GU #2 Flashcards
Electrolyte Studies purpose?
To delineate fluid and electrolyte status
Electrolyte Studies useful in?
Hospitalized patients
Critical or unstable patients
Post-operative patients
Outpatients
**useful in hospitalized patients - cause we need to constantly monitor them
*
** dehydration
dialysis - potassium, phosphorus *
What does a BMP have?
Glucose Calcium Sodium Potassium CO2 Chloride Blood urea nitrogen (BUN) Creatinine Anion Gap
What are the CMP adds to a BMP?
Albumin Protein ALP AST ALT Total Bilirubin
Sodium is the major ______ in the _____cellular space
Major cation in the extracellular space
What is the major determinant of extracellular osmolality?
Na
Balancing sodium is a trade off between _________ intake and renal _________
dietary intake and renal excretion
what is the average daily intake of Na needed to maintain sodium balance in adults?
90-250 meQ/day
**contains the osmotic gradient, water follows sodium, controlled by kidneys and they are constant balancing dietary intakes and excretion of sodium, aldosterone - reabsorb sodium and ADH - reabsorb water ( 2 main players in regulating sodium concentration)*
Normal sodium level?
135-145 mEq/L
Sodium critical values?
<120
> 160
Sodium critical values: <120 sxs.?
weakness, fatigue, delirium, hyperreflexia
Sodium critical values: >160 sxs.?
confusion, hyperreflexia, seizures, coma
**you can go into a coma with low or high*
Sodium increased: increased NA intake causes?
Increased dietary intake
Hyperosmotic IV fluids -
can raise sodium levels so be careful
Sodium increased: Decreased Na loss causes?
Cushing syndrome
excess mineralocorticoids
hyperaldosteronism - increased aldosterone you are going to not longs so much sodium which will give you increased serum sodium levels
Sodium increased: Excessive free water loss?
GI loss Excessive sweating Extensive burns Diabetes insipidus Osmotic diuresis
**losing water you get more conc. of particles *
Sodium decreased: Decreased Na intake causes?
Deficient intake
Hypotonic IV fluids
Sodium decreased: Increased Na loss causes?
Addison disease
Diarrhea/vomiting
NG suction
Diuretics
CRI
Sodium decreased: Increased free water causes?
Psychogenic polydipsia
drink to much water
Hyperglycemia
shift osmotic gradient where you have increased free water in the vasculature cause the glucose pulls it in
CHF
Ascites
SIADH - increased in ADH and pull water back into the vascular
Hypovolemic Hyponatremia: renal causes?
Primary adrenal insufficiency (aldosterone deficit)
Interstitial nephropathies
Hypovolemic Hyponatremia: Nonrenal causes?
GI loss - Vomiting, diarrhea, tube drainage
Hypovolemic Hyponatremia:
Insensible loss?
Sweating or burns in the absence of repletion
Euvolemic Hyponatremia is caused secondary by _____________________ from the pituitary gland
adrenal insufficiency
glucocorticoid deficiency
Euvolemic Hyponatremia is also caused by _____ which is most frequent
SIADH
** most frequent cause (steady subclinical hypervolemia)
they are subclinical euvoluemic *
Hypervolemic Hyponatremia causes?
CHF
Cirrhosis
Nephrotic syndrome - CHF liver disease fluid overload , retains water
Potassium in the major _____cellular cation
intracellular
** hemolysis can affect it
dietary is only was to get K in and no way to reabsorb it*
Potassium is most important in?
membrane electric potential
K is excreted by ?
kidenys
This is no ___________ by the kidneys with K.
no reabsorbtion
NL K range?
3.5-5.0 mEq/L
K critical values?
<2.5
> 6.5
K critical values: <2.5 sxs?
V fib/Torsades
K critical values: >6.5 sxs?
Myocardial irritibality
Potassium indications?
Routine evaluation
Monitor patients on diuretics
K-sparing = Sprinolatcton - monitor to make sure K is not getting to high
Monitor with patients with poor kidney function
K interfering factors?
