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CLIN CHEM > ELECTROLYTES & BLOOD GASES > Flashcards

ELECTROLYTES & BLOOD GASES Flashcards

1
Q

Stimulates water reabsorption at the COLLECTING DUCT of the nephrons

A

ADH / AVP (Vasopressin)

*AVP = arginine vasopressin peptide

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2
Q

Released from the myocardial atria in response to volume expansion, promotes SODIUM EXCRETION

A

Atrial natriuretic peptide

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3
Q

A system that primarily responds to changes in plasma sodium and blood pressure

A

RAAS - renin angiotensin-aldosterone system

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4
Q

RAAS

Low plasma sodium and blood pressure stimulates the kidneys (Juxtaglomerular apparatus) to release an enzyme called ___ ; converts angiotensinogen to angiotensin I

A

RENIN

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5
Q

RAAS

A blood-borne substrate of RENIN ; produced by the liver and secreted to the blood

A

Angiotensinogen

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6
Q

RAAS

An enzyme produced by the lungs ; acts on angiotensin I to be converted to angiotensin II

A

Angiotensin-converting enzyme (ACE)

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7
Q

Inactive form of angiotensin

A

Angiotensin I

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8
Q

Active form of angiotensin

A

Angiotensin II

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9
Q

Immediate actions of angiotensin II

A

Promotes vasodilation of afferent arteriole
Vasoconstriction of efferent arteriole
Sodium reabsorption in PCT
Stimulates aldosterone secretion promoting sodium reabsorption in DCT

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10
Q

Effect of increased sodium reabsorption in DCT (via the stimulation of aldosterone) to the plasma sodium

A

Increased

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11
Q

Effect of increased potassium excretion (via aldosterone stimulation) to plasma potassium

A

Decreased

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12
Q

Hormone that promotes sodium reabsorption in the DCT (increased plasma sodium) and promotes potassium excretion (decreased plasma potassium)

A

ALDOSTERONE

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13
Q

Functions of electrolytes : volume and osmotic regulation

A

Na, Cl, K

Sodium, potassium, chloride

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14
Q

Functions of electrolytes : myocardial rhythm and contractility and neuromuscular excitability

A

K, Mg, Ca

Potassium, Magnesium, Calcium

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15
Q

Functions of electrolytes : cofactors in enzyme activation

A

Mg, Ca, Zn, Cl

Magnesium, Calcium, Zinc, Chloride

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16
Q

Functions of electrolytes : regulation of ATPase-ion pumps

A

Magnesium

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17
Q

Functions of electrolytes : blood coagulation

A

Ca, Mg

Calcium, magnesium

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18
Q

Functions of electrolytes : production and use of ATP from glucose

A

Magnesium, phosphate

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19
Q

Functions of electrolytes : maintenance of acid-base balance

A

HCO3, Cl, K

Bicarbonate, chloride, potassium

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20
Q

Electrolyte photometric technique : measurement of light emitted by atoms following excitation by heat energy ; traditionally used to determine the concentration of Na, K and Li ; employs an internal standard

A

Flame photometry

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21
Q

Internal standard for sodium and potassium

A

Lithium

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22
Q

Internal standard for lithium

A

Cesium

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23
Q

Electrolyte photometric technique : reference method for divalent cations (Mg and Ca) ; measurement of the amount of light absorbed by ground state atoms

A

Atomic Absorption spectrophotometry (AAS)

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24
Q

light source for AAS

A

Hallow cathode lamp

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25
Q

Electrochemical technique : measurement of electric potential (voltage) due to the activity of free ions

A

Potentiometry

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26
Q

Electrochemical technique : H+ - sensitive glass electrode containing Ag/AgCl wire in electrolyte known pH and reference electrode (Hg/Hg2Cl2)

A

pH electrode

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27
Q

Electrochemical technique : pH electrode covered with membrane permeable to CO2 with bicarbonate buffer between membrane electrode ; also called as Severinghaus electrode

A

PCO2 electrode

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28
Q

Electrochemical technique : used to measure Na, K, Cl, I-Ca

A

Ion-selective electrode

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29
Q

Electrochemical technique : measurement of the amount of electricity in COULOMBS at a fixed potential

A

Coulometry

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30
Q

Coulometry : used in serum and and sweat chloride analysis ; endpoint is increased in conductivity measured by amperometry

A

Cotlove chloridometer

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31
Q

Electrochemical technique : measurement of the CURRENT FLOW produced by an oxidation-reduction at a fixed applied potential to the electrodes

