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CDM 1 > INTERPRETING CLINICAL LABORATORY DATA > Flashcards

INTERPRETING CLINICAL LABORATORY DATA Flashcards

1
Q

Quantitative: data is

A 
Data can be accurately 
measured, but not observed
Examples:
Temperature of 39°C
Respiratory Rate of 22
Pain is a 6 out of 10
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2
Q

Qualitative data is

A 
Data can be observed, but not 
accurately measured
Examples:
Fever
Hyperventilation
Wincing in pain
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3
Q

NORMAL RANGE

A

Can vary based on the studied population
 Heart rate for athletes vs. non-athletes
Typically a fixed point
 Normal heart rate is approximately 80 beats/min (bpm)

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4
Q

REFERENCE RANGE

A

Provides a wider range of accepted values
Derived from the mean ± 2 standard deviations
 Heart rate range from 60 to 100 bpm

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5
Q

TEMPERATURE FOR NORMAL and reference ranges are

A

Normal:
 98.6 F or 37 C

Reference range:
 97 to 100.3 F or 36.1 to 37.9 C

Hypothermia: ≤ 96.9 F / 36 C
Hyperthermia: ≥ 100.4 F / 38 C
 Cut-offs above are ‘general’ and may be individualized

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6
Q

TEMPERATURE CONVERSIONS

A

Conversion to Celsius: (Temp. in Fahrenheit minus 32) / 1.8

Conversion to Fahrenheit: (Temp in Celsius x 1.8) + 32

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7
Q

BLOOD PRESSURE systolic and diastolic range

A

Systolic
 Peak pressure in the arteries
Normal is 120, Range (typical) is 100 to 140 mmHg

Diastolic
Lowest arterial pressure
Normal is 80, Range (typical) is 70 to 90 mmHg

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8
Q

INTERPRETING BLOOD PRESSURE for Hypotensive, Normotensive and Hypertensive

A

❖Hypotensive
 Systolic < 100 mmHg or Diastolic < 70 mmHg or both

❖Normotensive:
 Systolic between 100-139 and Diastolic between 70-89

❖Hypertensive:
 Systolic ≥ 140 mmHg or Diastolic ≥ 90 mmHg or both

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9
Q

HEART AND LUNGS (Heart Rate range, Bradycardia, Tachycardia, Respiratory range. Oxygen saturation range)

A

Heart Rate –> Reference Range: 60 to 100 bpm

Bradycardia: HR <60 bpm

Tachycardia: HR >100 bpm

Respiratory Rate: Reference Range: 14 to 18 breaths/min

Oxygen Saturation: O2 Sat or SaO2
Reference Range: 92 to 100% on room air

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10
Q

WEIGHT

ABW (Actual Body Weight)

IBW (Ideal Body Weight)

A

ABW (Actual Body Weight) Wt in Lbs. ÷ 2.2 = wt. in Kg.

IBW (Ideal Body Weight)

Men: 50 + 2.3 (# of inches over 5 ft)

Women: 45.5 + 2.3 (# of inches over 5 ft)

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11
Q

SODIUM RANGE IS

A

(135 TO 146 MEQ/L)

Sodium is predominantly found in the extracellular fluid
Sodium abnormalities are usually a result of changes in water homeostasis
Fluid imbalances can be caused by volume overload (e.g. heart/liver failure) or volume depletion (e.g. vomiting / blood loss)

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12
Q

POTASSIUM Range is

A

(3.4 – 5.2 MEQ/L)

Potassium is predominantly an intracellular cation, all but 2% is located within cells

Required for various enzymatic processes e.g. sodium/potassium ATPase, Krebs cycle

Plays an important role in skeletal and smooth muscle contraction

Hypokalemia: K < 3.4 mEq/L
Typically caused by fluid loss:
Bleeding, diarrhea, diuresis, vomiting
E.g. Stools can contain 40-60 mEq/L of K

Hyperkalemia: K > 5.2 mEq/L
Typically caused by renal dysfunction (decr. clearance)
It May be drug-induced (ACEI/ARB, Potassium-sparing diuretics)

Muscle weakness:
Results from either low levels or high levels of potassium as K helps
to regulate activities of skeletal, cardiac, and smooth muscle cells.

