major clinical uses of osmolality include ?

A 
DR FDC 
Dz Monitoring  
Response to ADH
Fluid therapy
DDx of Hyper/onatremia
Concentration ability
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55
Q

Define ADH Neurogenic

Define ADH Nephrogenic

A

Neuro- DI from dec ADH production, concentration will occur after ADH injection

Neph- inability of tubules to respond to ADH, CD doesn’t have ADH receptors

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56
Q

Significance of positive blood results can mean one of what three things?

A

Intact RBCs
Free Hgb
Mgb

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57
Q

What are five causes of hematuria?

A 
Glomerulonephritis
Lower UTI
Exercise
Menstruation
Renal calculi
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58
Q

What can cause hemoglobinuria?

A

Intravascular hemolysis
Exercise

May result from lysis of RBCs in UT, especially in dilute, alkaline urine

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59
Q

What causes Myoglobinuria?

How does it present?

A

Trauma/crush or Rhabdo

Normal appearing serum, elevated creatinine kinase and lactate dehydrogenase

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60
Q

Urinary pH may indicate what type of kidney issue?

A

Inability to secrete/absorb acid-base

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61
Q

What type of urine reduces/prevents calculi formation?

A

Alkaline

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62
Q

What serum protein is found in normal urine?

A

Albumin

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63
Q

Define Uromodulin

A

Tamm-Horsfall proteins- mucoprotein made in DCT and involved in cast formations

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64
Q

Chemstrips are most sensitive for detecting what protein in urine?

A

Albumin

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65
Q

Proteinuria is related to changes in what two things?

A

Glomerular blood flow

Enhanced glomerular permeability

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66
Q

What is pre-renal proteinuria associated with?

A

Non-renal Dzs causing increase in low weight plasma proteins (Hgb, Mgb) and acute reactants associated with infection/inflammation to pass through

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67
Q

PT with Multiple Myeloma will present with what changes to their urine samples?

A

Excess of Immunoglobulin light chains

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68
Q

What are causes of pre-renal proteinuria?

A 
Multiple myeloma
Renal artery stenosis 
HTN
Fever
Muscle injury
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69
Q

What causes renal proteinuria?

A

Kidney Dzs
Primary- glomerulonephritis, nephrotic syndrome
Induced- drug/toxin, systemic dz

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70
Q

What are three causes of tubular proteinuria (renal proteinuria)?

A

Defective tubular reabsorption characterized by increased levels of low weight proteins from:
Drug/toxin
Severe infection
Fanconi’s Syndrome

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71
Q

What are three causes of post-renal proteinuria?

A

Cystitis
Urethritis
Postatitis

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72
Q

What types of microbes can cause a nitrate change on Chemstrips?

A

E Coli

Proteus Sp

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73
Q

What type of urine sample is preferred for testing for nitrites?

A

First morning- allows for bacteria accumulation and longer conversion time of nitrate to nitrite

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74
Q

What can cause a false-positive urine nitrite results?

A

Positive nitrite result w/out UTI

Improper preservation of specimen causing increased E COli

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75
Q

Bacteria presence in urine specimen in significant numbers cn be due to infections in what two place?

A

Entire urinary system

Nephron to bladder

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76
Q

What is the significance of positive Leukocyte Esterase in urine samples?

A

Pyuria- inc WBCs due to infection/inflammation in GU system

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77
Q

Bacteria infections in UT generating a positive urine LE will often have what other positive test indicator?

A

Nitrite

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78
Q

A positive LE urine sampled will be microscopically examined and might be able to see what three things?

A

Yeast
Bacteria
Trichomonas

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79
Q

What part of a urine sample will be altered/changed the most by prolonged exposure to light?

A

Bilirubin

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80
Q

Dark urine samples are most likely due to what part of the sample?

A

Bilirubin

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81
Q

___ are more permeable to H2O and Na than other capillaries

A

Glomeruli

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82
Q

High blood osmolality triggers what to be released in the body?

A

ADH

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83
Q

SpecGrav is an index of the kidney’s abilities to do ? function

A

Concentrate urine

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84
Q

What urine sample is most appropriate for suspected pregnancy test?

A

First morning

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85
Q

Urine sample with elevated urobilinogen and negative bilirubin levels may indicate what issue?

