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Clin LAB Med > L3: CMP and Electrolytes > Flashcards

L3: CMP and Electrolytes Flashcards

1
Q

Draw the fishbone for CMP.

A

Top row: Na+ | Cl- | BUN
Bottom row: K+ | HCO3- | creatinine
Fish tail: Glucose

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2
Q

What are the 2 pancreatic hormones that regulate glucose? When are they released?

A
  1. Insulin: released in response to high blood glucose

2. Glucagon: released in response to low blood glucose

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3
Q

Name 4 functions of the kidney.

A
  • Excrete metabolic wastes and substances
  • Regulate BP, volume, and electrolyte balances
  • Maintain acid-base balance
  • Secrete hormones
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4
Q

What is BUN? What does it measure?

A
  • Urea is a byproduct of liver metabolism and is excreted by the kidneys
  • BUN INDIRECTLY measures metabolic function of LIVER and excretory function of KIDNEY
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5
Q

How does severe primary liver disease affect BUN?

A

Decreases BUN

Secondarily decreases urea synthesis

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6
Q

How does primary renal disease affect BUN?

A

Increases BUN

Secondarily reduces urea excretion

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7
Q

Dehydration will cause ____ BUN levels.

A

Increased (causes BUN to become concentrated)

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8
Q

Overhydration will cause ____ BUN levels.

A

Decreased (dilutes BUN)

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9
Q

Upper GI bleed (UGIB) will cause _____ BUN levels. Why?

A

Increased

Blood overloads gut with protein

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10
Q

Low protein diets will cause _____ BUN levels.

A

Decreased

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11
Q

High protein diets will cause _____ BUN levels.

A

Increased

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12
Q

List 6 causes of hyperglycemia.

A
  • Diabetes
  • Gestational diabetes
  • IV Dextrose infusion
  • Drugs (steroids, etc.)
  • Stress (trauma, illness, infection, burnes, surgery, etc.)
  • Endocrine disorders (Cushing’s, Acromegaly)
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13
Q

List 3 causes of hypoglycemia.

A
  • Drugs (insulin)
  • Starvation
  • Endocrine disorders (Addison’s, Hypopituitarism)
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14
Q

Name endocrine disorders that would cause hyperglycemia and hypoglycemia (2 each)

A

Hyper: Cushing’s, Acromegaly
Hypo: Addison’s Disease, Hypopituitarism

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15
Q

Creatinine is excreted entirely by _____, and therefore is a _____.

A

The kidneys

Measurement of kidney function

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16
Q

Creatinine levels are an approximation of ____.

A

GFR

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17
Q

Describe the relationship between creatinine and GFR.

A

Inverse relationship

Ex: Doubling of Cr suggests 50% reduction in GFR

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18
Q

What are some factors that can cause a misleading creatinine level?

A

Serum levels influenced by:

  • Muscle mass
  • Protein intake
  • Certain drugs
  • Unstable, critically ill patients
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19
Q

A patient with AKI or chronic kidney disease will show _____ levels of Cr.

A

Increased

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20
Q

A debilitated patient will show _____ levels of Cr.

A

Decreased

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21
Q

A patient with Myasthenia Gravis or Muscular Dystrophy will show _____ levels of Cr.

A

Decreased

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22
Q

A patient with rhabdomyolysis will have _____ levels of Cr.

A

Increased

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23
Q

A dehydrated patient will show _____ levels of Cr.

A

Increased

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24
Q

What is the BUN/Cr ratio most helpful for determining?

A

Cause of AKI

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25
Q

What is a normal BUN/Cr ratio?

A

~10-20/1 (BUN = 10, Cr = 1)

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26
Q

A patient with a prerenal AKI will have a BUN/Cr ratio of:

A

> 20:1

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27
Q

A patient with an intrinsic AKI will have a BUN/Cr ratio of:

A

~10:1

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28
Q

A patient with a postrenal AKI will have a BUN/Cr ratio of:

A

Variable ratio

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29
Q

A prerenal AKI is due to an issue with _____. List 3 causes of this disease.

A

Perfusion

Causes:

  • Hypovolemia
  • CHF (kidneys not being perfused well due to ineffective pump)
  • Change in vascular resistance (stenosis of renal artery)
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30
Q

An intrinsic AKI is due to an issue with _____. List 3 causes of this disease.

A

Filtration

Causes:

  • Acute tubular necrosis (IV contrast)*
  • Prerenal AKI
  • Postrenal AKI
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31
Q

A postrenal AKI is due to an issue with _____. List 4 causes of this disease.

A

Excretion

Causes:

  • Ureteral stones
  • Bladder outlet obstruction (like bladder cancer)
  • BPH
  • Urethral stricture
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32
Q

Measurement of Cl levels in a CMP is useful for:

A

eval of electrolyte and acid-base disturbances

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33
Q

Hypochloremia and hyperchloremia rarely occur alone. What are these changes usually accompanied by?

A

Shifts in Na2+ and bicarbonate

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34
Q

CO2 levels are an indirect measurement of _____.