Since K regulates cardiac muscle cells, dysrhythmias can be induced

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13
Q

CHLORIDE range is

A

(98 – 110 MEQ/L)

Accounts for approx. 1/3 of all serum in the extracellular fluid

Is actively filtered via the kidneys, along with Na

Hypo and hyperchloremia occur for reasons similar to those causing hypo and
hypernatremia. Diuretic use, vomiting

Hypochloremia may cause muscle excitability and tremors

Hyperchloremia may cause weakness and lethargy

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14
Q

BICARBONATE: HCO3 range is

A

(24-32 MEQ/L)

Measures the bodies level of carbon dioxide
Is a marker of acid/base balance

Hypobicarbonatemia levels may indicate an acidotic process e.g. metabolic, diabetic ketoacidosis, or an overdose of ethylene, methanol, or salicylates

Hyperbicarbonatemia levels may indicate long term COPD (carbon dioxide retention), or an alkalotic process

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15
Q

BLOOD UREA NITROGEN: The BUN range is

A

(7-23 MG/DL)

The waste product from the production of ammonia by the liver

Healthy kidneys can filter and remove this urea via the urine

Low BUN levels may indicate: Liver disease/damage, malnutrition

High BUN levels may indicate: Renal disease/damage, dehydration, or high protein intake

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16
Q

SERUM CREATININE: SCR range is

A

(0.5-1.1 MG/DL)

SCR is a chemical waste product produced primarily by muscle metabolism
Filtered via the kidneys, similarly to BUN

Low Scr can indicate: Lack of nutrition/muscle mass

High Scr can indicate: Renal disease/damage, excess muscle mass

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17
Q

GLUCOSE: GLU range is

A

(70-100 MG/DL)

Is a source of energy for most cells in the body

Carbohydrates are broken down in the body into glucose

Regulated by insulin and glucagon

Levels <60 mg/dL can induce somnolence and coma

Levels >125 mg/dL indicate impairment and may lead to a diagnosis of
diabetes

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18
Q

SERUM CALCIUM: CA range is

A

(8.4 – 10.4 MG/DL)

Involved in muscle contraction and bone formation

99% is stored in skeleton and teeth

Regulated by vitamin D and parathyroid hormone

40% bound to serum albumin

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19
Q

HYPOCALCEMIA: CA < 8.4 MG/DL and HYPERCALCEMIA: CA > 10.4 MG/DL

A

Causes:
Poor calcium intake and/or Vit. D deficiency
Approx. 500 mg of calcium is removed from the bones/day
Vit. D stimulates calcium absorption
 Hypoparathyroidism: part of a feedback loop that regulates reabsorption of calcium
from bone

S/sx:
 Paraesthesia
 Tetany
 QTc Prolongation/arrhythmias

Causes:
Malignancy due to bone metastases
Hyperparathyroidism
Renal insufficiency

S/sx: “Bones, stones, groans, and psychic moans”
Lytic lesions
 Urinary calculi
 Malaise
N/V
 Mental status changes (confusion, depression)

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20
Q

COMPONENTS OF SERUM CALCIUM which contain

A

Albumin-bound calcium(40%)

Ionized (free) calcium (45%)

Salt-bound calcium(15%)

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21
Q

IONIZED CALCIUM

A

Ionized calcium only fluctuates with changes in the parathyroid hormones and vitamin D levels

Reference ranges:
Children: 4.4 - 6.0 milligrams per deciliter (mg/dL)
Adults: 4.4 - 5.3 mg/dL

22
Q

CORRECTED CALCIUM

A

Corrected serum Ca calculation: Observed serum Ca + 0.8 (4 – serum albumin)

Examples:
Ca: 8.1 mg/dL, Alb: 1.8 gm/dL
Does this patient need calcium replacement?