A

Intravascular hemolysis

86
Q

Microabluminuria, pre-eclampsia and orthostatic proteinuria are all examples of proteinuria coming from what part of the system?

A

Renal

87
Q

Acute phase reactants and multiple myeloma are both conditions that cause proteinuria from where?

A

Pre-renal

88
Q

Prostatits and vaginal inflammation are both causes of proteinuria from what part of the system?

A

Post-renal

89
Q

What is the purpose of microscopic examination of urine sediment?

A

Detect and identify insoluble materials

90
Q

What are insoluble materials that can be identified in urine?

A 
MY B SCREW CAP
Mucus
Yeast
Bacteria
Sperm
Casts
RBC
Epithelial
WBC
Crystals
Artifacts
Parasites
91
Q

Define Aliquot

A

10mL of urine specimen centrifuged to concentrate insolubles at bottom of sample

92
Q

RBCs in a urine sample are associated with ?

A

Glomerular damage

93
Q

PTs bleeding into their urinary tract from the renal pelvis to urethra will have what type of urine sample?

A

No significant proteinuria
No other cell types
No casts

94
Q

What are 5 examples of issues that can cause bleeding from renal pelvis to urethra and cause RBCs to be found in urine?

A

Stones
Neoplasms
Trauma
Prostatitis

95
Q

Hematuria associated with a UTI will be associated with ?

A

Pyruia

96
Q

Nephronal hematuria is seen with ? and ?

A

Proteinuria

RBC casts

97
Q

Nephronal hematuria is seen with proteinuria and casts but is caused by ?

A

Glomerular disease

Tubular disease

98
Q

What considerations need to be present when considering cause of RBCs in urine samples?

A

Exercise

Menstruation

99
Q

Pyuria indicates the presence of ? or ? in GU system?

A

Infection

Inflammation

100
Q

What three findings are more indicative of a kidney infection?

A

Mod/heavy proteinuria
WBC casts
Hematuria

101
Q

How are lab results differentiated between a kidney infection and a bladder infection?

A

Bladder- hematuria, less proteins and no casts

102
Q

What type of cell is most frequently seen but least relevant for clinical use in urine samples?

A

Squamous Epithelial cells

103
Q

Squamous epithelial cells arise from where in the fe/male GU system?

A

Female- entire

Male- lower urethra

104
Q

Large numbers of squamous epithelial cells in a sample is indicative of ?

A

Contamination

105
Q

Where are transitional epithelial cells found within the GU system?

A

Renal pelvis lining
Ureters
Bladder
Upper male urethra

106
Q

Finding transitional epithelial cells is only considered pathological if ?

A

No instrument procedure has been recently performed

107
Q

What can cause renal tubular epithelial cells to be found in urine samples?

A

Heavy metals
Drugs
Hbg/Mgb toxicity
Pyelonephritis

108
Q

Define Oval Fat Bodies and when are they seen

A

RTE cells containing lipids

Common in nephrotic syndrome

109
Q

Where are casts primarily formed?

A

Lumen of DCT and CD

Origin site determines width

110
Q

Casts are usually formed/found in what type of urine?

A

Concentrated acidic

111
Q

What are the 3 major factors that enhance cast formation?

A

Proteinuria
Stasis
Tamm-Horsfall proteins

112
Q

What type of cell is Tamm-Horsfall proteins and where are they made?

A

Mucoprotein

Renal tubular cells

113
Q

What appearance do casts have?

A

Parallel sides and rounded edges

May be wrinkled/convoluted depending on age

114
Q

Characteristics of Hyaline Casts

A

Almost entirely of Tamm-Horsfall proteins that are colorless w/ a refractive index close to urine

115
Q

Non-pathological causes of hyaline cast formation?

A

FEED

Fever Exercise Emotional stress Dehydration

116
Q

Pathological causes of hyaline cast formation?

A

Glomerulonephritis
Pyelonephritis
Chronic renal disease

117
Q

The presence of ___ casts is indicative of serious renal disease

A

Cellular

118
Q

RBC casts are primarily associated with damage to ?

A

Glomerulus (glomerularnephritis)

119
Q

WBC casts are indicative of ?

