Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Lab Medicine > Glucose, magnesium, phosphate and proteins > Flashcards

Glucose, magnesium, phosphate and proteins Flashcards

1
Q

Glucose draw, range, location and general function

A

Glucose concentration in extracellular fluid is closely regulated so that a source of energy is readily available to tissues.

Draw tube: SST (as part of chem -7 panel), PPT, gray (if drawing only glucose)

Normal range: 60–110 mg/dL
Panic values: < 40 or > 500 mg/dL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Conditions and drugs causing Hyperglycemia

A

Diabetes mellitus, Cushing syndrome (10–15%), chronic pancreatitis (30%)

corticosteroids,phenytoin, estrogen, thiazides

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Conditions and drugs causing Hypoglycemia

A

Hypoglycemia seen with insulinoma, adrenocortical insufficiency, hypopituitarism, diffuse liver disease, enzyme deficiency diseases (eg, galactosemia).

Drugs:insulin, ethanol,propranolol; sulfonylureas,tolbutamide, and other oral hypoglycemic agents.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

DIABETES MELLITUS Diagnosis components

A

Diagnosis of diabetes mellitus requires:

A fasting plasma glucose of > 126 mg/dL on two or more occasions

Spot plasma glucose level ≥200 mg/dL

HbA1c≥ 6.5% along with symptoms of diabetes.

Patients with fasting blood glucose levels 110 mg/dL to 126 mg/dL are considered to have impaired fasting glucose.

Glycosylated hemoglobin levels (HbA1c ) are favored to monitor glycemic control in patients with diabetes mellitus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Calcium function skeletally

A

CA PROVIDES STRENGTH & STABILITY FOR THE COLLAGEN & GROUND SUBSTANCES THAT FORMS THE STRUCTURAL MATRIX OF THE SKELETAL SYSTEM & IS A HUGE RESERVOIR FOR MAINTAINING BLOOD LEVELS OF CALCIUM

Bulk of Ca++ is stored in the skeleton

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Anion Calcium integration

A

ANIONS (BICARBONATE, LACTATE, & CITRATE)
CA USED IN MUSCULAR CONTRACTIONS, CARDIAC FUNCTION, TRANSMISSION OF NERVE IMPULSES, & BLOOD CLOTTING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Albumin influence on calcium

A

DECREASES OR INCREASES IN ALBUMIN WILL AFFECT THE TOTAL CALCIUM LEVEL, BUT WILL NOT AFFECT THE IONIZED PORTION

Amount of protein in blood will affect Ca++ levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Muscular system, cardiac, nervous and heme calcium roles

A

CA USED IN MUSCULAR CONTRACTIONS, CARDIAC FUNCTION, TRANSMISSION OF NERVE IMPULSES, & BLOOD CLOTTING

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Total Ca++ is made up of 3 fractions

A

Protein bound (∼40%)
Anion bound (∼10%)
Ionized “free” (∼50%) (metabolically active)

Only the ionized Ca++ can be used by the body for vital cellular processes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Calcium regulation

A

controlled by PTH, calcitonin, vitamin D & renal reabsorption

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Ionized calcium functions

A

Participates in enzyme reactions
Important intracellular second messenger for “amplification”

Contributes to membrane potentials & neuronal excitability

Exocytosis of neurotransmitters at NMJ & CNS
Muscle contraction (skeletal, smooth, cardiac)

Participates in hormone release
Influences cardiac automaticity
Required for coagulation in intrinsic pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

SERUM CALCIUM uses

A

Evaluating pts with known or suspected hyper/hypocalcemia

Evaluating electrolyte status in pts receiving IV fluids

Procedure:
Obtain 5ml of venous blood collected in red, yellow or speckled top tube

Reference range:
Varies considerably throughout adolescent years
Normal adult values: 8.9-10.1 mg/dl

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Interfering factor in calcium

A

Thiazide diuretics
Large amount of blood transfusions
Pts undergoing dialysis

Excessive laxative use
Acid base disorders
Increased or decreased protein levels

Calcium levels are inversely related to phosphate levels

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

HYPERCALCEMIA

A

total Ca++ >12 mg/dl

Etiology:
Hyperparathyroidism
Malignancy (PTHrP producing tumors)
Granulomatous diseases

Thyrotoxicosis
Paget’s disease of bone
Bone fractures

Prolonged immobilization
Excessive intake of vitamin D

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Clinical Manifestations of Hypercalcemia

A

Increased thirst
Polyuria, flank pain, signs of kidney stones or renal insufficiency

Anorexia, nausea, vomiting, constipation
Muscle weakness, atrophy, ataxia & loss of muscle tone