23
Q

PHOSPHATE: PO4 range is

A

(2.4 – 4.4 MG/DL)

Major intracellular anion

Important role in:
 Bone mineralization
 Storage and transfer of energy
 Muscle contraction
 Metabolism of glucose and lipids
 Maintenance of acid-base balance
24
Q

HYPOPHOSPHATEMIA: PO4 < 2.4 MG/DL
HYPERPHOSPHATEMIA: PO4 > 4.4 MG/DL

A

HYPOPHOSPHATEMIA: PO4 < 2.4 MG/DL

Moderate: 1 - 2.5 mg/dL
Severe: < 1 mg/dL
❖Causes:
Inadequate dietary intake
Hyperparathyroidism (increased excretion)
DKA (diabetic ketoacidosis)
❖S/Sx:
 Muscle weakness/dysfunction
 Mental status changes
HYPERPHOSPHATEMIA: PO4 > 4.4 MG/DL
Common cause:
Renal failure
❖Calcium-Phosphate product
 Ca x PO4 = Calcium-phosphate product
 If a product is > 55 in CKD, precipitation occurs and lytic lesions form
25
Q

MAGNESIUM: MG range is

A

(1.6 – 2.6 MG/DL)

Second most abundant intracellular cation

Required for utilization of ATP for energy

Important in regulating energy, protein synthesis, neuromuscular transmission, CV tone

Located mostly in bone and muscle tissues

26
Q

HYPERMAGNESEMIA: MG > 2.6 MG/DL
HYPOMAGNESEMIA: MG < 1.6 MG/DL

A

HYPERMAGNESEMIA: MG > 2.6 MG/DL

Common causes:
Excessive magnesium intake or renal failure

❖S/Sx:
Sedation, nausea, vomiting, decreased reflexes, and EKG changes

HYPOMAGNESEMIA: MG < 1.6 MG/DL

Common causes: Vomiting, diarrhea, diuretics
Often coincides with hypokalemia: Need to replace magnesium along with potassium

❖S/sx:
Nausea, vomiting, and EKG changes

27
Q

LIVER AND GASTROENTEROLOGY TESTS are

A 
AST (aspartate aminotransferase)
ALT (alanine aminotransferase)
ALP (alkaline phosphatase)
LD or LDH (lactate dehydrogenase)
Bilirubin
Albumin
Amylase and Lipase
INR (international normalized ratio)
28
Q

AST/ALT: Range is

A

0 - 35 IU/L

AST/ALT are enzymes found w/in the liver that aid in metabolism of proteins and amino acids

Increases may indicate hepatocellular injury (e.g., hepatitis or cirrhosis), as they leak from the liver into the
serum

Can see ↑AST in other types of cell injury (post-MI), ALT more specific for liver

Several medications may increase ALT/AST
Statins, TZDs, EtOH

29
Q

ALKALINE PHOSPHATASE: the range is

A

30–120 U/L

ALP is an enzyme that aids in producing proteins within the body
 Primarily located in liver and bone, secreted in bile

increases may indicate an obstruction (liver/biliary), or bone disease/breakdown (Paget’s disease)

30
Q

LACTATE DEHYDROGENASE: range is

A

50–150 U/L

LD is necessary for the citric acid cycle to produce NADH, pyruvate and thus, energy

Present in most tissues (making it nonspecific for liver)

Increases may indicate some type of liver dysfunction

Almost always increases post-MI within 10-12 hours

31
Q

BILIRUBIN and DIRECT BILIRUBIN range is

A

Bilirubin 0.1–1 MG/DL; DIRECT: 0–0.2 MG/DL

A metabolic byproduct of the lysis of erythrocytes by the reticuloendothelial system

Hyperbilirubinemia
Pre hepatic (hemolysis)
Hepatic (defective removal of bilirubin from blood or conjugation)
Posthepatic or cholestatic (obstruction)

If total bilirubin increases > 2 mg/dL, jaundice can develop

32
Q

ALBUMIN range is

A

3.5 – 5 G/DL

Most abundant protein in the body

Synthesized in the liver
Therefore is a marker of true hepatic function

3 major functions:
Controlling oncotic pressure in the plasma
Transporting amino acids synthesized in the liver to other tissues
Transporting poorly soluble ligands

33
Q

AMYLASE and LIPASE range is

A

AMYLASE (0 – 130 IU/L)

LIPASE (0 - 160 IU/L)

