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diagnostic methods > clinical chemistry > Flashcards

clinical chemistry Flashcards

1
Q

what is the difference between plasma and serum

A

plasma has clotting factors, serum does not

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2
Q

ion selective electrodes

A
  • converts activity of specific ion dissolved in a solution to an electrical potential
  • measured by voltemeter
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3
Q

spectrophotometry

A

measures change in light absorbance at certain wave length

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4
Q

enzyme linked immunosorbet assay (ELISA)

A

detects serum antibodies or antigens

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5
Q

critical value

A
  • any test result that may require rapid clinical attention to avoid pt morbidity or mortality
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6
Q

what studies make up a comprehensive metabolic panel (CMP)?

A
  • basic metabolic panel (BMP)
  • calcium
  • liver function tests
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7
Q

what is measured in a basic metabolic pannel?

A
  • Na
  • K
  • Cl
  • CO2
  • BUN
  • creatinine
  • glucose
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8
Q

serum sodium

A
  • reflects changes in water balance
  • makes up 90% of extracellular solutes
  • strong cation
  • normal levels = 135-145 mEq/L
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9
Q

functions of sodium

A
  • maintain osmotic pressure of extracellular fluids
  • acid base balance
  • neuromuscular function
  • absorption of glucose
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10
Q

hyponatremia

A
  • first sx occur at less than 125 mEq/L
  • less than 115 causes confusion, lethargy, muscle twitching, convulsions, coma, brain stem herniation
  • 110-115 likely to cause severe and irreversible neurological damage
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11
Q

treatment of hyponatremia

A
  • treat underlying cause
  • dehydrate -> hydrate
  • fluid overload -> diurese
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12
Q

normal saline

A
  • 0.9% NaCl
  • isotonic saline
  • treats dehydration
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13
Q

IV1/2NS

A
  • 0.45% NaCl

- used as maintenance fluid

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14
Q

lactated ringers

A
  • contain NaCl, sodium lactate, KCl, CaCl in water

- used in trauma, surgery

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15
Q

hypertonic saline

A
  • 3% NaCl
  • used for sudden precipitous drops in Na
  • i.e. marathon runners
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16
Q

treatment of hypernatremia

A
  • admin free water with 5% dextrose (D5W)
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17
Q

why cant you administer just free water for hypernatremia

A
  • will cause hemolysis

- water will flood cells through osmosis

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18
Q

why cant you correct sodium too rapidly?

A
  • central pontine myelinolysis
  • cerebral edema
  • brain stem herniation
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19
Q

central pontine myelinolysis

A
  • destruction of myelin covering nerve cells in brainstem
  • confusion, encephalopathy, lethargy
  • weakness, paralysis
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20
Q

main functions of serum potassium

A
  • maintain intracellular osmolality
  • acid-base balance
  • transmission of nerve impulses
  • essential to skeletal, cardiac, and smooth muscle function
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21
Q

when can you get falsely elevated K

A
  • hemolysis

- common complication of collecting blood samples

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22
Q

how does insulin regulate potassium

A
  • K enters portal circulation
  • stimulates release of insulin
  • glucose enters cell
  • K follows into cell
23
Q

how is potassium excreted

A

by kidneys in urine

24
Q

causes of hypokalemia

A
  • inadequate intake (Diet)
  • excessive losses i.e. diarrhea, kidneys, burns
  • redistribution into cells i.e. insulin
25
Q

causes of hyperkalemia

A
  • decreased renal elimination (most common)
  • excessive rapid administration
  • movement of K from inside the cell to outside i.e. trauma
26
Q

signs/sx of hypokalemia

A
  • weakness, muscle cramps, paralysis
  • EKG changes and arrhythmias
  • paralytic ileus
27
Q

signs/sx of hyperkalemia

A
  • weakness, muscle cramps, paresthesias
  • EKG changes and arrhythmias
  • intestinal cramping
28
Q

chloride

A
  • normal is 98-106
  • maintain electrical neutrality by binding to pos charged ions
  • indicator of hydration tatus
29
Q

carbon dioxide

A
  • in serum most is bicarb
  • normal is 23-30
  • assists in eval of pH
30
Q

anion gap

A
  • difference between the primary cations and anions in serum

- AG is normally 8-16

31
Q

cations measured for anion gap

A
  • sodium

- potassium

32
Q

anions measured for anion gap

A
  • chloride

- bicarb

33
Q

blood urea nitrogen (BUN)

