Intro, Urine Studies, & CMP Flashcards by Ashton Fischer

Presence of ketones could be from?

Metabolic abnormalities (DM, hyperthyroidism)
Dietary conditions (vomiting, diarrhea, anorexia, high fat/low carb diet)

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Increased levels of Magnesium can be found in:

acute/chronic renal failure
dehydration 
hypothyroidism 
Addison's disease 
Magnesium supplementation

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Alkaline urine seen in:

Chronic renal failure

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Diseases that would have hypersthenuria

DM
dehydration
CHF

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Decreased levels of Magnesium can be found in:

hypercalcemia; diabetic acidosis; hemodialysis; chronic pancreatitis; chronic cirrhosis; chronic glomerulonephritis

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Calcium is important for:

neuromuscular activity
blood coagulation
bone metabolism
maintaining functional integrity of cell membranes

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What are reasons for increased total bilirubin?

bile duct obstruction
cirrhosis of the liver
hepatitis 
infectious mono
chemotherapy
malignancy of the liver or gallbladder

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A cause of this could be patients who are post dialysis

Hypokalemia

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Increased levels of blood phosphorous levels are most commonly found:

In association with kidney dysfunction

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Symptoms of hypermagnesium

Weakness
Nausea/vomiting 
Impaired breathing 
Hypotension
Arrhythmias

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Symptoms of hypomagnesium

Tetany

Involuntary contraction of muscles

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What type of cast can be found in patients who were exposed to a toxin or virus?

Epithelial casts

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This most commonly occurs with hypervolemia caused from diseases of the liver and kidney, like cirrhosis and chronic kidney disease

Hyponatremia

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Calcium oxalate crystals can indicate

chronic renal failure; or be from high doses of ascorbic acid/Vitamin C

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Liver functions:

protein synthesis; production of biochemicals; decomposition of RBCs; metabolize and store carbohydrates; hormone production; production of blood clotting factors; breakdown drugs, alcohol and other toxins

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A 24 hour urine collection useful when looking at patients is?

Electrolyte balance
Acid-base balance
Total protein excretion
Metabolism Imbalance
Hormonal imbalance

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Too much or too little sodium in the body leads to?

Cell malfunction and possibly cell death

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Hypernatremia causes:

sodium overload from ingestion
intravenous infusion
hyperaldosteronism

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Acidic urine may be seen in:

Metabolic acidosis
Respiratory acidosis
UTI

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People who are on diuretics can suffer from?

Hyponatremia

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Most commonly caused by renal insufficiency, acute or chronic

Hyperkalemia

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symptoms of liver damage include:

pale stools; dark urine; jaundice; swelling of the abdomen, ankles, and feet; excessive fatigue; bruising and easy bleeding

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Hypercalcemia is associated with

Hypoparathyroidism
Malignancy (CA)
Vitamin D toxicity

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3 types of crystals in patients with kidney stones?

Uric acid crystals
Crystine crystals
Calcium oxalate crystals

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What type of cast is found in patients with pyelonephritis?

WBC cast

What type of cast indicates severe renal failure or nephrotic syndrome?

Waxy casts

What type of cast is found in nephrotic syndrome?

Fatty casts

What are the 4 most probably pathogens in a UTI?

E. coli-->most common S. saprophyticus P. aeruginosa S. aureus

Reddish urine can be from?

hematuria; hemoglobinuria; myoglobin; menstrual contamination; certain medications; consumption of foods (beets, rhubarb and food dyes)

sodium levels of >160 can lead to?

Heart failure

Casts are made of?

WBCs, RBCS OR | kidney cells and proteins secreted from the renal tubule

What type of cast is found in glomerulonephritis?

RBC cast

What type of cast indicates acute tubular necrosis?

Granular casts

Green urine can be from?

Pseudomonal infection Bilirubin Medications

Increased cellular uptake of potassium into the cells as in excessive amount of insulin and metabolic acidosis can lead to

Hypokalemia

Increased urobilinogen may be present in what diseases?

Hemolytic disease Hepatic disease *Not biliary obstruction

Ketones evaluate for the presence of?

Acetone

5 non-renal causes for proteinuria:

Infection; Stress: Leukemia; Pre-eclampsia in pregnancy; Kidney stones

When the body loses water, what is the order the body pulls excess fluid from?

Plasma Interstitial Fluid Intracellular fluid

How are protein results recorded?