A

Amperometry

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32
Q

Amperometry : uses a platinum cathode and Ag/AgCl anode covered with gas-permeable membrane which allows dissolved O2 to pass through

A

PO2 electrode

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33
Q

Electrochemical technique : measurement of current produced at GRADUALLY INCREASING voltage applied between two electrodes in contact with a solution containing the analyte

A

Polarography

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34
Q

Electrochemical technique : measurement of current flow as a metal is stripped off the anode of a polagraphic cell ; used for Pb and Fe testing (lead and iron)

A

Anodic stippling voltammetry

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35
Q

Electrochemical technique : measurement of osmolality indirectly by measuring one of the colligative properties of solution which change proportionally with the number of dissolved particles present

A

Osmometry

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36
Q

Colligative properties: As OSMOLALITY INCREASES for every 1 mole of solute, ___ and ____ also increase, while freezing point and vapor pressure are decreased

A

Boiling point and osmotic pressure

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37
Q

Colligative properties: As OSMOLALITY INCREASES for every 1 mole of solute, boiling point and osmotic pressure also increase, while ____ and ___ are decreased

A

Freezing point and vapor pressure

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38
Q

Most commonly used colligative property by clinical osmometers

A

Freezing point

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39
Q

Major extracellular cation ; major contributor to plasma osmolality ; principal osmotic particle outside the cell

A

Sodium

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40
Q

Sodium renal threshold

A

110-130 mmol/L (ave. 120 mmol/L)

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41
Q

Sodium reference value

A

136-145 mmol/L

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42
Q

Sodium panic values

A

120 mEq/L or less ; 160 mEq/L or greater

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43
Q

Most common method for sodium and potassium determination

A

ISE

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44
Q

ISE method : no sample dilution ; prevents pseudohyponatremia

A

Direct ISE

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45
Q

ISE method : with sample dilution ; prone to pseudohyponatremia

A

Indirect ISE

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46
Q

Color of sodium in flame photometry

A

YELLOW

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47
Q

Electrolyte method : an obsolete sodium colorimetric method

A

Albanese-Lein

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48
Q

Caused by loss of water, gain of sodium or both ; usually results from excessive water loss

A

Hypernatremia

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49
Q

Chronic hypernatremia in an alert patient is indicative _____

A

Hypothalamic disease

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50
Q

Major defense against hyperosmolality and hypernatremia

A

Thirst

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51
Q

Condition associated with the use of indirect ISE in the presence of increased plasma protein and lipid concentration

A

Pseudohyponatremia

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52
Q

Test performed when sodium is low due to pseudohyponatremia

A

Osmolality

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53
Q

Most common electrolyte disorder ; may lead to neuropsychiatric symptoms ; failure to concentrate the urine due to renal failure

A

Hyponatremia

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54
Q

Associated with hyperlipidemia and hyperproteinemia

A

Artifactual hyponatremia

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55
Q

Major intracellular cation ; 20x higher inside the cells ; otherwise known as “Kalium” ; permits neural signal to move down the nerve fiber ; most important analyte in terms of an abnormality being immediately LIFE THREATENING

A

Potassium

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56
Q

Potassium reference value (SERUM)

A

3.5-5.1 mmol/L

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57
Q

Potassium reference value (PLASMA)

A

3.5 - 4.5 mmol/L

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58
Q

Potassium panic value

A

2.8 mmol/L or less ; 6.2 mmol/L or greater

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59
Q

Antibiotic or electrode used for potassium measurement in ISE

A

Valinomycin-based electrode

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60
Q

Color produced by potassium in flame photometry

A

Violet

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61
Q

Lockhead-Purcell

A

Potassium measurement

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62
Q

Influx of potassium to the cells / cellular shift (potassium ions entering the cells in exchange of H+ release, resulting to low potassium level in the blood) ; GI loss and Renal loss (potassium excretion)

A

Hyponatremia

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63
Q

Efflux of potassium from the cells ; high potassium intake ; decreased renal excretion

A

Hyponatremia

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64
Q

Effect of hemoconcentration, hemolysis, and thrombocytosis to potassium (plasma sample)

A

Artifactual pseduohyperkalemia

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65
Q

Major extracellular anion ; passively follows sodium ; inverse relationship with bicarbonate

A

Chloride

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66
Q

Uses polocarpinne iontophoresis to stimulate sweat production with subsequent collection for analysis