A
  • directly related to excretory fn of kidneys
  • if kidneys aren’t excreting properly then BUN will rise
  • changes in protein levels can change BUN
34
Q

how is urea formed?

A
  • proteins broken down into AA
  • free ammonia formed
  • ammonia molecules combine to form urea
35
Q

azotemia

A

elevated BUN levels

36
Q

prerenal azotemia

A

elevated BUN as result of kidney dysfunction from hypoperfusion

37
Q

postrenal azotemia

A
  • elevated BUN as result of post renal obstruction
38
Q

creatinine

A
  • normal is 0.6- 1.2
  • used to approximate renal function
  • BUN:Cr ratio of >20:1 indicates dehydration
39
Q

normal glucose levels

A
  • fasting= 70-110
  • random <200
  • critical is <50 or >450
40
Q

calcium

A
  • 40% bound to albumin
  • 15% bound to anions
  • 45% physiologically active ionized calcium
  • need to get corrected calcium level to account for albumin bound Ca
41
Q

causes of hypocalcemia

A
  • impaired ability to mobilize Ca from bone i.e. hypoparathyroidism
  • decreased intake or absorption i.e. vit d def
  • abnormal renal losses i.e. hyperphophatemia
42
Q

causes of hypercalcemia

A
  • excessive intake
  • increased bone resorption i.e. hyperparathyroidism
  • decreased elmination
43
Q

signs and sx of hypocalcemia

A
  • paresthesias
  • skel muscle cramps
  • tetany
  • hyperreflexia
  • cardiac arrhythmias (prlonged QT)
  • bone fx
44
Q

signs and sx of hypercalcemia

A
  • kidney stones
  • anorexia, N/V
  • muscle weakness, atrophy
  • lethargy, coma
  • EKG changes (shortened QT)
  • HTN
45
Q

LFTs

A
  • albumin
  • total protein
  • ALP- resides in walls of bile ducts
  • ALT
  • AST
  • total bilirubin, direct bilirubin, indirect bilirubin
46
Q

AST to ALT ratio

A
  • ALT normally higher than AST

- AST to ALT ratio of 2:1 suggests alcoholic liver disease

47
Q

labs for acute pancreatitis

A
  • elevated amylase
  • elevated lipase
  • elevated amylase/creatinine clearance
48
Q

labs for chronic pancreatitis

A
  • amylase, lipase, and amylase/lipase clearance can all be variable
49
Q

diagnosing pancreatitis

A
  • lipase assays are best markers
  • amylase peaks in 48 hours, normalizes in 5-7 days
  • lipase doesn’t normalize for 8-14 days
50
Q

lactic acid

A
  • quantifies degree of tissue hypoxia

- correlated with severity of illness

51
Q

cardiac biomarkers

A
  • Troponin I and II (preferred)
  • CK-MB and total CK
  • if CK:CK-MB ratio is > 1.5 it indicates potential cardiac injury
52
Q

why use arterial blood gas

A
  • determine acid- base balance

- determine oxygen status

53
Q

C/I to ABG

A
  • no pulse
  • cellulitis or compromised skin
  • no ulnar A
  • AV fistula
  • coagulopathy
  • must do Allen test before performing ABG
54
Q

what does ABG report include

A
  • pH
  • PCO2 controlled by lungs
  • HCO3 controlled by kidney, is the metabolic component

diagnostic methods (6 decks)

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