A

Nephron infection/inflammation

Most frequently with pyelonephritis

120
Q

How are WBC and RTE cell casts differentiated visually?

A

RTE- look for central round nucleus

121
Q

RTE cell casts are indicative of ? and are usually seen with what other findings?

A

Renal tubular disease

Red and White cell casts

122
Q

What are fatty casts associated with?

A

Renal diseases
Particularly- nephrotic syndrome
Possible- toxic tubular necrosis, DM

123
Q

What are non-pathogenic granular casts indicative of?

A

By product of protein metabolism excreted by tubule cells and can be seen in normal/healthy PTs

124
Q

What are pathological granule casts associated with?

A

Any disorder causing cell cast formations

Degeneration of cell casts occurs as stasis worsens

125
Q

Characteristics of waxy casts

A

Severe urine stasis in tubules

Frequently found in chronic renal failure

126
Q

Characteristics of broad casts

A

Formed in diluted tubules with very severe stasis and referred to as renal failure/end stage failure casts

127
Q

When are crystals formed in urine?

What types are formed in what types of urine?

A

Precipitation of urine salts subjected to pH/concentration changes
Amorphours urates- acidic
Amorphous phosphates- alkaline

128
Q

Urine crystals may represent what types of disorders?

A

Liver Dz
Genetic defects
Renal damage from crystal deposits in tubular cells

129
Q

Bacteria presence in urine is indicative a clean catch did not happen, but is usually reported when identified in fresh specimens if what else is seen in the sample?

A

WBCs

130
Q

What organism is most commonly found in urine?

What cell is this commonly confused with?

A

Candida albicans

RBCs

131
Q

What is the most frequently encountered parasite in urine?

What characteristic is required for ID?

A

Trichamonas vaginalis

Movement, immobility resembles WBCs

132
Q

Intestinal parasites (adult or eggs) in urine samples are indicative of what?

A

Fecal contamination

133
Q

Urine sample Chemstrips can have a false positive result for proteins if ? is in the urine?

A

Sperm

134
Q

What insoluble finding in urine is not clinically relevant?

A

Starch granules- body power

135
Q

First thing lab does to urine sample?

A

Look at color/clarity

136
Q

Urine sample positive for nitrite and leukocyesterase indicates ?

A

UTI

137
Q

Urine sample positive for glucose, ketones and has a low pH?

A

DM

138
Q

Urine sample with bilirubin, but no urobilinogen means?

A

Post hepatic biliary obstruction

139
Q

ALT/AST more indicative for ? organ?

Lipase is for ? organ?

A

Liver

Pancreas

140
Q

Unconjugated bilirubin is __ soluble
Conjugatd bilirubin is __ soluble
Urobilinogen is _ soluble

A

Un- lipid
Con- water, added sugar
Lipid

141
Q

Insulin is made in _ cells

Glucagon is made in _ cells

A

B

A

142
Q

Define Glycogenesis

Define Glycolysis

A

Glucose from G6P

G6P to pyruvic/lactic acid

143
Q

Hyperglycemia is what type of issue?

Hypoglycemia is what type?

A

Osmotic water loss

Cerebral problem

144
Q

T1DM is called ?

T2DM is called ?

A 
1= insulin dependent
2= Non-insulin dependent/insulin resistant
145
Q

The AMA panel for DM management includes what tests?

A 
LAAB
Lipid profile
A1C
Anion Gap
BMP
146
Q

What is an early indicator of diabetes?
What lab result is typically only seen in T1DM?
What 3rd test may also be included?

A

Micro-ablumin

Ketone bodies

Fructosamine

147
Q

Glycated Hgb is made from ___ + ____

A

Glucose

Schiff base

148
Q

A1C levels indicate what time frame?

A

6-8wks

149
Q

A1C is a lower diagnostic performance in what PT populations?

A

Pregnancy
Elderly
Non-Hispanic blacks

150
Q

What are the functions of fructosamine and glycated albumin tests?

A

Monitoring tools to help diabetics control glucose levels
(diet/med adjustments evaluation)
NOT for diabetes Dx

151
Q

Diabetic A1C, FPG and OGTT numbers?

A

+6.5
+126
+200

152
Q

Prediabetic A1C, FPG and OGTT numbers?

