Exam 1: Interpreting Clinical Lab Results Flashcards
What are vital signs (4+2)
Temperature, BP, HR, RR, O2 Sat, Pain
What is included in chem-7?
Na, Cl, BUN, K, HCO3, Cr, Glucose
What are some hematology tests?
WBC, platelets, Hgb, HCT
Temperature: reference range
97-100.3 F or 36.1-37.9 C
BP: Reference range
100-140 mmHg / 70-90 mmHg
HR: Reference range
60-100 bpm
RR: Reference range
14-18 breaths/min
O2 Sat: Reference range
92-100% on room air
Pain: Reference range
0-10
Sodium: Reference Range
135-146 mEq/L
Potassium: Reference Range
3.4-5.2 mEq/L
Chloride: Reference Range
98-110 mEq/L
Bicarbonate: Reference range
24-32 mEq/L
BUN: Reference range
7-23 mg/dL
Cr: Reference range
0.5-1.1 mg/dL
Glucose: Reference range
70-100 mg/dL
Calcium: reference range
8.4-10.4 mg/dL
Magnesium: Reference range
1.6-2.6 mg/dL
Phosphorus: Reference range
2.4-4.4 mg/dL
AST/ALT: Reference range
0-35 IU/L
Alkaline Phosphaase: Reference Range
30-120 U/L
Amylase: Reference Range
0-130 IU/L
Lipase: Reference range
0-160 IU/L
LDH: Reference range
50-150 U/L
Total Bilirubin: Reference range
0.1-1mg/dL
Direct Bilirubin: Reference range
0-0.2 mg/dL
Albumin: Reference Range
3.5-5 g/dL
INR: Reference Range
0.8-1.2
WBC: Reference Range
3.2-9.8 x10^3 cells/mm^3
Platelets: Reference Range
140-440 x10^3 /mL
Hgb: Reference range
14-18 g/dL for males
12-16 g/dL for females
HTC: Reference range
39-49% for males
33-43% for females
HR: What is considered bradycardia?
<60 bpm
HR: What is considered tachycardia?
> 100 bpm
Weight: ABW formula
Actual body weight: (wt in lbs) / 2.2 = wt in kg
Weight: IBW formula
Men: 50 + 2.3(# inches over 5ft)
Women: 45.5 + 2.3(# inches over 5ft)
Sodium: Where is it predominately found?
Extracellular fluid
Sodium: Why do sodium abnormalities usually occur?
Usually a result of changes in water homeostasis – volume overload (heart/liver failure) or volume depletion (vomiting/blood loss)
Sodium: HYPOnatremia: Na Loss examples
Excess sweating, N/V, medications (diuretics), shifting from extra to intracellular spaces
Sodium: HYPOnatremia: water gain examples
Increased intake, SIADH (syndrome of inappropriate ADH > increases water retention)
Sodium: HYPOnatremia: Symptoms
Fatigue, confusion, muscle weakness/spasms, and coma in serious cases
Sodium: HYPERnatremia: Causes
Secondary to intake of high Na containing products (ex. 0.9% NaCl, some antibiotics (oxacilin)
Sodium: HYPERnatremia: Symptoms
Asymptomatic but muscle spasms may occur
Potassium: Where is it found?
Predominately an INTRAcellular cation (all but 2% is located within cells)
Potassium: Importance
Required for various enzymatic processes (Na/K ATPase, Krebs cycle)
Plays important role in sk. and sm. muscle contraction
Potassium: HYPOkalemia
Typically caused by fluid loss (bleeding, diarrhea, diuresis, vomiting)
Stool can contian 40-60mEq/L of K
Stool can contain ____ of K
40-60mEq/L
Potassium: HYPERkalemia
Typically caused by renal dysfunction (decreased clearance) – may be drug induced (ACEI/ARB, K-sparing diuretics)
Potassium: HYPO/HYPERkalemia s/sx
Muscle weakness - results from either LOW or HIGH levels of K
Dysrhythmias can be induced
Chloride: Where is it found?
Accounts for approximately 1/3 of all serum in EXTRAcellular fluid
___ accounts for approximately 1/3 of all serum in ___cellular fluid
Chloride, extracellular
Chloride: how is it filtered
Actively filtered via the kidneys (along with Na)
Chloride: Abnormalities causes
Reasons similar to those causing hypo+hypernatremia - diuretic use, vomiting
Chloride: HYPOchloremia s/sx
muscle excitability + tremors
Chloride: HYPERchloremia s/sx
weakness + lethargy
Bicarbonate: What does it measure
Levels of CO2 (Acid/base balance)
Bicarbonate: HYPObicarbonatremia
ACIDIC process
Metabolic, diabetic, ketoacidosis, or an overdose of ethylene, methanol, salicilates
Bicarbonate: HYPERbicarbonatremia
ALKOLOTIC process or long term COPD (CO2 retention)
BUN: Def
Waste product from production of ammonia by the liver
BUN: How is it filtered?