Lethargy, personality/behavioral changes, stupor or possible coma

HTN, shortening of QT interval & possible AV block

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

HYPOCALCEMIA

A

total Ca++ <8.5 but true hypocalcemia is ionized Ca++ <4.0 mg/dl

Etiology:
Pseudohypocalcemia
0.8 (nl alb - measured alb) + reported Ca
Hypoparathyroidism

Hyperphosphatemia
Malabsorption syndromes & malnutrition
Pancreatitis

Alkalosis
Vit D deficiency (rickets or osteomalacia)
Alcoholism & cirrhosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Clinical Manifestations of Hypocalcemia

A

Paresthesias
Skeletal muscle cramps, abdominal spasms & cramps
Hyperactive reflexes, + Chvostek’s & Trousseau’s signs, tetany & laryngeal spasm

Hypotension, cardiac insufficiency, no response to drugs with Ca-mediated mechanism
Osteomalacia, bone pain, deformities & fractures

18
Q

IONIZED CALCIUM uses and procedure

A

Particularly helpful during any surgical procedure that requires rapid & multiple whole blood transfusions

Second order test in the evaluation of pts with abnormal Ca++ levels

Neonatal calcium measurement

Assessing Ca++ levels in critically ill pts

Procedure:
5ml of venous blood in red, yellow, or speckled top tube

19
Q

IONIZED CALCIUM LEVEL

A

Reference range:
Normal: 4.75-5.20 mg/dl
Panic values: <2.0 mg/dl may produce tetany or life-threatening complications, levels >7.0 mg/dl may cause coma

Increased levels:
Hyperparathyroidism
Ectopic PTHrP tumors
Increased vitamin D intake

20
Q

Ionized calcium decreased levels and Interfering factors

A

Decreased levels:
Hypoparathyroidism
Vitamin D deficiency

Pts receiving bicarbonate to control metabolic acidosis
Acute pancreatitis

Hyperventilation to control increased ICP
Magnesium deficiency
Multiple organ failure

Interfering factors:
Improper specimen collection in EDTA

21
Q

SERUM PHOSPHATE functions

A

85% of the body’s total phosphorus is combined with Ca+ inside bone; 14% resides within cells; 1% is the the extra-cellular compartment

Multiple functions – bones, glucose, lipids, acid-base balance, storage & energy transfer

Moves into cells after carbohydrate ingestion & therefore is lowered in the plasma
Inversely related to Ca++

22
Q

SERUM PHOSPHATE functions 2

A

Major role in bone formation (bone matrix)
Essential for certain metabolic processes (ATP formation, building of enzymes for glucose, fat, & protein metabolism)

Cell structure (nucleic acids of DNA/RNA, membrane phospholipids

Serves as a acid-base buffer in the ECF & in the renal excretion of H+ ions

O2 delivery by RBCs through organic phosphates & 2,3 diphosphoglycerate

23
Q

Serum phosphate uses

A

Evaluating pts with CKD or hyperparathyroidism
Evaluating alcoholic & malnourished pts or pts receiving TPN

Evaluating status of pts recovering from diabetic ketoacidosis or pts receiving IV fluids containing phosphorus

Evaluating pts with hyperparathyroidism
Procedure: same as other electrolytes

Reference range: 2.5-5.0 mg/dl
Interfering factors: hemolysis

24
Q

HYPERPHOSPHATEMIA

A

Definition: >5 mg/dl

Etiology:
Decreased excretion due to renal failure
Hypoparathyroidism
Adrenal insufficiency & acromegaly
Increased intake & absorption
Redistribution/cellular release
Hypocalcemia
Bone tumors & cancer metastases

25
Q

Clinical Manifestations of Hyperphosphatemia

A

Manifestations are usually related to the reciprocal changes that are seen in calcium (hypocalcemia)

Paresthesia’s, tetany, Chvostek’s and Trousseau’s signs
Hypotension and cardiac dysrhythmias

Skeletal muscle cramps, abdominal spasms & cramps
Bone pain

26
Q

HYPOPHOSPHATEMIA

A

Definition: <2.5 mg/dl

Etiology:
Hyperparathyroidism
Diabetic ketoacidosis
Antacids
Severe diarrhea
Vitamin D deficiency
Alkalosis
Alcoholism, malnutrition, and TPN
Renal tubular absorption defects

27
Q

Clinical Manifestations og Hypophosphatemia

A

Manifestations usually related to reciprocal calcium changes (hypercalcemia)

Ataxia, hyporeflexia, muscle weakness, joint & bone pain

Increased thirst, anorexia, N/V, & constipation

Lethargy, personality/behavioral changes, stupor or possible coma

POLYURIA, FLANK PAIN, SIGNS OF KIDNEY STONES OR RENAL INSUFFICIENCY

HTN, SHORTENING OF QT INTERVAL & POSSIBLE AV BLOCK

28
Q

SERUM MAGNESIUM

A

50% in bone, 49% in body cells, & 1% is dispersed within the serum

Mg is required as a cofactor for the production of cellular energy and function of cellular messenger systems