Hemolysis of blood during a venipuncture ( increase falsely)
Alkalotic states lower potassium
Acidotic states increase potassium (DKA)
K increased?
Excessive dietary intake
Renal failure
Addison disease
low levels of aldosterone
Potassium sparing diuretics
Crush injury to tissues
Transfusion of hemolyzed blood
Acidosis
Dehydration - falsely increase K cause lower free water
K decreased?
Deficient intake
Burns
GI disorders - not absorbing it
Diuretics
Alkalosis
Insulin administration - drive
K into the cells
Ascites
Renal artery stenosis
**hyperkalemia tx is also insulin to drive K & glucose into the cell and out of the serum and lowering serum concentrations *
Calcium function?
Membrane and cell function
Contractility of cardiac and skeletal muscle
Clotting activation
Neural transmission
**has a lot to do with skeletal muscle contractility , decreased albumin you might have a decreased calcium as well *
Calcium exists as?
1/2 exists in free (ionized form)
1/2 exists in protein bound form (mostly with albumin)
** measure of Ca gives you both - free and protein bound *
Calcium NL range?
9-10.5 mg/dL
**10.8 is important - investigate it more ( not so much sensitive with Na), - .3 over is significant, over 10.5 investigate it by looking at PTH hormone or just retest*
Calcium critical values?
<6
> 13
Ca critical values: <6 sxs?
tetany/convulsions
low calcium - tapping on the face, and you get a reflex
Ca critical values: >13 sxs?
arrythmias/coma
Ca indications?
Evaluate parathyroid function
Evaluate calcium metabolism
Ca is indicated to monitor patients with what ?
Renal failure
Renal transplant
Hyperparathyroidism
Malignancies
After large volume blood transfusions
**important to monitor in renal patients hypo and hyper be carful *
Ca increased causes?
Hyperparathyroidism
Mets to bone
Paget disease of bone
Vit D intoxication
Addison disease
Prolonged immobilization
Increased Ca symtpoms?
stones ( kidney stones made up calcium oxylate, cholesterol as well)
bones ( they get broken bones causing losing Ca from bone cause it is increased in the serum)
abd groans(vague abd pain)
psychic moans ( changes in behavior and depression)
Ca decreased causes?
Hypoparathyroidism
Renal failure - cA is just spilling out
Hyperphosphatemia
Rickets
Vit D deficiency
Osteomalacia
Malabsorption
Pancreatitis
Ca decreased symptoms?
Chvostek, tap on facial nerve and they get spasm
Trousseau - when you put BP cuff on then it cause tetany of hand
Calcium and phosphorus relations?
higher the P then the lower the Ca ( inversely proportions)
NL urine sodium?
> 20 mEq/L
What causes urine sodium >20 mEq/L?
Dehydration
Adrenocortical insufficiency
Diuretic therapy
SIADH - retaining free water
Diabetic ketoacidosis
Chronic renal failure - spill sodium cause we cannot reasrobe it
what causes urine sodium <20 mEq/L?
CHF
Malabsorption
Diarrhea - losing Na from the
bowel
Cushing disease
Aldosteronism - low urine sodiums
Inadequate intake
Urine osmolality increased?
SIADH - conc. urine and through free water rout
Ectopic source of ADH (carcinoma)
Shock
Cirrhosis
CHF
Urine osmolality decreased?
Diabetes insipidus
Excess fluid intake
Renal tubular necrosis
Severe pyelonephritis
Chloride function is a major _____cellular anion?
extracellular
Cl function?
Osmotic gradient
Not meaningful by itself but combined with other tests gives an indication of acid-base balance
Maintain electrical neutrality with NA+
Follows NA+ loss and accompanies NA+ excess
**lets important electrolytes we look at it is not meaning ful by itself , just know it follows Na - high Na = high Cl and low = low, if you increase Na will cause increase in Cl *
NL Cl range?
98-106 mEq/L
Cl critical values?
<80
> 115
Cl indications?
Routine electrolyte studies
Acid-base balance
Cl interfering factors?