A

5.7 - 6.4
100 - 125
140 - 199

153
Q

Normal A1C, FPG and OGTT numbers?

A

5
99 or less
139 or less

154
Q

How is serum fructosamine formed?

A

Non-enzymatic glycosylation of serum proteins (albumin makes up 80%)

155
Q

Serum glycated albumin generally reflects state of glycemic control for what time frame?

A

Preceding 2-3wks

156
Q

Other than shorter time frame monitoring, Fructosamine and Glycated Albumin are usefule for what PT population?

A

Disorders causing shortened RBC lifespan (hemolytic anemia, pregnancy)

157
Q

What type of Hbg variant may affect A1C measuring methods?

A

HbSS

158
Q

Fructosamine and glycated albumin results are both affected by what types of condition?

A

Anything that affects serum albumin production

159
Q

Ketone bodies in T1DM PTs are a result of what two things?

These result in what types of ketones to build up?

A

Inc lipolysis, dec re-esterification of FA to triglycerides

Acetoacetate and B-hydroxybutyrate

160
Q

Ketone lab tests usually use ___ methods like ? or ?

A

Semi-quantitative

Acetest or KetoDiastix

161
Q

AceTest and KetoDiastix are only sensitive for what ketone?

Why is this importatn?

A

Acetoacetate

Neg test do not rule out ketoacidosis due to inc B-Hydroxy levels

162
Q

Persistent proteinuria detectable by routine screening indiates ?

A

Overt diabetic neuropathy

163
Q

What precedes the proteinuria diabetic nephropathy stage that is not detected by routine lab methods?

A

Inc urine albumin excretion

164
Q

What lab results defines microalbuminuria?

What does this result NOT indicate?

A

Proteinuria >30 <300/24hrs or urine albumin excretion

Not0 smaller than normal size albumin

165
Q

INcreased urine albumin excretion indicates an increase in ? and is a marker of ?

A

Transcapillary passage

Marker of micro-vascular dz

166
Q

What are four causes of non-diabetic hyperglycemia?

A

CF diabetes
Corticosteroids/BBs
Multi-organ failure
Shock

167
Q

What is the counter result of hyperglycemia?

A

Each 100mg increase in blood sugar decreases plasma sodium by 1.7 = dilutional hyponatremia

168
Q

What are the six causes of hypoglycemia?

A 
G HOME
Hormone deficiency
Overtreatment of insulin
Malnutrition
Excessive ETOH
Glycogen strorage Dz
169
Q

What other causes other than G HOME can cause hypoglycemia?

A

Islet cell hyperplasia

Insulinoma

170
Q

What is the recommended cutoff for early detection of CKD in diabetics using the test for microalbumin?

A

> 30mg/24hrs

171
Q

What is the ADA recommended cutoff value for adequate control of glucose as measured by glycated Hgb?

A

6.5%

172
Q

BMP tests include ?

A

Ca CO2 Cl K Na
Creatinine
Glucose
BUN

173
Q

What are the intra/extacellular cat/anions?

A

Cl- EC anion
K- IC cation
Na- EC cation

174
Q

CLs funciton in the body?

A

Maintains acid-base balance

Facilitates O2/CO2 exchange in RBCs

175
Q

Electrolytes have key roles in what four processes?

A

Water homeostasis
pH regulation
Heat, nerve and muscle function
RedOx reactions

176
Q

What electrolyte is most important for water regulation and how is it regulated?

A

Na
Aldosterone- raises
ANP- lowers

177
Q

What is an important initial step in assessment of hyponatremia?

A

Plasma osmolality

178
Q

What are two causes of Hypo-osmotic hyponatremia normovolemic?
What is the pathalogy causing this?

A

Isolated NaCl deficit
Normal TBF

SIADH
Diuretics
Hypothyroid/aldrenalism

179
Q

What causes hyperosmotic hyp0natremia?

A

Inc quantities of solutes in ECF from shift of water/ ICF shift of Na to maintain balance between ECF/ICF compartments

180
Q

Define Isosmotic Hyponatremia

A

Dec plasma Na but,
plasma osmolality, glucose and urea are norm= pseudohyponatremia from electrolyte exclusion
(hyper protein/lipid emia)

181
Q

How is K reulated?

