Intro, Urine Studies, & CMP Flashcards
Presence of ketones could be from?
Metabolic abnormalities (DM, hyperthyroidism) Dietary conditions (vomiting, diarrhea, anorexia, high fat/low carb diet)
Increased levels of Magnesium can be found in:
acute/chronic renal failure dehydration hypothyroidism Addison's disease Magnesium supplementation
Alkaline urine seen in:
Chronic renal failure
Diseases that would have hypersthenuria
DM
dehydration
CHF
Decreased levels of Magnesium can be found in:
hypercalcemia; diabetic acidosis; hemodialysis; chronic pancreatitis; chronic cirrhosis; chronic glomerulonephritis
Calcium is important for:
neuromuscular activity
blood coagulation
bone metabolism
maintaining functional integrity of cell membranes
What are reasons for increased total bilirubin?
bile duct obstruction cirrhosis of the liver hepatitis infectious mono chemotherapy malignancy of the liver or gallbladder
A cause of this could be patients who are post dialysis
Hypokalemia
Increased levels of blood phosphorous levels are most commonly found:
In association with kidney dysfunction
Symptoms of hypermagnesium
Weakness Nausea/vomiting Impaired breathing Hypotension Arrhythmias
Symptoms of hypomagnesium
Tetany
Involuntary contraction of muscles
What type of cast can be found in patients who were exposed to a toxin or virus?
Epithelial casts
This most commonly occurs with hypervolemia caused from diseases of the liver and kidney, like cirrhosis and chronic kidney disease
Hyponatremia
Calcium oxalate crystals can indicate
chronic renal failure; or be from high doses of ascorbic acid/Vitamin C
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
A 24 hour urine collection useful when looking at patients is?
Electrolyte balance Acid-base balance Total protein excretion Metabolism Imbalance Hormonal imbalance
Too much or too little sodium in the body leads to?
Cell malfunction and possibly cell death
Hypernatremia causes:
sodium overload from ingestion
intravenous infusion
hyperaldosteronism
Acidic urine may be seen in:
Metabolic acidosis
Respiratory acidosis
UTI
People who are on diuretics can suffer from?
Hyponatremia
Most commonly caused by renal insufficiency, acute or chronic
Hyperkalemia
symptoms of liver damage include:
pale stools; dark urine; jaundice; swelling of the abdomen, ankles, and feet; excessive fatigue; bruising and easy bleeding
Hypercalcemia is associated with
Hypoparathyroidism
Malignancy (CA)
Vitamin D toxicity
3 types of crystals in patients with kidney stones?
Uric acid crystals
Crystine crystals
Calcium oxalate crystals
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
- Clean external genitalia
- 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)?
- Patient has atypical symptoms or complicated infection
- Patient didn’t respond to first abx
- 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
- Water maintenance
- pH balance
- 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:
- Gross evaluation
- dipstick
- Microscopic Exam
pH range
4.6-8.0
Normal arterial pH
7.35-7.45