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Clin Med Lab > CMP > Flashcards

CMP Flashcards

1
Q

What is in a basic metabolic panel

A
  • glucose
  • BUN
  • creatinine
  • BUN/creatinine ratio
  • Na
  • K
  • Cl
  • CO2
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2
Q

A comprehensive metabolic panel includes the BMP plus

A
  • total protein
  • albumin
  • Ca
  • alk phos
  • ALT
  • AST
  • total bilirubin
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3
Q

shorthand fishbone diagram

A
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4
Q

What does the Blood Urea Nitrogen (BUN) lab value signify

A
  • Urea formed in liver -> byproduct of protein metabolism
    • deposited in blood and transported to kidney (excretion)
  • directly related to liver and kidney function
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5
Q

critical value for BUN

A

BUN > 100 mg/dl

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6
Q

azotemia

A

retention of nitrogenous waste

  • will see an increase in BUN and creatinine
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7
Q

how can renal disease impact BUN levels

A
  • renal disease -> inadequate urea excretion
  • inadequate urea excretion = increased BUN concentration
  • *unilateral kidney disease -> compensation
    • may not see rise in BUN
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8
Q

how can excess protein intake effect BUN

A

increase BUN

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9
Q

how can hydration status affect BUN levels

A
  • dehydration = increased BUN
  • overhydration = decreased BUN
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10
Q

what BUN levels are expected in combined liver and renal disease

A
  • WNL
  • kidneys are not excreting as much but liver is not making as much
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11
Q

How is creatinine formed

A
  1. catabolic product on creatine phosphate (used in skeletal muscle contraction)
    1. daily production and levels related to muscle mass
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12
Q

explain how creatinine levels vary diurnal and postprandial

A
  • Lowest point: 7 am
  • Peak point: 7 pm
  • eating a high protein meal will cause increase
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13
Q

critical value of creatinine

A

> 4 mg/dL

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14
Q

creatinine is a marker for which organ’s function

A
  • directly proportional to renal function
  • excreted entirely by kidneys
  • approximation of GFR
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15
Q

what does elevated creatinine serum concentration mean

A
  • serum concentration tends to rise later -> suggests chronicity of renal disease
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16
Q

serum creatinine levels are influenced by what

A
  • muscle mass and protein intake
    • more muscle mass -> elevated creatinine
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17
Q

what is the function of BUN/Cr ratio

A
  • measurement of kidney and liver function
  • increased ratio = decrease in the flow of blood to the kidneys
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18
Q

what are some conditions that can cause increased BUN/Cr ratio

A
  • renal hypoperfusion
  • GI bleed
  • high protein diet
  • sepsis/hypermetabolic state
  • drugs
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19
Q

what are some conditions that can cause decreased BUN/Cr ratio

A
  • malnutrition
  • low protein diet
  • ketoacidosis
  • drugs
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20
Q

a serum creatinine increase greater than over baseline indicates an acute kidney injury

A
  • > or = 0.5 mg/dL
  • >50% over baseline
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21
Q

signs of acute kidney injury

A
  • rapid deterioration of GFR
  • decrease in urine output
  • accumulation of nitrogenous wastes
    • urea and Cr (azotemia)
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22
Q

an elevated BUN/Cr ratio greater than (20:1) is associated with what

A
  • Prerenal Azotemia
  • causing reduced renal perfusion
  • Azotemia is an elevation of blood urea nitrogen (BUN) and serum creatinine levels.
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23
Q

what are some causes of Prerenal Azotemia

A
  • reduced renal perfusion
    • hypovolemia
    • shock
    • burns
    • dehydration
    • CHF (low CO)
    • MI
    • excessive protein ingestion
    • sepsis
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24
Q

treatment of Prerenal Azotemia

A
  • restore intravascular volume
    • fluids
  • reduce or d/c diuretics
  • monitor BUN/Cr
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25
Q

an elevated BUN/Cr ratio (10:1) is associated with what

A

Intrinsic renal azotemia

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26
Q

list some causes of Intrinsic renal azotemia

A
  • acute tubular necrosis: most common cause
  • nephrotoxins
    • NSAIDS, aminoglycosides
  • Glomerulonephritis
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27
Q

Name some causes of Postrenal Azotemia

A
  • BUN/Cr ratio variable
  • causes: obstruction to urine flow
    • ureter and renal pelvis: blood clot, stones
    • bladder
      • malignancy
    • urethral stricture
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28
Q

function of Chloride

A
  • extracellular anion
  • maintains electrical neutrality
  • water moves with sodium and chloride
  • buffer to assist in acid-base balance
    • as CO2+ and H+ rise -> Cl- shifts into cells
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29
Q

critical value of Chloride

A
  • < 80 mEq/L
  • > 115 mEq/L
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30
Q

will you often see changes in chloride levels on its own?