Excessive infusions of saline
Cl interfering factors: increased?
Acetozolamide
NSAIDs
Cl interfering factors: decreased?
Bicarbonates
Steroids
Loop diuretics
Cl increased?
Dehydration
Excessive saline IV
Metabolic acidosis
Cl decreased?
Vomiting
NG suction
Burns
CO2 functions?
Indirect measurement of the
HCO3 anion
Second in importance to the chloride anion
Used as a “rough guide” for acid-base imbalance
**different than pCO2 but it does give you idea if someone is acidotic or alkaloid ( give idea of what the bicarb might be)*
CO2 NL range?
23-30 mEq/L
CO2 critical values?
<6
CO2 indications?
Evaluate pH status in a patient with possible acid-base imbalance
Do NOT confuse with PCO2
**poor mans blood gas *
CO2 increased?
Alkalosis
Severe vomiting
NG suction
COPD
CO2 decreased?
Acidosis
Chronic diarrhea
Renal failure
DKA
Starvation
Shock
Anion Gap functions?
Difference between the cations and anions in the extracellular space
Anion Gap formula?
(NA + K ) – (Chloride + HCO3)
AG increased?
Lactic acidosis
DKA
Alcoholic ketoacidosis
Starvation
Renal failure
GI loss of HCO3
more acidotic states
**more acidotic state = more anion gap *
** number give you a rough indication o how bad the acid base balance disturbance might be *
AG decreased?
Chronic vomiting
GI suction
Lithium toxicity
Hypoproteinemia
more alkaloid states
BUN function?
Indirect and rough measurement of kidney function
**good indication on how well the kidney are working *
BUN elevated levels?
Elevated levels = azotemia
Can be prerenal, renal, or postrenal ( after kidneys)
what are the kidney function tests?
BUN + creatinine
** like ast, alt and alk pos are for liver function*
BUN NL range?
10-20 mg/dL
BUN critical value?
> 100
BUN interfering factors?
High/low protein diets
GI bleeding
Overhydration or dehydration
BUN increased: prerenal?
Hypovolemia - dont have excess free water
Shock
Dehydration
CHF - increase BUN
BUN increased: renal?
Renal disease - cant excrete the BUN
Nephrotoxic drugs
BUN increased: postrenal?
Ureteral obstruction
Bladder outlet obstruction - its going through the kidney but cant be excretes , maybe uretheeral obstruction
BUN decreased?
Liver disease - cause it is not even being made
Creatinine function?
Catabolic product of creatine phosphate used in skeletal muscle contraction
Not effected much by the liver
**extremely sensitive indicator for kidney function it is only affected by the kidney so elevated C it is definitely in the kidney not pre or post *
Cr is excreted ________ by the kidneys
entirely
Cr NL range?
0.5 – 1.2 mg/dL
**0.6 or 0.4 dont have to worry about it cause some healthy people will have lower levels *
Cr critical values?
> 4
serious renal impairment
Cr increased causes?
All diseases affecting renal function
Rhabdomyolysis - cause C is a end product of creatinine kinase
Cr decreased causes?
Decreased muscle mass
**not worried about this as much *
Creatinine Clearance (CC) function?
Used to measure the glomerular filtration rate (GFR) of the kidney (how well are we clearing the C, how well are our kidney working)
CC requires?
Requires a 24 hour urine collection and a serum creatinine level
CC is a function of what ?
CC= UV/P
CC is a function of urinary volume over serum creatinine ( serum C in the plasma)
Estimated GFR equation?
GFR = 186 x (Pcr) -1.154 x (age) -0.203 x (0.742 if female) x (1.210 if AA)
__ usually have a different GFR than anyone else?
African American
Why do we need to know GFR?
medications , renal or hepatic alt dosed
a 99 yo who need keflex if she has cellulitis then the dose is probably going to be lower cause of the lower GFR and pharmacokinetics of the 90 yer old
CC increased causes?
Exercise
High cardiac output
pregnancy
CC decreased causes?
Decreased blood flow to the kidney
Shock
Dehydration
Impaired kidney function
Phosphate NL range?