Healthy kidneys can filter and remove urea via urine
BUN: Low BUN
LIVER disease/damage, malnutrition
BUN: High BUN
RENAL disease/damage, dehydration, or high protein intake
SCr: Def
Chemical waste product produced primarily by muscle metabolism, filtered via kidneys, similarly to BUN
SCr: Low Scr
Lack of nutrition/muscle mass
SCr: High SCr
RENAL disease/damage, excess muscle mass
What 2 Chem-7 lab results may indicate renal disease/damage?
High BUN and SCr – if kidney is not properly filtering out, high BUN/SCr = renal disease/damage
Glu: Def
Source of energy for most cells
Carbohydrates to glucose (regulated by insulin and glucagon)
Glu: LOW Glu: s/sx
Induce somnolence and coma
Glu: HIGH Glu: s/sx
Indicate impairment –> diagnosis of DIABETES?
Ca: Importance
Involved in muscle contraction and bone formation
Ca: Storage
99% in skeleton and teeth
Ca: How is it regulated
Vit D and parathyroid hormone
Ca: Breakdown % of albumin bound, free, salt bound
40% albumin
45% free
15% salt
Ca: HYPOcalcemia: causes
Poor Ca intake or vit D deficiency (~500mg of Ca removed from bones/day)
HYPOparathyroidism (part of feedback loop that regulates reabsorption of Ca from bones)
Ca: HYPOCalcemia: s/sx
Paraesthesia
Tetany
QTc prolongation/arrhythmias
Ca: HYPERcalcemia: Causes
Malignancy due to bone metastases
HYPERparathyroidism
Renal insufficiency
Ca: HYPERcalcemia: s/sx
Bones, stones, groans, psychic moans
Lytic lesions Urinary calculi Malaise N/V Mental status changes (confusion and depression)
Ca: Ionized calcium only changes with changes in ____
Vit D or parathyroid hormones
Ca: Ionized Ca: Ref Ranges Children/Adults
Children: 4.4-6 mg/dL
Adults: 4.4-5.3 mg/dL
Corrected calcium calculation equation
Observed serum Ca + 0.8(4 - serum Alb)
Phosphate: Where is it found
Major INTRAcellular anion
Phosphate: Importance
Important role in: Bone mineralization Storage and transfer of energy Muscle contraction Metabolism of glu and lipids Maintenance of acid/base balance
Phosphate: HYPOphosphatemia: Levels
Moderate: 1-2.5mg/dL
Severe: <1mg/dL
Phosphate: HYPOphosphatemia: Causes
Inadequate dietary intake
Hyperparathyroidism (increased excretion)
DKA (diabetic ketoacidosis)
Phosphate: HYPOphosphatemia: s/sx
Muscle weakness/dysfunction and mental status changes
Phosphate: HYPERphosphatemia: Causes
Common cause: renal failure
Calcium-Phosphate Product > 55 in CKD then ____
precipitation occurs and lytic lesions form
Magnesium: Where is it found?
2nd most abundant INTRAcellular cation
Magnesium: Importance
Required for utilization of ATP for energy
Important for regulating energy, protein synthesis, neuromuscular transmission, CV tone
Magnesium: Storage
Bone and muscle tissues
Magnesium: HYPOmagnesemia: Causes
Vomiting, diarrhea, diuretics
Magnesium: HYPOmagnesemia: Often coincides with ___
HYPOkalemia
Magnesium: HYPOmagnesemia: s/sx
N/V, EKG changes
Magnesium: HYPERmagnesemia: causes
Excessive Mg intake or renal failure
Magnesium: HYPERmagnesemia: s/sx
Sedation, N/V, decreased reflexes, EKG changes
Cockcroft-Gault Formula: CrCl equation
CrCl = (140-age)(IBW) / (72*SCr) * 0.85(if female)
T/F: Cockcroft -Gault equation is the only validated method of renal fxn for drug dosing
True
Cockcroft-Gault equation: Issues
- unstable kidney fxn (change in Scr by >50% in 24hours): CrCl over estimated
- Elderly (> 65): some institutions will round Scr to 1 if <1
AST/ALT: What are they?