Enzymes are secreted by the pancreas to breakdown carbs, proteins, and fats

Increases after the onset of acute pancreatitis in most patients

34
Q

INR range is

A

0.8-1.2

Measures the clotting tendency or coagulation properties of the blood

Prolonged in those:
Receiving warfarin
With liver damage

35
Q

COMPLETE BLOOD COUNTS INCLUDE

A

Hgb
Hct
WBCs
RBCs

36
Q

ERYTHROCYTES (RBCs)

A

Produced in the bone marrow, released into peripheral blood, circulate for 120 days (60 days in those with CKD)

Main function is to carry oxygen from the lungs to the Tissues

Anemia occurs when Hgb, Hct, and/or RBCs decrease Causes may be multifactorial e.g. nutritional deficiencies (iron,
folate, thiamine), bone marrow alterations, chronic disease

37
Q

HEMOGLOBIN (HGB)

A

Oxygen carrying compound contained in RBCs

38
Q

HEMATOCRIT (HCT)

A

Percentage of RBCs in a volume of whole blood

39
Q

PLATELETS (PLTS)

A

Maintaining the integrity of blood vessels plays a key role in hemostasis and blood clotting

Lifespan = 8 – 12 days

40
Q

WHITE BLOOD CELLS PLUS DIFFERENTIAL

A

WBCs (Leukocytes):

Consists of cells of the immune system
Include the following types of cells:
Neutrophils
Bands
Lymphocytes
Monocytes
Eosinophils
Basophils
41
Q

NEUTROPHILS are

A

Makeup approx. 60% of total WBC

Neutrophils = segs = polys = PMNs = granulocytes

Increase in infections, tissue destruction, inflammatory disease, stress, steroids

Decrease in cancer, post-chemotherapy, side effects of drugs

Absolute neutrophil count (ANC) = (WBC)(% neutrophils)

Neutropenia (ANC < 500/mm3) increases risk of infection

42
Q

BANDS are

A

Bands:

Makeup 5% of WBC

Immature neutrophils
Increase in response to acute infection

(left shift = bands >5%)

43
Q

LYMPHOCYTES

A

Makeup 30% of WBC

Recognize foreign substances and initiate the immune response

Two types: 
T lymphocytes (cell-mediated immunity) 
B lymphocytes (antibody-mediated immunity)
44
Q

MONOCYTES are

A

Make up 7% of WBC

Formed in bone marrow, migrate to tissue and mature into macrophages

Increased in subacute bacterial endocarditis, malaria, tuberculosis, recovery phase from infections, initial
recovery from chemotherapy

45
Q

EOSINOPHILS are

A

Makeup 3% of WBC

Surface receptor for IgG and IgE

Involved in hypersensitivity response or any allergic disorder

46
Q

BASOPHILS

A

Make up <1% of WBC

Probably involved in immediate hypersensitivity reactions and delayed allergic reactions

May be increase in chronic inflammation and leukemia’s

47
Q

METHODS FOR ESTIMATING RENAL FUNCTION

A

❖Cockcroft and Gault

❖Others do exist, but will not be reviewed here:
MDRD
Modifications in Diet and Renal Disease
Salazar Corcoran (for obese patients)
Urinary creatinine (24-hr creatinine)
Jelliffe
Schwartz
48
Q

COCKCROFT AND GAULT

A

CrCl= [ (140-age) x IBW / 72 x SCr ] x0.85 (women)

CrCl = Creatinine clearance in mL/min/1.73 m2
Use IBW unless patient’s ABW weight is < than their IBW, then use ABW
• Weight = kg
• SCr = mg/dL

49
Q

USES FOR COCKCROFT AND GAULT

A

Estimation of creatinine clearance, not the direct calculation of creatinine clearance or GFR (glomerular filtration rate)

Currently C-G equation is the only validated method of renal function that can be utilized for drug dosing.

Validated in most patient populations:
Men
Women
Those with comorbidities

50
Q

ISSUES SURROUNDING THE USE OF C-G

A

Unstable kidney function:
Defined as a change in Scr by ≥ 50% in 24 hours
C-G greatly over-estimates CrCl
No good method in this situation currently exists
Use best clinical judgment when evaluating the renal function for drug dosing

Elderly patients (≥ 65 years in age):
Some institutions will round up Scr to 1, if the actual value is <1
For this class, you should use given Scr, and do not round up to 1

CDM 1 (15 decks)

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