A
  • no
  • usually part of Na or bicarbonate shifts
  • part of anion gap calculation
    • (Na+ -(HCO3- + Cl-))
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31
Q

what proteins make up Total protein? Function of total protein

A
  • Total protein = albumin + globulin + prealbumin
  • most significant component contributing to osmotic pressure in vascular space
    • keeps fluid in vascular space
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32
Q

what is albumin formed? what is its half-life

A
  • formed in liver
  • half-life 12-18 days
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33
Q

albumin makes up what percentage of total protein

A

60%

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34
Q

name some conditions that can decrease albumin levels

A
  • burns
  • malnourished
  • liver diseae
  • third spacing : lost into extravascular space
35
Q

why is prealbumin measured

A
  • early indicator of nutritional status
    • distinct maker for protein synthesis
  • 3 day half life
  • synthesis increases within 48 hours of appropriate nutritional support
36
Q

Acute-phase proteins

A

class of proteins whose plasma concentrations increase (positive acute-phase proteins) or decrease (negative acute-phase proteins) in response to inflammation.

Ex:

  • prealbumin: negative
  • CRP: positive
37
Q

Where are globulins formed? Function?

A
  • mostly made in bone marrow and lymph tissue
  • building blocks for
    • Antibodies
    • transport
38
Q

what are the three groups of globulins

A
  • alpha
  • beta
  • gamma
    • gammaglobulins = immunoglobulins
39
Q

normal albulin/globulin ratio? What does a lower ratio indicate?

A
  • normally exceeds 1.0
  • lesser ratios indicate albumin level affected
40
Q

function of serum protein electrophoresis

A
  • separates serum components based on electrical charge
  • ex: multiple myeloma
    • SPEP demonstrates: M-spike (spike in beta or gamma globulin)
41
Q

What does total calcium measure?

A
  • Total Ca = free (ionized) + protein bound
    • measure albumin simultaneously
  • absorbed through GI tract (influenced by vit D)
  • stored in bone
  • excreted by kidney
42
Q

it is important to monitor total calcium in patients with

A
  • renal failure
  • hyperparathyroidism
  • malignancies
43
Q

critical value of total calcium

A
  • < 6.0 mg/dl
  • > 13 mg/dl
44
Q

describe calcium distribution in the body

A
  • 99% bone
  • 0.8-1.0% in cells
  • 0.1-0.2% in ECF
    • 40% is protein bound (albumin)
45
Q

serum calcium is dependent on what two things

A
  • parathyroid hormone
    • secretion -> increase in serum Ca
  • vitamin D
46
Q

serum calcium elevated x 3 is associated with what three conditions

A
  1. Hyperparathyroidism
    1. most common: increased GI absorption, descreased excretion, increased bone reabsorption
  2. Malignancy: 2nd most common
    1. tumor metastasis to bone causing Ca reabsorption into blood
  3. chronic renal failure
  4. excessive vit D
  5. granulomatous infections
47
Q

causes of hypercalcemia: CHIMPANZEES

A
  • Calcium supplementation
  • Hyperparathyroidism
  • Iatrogenic
  • Multiple myeloma, medication
  • Parathyroid hyperplasia or adenoma
  • Alcohol
  • Neoplasm
  • Zollinger Ellison syndrome
  • Excessive Vit D
  • Excessive Vit A
  • Sarcoidosis
48
Q

clinical presentation

  • muscle weakness, loss of muscle tone, lethargy, coma
  • HTN, EKG abnormalities (short QT interval)
  • polyuria, increased thirst, kidney stones
  • anorexia, N/V, constipation
A

hypercalcemia

49
Q

what are some conditions associated with hypocalcemia

A
  • hypoalbuminemia
  • large blood transfusion
    • citrate addictives -> bind free calcium
  • intestinal malabsorption
    • vit D deficiency
  • renal failure: excessive loss of Ca
  • alkalosis: protein binding to Ca
  • acute pancreatitis: saponification of fat (fatty acid binds to Ca)
  • hypomagnesemia
    • magnesium defiency inhibits PTH
50
Q

what equation can be used to determine actual total Ca levels when albumin levels are high or low

A
  • = measured total calcium + 0.8 (4.0 - serum albumin)
51
Q

clinical presentation

  • (increased excitability): paresthesia, muscle cramps
  • hyperactive reflexes
    • positive Chvostek and Trousseau signs
  • tetany
  • hypotension, EKG changes (prolonged QT interval); arrhythmias
A

hypocalcemia

CATS go numb”- Convulsions, Arrhythmias, Tetany and numbness/parasthesias in hands, feet, around mouth and lips

52
Q

what is tetany

A
  • lowered threshold for muscular excitability
    • involuntary sustained contractions
  • contractions of hands and feet -> carpopedal spasms
53
Q

Chvostek’s sign

A
  • tapping facial nerve against bone just in front of ear results in contraction of facial muscles
  • tetany
54
Q

Trousseau’s sign

A
  • occluding brachial artery for 3 minutes with BP cuff induces carpal spasms
  • tetany
55
Q

treatment for severe (symptomatic) hypocalcemia

A
  • 100-300 mg elemental calcium
    • calcium chloride or D5W
56
Q

treatment for mild hypocalcemia

A
  • oral calcium + vit D
    • calcium carbonate (tums) = no vit D
    • calcium citrate = contains Vit D
57
Q

function of magnesium

A
  • bound to ATP
  • organs and neuromuscular tissue depend on Mg
  • intimately tied to potassium and calcium to maintain neutral intracellular charge
58
Q

magnesium is present in what types of food

A
  • green veggies
  • grains
  • nuts
  • meats
  • seafood
  • *25-65% is absorbed
59
Q

how is magnesium regulated by the kidneys

A
  • Mg reabsorption decreased if
    • serum level of Mg is elevated
    • serum level of Ca is elevated
  • Mg reabsorption decreased by loop diuretics
60
Q

Name some conditions that commonly cause increased levels of magnesium

A
  • renal insufficiency
  • addison’s disease
  • hypothyroidism
  • ingestion of Mg-containing compoungs
    • antacids, laxatives
61
Q

clinical presentation

  • hyperactive reflexes, paresthesias, muscle weakness and tremors, tetany with + chvostek and + trousseau signs
  • prolonged PR and QT intervals
  • widening of QRS
A

Hypomagnesemia

  • neuromuscular effects (similar to hypocalcemia)
  • **clinically, more common and significant than hypermagnesemia
62
Q

treatment of hypomagnesemia

A
  • oral replacement
    • magnesium oxide (400 mg tabs)
    • use cation in patients with renal disease
  • IV replacement
    • magnesium sulfate infusion followed by additional infusion over 3-7 days
    • follow blood levels and DTR’s
63
Q

how does low Mg+ affect calcium and potassium levels

A
  • hypomagnesemia -> hypocalcemia
    • low PTH levels
  • impairs ability of kidney to conserve K+
64
Q

clinical presentation

  • hyporeflexia
  • muscle weakness; respiratory paralysis
  • confusion
  • hypotension
  • cardiac arrhythmias
A

hypermagnesemia

65
Q

phosphate levels are determined by

A
  • calcium metabolism
    • Phosphorous is combined with calcium in skeleton
  • PTH
  • renal excretion
  • intestinal absorption (small bowel)
66
Q

what is the critical value of phosphate (inorganic phosphate is measured)

A

< 1 mg/dL

67
Q

what effect does antacids have on phosphate absorption

A
  • dietary phosphate is absorbed in small intestine and decreased with antacids (opposite of Ca)
68
Q

relationship between phosphate and calcium

A
  • INVERSE
  • PTH decreases phosphate reabsorption by the kidneys
69
Q

what can cause phosphate elevation

A
  • treatment of DKA
  • alcohol withdrawal
  • hypoparathyroidism
70
Q

alkaline phosphate has the highest concentrations where in the body

A
  • liver
    • in kupffer cells
  • biliary tract epithelium
    • excreted in bile
  • bone
71
Q

causes of elevated alkaline phosphatase

A
  • extrahepatic and intrahepatic obstructive biliary disease and cirrhosis
  • new bone growth : high in adolescents
  • osteoblastic metastatic tumors
72
Q

where is alanine aminotransferase (ALT) found in body?

A
  • predominately in liver
  • injury/disease to liver -> release of ALT
73
Q

AST:ALT ratio < 1 indicates what

A
  • < 1 indicates viral hepatitis
  • > 1 indicates hepatocellular disease other than viral hepatitis
  • **less accurate if AST exceeds 10 x normal value
74
Q

AST is released by liver with hepatocellular injury. elevation occurs how long after cell injury

A
  • elevation occurs 8 hrs after injury
  • peak: 24-36 hours
75
Q

AST levels 20 x normal value indicates

A

acute hepatitis

76
Q

AST levels 10 x normal indicates

A
  • acute extrahepatic obstruction (i.e. gallstones)
77
Q

how is biliruben formed

A
  • breakdown of RBC
    • hemoglobin released from RBC and broken down into heme and globulin
    • heme transformed into biliruben
78
Q

critical value of total biliruben

A
  • total = unconjugated (indirect) + conjugated (direct)
  • critical value= > 12 mg/dL
79
Q

differentiate between indirect and direct biliruben

A
  • indirect = unconjugated
    • normally makes up 70-85% of total bili
    • heme -> biliruben
  • direct = conjugated
    • indirect bili is conjugated in liver
    • excreted from liver into hepatic ducts, common bile duct, and bowel
80
Q

a total serum bili exceeding what value will present with jaundice

A

2.5 mg/dl

81
Q

what conditions would lead to elevated levels of unconjugated and conjugated biliruben

A
  • elevated unconjugated
    • hepatocellular dysfunction (hepatitis, RBC hemolysis)
  • elevated conjugated
    • extrahepatic obstruction (gallstones, tumor)
82
Q

cause of physiologic jaundice of newborn

A
  • newborn liver is immature
    • not enough conjugating enzymes
  • high circulating blood level of unconjugated bili
    • can pass blood-brain barrier -> brain
    • encephalopathy (kernicterus)
83
Q

critical value of unconjugated bili

A

>15 mg/dL

Clin Med Lab (6 decks)

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