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Diagnostics Exam 3- CMP, Inflammation, LFTs > CMP > Flashcards

CMP Flashcards

1
Q

What is measured in a BMP?

A 
BUN
Cr
CO2
Glucose
CL
K
Na
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2
Q

Name the electrolytes measures in a chemistry panel?

A

Sodium
Potassium
Chloride
Carbon dioxide

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3
Q

The defining feature of an amino acid is what?

A

its side chain

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4
Q

Total protein measures what? What is it used to diagnose/monitor in patients?

A

prealbumin
albumins- 60%
globulins

CA
immune disorders
impaired nutrition
protein-losing enteropathies
liver disease
edema
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5
Q

What are the functions of proteins?

A
  • makes up tissues, enzymes, hormones
  • transport substances in the serum
  • creates osmotic pressure in the intravascular space (by pulling fluid in/or preventing fluid from leaving)
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6
Q

Functions and indicators of Albumin

A

Functions:
osmotic pressure
transports drugs, hormones, enzymes

Indicator ir nutritional status and liver function (synthesized in liver)

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7
Q

Causes of decreased albumin?

A
  • malnourishment
  • “protein losing enteropathies”
  • nephrotic syndrom
  • liver disease
  • inflammatory disease
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8
Q

Causes of increased albumin?

A

Dehydration

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9
Q

Multiple Myeloma shows what specific pattern in SPEP (serum protein electrophoresis) and what is urine?

A
  • characteristic “M-spike”- (spike in beta or gamma globulin)
  • “monoclonal gammopathy”

-Bence-Jones proteins in urine

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10
Q

ECF consists of what percentage of interstitial and what percentage of plasma?

A

interstitial- 75-80%

plasma- 15-20%

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11
Q

How does TBW change over lifetime?

A

100% fetus
80% baby
70% adult
50% elderly person

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12
Q

What is osmolarity?

A

the solute or particle concentration of a fluid

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13
Q

Abnormal extracellular fluid volume is due to?

A

Sodium control mechanisms

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14
Q

Abnormal extracellular fluid sodium concentration is due to?

A

Problems with water control

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15
Q
  • too little Na= ?

- too much Na= ?

A

Fluid volume deficit

Fluid volume excess

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16
Q
  • Too much water=?

- Too little water=?

A

Hyponatremia

Hypernatremia

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17
Q

Pseudohyponatremia

A

Low Na, but nl osmolarity

-due to hypertriglyceridema or hyerproteinemia

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18
Q

Hyponatremia due to hyperosmolar state

A

increased glucose in ECF causes shift of water from ICF to ECF, thus lowering serum Na

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19
Q

Hyponatremia with Hypervolemia-

Fluid overload conditions

A

CHF
Renal failure
nephrotic syndrom
hepatic cirrhosis

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20
Q

Clinical findings in pt with fluid overload

A
  • pedal edema, pulmonary crackles, JVD
  • anemia
  • other signs of heart, liver, or renal disease
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21
Q

Hyponatremia with Hypovolemia:

  • renal causes
  • non renal causes
A

renal- diuretics

nonrenal- vomiting, fistula

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22
Q

Clinical characteristic of dehydration

A

reduced skin turgor
dry MM
orthostatic BP/pulse changes

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23
Q

Function of Potassium and route of elimination

A
  • The major intracellular cation

- renal excretion

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24
Q

Hypokalemia:

  • value
  • clinical manifestations
A

< 3.5

  • Neuro= weakness, fatigue, paralysis
  • GI= constipation, ileus
  • Nephrogenic -Diabetes Insidius
  • ECG changes: flattened T waves, prominent U waves
  • cardiac arrhythmia
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25
Q

In presence of ____, a low K+ concentration needs to be corrected. Why?

A

Alkalosis

is pH > 7.45 there is 0.3mEq/L K decrease for each 0.1 increase in pH

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26
Q

Hyperkalemia:
Value
Clinical manifestations

A

> 5.0

  • weakness, ascending paralysis
  • respiratory failure
  • ECG changes: peaks Ts, flattened Ps, prolonged PR, wide QRS
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27
Q

Elevated potassium correction in metabolic acidosis

A

0.7 mEq/L increase for every 0.1 decrease in pH

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28
Q

Elevated potassium correction in respiratory acidosis

A

0.3 mEq/L increase for every 0.1 decrease in pH

29
Q

What is Ca used to measure?

A

Parathyroid function

30
Q

10-20% of patients with malignancy have??

A

Elevated Ca ++

31
Q

A decrease in serum Ca triggers?

A

PTH secretion = increase in serum Ca

32
Q

Actions of PTH

A
  • Increase vit. D activation (calcitriol)= increase Ca absorption form gut
  • promotes Ca release from bone
  • promotes conservation of Ca by kidneys
33
Q

Free (ionized) Ca++ does what?

A

Cardiac contractility

34
Q

What EKG abnormality will you see with hypercalcemia?

