CMP Flashcards
What is measured in a BMP?
BUN Cr CO2 Glucose CL K Na
Name the electrolytes measures in a chemistry panel?
Sodium
Potassium
Chloride
Carbon dioxide
The defining feature of an amino acid is what?
its side chain
Total protein measures what? What is it used to diagnose/monitor in patients?
prealbumin
albumins- 60%
globulins
CA immune disorders impaired nutrition protein-losing enteropathies liver disease edema
What are the functions of proteins?
- 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)
Functions and indicators of Albumin
Functions:
osmotic pressure
transports drugs, hormones, enzymes
Indicator ir nutritional status and liver function (synthesized in liver)
Causes of decreased albumin?
- malnourishment
- “protein losing enteropathies”
- nephrotic syndrom
- liver disease
- inflammatory disease
Causes of increased albumin?
Dehydration
Multiple Myeloma shows what specific pattern in SPEP (serum protein electrophoresis) and what is urine?
- characteristic “M-spike”- (spike in beta or gamma globulin)
- “monoclonal gammopathy”
-Bence-Jones proteins in urine
ECF consists of what percentage of interstitial and what percentage of plasma?
interstitial- 75-80%
plasma- 15-20%
How does TBW change over lifetime?
100% fetus
80% baby
70% adult
50% elderly person
What is osmolarity?
the solute or particle concentration of a fluid
Abnormal extracellular fluid volume is due to?
Sodium control mechanisms
Abnormal extracellular fluid sodium concentration is due to?
Problems with water control
- too little Na= ?
- too much Na= ?
Fluid volume deficit
Fluid volume excess
- Too much water=?
- Too little water=?
Hyponatremia
Hypernatremia
Pseudohyponatremia
Low Na, but nl osmolarity
-due to hypertriglyceridema or hyerproteinemia
Hyponatremia due to hyperosmolar state
increased glucose in ECF causes shift of water from ICF to ECF, thus lowering serum Na
Hyponatremia with Hypervolemia-
Fluid overload conditions
CHF
Renal failure
nephrotic syndrom
hepatic cirrhosis
Clinical findings in pt with fluid overload
- pedal edema, pulmonary crackles, JVD
- anemia
- other signs of heart, liver, or renal disease
Hyponatremia with Hypovolemia:
- renal causes
- non renal causes
renal- diuretics
nonrenal- vomiting, fistula
Clinical characteristic of dehydration
reduced skin turgor
dry MM
orthostatic BP/pulse changes
Function of Potassium and route of elimination
- The major intracellular cation
- renal excretion
Hypokalemia:
- value
- clinical manifestations
< 3.5
- Neuro= weakness, fatigue, paralysis
- GI= constipation, ileus
- Nephrogenic -Diabetes Insidius
- ECG changes: flattened T waves, prominent U waves
- cardiac arrhythmia
In presence of ____, a low K+ concentration needs to be corrected. Why?
Alkalosis
is pH > 7.45 there is 0.3mEq/L K decrease for each 0.1 increase in pH
Hyperkalemia:
Value
Clinical manifestations
> 5.0
- weakness, ascending paralysis
- respiratory failure
- ECG changes: peaks Ts, flattened Ps, prolonged PR, wide QRS
Elevated potassium correction in metabolic acidosis
0.7 mEq/L increase for every 0.1 decrease in pH
Elevated potassium correction in respiratory acidosis
0.3 mEq/L increase for every 0.1 decrease in pH
What is Ca used to measure?
Parathyroid function
10-20% of patients with malignancy have??
Elevated Ca ++
A decrease in serum Ca triggers?
PTH secretion = increase in serum Ca
Actions of PTH
- Increase vit. D activation (calcitriol)= increase Ca absorption form gut
- promotes Ca release from bone
- promotes conservation of Ca by kidneys
Free (ionized) Ca++ does what?
Cardiac contractility
What EKG abnormality will you see with hypercalcemia?
Short QT
Most common causes of hypercalcemia?
Other cause?