Along with Na, K, & Ca ions, Mg also regulates neuromuscular irritability and the clotting mechanism

The secretion, synthesis, & action of PTH is influenced by Mg

Mg & Ca are intimately linked in their body functions

29
Q

Serum Magnesium further functions

A

Cofactor for intracellular enzyme reactions (transfers phosphate groups)

Essential for all ATP reactions

Essential for every step related to replication & transcription of DNA & for translation of messenger RNA

Required for cellular energy metabolism, function of the Na+/K+/ATPase pump

Stabilizes membranes

Contributes to nerve conduction, ion transport, & calcium channel activity

30
Q

Serum Magnesium uses, procedure and Interfering factors

A

Evaluating renal function & electrolyte status in hospitalized patients

Pts with hypocalcemia or hypokalemia not responding to electrolyte correction

Identification of malabsorption disorders
Monitoring tx of pre/eclampsia

Procedure: same as other electrolytes

Reference range: 1.5-3.0 mEq/L
Interfering factors:
Hemolysis, lithium or salicylates use

31
Q

HYPERMAGNESEMIA

A

Definition: >3.0 mEq/L

Etiology:
Renal failure or dehydration
Treatment of pre/eclampsia

Rhabdomyolysis
Excessive use of antacids

32
Q

Clinical manifestations of Hypermagnesmia

A

Lethargy, hyporeflexia, muscle weakness
Depressed respiration, apnea, confusion

33
Q

HYPOMAGNESEMIA

A

Definition: <1.5 mEq/L

Etiology:
Alcoholism, malnutrition, malabsorption & starvation
Parenteral nutrition
Pancreatitis

Hypoparathyroidism

34
Q

Clinical Manifestations of Hypomagnesmia

A

Personality changes, tetany, nystagmus, Chvostek’s & Trousseau’s sign, TACHYCARDIA, HYPERTENSION, and CARDIAC ARRHYTHMIAS

Altered PTH secretion/action may occur

35
Q

SERUM PROTEINS functions

A

Source of nutrition
Buffer system
Immune function

Carrier proteins
Metabolic function
Chromosomal & DNA components

Cell membrane structure
colloidal osmotic pressure
Antiprotease

36
Q

Serum Albumin

A

Part of a diverse microenvironment which primarily maintains colloidal osmotic pressure

Source of nutrition & also part of a complex buffer system. It is a “negative” acute phase reactant

Useful for:
Evaluation of nutritional status, albumin loss in acute illness

Evaluation of pts with liver or renal disease, hemorrhage, burns or leaks in GI tract

37
Q

Serum Albumin

A

Reference range:
Normal: 3.5-4.8 g/dl

Increased levels:
Volume depletion or dehydration

Decreased levels:
Acute/chronic inflammation & infection
Cirrhosis, liver disease & alcoholism
Nephrotic syndrome
Crohn’s, colitis, malabsorption
Burns & severe skin disease

Procedure: same as electrolytes (red, yellow SST tube or plain red tube )

38
Q

Serum Albumin interferring factors

A

Pregnancy
Oral contraceptives (OCP) & estrogen replacement
Prolonged bed rest

IV fluids, rapid hydration or overhydration
Is not a good indicator of recent changes in nutrition due to prolonged half-life in serum

39
Q

SERUM PROTEIN ELECTROPHORESIS (SPEP)

A

Separates albumin & globulins with an electric field to differentiate the proteins according to size, shape & electric charge into 5 distinct fractions

[Albumin, alpha-1-globulin, alpha-2-globulin, beta-globulin, gamma-globulin]

Useful for:
Detection of monoclonal protein or monitoring size of monoclonal peak in multiple myeloma pts

40
Q

SPEP Interpretation

A

↑ & ↓ albumin
↑ in total serum protein
Volume depletion or dehydration
Multiple myeloma

Sarcoidosis & other granulomatous diseases
Any inflammatory state
↓ in total serum protein

Poor nutritional status, liver disease, alcoholism, burns, severe skin disease
Renal disease, Crohn’s, UC

41
Q

SPEP more interpretation

A

Increases in gamma-globulin protein
Multiple myeloma, leukemia & other cancers
Autoimmune disease, chronic infections

Decreases in gamma-globulin protein
Nephrotic syndrome
Hereditary aggamaglobulinemia

Increases in beta-globulin protein
Multiple myeloma, biliary cirrhosis, obstructive jaundice

Decreases in beta-globulin protein
Nephrosis

Lab Medicine (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions