EXAM C Flashcards
What is the formula for osmolality?
2Na + (glucose/18) + (BUN/2.8)
How to calculate molarity
moles of solute / volume of solution
What is used to bind to inorganic phosphate?
Molybdenum Blue
What could cause hyponatremia?
-vomiting/diarrhea with adequate water intake
-sweating, burns
-renal reabsorption disease
-hypoaldosteronism (Addison’s’s disease)
-polyuria and osmotic diuresis (diabetes mellitus)
Normal range for sodium?
135-145 mmol/L
How is calcium and magnesium related?
directly
How is chloride and sodium related?
directly
How is phosphate and calcium related?
inversely
normal range for potassium?
3.5-5.2 eEq/L
normal range for calcium?
9.2-11 eEq/L
Normal range for magnesium?
1.3-2.1 eEq/L
Normal range for bicarbonate?
22-26 eEq/L
Normal range for chloride?
98-106 eEq/L
is phosphorous intra or extracellular?
intracellular
Normal range for phosphorus?
2.3-4.7
Hyperchloremia: Metabolic __________
acidosis
-Due to the ⬆ of Cl- that replaces [HCO3-] which ⬇ to compensate for the H+ production.
Hypochloremia: Metabolic ___________
alkalosis
-⬇ Cl- causes alkalosis from prolonged vomiting or an ⬆ in renal reabsorption of [HCO3-].
Insulin excess → will ____________ potassium
decrease
-Insulin will increase uptake of glucose by cells → more cellular respiration → ATP production will increase → activity of the sodium-potassium ATPase will be increased leading to decreased serum potassium levels.
What will happen if a blood gas sample is exposed to air?
Increase pH?
anemia of chronic infection lab values?
Iron Levels: ⬇ decreased
Transferrin % Saturation: decreased
TIBC: ⬇
Ferritin levels: Normal to high
PTH regulates _____level being reabsorbed in the intestine.
Mg+2
validation is used to….
check if the QC is good by what the manufacturer says
Verification is….
what an MLS must do before sending out results
Definition of calibration
the functional relationship between measured values and analytical quantities.
What is the transport time for arterial blood samples?
two hours in glass and 15 min in plastic ontainer
Increased Cl and Na could mean…
cystic fibrosis
What do the labs look like with bone disease?
osteoporosis the levels of Ca2+, phosphorus, and PTH are within normal limits. The levels of Ca2+and phosphorus are decreased while PTH increases in osteomalacia conditions. Levels of Ca2+ are increased, phosphorus is decreased, and PTH is increased.
What do labs look like with malabsorption?
Ca2+ & phosphorus ⬇ while PTH ⬆
What do labs look like with renal failure?
Ca2+ and PTH ⬆ and phosphate⬇ levels.
What do labs look like with liver disease?
all levels of Ca2+, phosphorus, and PTH ⬇
What are the labs with primary hyperparathyroidism?
PTH: increased
Calcium: increased
Phosphate: decreased
What are the labs with secondary hyperparathyroidism?
PTH: increased
Calcium: low to normal
Phosphate: low to high
What are the labs with primary hypoparathyroidism?
PTH: decreased
Calcium: decreased
Phosphate: Increased
What are the labs with Pseudohypoparathyroidism?
PTH: Increased
Calcium: decreased
Phosphate: Increased (opposite of primary HP)
What are the labs with secondary hypoparathyroidism?
PTH: decreased
Calcium: decreased
Phosphate: increased or decreased (depends on the severity of hypomagnesemia)
An increase in PTH would likely cause an increase of
Ca
you can determine whether a patient’s osmolality is being affected by factors other than sodium, potassium, chloride and bicarbonate; this is called the….
osmolal gap
Causes of an increased osmolal gap include …
presence of volatile substances such as alcohols
Causes of a decreased osmolal gap include
ADH oversecretion (SIDAH)
lung cancer
Osmolal gap =
measured osmolality – calculated osmolality,
abnormal gap indicates abnormal concentrations of…
unmeasured LMW substances in blood, such as ketone bodies or toxins (eg. ethanol, methanol, ethylene glycol)
What anticoagulant is used for blood gasses?
heparin
Copper physiologic function serves as a ___________ for many enzymatic activities.
cofactor
Ceruloplasmin is a __________enzyme that stores and transports copper to wherever the body needs it.
metallo
Copper Excess
is an inherited autosomal recessive disorder that causes a defect in Cu2+ metabolism. This causes a build up of copper in tissues such as liver, brain, kidney and cornea (cooper-kayser-fleisher rings) to a toxic toxic level.