A

Gibson and Cooke’s method

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67
Q

Chloride reference value (SERUM)

A

98-107 mmol/L

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68
Q

Chloride reference value (SWEAT)

A

<40 mmol/L

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69
Q

Chloride panic value (SERUM)

A

80 mmol/L or less ; 120 mmol/L or greater

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70
Q

Chloride panic value (SWEAT)

A

60 mmol/L or greater (cystic fibrosis)

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71
Q

ISE method for chloride is made of

A

Tri-n-octylpropylammonium chloride decanol (TNOPAC)

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72
Q

Chloride method : Coulometric-amperometry titration

A

Cotlove chloridometry

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73
Q

Chloride method : Mercuric titration using mercuric nitrate and diphenylcarbazone indicator (BLUE-VIOLET)

A

Schales-Schales

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74
Q

Chloride method : spectrophotometric assay using mercuric thiocyanate (Red complex)

A

Whitehorn titration

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75
Q

Aldosterone deficiency, salt-losing nephropathy, DKA, prolonged vomiting or diarrhea, compensated respiratory acidosis

A

Hypochloremia

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76
Q

Renal tubular acidosis, GI loss of bicarbonate, metabolic acidosis, compensated respiratory alkalosis

A

Hyperchloremia

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77
Q

Second major extracellular anion ; comprises >90% of the total CO2 at physiologic pH

A

Bicarbonate

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78
Q

Total CO2 Reference values

A

23-27 mmol/L

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79
Q

Bicarbonate Reference values

A

22-26 mmol/L

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80
Q

Directly measured as part of ABG

A

Total CO2

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81
Q

ABG parameter that is calculated

A

Bicarbonate

82
Q

Bicarbonate panic value

A

10 mmol/L or less ; 40 mmol/L or greater

83
Q

Methods (Total CO2) : involves acidification of the sample followed by electrode-based detection of released CO2

84
Q

Bicarbonate clinical significance : metabolic acidosis, compensated respiratory alkalaosis, renal tubular acidosis, GI loss of bicarbonate

A

Low bicarbonate

85
Q

Bicarbonate clinical significance : metabolic alkalosis compensated respiratory acidosis

A

High bicarbonate

86
Q

Panic value for bicarbonate

A

10 mmol/L and below ; 40 mmol/L and above

87
Q

2nd major intracellular cation ; Cofactor of > 300 enzymes ; 13x higher inside RBCs

88
Q

Magnesium distribution : 55%

89
Q

Magnesium distribution : 30%

A

Bound to proteins

90
Q

Magnesium distribution : 15%

A

Bound to ions

91
Q

Reference method for magnesium determination

92
Q

Magnesium panic values

A

1 mg/dL and below ; 4.7 and above mg/dL

93
Q

Plasma level is regulated by PTH, active vitamin D, calcitonin

94
Q

Stimulates bone resorption, vitamin D activation, and calcium reabsorption leading to a net increase in plasma calcium level

A

Parathyroid hormone

95
Q

25(OH)D3

A

Inactive form of vitamin D a

96
Q

1,25(OH)2D3

A

Active form of vitamin D

97
Q

Active vitamin D other name

A

Calcitriol

98
Q

Stimulates intestinal absorption of calcium (increased plasma calcium level)

A

Active vitamin d

99
Q

Inhibits PTH action ; hypocalcemic

A

Calcitonin

100
Q

Promotes PO4 excretion

101
Q

Promotes PO4 reabsorption

A

Active vitamin D

102
Q

Calcium distribution : 50%

103
Q

Calcium distribution : 40%

A

Bound to proteins

104
Q

Calcium distribution : 10%

A

Bound to ions

105
Q

Calcium panic value

A

6 mmol/L and below ; 13 mmol/L and above

106
Q

Reference method for calcium determination

107
Q

ISE consists of PVC membrane impregnated with a calcium ion exchanger ; used to measure ____

A

Ionized calcium

108
Q

Dye-binding (CALCIUM) : requires addition of 8-HYDROXYQUINOLINE to prevent magnesium interference

A

O-cresolphthalein complexone (CPC) method

109
Q

Major intracellular anion ; component of several essential biomolecules

110
Q

Phosphate is usually measured as

A

Inorganic phosphate

111
Q

Phosphate panic value

A

1 mg/dL and below ; 8 mg/dL and above

112
Q

By-product of anaerobic glycolysis

113
Q

Accumulation of lactate in the blood indicates ____

114
Q

Lactate is converted back to glucose by the _____ through the process called _____