A

Short QT

35
Q

Most common causes of hypercalcemia?

Other cause?

A
  • # 1= hyperparathyroidism
  • Malignancy (bone destruction or stimulation of osteoclast activity)

-Other: Drugs- thiazide diuretics

36
Q

Usual etiology of hyperparathyroidism and sx

A

Parathyroid adenoma

  • typically asymptomatic
  • “Bones, stone, abnormal groans, psychic moans, with fatigue overtones”
37
Q

How would you dx hyperparathyroidism?

A
  • Hypercalemia

- Hypophosphatemia

38
Q

Three main causes of HYPOcalcemia

A
  1. decreased ability to mobilize bone stores
  2. excess loss of Ca from kidneys
  3. increased protein binding
39
Q

What is the most common cause of reported hypocalcemia?

A

Hypoalbuminemia- Not true hypocalcemia

If serum albumin if low, Ca measurement must be corrected

40
Q

Sx of HYPOcalcemia

A

Neuromuscular: increased excitability

  • carpopedal spasms
  • positive Chovostek and Trousseau signs
  • Tetany
41
Q

What is Chvostek sign?

A

tapping facial nerve against the bone just anterior to the ear results in contraction of facial muscles

42
Q

What is Trousseau sign?

A

occluding brachial artery from 3 min with BP cuff induces carpal spasms

43
Q

Treatment for hypocalcemia:
Asymptomatic?
Tetany?
Chronic?

A

Asym= oral calcium chloride or calcium gluconate

Tetany= IV calcium gluconate or calcium chloride

chronic= dietary changes, eval Vit D

44
Q

What is phosphates relationship with Ca?

A

Inverse relationship with Ca

45
Q

PTH does what to phosphate?

A

Decreases phosphate reabsorption by the kidneys

= increased urinary PO4 excretion; Increased Ca absorption

46
Q

Causes of increased phosphate?

A

hypoparathyroidism
renal failure
increased dietary intake
acromegaly

47
Q

Causes of decreased phosphate?

A 
decreased intake/malnutrition
drugs
EtOH
hyperparathyroidism
increased renal loss
48
Q

Where is Magnesium highest in the body?

A

Bone- 50-60%

49
Q

It is common to see hypocalcemia with hypomagnesemia because?

A

K, Mg, and Ca are closely related, absorption and excretion are interdependent

50
Q

How is Magnesium regulated?

And how would you increase excretion?

A

By the kidneys

loop diuretics (furosemide)

51
Q

What patients often have hypomagnesemia?

A
  • ICU and ED patients

* *Common in pt’s with CHF due to diuretic use**

52
Q

Clinical signs of hypomagnesemia

A
  • Neuromuscular effects, similar to low Ca

- CV effects- HTN, tachy, arrythmias

53
Q

Magnesium deficiency can cause?

And what is needed to correct first?

A

Hypocalcemia and hypokalemia

Need to correct Mg deficits to fix K and Ca level

54
Q

When treating Hypomagnesemia what patients do you need to use caution with?

A

Patients w/ renal disease

55
Q

Most common cause of HYPERmagnesemia

A

Renal insufficiency

because kidneys are usually able to excrete excess MG so high Mg is rare

56
Q

What does blood urea nitrogen (BUN) measure?

A

rough measurement of renal function and globular filtration

57
Q

Increased BUN= ?

A

AZOTEMIA

58
Q

Almost all renal disease cause ____ excretion of urea, which causes BUN to ____?

A

inadequate

rise

59
Q

What causes decrease in BUN?

A

Low protein diet

overhydration

60
Q

What causes increase in BUN?

A

high protein diets

dehydration

61
Q

Kidney failure= what level of creatinine?

A

> 4 mg/dl= critical value

62
Q

BUN/creatinine ratio:
Prerenal Azotemia=
Renal azotemia=
post renal azotemia=

A 
Prerenal= >20/1 (elevated)
Renal= ~10-15/1
Post= variable ratio
63
Q

Characteristics of prerenal Azotemia

A
  • Elevated BUN/Cr ratio
  • no inherent kidney disease
  • hypovolemia
  • infection
  • low cardiac output
64
Q

Prerenal azotemia is a sign of?

A

intravascular volume depletion or hypotension

65
Q

How do you treat prerenal azotemia?

A

GIVE FLUIDS

66
Q

Most common cause of renal azotemia

A

acute tubular necrosis

chronic renal disease
acute glomerulonephritis

67
Q

When BUN and Cr both increase, suspect?

A

Intrinsic renal disease

68
Q

Most cause of Postrenal Azotemia

A

obstruction to urine flow

  • Ureter and renal pelvis: blood clot, stone, sickle cell
  • Bladder: prostatic hypertrophy or malignancy, neuropathic bladder, blood clot
  • Urethral stricture

Diagnostics Exam 3- CMP, Inflammation, LFTs (3 decks)

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