3.0-4.5
Phosphate critical value?
<1 mg/dL
Phosphate indications?
assists in studies re: calcium and parathyroid tests
**inversely proportions to Ca
looking at inorganic phosphate *
Phosphate function?
“inorganic phosphate”
Intracellular storage of energy-organic
Electrical and acid-base homeostasis
Inverse relationship between CA and Phosphate
increases with everything that decreases calcium
Phosphate increase causes?
Hypoparathyroidism
Renal failure - cA is just spilling out
Hyperphosphatemia
Rickets
Vit D deficiency
Osteomalacia
Malabsorption
Pancreatitis
Phosphate decrease causes?
Hyperparathyroidism
Mets to bone
Paget disease of bone
Vit D intoxication
Addison disease
Prolonged immobilization
Mg Nl range?
1.3-2.1 mEq/L
Mg critical values?
<0.5
> 3
Mg function?
Found mostly intracellularly
Critical to metabolic processes
Increases the intestinal absorption of Calcium
** important in cardiac patients and it can be squed by hemolysis *
**it follows glucose , aldosterone increase Mg excretion and decrease serum Mg when hemolysis increased Mg serum *
Mg interfering factors?
hemolysis
Mg increased causes?
Renal insufficiency - cause Mg is excreted by kidneys
Addison disease - decrease in aldosterone will then increase Mg levels
Mg decreased causes?
Malabsorption
Malnutrition
Alcoholism - cause malnutrition ass. with ETOH
Diabetic acidosis
Hypoparathyroidism
Anti-glomerular basement membrane Ab are used to detect the presence of circulating __ towards __________________________ .
Used to detect the presence of circulating Ab towards kidneys glomerular BM
Ab are used to ________ tx?
monitor
When are Anti-glomerular BM Ab present?
Present in autoimmune-induced nephritis (Goodpasture syndrome)
Goodpasture syndrome triad?
Antibodies
Pulmonary hemorrhage
Glomerulonephritis = kidney failure and then they need dialysis
Ab for kidneys?
Anti-glomerular basement membrane Ab
Antispermatozoal Ab
Antispermatozoal Ab is a screening test for ?
infertility
Antispermatozoal Ab function?
Tests for Ab against sperm which can be an autoimmune cause of infertility
Antispermatozoal Ab can be found in?
serum
sperm
cervical mucous
PSA indictions?
Used as a screening exam for prostate CA
Used to monitor treatment of prostate CA - while in remission
PSA NL range?
0-2.5 ng/mL
PSA is a __________ found in __________ _____
Glycoprotein found in prostatic lumen
PSA ________ usually prevent high levels from reaching the blood stream, example?
Barriers
i.e. glandular tissue
PSA barriers can be breached with?
cancers
infections
hypertrophy - allows more leakage of PSA into the serum
___ is more sensitive and specific than other prostate tumor markers.
PSA
____ of men with prostate CA have PSA of >4 ng/mL
80%
**4-10 is like a PSA grey zone and over 10 they have CA and under 4 they dont and in between maybe they have BPH*
PSA velocity ?
Shows how fast the PSA is rising per year
**velocity is more accurate than total PSA *
**compare the PSA from 1 year versus another year ( 2 one yeas then 2.8 the next year - may want to look into it even though they are still below 4 - maybe a prostate exam or Bx.)*
**highly metabolic tissue are more prone to developing CA - like prostate and breast than any other tissues *
120 yo we will all have P and B CA
PSA velocity __________ per year is associated with higher risk of dying from prostate CA
> 0.35 ng/mL
Age adjusted PSA
Table 2-39 (Mosby’s)
<50 = <2.4 ng/mL
Free versus attached PSA(bound to protein)?
Benign conditions are associated with more free PSA
PSA considerations?
PSA should be drawn before DRE. DRE may minimally elevate PSA
Ejaculation within 24 hours of serum testing will raise PSA.
Finsteride (Proscar) may decrease levels of PSA
it shrinks the prostate