A

Liver ; gluconeogenesis

115
Q

Physical property of a solution that is based on the concentration of solutes (Expressed as milliosmoles) per kilogram of solvent ; affected only by the number of dissolved particles present

A

Osmolality

116
Q

Specimen for osmolality

117
Q

Based on the measurement of a decrease in ____

A

Freezing point

118
Q

Calculated osmolality

A

2Na + (glucose/18) + (BUN/2.8)

119
Q

Osmolal gap formula

A

Measured Osm - Calculated Osm

120
Q

Effective screening method in detecting the presence of toxic compounds

A

Osmolal gap

121
Q

Reference values : serum osmolality

A

275-295 mOsm/kg

122
Q

Reference values : osmolal gap

A

5-10 mOsm/kg

123
Q

Clinical significance (OG >12 mOsm/kg)

A

Lactic acidosis
Uremia
Diabetic ketoacidosis
Intoxication : alcohols, ethylene glycol and salicylate

“LUDI”

124
Q

Used as a form of quality for electrolyte analyzers

125
Q

Anion gap formula : with potassium
Reference value : ?

A

(Na + K) - (Cl + HCO3)

10-20 mmol/L

126
Q

Anion gap : potassium is omitted
Reference value: ?

A

Na - (Cl + HCO3)

7-16 mmol/L

127
Q

Increased Anion gap : INCREASED unmeasured anions

A

Methanol, uremia, DKA, Paraldehyde, inhalants, lactic acidosis, ethylene glycol, salicylate

“MUDPILES”

128
Q

Increased Anion gap : DECREASED unmeasured cations

A

Hypocalcemia

129
Q

Increased Anion gap : lab error

A

Falsely increased sodium
Falsely decreased chloride/bicarbonate

130
Q

Decreased anion gap : DECREASED unmeasured anions

A

Hypoalbuminuria

131
Q

Decreased anion gap : INCREASED unmeasured cations

A

Hypercalcemia, multiple myeloma

132
Q

Decreased anion gap : lab error

A

Falsely decreased sodium
Falsely increased chloride/bicarbonate

133
Q

Substance that can yield hydrogen ions (H+) when dissolved in water (Arrhenius) ; proton donor (Bronsted and Lowry)

134
Q

Substance that can yield hydroxyl ions (OH-) ; proton acceptor

135
Q

Combination of a weak acid and its salt or conjugate base that resists changes in pH

136
Q

Buffer system : second most important blood buffer ; contains 38 histidine residues that bind H+

A

HEMOGLOBIN

137
Q

Have free carboxyl and amino groups that are able to bind H+

A

PLASMA PROTEINS

138
Q

Uses HPO42- (hydrogen phosphate) and H2PO4- (dihydrogen phosphate) to minimize pH changes in plasma and erythrocytes

A

Phosphate buffer

139
Q

Uses HPO42- (hydrogen phosphate) and H2PO4- (dihydrogen phosphate) to minimize pH changes in plasma and erythrocytes

A

Phosphate buffer

140
Q

Most important buffer system in the blood

A

Bicarbonate / carbonic acid buffer system

141
Q

Henderson-Hasselbach equation : the numerator (bicarbonate) denotes function of the __ and __ to pH

A

Kidney ; directly proportional

142
Q

Henderson-Hasselbach equation : the denominator (pCO2 or H2CO3 - carbonic acid) denotes function of the __ and __ to pH

A

Lungs ; inversely proportional

143
Q

When the ratio between HCO3 and H2CO3 is 20:1, the pH is

144
Q

Preferred anticoagulant for blood gas analysis

A

Lyophilized heparin

145
Q

ABG must be assayed within __ mins

146
Q

Method used for the measurement of pH and pCO2

A

Potentiometry

147
Q

pH calibration

A

2 phosphate buffers stored anaerobically at room temperature

148
Q

Method used for pO2 measurement

A

Amperometry

149
Q

PH

Reference range
Panic value

A

7.35-7.45
7.2 and below ; 7.6 and above

150
Q

pCO2

Reference range
Panic value

A

35-45 mmhg
20 mmhg and below ; 60 mmhg and above

151
Q

pO2

Reference range
Panic value

A

80-100 mmhg
40 mmhg and below

152
Q

HCO3

Reference range
Panic value

A

22-26 mmol/L
10 mmol/L and below ; 40 mmol/L and above

153
Q

Total CO2

Reference range

A

23-27 mmol/L

154
Q

Base excess

Reference range

155
Q

O2 saturation

Reference range

156
Q

causes of shit to the right in oxyhemoglobin dissociation curve

A

High lahat

C = pCO2
A = Acid pH (high H+)
D = 2,3-DPG
E = Excessive exercise
T = temperature