A

Insulin and catecholamines- causes K movement into cells

182
Q

What are the physiological roles of K?

A

Muscle repolarization

pH balance- acidosis= K into plasma, H into cell; alkalosis= k into cells

183
Q

What are the two types of hypokalemia?

A

True deficit- renal or nonrenal loss based on K urinary excretion
Redistribution- from insulin, epi, alkalosis

184
Q

What are the physiological roles of Cl?

A

Opposes Na, maintaines osmotic press/elec neutral
Moves passively with Na, inversely with BiCarb
Inc resting potential

185
Q

Why do blood cells need to be separated from plasma prior to testing?

A

BiCarb -> CO2

Artificial inc of Cl to balance loss of BiCarb and dec of total CO2

186
Q

3 causes of hypochloremia?

A

Hyponatremia
Vomiting
Inc BiCarb- Met Alk; Resp Acid

187
Q

What are 4 causes of hyperchloremia?

A

Hypernatremia
DI
Dehydration
Met acid/Resp alk

188
Q

What is BiCarb a measurment of?

A

Metabolic component of acid-base balance

189
Q

How is Ca regulated?

What E+ is it’s inverse?

A

Calcitonin and PTH

PO4

190
Q

What enzyme is a cofactor for enzymatic reactions?

A

Mg

191
Q

Intracellular Cations x 2
Extracellular Anions x 2
Extracellular Cations x 1

A

Intra C- K Mg
Extra A- Cl BiCarb
Extra- Na

192
Q

Elevated Anion Gap Metabolic Acidosis acronym?

A 
MULEPAKS
Methanol intox
Uremia
Lactic acidosis
Ethylene glcyol intox
Paraldehyde Intox
Alcohol ketoacidosis
Ketoacidosis
Salicylate intox
193
Q

DDx Non-Gap Acidosis

A

GI BiCarb loss- diarrhea

Renal BiCarb loss- CAIs, renal tube acidosis, aldosterone inhibitors, hypoaldosteronism

194
Q

When water is lost but E+ are retained and osmolarity of ECF rises, osmosis will move water in what direction?

A

Out of ICF into ECT until isotonicity is reached

195
Q

What E+ movement will not affect fluid levels in blood?

A

Cl shift

196
Q

ABG measures what four things in blood?

A

Calculated: pH, PCO2, HCO3
Estimated: PO2

197
Q

What happens to Co2 and BiCarb when blood pH increases?

A

Alkaline= dec CO2 or inc BiCarb

198
Q

What happens to PO2 when PCO2 rises?

A

Blood pH dec
PCO2 dec
blood pH rises (basic)

199
Q

O2 saturation can be used to calculate what parts of the acid-base balance?

A

Base excess/deficit

Sum of metabolic anions: Hgb, protein, PO4 and BiCarb

200
Q

Typical cause and compensation mechanism for metabolic acidosis?

A

DKA, Lactic acidosis

Hyperventilate

201
Q

Typical cause and compensation mechanism for metabolic alkalosis?

A

Vomiting

Hypoventilate

202
Q

Typical cause and compensation mechanism for respiratory acidosis?

A

COPD; respiratory paralysis

Inc H secretion, BiCarb retention

203
Q

Typical cause and compensation mechanism for respiratory alkalosis?

A

Anxiety; pain

Dec H Secretion, excretion of BiCarb

204
Q

Causes of Metabolic Acidosis

A 
DKA
Lactic acidosis
Meth/Ethyl glycol poison
RF
Diarrhea
205
Q

Causes of Metabolic Alkalosis

A

Vomit
Diuretic therapy
Hyperadrenocortical Dz
Exogenous base excess

206
Q

Causes of Respiratory Acidosis?

A

Emphysema
Pneumonia
Pulmonary Fibrosis
COPD

207
Q

Causes of Respiratory Alkalosis

A

Hysteria
Fever
Salicylate poisoning
Asthma

208
Q

What is the primary role of the carbonic acid-bicarbonate buffer system?

A

Prevent pH change from organic/fixed acids in ECF

209
Q

How do the kidneys respond to respiratory acidoses when pulmonary response is ineffective?

A

Inc rate of H secretion into filtrate

210
Q

Done with

A

Lect 1-3 for this Card Deck

IPAP (212 decks)

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