Negative Trace 1+, 2+, 3+, or 4+

Symptoms of hypernatremia:

Lethargy; weakness: confusion; muscle twitching; tremors; seizures; irritability

A serum sodium level of <110 can lead to

Seizures and coma

Symptoms of hyponatremia:

Nausea; Malaise; HA; Lethargy; Confusion; Muscle twitching; Weakness

Acidosis, low insulin levels, and beta blocker therapy can cause

Hyperkalemia

"Pins and Needles" feeling is due to:

Hypocalcemia It is an example of tetany

______% of Calcium is bound in the skeleton

99%

Hypocalcemia is associated with:

Hypoparathyroidism Vitamin D deficiency Hypoalbuminemia Pancreatitis

______ is required for generation of bony tissue and functions in the metabolism of glucose and lipids, in the maintenance of acid-base balance, and in the transfer of energy from site in the body to another

Phosphate

Urine bilirubin indicates

``` Liver dysfunction (hepatitis or cirrhosis) Biliary tract infection ```

_____ removes bilirubin from the blood

Liver

Muscle cramping, pre-ventricular contractions, fatigue, confusion, weakness are all signs of issues with

Neuromuscular control

This electrolyte helps maintain electrolyte balance, hydration and osmotic balance

Chloride

What are ways the body loses water?

Sweating Fever Hydration

Gastrointestinal losses prolonged vomiting or nasogastric suctioning is the most common reason for:

Hypochloremia

What is the treatment for neonatal jaundice?

Phototherapy

How many days does it take neonatal jaundice to occur?

2-3 days

Neonatal jaundice is due to an elevated?

Unconjugated bilirubin

What type of bilirubin is water soluble?

Conjugated bilirubin

What form of bilirubin is not water soluble?

Unconjugated bilirubin

Total bilirubin can be divided into:

Conjugated and unconjugated bilirubin

Total bilirubin is a product of?

The breakdown of hemoglobin

What is the most abundant electrolyte in the human body?

Calcium

When Calcium levels are ____, phosphorous levels are increased

Decreased *Calcium levels increased, Phosphate levels are decreased

Peaked T-waves on an EKG indicate?

Hyperkalemia

______-______% of Potassium is excreted in urine

80-90%

Potassium is excreted in the urine by the?

Glomeruli of the kidneys

Potassium is the major ____ cation

Intracellular

How many mL of urine are filtered daily?

1200 mL

Glomeruli function

Main filtering system in the kidneys (cortex)

Tubule function

Reabsorption and secretion

Components of a nephron

Glomerulus and tubule

What helps to maintain salt and water balance?

Loop of Henle of the nephron and the collecting ducts

Components of urine

95% water 2% urea Other: chloride, sodium, potassium, sulfur, phosphate, creatinine, hormones, vitamins, meds

Patient steps for peeing in a cup

1. Clean external genitalia 2. Collect midstream - Collect from catheter tubing and not from the bag

2 components of gross evaluation

Turbidity and Color

Orange urine can be from?

Medications; Large consumption of carrots

what type of container should be used for collecting a culture and sensitivity

Sterile container

Urine dipstick test components (10):

specific gravity; pH; protein; glucose; ketones; heme; leukocyte esterase; nitrite; bilirubin; urobilinogen

Diseases that would have hyposthenuria

Diabetes Insipidus | Glomerulonephritis

What are 3 indications for culture (after positive dipstick)?

1. Patient has atypical symptoms or complicated infection 2. Patient didn't respond to first abx 3. Symptoms reoccur within one month of last UTI

What type of cast is considered a normal finding

Hyaline casts

What type of crystal is the most common in kidney stones?

Calcium oxalate crystals

Uric acid crystal may correlate with?

Gout

Main cells found in urine sediment? (3)

- RBCs - WBCs - Epithelial cells (majority are squamous epithelial-->benign; renal epithelial cells-->tubular damage)

What 4 things does the microscopic exam of urine sediment examine?

Microorganisms Cells Casts Crystals

High glucose levels are seen with patients who have?

DM | Gestational diabetes

How are bilirubin results recorded

Negative 1+, small 2+, moderate 3+, large

Decreased levels of bicarbonate

Metabolic acidosis

This electrolyte regulates the total amount of water in the body

Sodium

Sodium is a ____ cation

Extracellular

Protein in the urine is usually in the form of?

Albumin

Increased levels of bicarbonate

Metabolic alkalosis

Protein in the urine often indicates?

Renal disease

The presence of nitrites in the urine indicates the presence of?

Bacteria

Ketonuria in DM patients suggests:

Inadequate blood sugar control

What fraction of ECFV is in interstitial fluid

3/4th-->interstitial fluid

What fraction of ECF is in plasma volume

1/4th-->plasma volume

What fraction of TBW is in intracellular fluid

2/3rd is in ICFV

What fraction of TBW is in the extracellular compartment

1/3rd is in ECFV

What is urobilinogen?

product from the breakdown of bilirubin in the intestine

What type of bilirubin is found in the urine if present?

Conjugated/direct bilirubin

3 functions of electrolytes

1. Water maintenance 2. pH balance 3. Neuromuscular control

What part of contrifuged blood is used in a CMP

Plasma portion

Is conjugated bilirubin water soluble or not?

Water soluble | *Unconjugated is not water soluble

Components in a CMP

Potassium; Chloride; Sodium; Glucose; Creatining; Blood Urea nitrogen; ALT; AST; ALP; Total bilirubin; Calcium; Bicarbonate; Total protein; Albumin

What are the 2 types of bilirubin?

Unconjugated/Indirect & Conjugated/Direct

A complete urinalysis includes:

1. Gross evaluation 2. dipstick 3. Microscopic Exam

pH range

4.6-8.0

Normal arterial pH

7.35-7.45