Wilson’s disease
what lab result with Wilsions disease?
There will be NO copper found in the serum due to low levels of ceruloplasmin
Copper deficiency syndrome?
Menkes kinky hair syndrome
glucose producing lactic acid: what could it affect?
decrease pH? The osmo gap
Deficiency of what is associated with poor wound healing:
Zinc
The conditions associated with hypokalemia are…
Vomiting & diarrhea,
hyperaldosteronism/cushing’s syndrome
renal reabsorption disease
metabolic alkalosis
insulin excess
diuretic therapy.
The conditions associated with hyperkalemia:
hypoaldosteronism/Addison’s disease,
renal failure,
acidosis,
insulin deficiency,
cellular breakdown
Anoxia (lack of oxygen)
Which disease is associated with decreased Mg intestinal absorption and increased urinary Mg excretion
Alcohol
What is the purpose of EDTA?
Chelate calcium; decrease interferences
Increased ammonia is due to what pathology?
Hepatic encephalitis
When preparing 10% sulfuric acid. To make 100 mL what do you add first?
Add water first! (add acid)
What is the primary benefit of westgard multirules
a. Reduce errors
b. Predict trends
c. Correlate todays results to previous days results
d. Evaluate controles from multiple runs
D
The purpose of running controls each day is to check the?
accuracy
What is the confidence limit of a sample falling within 2SD of the mean?
95%
When comparing two methods of analysis your scatter plot should ….
a. Constant error
b. No error
c. Random error
d. Proportional error
?
In QC, in term range refers to:
Mean +/- 2 SD
HOW TO CALCULATE W/V %
mass of solute / volume of solution x100
How to calculate CV
SD/mean x100
iron is released from transferrin in an ________ environment.
acidic
-It also reduces 3+ to 2+ in this environment.
any other reasons for the high osmolality or it was only bc of glucose?
-Sodium
-Osmolarity = 2Na + glu/18 + BUN/2.8
-Sodium accounts for way more in the calculation
b-HCG allows for more,,,
sensitive/specificity
The function of hydroxyquinoline in calcium measurements?
Chelate Mg2+; decrease interference
Which has an effect on calcium levels?
a. Calcitonin (c-cells from the thyroid id)
d. PTH
c. Vit D
d. All of the above
all the above
What is the principle of “active” calcium measurements?
a. OCPC (o-cresolphthalein complexone) red complex
b. If it asks for ionized calcium → ISE
PTH case study with pt mention of bone lesions (osteitis fibrosa). Data had high PTH and Ca^2+ and low phosphate.
Primary hyperparathyroidism
Know the changes that would occur to calcium (?) and phosphate in metabolic ___
Metabolic acidosis: ⬆ionized calcium and Phosphorus → stone (hydroxyapatite)
6 linear points out of the mean would be….
Trend
What occurs with a right shift for oxygen binding?
everything increased (⬆H+, temp, 2,3-Bpg) but affinity and pH ⬇
Uriniary blockage can cause hypo_______
hyponatremia
hyperaldosteronism is ___________ syndrome
cushing’s
Potassium is ________ with hypoaldosteronism
increased
____ will enter the cell in acidosis while ___ leaves the cells.
H+, K+
causes hyperkalemia and vise versa
Insulin causes potassium to ___________ and vise versa.
decrease
Hypochloremic metabolic __________.
alkalosis
How is anion gap calculated?
(Na + K) - (Cl + HCO3) = 15 mmol/L (10-20)
Na - (Cl + HCO3) = 12 mmol/L (7-16)
What parameters constitute total CO2?
Total CO2 exists as dissolved CO2 (3%), carbamino derivatives of plasma protein (33%),
and as bicarbonate (64%).
What is the major from of CO2 that is transported in the blood?
bicarbonate
Acidosis can result in elevated levels of plasma _____________.
potassium
What is the result of alkalosis on potassium?
total body potassium will be increased. Potassium will move from the extracellular to intracellular space, shifting with H+; The increase in intracellular potassium stimulates the cells of the distal nephron of the kidney to secrete potassium in the urine.
Describe the relationship between parathyroid hormone and magnesium levels.
There is a lack of parathyroid hormone production with the decrease in magnesium levels. Magnesium is required for enzymes involved with parathyroid hormone secretion and target organs responses.
Why is measured serum osmolality compared with calculated osmolality?
to detect presence of unmeasured osmotically active substances, mainly volatile substances, that only contribute to the measured osmolality
Formula for calculated osmolality:
2 (Na+) + Glucose + Urea
What tube is used for lactic acid?
grey top: sodium fluoride
