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IPFC 1 Midterm 1 > Clinical Biochem 2 > Flashcards

Clinical Biochem 2 Flashcards

1
Q

In a volume assessment, what effects can happen in a depleted volume

A
  • postural hypotension –> inc HR
  • Dry mouth
  • Poor skin turgor test
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2
Q

In a volume assessment, what would volume overload look like?

A
  • inc resp. rate
  • wheezy chest
  • inc jugular venous pressure, >3 cm above sternal angle
  • positive hepatojugular reflex (push chest down, if jugular veins stay up = +)
  • Edema (swelling)
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3
Q

What BUN (blood urea nitrogen) to creatinine ratio mean dehydration? Why?

A

Ratio greater than 0.08+
- bc the kidneys reabsorb BUN more than creatinine when patient is dehydrated
- give IV replacement fluids

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4
Q

Sodium (mostly ECF)
Reference range?
Primary function?
Low levels + symptoms?
High levels + Symptoms?

A

Reference range?
135-145 mmol/L

Primary function?
- regulation of fluid volume (by thirst, ADH, renal)
- major cation of ECF

Low levels + symptoms?
- <120 mmol/L Hyponatremia
- Hypotonic ECF –> water flows into cell(burst)
- Nausea, vomiting, anorexia

High levels + Symptoms?
- 160mmol/L+ hypernatremia
- Hypertonic ECF –> water flows out of cell
- Seizures, thirst, lethargy, coma, irritability

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5
Q

In Hypotonic-hyponatremia, define HYPOvolemic and causes

A

Hypovolemic (low)
- due to water loss from different areas of the body

Causes:
- GI losses
- Skin losses
- Lung losses
- Renal losses
- Diuretics

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6
Q

In Hypotonic-hyponatremia, define ISOvulemic and causes

A

Isovolemic (normal)
- dilutional –> water accumulation without sodium accumulation (low Na levels)

Causes
- Water intoxication
- Renal failure
- Symptom of inappropriate ADH

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7
Q

In Hypotonic-hyponatremia, define HYPERvolemic and causes

A

hypervolemic (high)
- smaller inc in body sodium and bigger inc in total body water –> diluted sodium in the body

Causes
- congestive heart failure
- Liver damage
- Nephrosis

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8
Q

in NON-hypotonic hyponatremia, explain isotonic hyponatremia, give an example

A

Isotonic
- administration of isotonic, sodium free, Intravenous solution
- eg. 5% dextrose

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9
Q

in NON-hypotonic hyponatremia, explain hypertonic hyponatremia, give an example

A

hypertonic
- administration of hypertonic, sodium free, Intravenous solution
- eg. mannitol

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10
Q

What can non-hypotonic hyponatremia treat? (mannitol)

A

hypernatremia

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11
Q

What does Hypernatremia with LOW total body sodium and LOW fluid volume indicate?

A

more water loss than sodium loss

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12
Q

What does Hypernatremia with normal total body sodium indicate?

A

water loss WITHOUT sodium loss

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13
Q

What does Hypernatremia with high total body sodium indicate?

A

uncommon (due to infusion/ingestion of highly hypertonic solutions

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14
Q

Potassium (mostly ICF)
Reference range?
Primary function?
Low levels + symptoms?
High levels + Symptoms?

A

Reference range?
- 3.5-5 mmol/L

Primary function?
- Primary intracellular cation
- Regulates nerve and muscle excitability

Low levels + symptoms?
- <2.5 mmol/L Hypokalemia
- bradycardia (low HR)
- CRAMPS, weakness, ORTHOSTATIC hypotension, paralysis

High levels + Symptoms?
- 8+mmol/L Hyperkalemia
- VFIB, bradycardia (low HR), hypotension, CARDIAC ARREST, muscle weakness, paralysis

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15
Q

What are some causes of hyperkalemia? Hypokalemia?

A

Hypokalemia
- lack of intake
- excessive renal loss
- ICF shft
- Excessive GI fluid loss

Hyperkalemia
- Excessive intake
- Impaired renal function
- Redistribution to ECF

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16
Q

Explain pseudohyperkalemia

A

When RBCs hemolyze –> release potassium
- high false reading
- can be caused by needle size too small

17
Q

Chloride
Reference range?
Primary function? Regulated by?
Low levels + causes?
High levels + causes?