157
Q

Electrode chambers of blood gas analyzers are thermostatically controlled at ______

A

37 +/- 0.1 C

158
Q

For every 1C increase in body temperature, pCO2 increases by ____ ; pO2 decreases by ____ and pH decreases by ____ unit

A

3% pCO2 ; 7% pO2 ; pH 0.015 unit

159
Q

Specimen exposure to air

A

Low pCO2, high pO2, and high pH

160
Q

Prolonged storage of specimen (anaerobic)

A

High pCO2, low pO2, low pH

161
Q

Excess anticoagulant : dry heparin

162
Q

Excess anticoagulant : liquid heparin

163
Q

Major causes of metabolic acidosis

A

Ketoacidosis
Hypoxic acidosis
Renal failure
Renal tubular acidosis
Loss of bicarbonate

164
Q

Major causes of metabolic alkalosis

A

NaHCO3 overdose
Hypokalemia
Vomiting
GI suction
Corticosteroid excess

165
Q

Major causes of respiratory acidosis

A

COPDs
Acute airway obstruction
Circulatory failure
Impaired respiratory system

166
Q

Major causes of respiratory alkalosis

A

Hypoxia-induced hyperventilation
Anxiety
Pulmonary embolism
Pulmonary edema

167
Q

Metabolic acidosis compensation

A

Hyperventilation

168
Q

Metabolic alkalosis compensation

A

Hypoventilation

169
Q

Respiratory acidosis compensation

A

HCO3 reabsorption

170
Q

Respiratory alkalosis compensation

A

HCO3 excretion

171
Q

Component of heme -containing substances

172
Q

Iron transport protein

A

Transferrin

173
Q

Iron storage forms

A

Ferritin and hemosiderin

174
Q

Serum Iron reference range

A

50-160 mgdL

175
Q

Methods involve addition of sufficient ferric ions to saturate transferrin followed by removal of excess iron and measurement of bound iron by the same procedure used for serum iron

176
Q

TIBC estimation formula

A

TIBC (ug/dL) = transferrin (mg/dL) x 1.43

177
Q

% saturation / transferrin saturation formula

A

(Serum Fe / TIBC) X 100

178
Q

% saturation reference range

179
Q

Best test for iron deficiency ; determined using immunoassay

180
Q

IDA

Serum iron
% saturation
TIBC (tf)
Ferritin

A

⬇️
⬇️
⬆️
⬇️

181
Q

Anemia of chronic inflammation

Serum iron
% saturation
TIBC (tf)
Ferritin

A

⬇️
⬇️
⬇️
⬆️

182
Q

Hemochromatosis

Serum iron
% saturation
TIBC (tf)
Ferritin

A

⬆️
⬆️
⬇️
⬆️

183
Q

Cofactor for approximately 300 enzymes ; associated with acrodermatitis eneterohepatica, chronic liver and kidney disease, alcoholism

184
Q

Component of several metalloenzymes ;

185
Q

Failure of copper absorption

A

Menke’s syndrome / kinky hair syndrome

186
Q

Failure to excrete copper in bile, excess copper in liver, brain, and eyes (cornea) / kayser fleischer ring

A

Wilson’s disease

187
Q

Fat soluble vitamins

188
Q

Retinol ; night blindness

189
Q

Cholecalciferol ; rickets, osteomalacia

190
Q

Tocopherol ; mild hemolytic anemia

191
Q

Phylloquinone / menaquinone ; hemorrhage or bruising

192
Q

Water-soluble vitamins

A

Vit C and B-complex (1,2,3,5,6,7,9,12)

193
Q

Ascorbic acid ; scurvy

194
Q

Thiamine ; Beri-beri

195
Q

Riboflavin ; angular stomatitis

196
Q

Niacin ; pellagra

197
Q

Pantothenic acid ; paresthesia

198
Q

Pyridoxine ; facial seborrhea

199
Q

Biotin ; Dermatitis

200
Q

Folic acid ; megaloblastic anemia, neural tube defects

201
Q

Cyanocobalamin ; megaloblastic anemia

CLIN CHEM (10 decks)

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