Enzymes found within liver that aid in metabolism of proteins and AA
Increase in AST/ALT indicates ____
hepatocellular injury (hepatitis or cirrhosis) can see increase AST in other types of cell injury (post MI) but ALT is more specific for liver
Drug induced: statins, TZDs, EtOH
Which drugs can increase AST/ALT
Statins, TZDs, and EtOH
ALP: What is it?
Enzyme that aids in producing proteins within body
ALP: Where is it located and secreted?
Located in liver and bone
Secreted in bile
Increases in ALP indicates ___
obstruction (liver/biliary) or bone disease/breakdown (Paget’s disease)
Someone with Paget’s disease may see an increase of ___ (enzyme)
ALP
LDH: What is it?
LD is necessary for citric acid cycle to produce NADH and pyruvate – becomes energy
LDH: Where is it located?
Present in most tissues (making it non-specific for liver)
Increases in LDH may indicate ____
Some type of liver dysfunction
Almost always increases post MI within 10-12 hours
___ almost always increases post MI within 10-12 hours
LDH
Bilirubin: What is it?
Metabolic byproduct of the lysis of erythrocytes by reticuloendothelial system
Bilirubin: HYPERbilirubinemia
Prehepatic - hemolysis
Hepatic - defective removal of bilirubin from blood or conjugation
Posthepatic or cholestatic - obstruction
If total bilirubin > 2mg/dL - jaundice can develop
Albumin: What is it
Most abundant protein in body
Synthesized in liver –> marker of true hepatic function
Albumin: 3 Major functions
- controlling oncotic pressure in plasma
- transporting AA synthesized in liver to other tissues
- transporting poorly soluble ligands
Amylase+Lipase: What are they?
Enzymes secreted by pancreas to breakdown carbs, proteins, and fats
___ increases after onset of acute pancreatitis in most patients
Amylase and lipase
INR: What is it
Measures clotting tendency or coagulation properties of blood
INR is prolonged in those ___
receiving warfarin and those with liver damage
Erythrocytes: Produced in ___
Bone marrow
Erythrocytes: Released into ___ and circulate for ___H
Released into peripheral blood
Circulate for 120 days (60 days for those w CKD)
What is the difference between Hgb and HCT?
Hgb: O2 carrying compound in RBCs
HCT: % of RBC in volume of whole blood
Platelets: What are they
Maintain integrity of blood vessels, play key role in hemostasis + blood clotting
Platelets: lifespan
8-12 ays
Leukocytes (WBC): Neutrophils: % of total WBC
~60%
Leukocytes (WBC): Neutrophils: Increases in ___
infections, tissue destruction, inflammatory disease, stress, steroids
Leukocytes (WBC): Neutrophils: Decreases in ___
Cancer, post-chemotherapy, side effects of drugs
Absolute Neutrophil count equation
ANC = (WBC)(% neutrophils)
What is neutropenia?
ANC < 500/mm^3 –> increased risk of infection
Leukocytes (WBC): Bands: % of WBC
~5%
Leukocytes (WBC): Bands: What are they?
Immature neutrophils
Leukocytes (WBC): Bands: Increase in ___
response to acute infection (left shift = bands > 5%)
Leukocytes (WBC): Lymphocytes: % of WBC
~30%
Leukocytes (WBC): Lymphocytes: What do they do?
Recognize foreign substances and initiate immune response
Leukocytes (WBC): Lymphocytes: 2 types
T-lymphocytes: cell mediated immunity
B-lymphocytes: antibody mediated immunity
Leukocytes (WBC): Monocytes: % of WBC
~7%
Leukocytes (WBC): Monocytes: Where are they formed
In bone marrow, migrate to tissue and mature into macrophages
Leukocytes (WBC): Monocytes: Increase in ___
Subacute bacterial endocarditis, malaria, tuberculosis, recovery phase from infections, initial recovery from chemotherapy
Leukocytes (WBC): Eosinophils: % of WBC
~3%
Leukocytes (WBC): Eosinophils: What are they
Surface receptor of IgG and IgE
Leukocytes (WBC): Eosinophils: What do they do?
Involved in hypersensitivity response or allergic disorder
Leukocytes (WBC): Basophils: % of WBC
~<1%
Leukocytes (WBC): Basophils: What do they doinfla
Probably involved in immediate hypersensitivity reactions and delayed allergic reactions
Leukocytes (WBC): Basophils: May increased due to ___
Inflammation and leukemia