A

Reference range?
- 100-108 mmol/L

Primary function?
- major extracellular anion
- Primary passive role ( with sodium: fluid balance) (with CO2: acid-base balance)
- Regulated by sodium and bicarb

Low levels + causes?
- <75 mmol/L hypochloremia
causes:
- GI FLUID LOSS
- metabolic alkalosis
- renal losses (from Na loss)
- indirect caused by drugs

High levels + causes?
- 125+ mmol/L hyperchloremia (rarely on its own)
Causes
- accompanied by NA AND WATER RETENTION
- metabolic acidosis

18
Q

Magnesium (ICF)
Reference range?
Primary function?
Low levels + symptoms, caused by?
High levels + Symptoms, caused by?

A

Reference range?
- 0.8-1 mmol/L

Primary function?
- neuromuscular function (ATP), bone formation, enzymatic function

Low levels + symptoms, caused by?
- <0.5 mmol/L
- weakness, increased reflexes, IRREGULAR HEART, CNS changes, confusion
- Caused by GI or renal losses

High levels + Symptoms, caused by?
- 1.5+ mmol/L
- bradychardia, HEART BLOCK, confusion, DEACREASE TENDON REFLEX, weakness, HYPOCALCEMIA, decreased clotting mechanism
- Caused by Renal dysfunction or Mg overload

19
Q

What are large doses of Mg used for? What is the dose? What is the risk, antidote?

A

Prevention and treatment of seizures
- Mg 4g bolus + 1-2 g/hr infused via 40g/L intravenous solution

Risk
- very high dose = respiratory depression/arrest
- antidote: calcium injection

20
Q

Calcium
Reference range, location?
Primary function?
Low levels + symptoms, caused by?
High levels + Symptoms, caused by?

A

Reference range?
2.1-2.6 mmol/L
- 99% in bone
- 1% ECF (40% bound to albumin, 15% complexed with citrate, bicarb, phosphate, 45% free ionized active form)

Primary function?
- nerve impulse transmission, muscle contract, AV & SA Node, blood coagulation, endocrine, bone metabolism

Low levels + symptoms, caused by?
- <1 mmol/L
- Numbness, myalgias, tingling to tetany, cardiac arrhythmias, hypotension, seizures
- Caused by: disorders of Vitamin D metabolism or parathyroids hormone

High levels + Symptoms, caused by?
- 3+ mmol/L
- GI symptoms, lethargy, confusion, acute renal failure
- Caused by: malignancies, primary hyperparathyroidism, drug

21
Q

What do changes in albumin effect?

A

changes protein binding
- in turn affects both total serum calcium and free ionized calcium

22
Q

What is the relation between the drop of albumin and serum calcium

A

every 10g/L drop of albumin, calcium drops by 0.2 mmol/L

23
Q

What does alkalosis & acidosis refer to in terms of protein binding and unbound (ionized) calcium

A

Alkalosis: high protein binding = lower unbound (ionized) calcium

Acidosis: lower protein binding = higher unbound (ionized) calcium

24
Q

Phosphate (ICF)
Reference range?
Primary function?
Low levels + symptoms, caused by?
High levels + Symptoms, caused by?

A

Reference range?
0.8-1.6 mmol/L

Primary function?
- intracellular anion in bone & muscle
- role in metabolism + bone formation

Low levels + symptoms, caused by?
- < 0.3 mmol/L
- muscle weakness, rhabdomyoliss, haemolysis, platelet dysfunction, seizures
- Caused by: reduced intake, intracellular shift, increased excretion

High levels + Symptoms, caused by?
- 2.4+ mmol/L
- calcium phosphate deposition (calcification) in soft tissue, osteomalacia, accompanying hypocalcemia and hyperparathyroidism
- Caused by: excessive intake with renal disease

25
Q

What is the relationship between calcium and phosphate?

A

If one is high then the other is low

25
Q

Explain false hypercalcemia (high calcium)

A

turner kit left on too long

IPFC 1 Midterm 1 (8 decks)

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