- # 1= hyperparathyroidism
- Malignancy (bone destruction or stimulation of osteoclast activity)
-Other: Drugs- thiazide diuretics
Usual etiology of hyperparathyroidism and sx
Parathyroid adenoma
- typically asymptomatic
- “Bones, stone, abnormal groans, psychic moans, with fatigue overtones”
How would you dx hyperparathyroidism?
- Hypercalemia
- Hypophosphatemia
Three main causes of HYPOcalcemia
- decreased ability to mobilize bone stores
- excess loss of Ca from kidneys
- increased protein binding
What is the most common cause of reported hypocalcemia?
Hypoalbuminemia- Not true hypocalcemia
If serum albumin if low, Ca measurement must be corrected
Sx of HYPOcalcemia
Neuromuscular: increased excitability
- carpopedal spasms
- positive Chovostek and Trousseau signs
- Tetany
What is Chvostek sign?
tapping facial nerve against the bone just anterior to the ear results in contraction of facial muscles
What is Trousseau sign?
occluding brachial artery from 3 min with BP cuff induces carpal spasms
Treatment for hypocalcemia:
Asymptomatic?
Tetany?
Chronic?
Asym= oral calcium chloride or calcium gluconate
Tetany= IV calcium gluconate or calcium chloride
chronic= dietary changes, eval Vit D
What is phosphates relationship with Ca?
Inverse relationship with Ca
PTH does what to phosphate?
Decreases phosphate reabsorption by the kidneys
= increased urinary PO4 excretion; Increased Ca absorption
Causes of increased phosphate?
hypoparathyroidism
renal failure
increased dietary intake
acromegaly
Causes of decreased phosphate?
decreased intake/malnutrition drugs EtOH hyperparathyroidism increased renal loss
Where is Magnesium highest in the body?
Bone- 50-60%
It is common to see hypocalcemia with hypomagnesemia because?
K, Mg, and Ca are closely related, absorption and excretion are interdependent
How is Magnesium regulated?
And how would you increase excretion?
By the kidneys
loop diuretics (furosemide)
What patients often have hypomagnesemia?
- ICU and ED patients
* *Common in pt’s with CHF due to diuretic use**
Clinical signs of hypomagnesemia
- Neuromuscular effects, similar to low Ca
- CV effects- HTN, tachy, arrythmias
Magnesium deficiency can cause?
And what is needed to correct first?
Hypocalcemia and hypokalemia
Need to correct Mg deficits to fix K and Ca level
When treating Hypomagnesemia what patients do you need to use caution with?
Patients w/ renal disease
Most common cause of HYPERmagnesemia
Renal insufficiency
because kidneys are usually able to excrete excess MG so high Mg is rare
What does blood urea nitrogen (BUN) measure?
rough measurement of renal function and globular filtration
Increased BUN= ?
AZOTEMIA
Almost all renal disease cause ____ excretion of urea, which causes BUN to ____?
inadequate
rise
What causes decrease in BUN?
Low protein diet
overhydration
What causes increase in BUN?
high protein diets
dehydration
Kidney failure= what level of creatinine?
> 4 mg/dl= critical value
BUN/creatinine ratio:
Prerenal Azotemia=
Renal azotemia=
post renal azotemia=
Prerenal= >20/1 (elevated) Renal= ~10-15/1 Post= variable ratio
Characteristics of prerenal Azotemia
- Elevated BUN/Cr ratio
- no inherent kidney disease
- hypovolemia
- infection
- low cardiac output
Prerenal azotemia is a sign of?
intravascular volume depletion or hypotension
How do you treat prerenal azotemia?
GIVE FLUIDS
Most common cause of renal azotemia
acute tubular necrosis
chronic renal disease
acute glomerulonephritis
When BUN and Cr both increase, suspect?
Intrinsic renal disease
Most cause of Postrenal Azotemia
obstruction to urine flow
- Ureter and renal pelvis: blood clot, stone, sickle cell
- Bladder: prostatic hypertrophy or malignancy, neuropathic bladder, blood clot
- Urethral stricture