A

Bicarbonate (HCO3)

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35
Q

An acid-base disturbance will causes retention or excretion of ____.

A

Bicarbonate (HCO3)

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36
Q

What is the “equation” for total protein?

A

Total protein = Albumin + Globulin

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37
Q

List 6 conditions that fractionated total protein is used to diagnose, evaluate, and monitor.

A
  • Liver disease
  • Edematous states
  • Protein-losing conditions
  • Nutrition status
  • Immune disorders
  • Cancer
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38
Q

Where is albumin synthesized and what does an albumin measurement reflect?

A

Synthesized in the liver

Reflects synthetic liver function

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39
Q

What is the function of albumin in the body?

A
  • Maintains osmotic pressure (keeps fluid in the vascular space)
  • Transports hormones, enzymes, and drugs
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40
Q

A dehydrated patient will show _____ albumin levels.

A

Increased

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41
Q

Where is globulin synthesized and what is its function in the body?

A

Synthesized in bone marrow and lymph tissue

Globulin is building block for antibodies, acute-phase reactants, and transport

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42
Q

When albumin levels are low, what typically happens to globulin levels and why?

A

Globulin levels will be elevated to maintain normal total protein levels

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43
Q

List 6 causes of hypoalbuminemia.

A
  • Liver disease
  • Protein-losing enteropathies (Crohn’s or celiac disease)
  • Protein-losing nephropathies (nephrotic syndrome)
  • Burns
  • Malnutrition/malabsorption
  • Inflammatory diseases
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44
Q

Why can a patient with an inflammatory disease present with low albumin levels?

A

Inflammatory disease causes globulins to increase so albumin levels decrease

45
Q

A patient presents with normal total protein with low albumin and normal/increased globulin. Name 2 possible conditions that would cause this.

A
  • Chronic liver disease

- Collagen vascular disease (Lupus)

46
Q

A patient presents with an increased total protein with increased globulin fraction. Name a condition that might cause this.

A

Multiple Myeloma (remember M-spike and Bence-Jones proteins in urine)

47
Q

What labs would you expect to see (in regards to fractionation of total protein) in a patient with chronic liver disease?

A

Normal total protein with low albumin and normal/increased globulin

48
Q

What labs would you expect to see (in regards to fractionation of total protein) in a patient with multiple myeloma?

A

Increased total protein with increased globulin fraction

49
Q

Name the 4 liver tests in a CMP. Which 2 are transaminases?

A

AST *transaminase
ALT *transaminase
ALP
BILI

50
Q

What do the liver test detect?

A

Injury/disease of the hepatobiliary system

51
Q

Which 2 liver tests will be affected when there is injury to the hepatocytes? (Hepatocellular pattern)

A

AST and ALT

52
Q

Which 2 liver tests will be affected when there is injury to the bile ducts and/or bile flow?

A

ALP and total Bili

53
Q

Aspartate Aminotransferase (AST) is an enzyme found where? What happens to AST levels when there is injury/disease affecting these tissues?

A

Found in liver, cardiac muscle, skeletal muscle, kidney, and brain

Injury/disease = Increased AST into bloodstream

54
Q

Alanine Aminotransferase (ALT) is an enzyme found predominantly where? What happens to ALT levels when there is injury/disease affecting this tissue?

A

Liver (found in lesser quantities in kidneys, cardiac muscle, skeletal muscle

Injury/disease = Increased ALT into bloodstream

55
Q

Alkaline Phosphatase (ALP) is an enzyme found predominantly where? What is it excreted into?

A

Liver, biliary tract, and bone

Excreted into bile

56
Q

What happens to ALP levels when there is an obstruction of bile flow?

A

ALP increases

57
Q

What is the “equation” for total bilirubin (Bili)?

A

Total Bili = Unconjugated (indirect) + Conjugated (direct)

58
Q

What are the 4 steps of bilirubin traveling from the spleen to your poop (idk what this process is called lmao). Indicate if it is conjugated or unconjugated at each step.

A
  1. Hemolysis (unconjugated)
  2. Uptake (unconjugated bound to albumin)
  3. Conjugation (conjugated)
  4. Excretion (conjugated from biliary ducts into duodenum)
59
Q

Jaundice is caused by:

A

Abnormally high levels of bilirubin (can be caused by defect at any stage)

60
Q

Generally, AST and ALT > ALP reflects what kind of process?

A

Hepatocellular
***Serum bili may also be elevated!
(see slide 42 for DDx of elevated AST and ALT - too many)

61
Q

Generally, AST and ALT < ALP reflects what kind of process?

A

Cholestatic
***Serum bili may also be elevated!
(see slide 43 for DDx of elevated ALP)

62
Q

A patient presents with an isolated elevated ALP (all other tests normal). What should this raise suspicion for? What is the most common cause?

A

Raises suspicion for extrahepatic cause

-BONE is the most frequent extrahepatic source of ALP!

63
Q

What test can we use to distinguish between liver and bone isolated ALP levels?

A

ALP isoenzymes

64
Q

What are 3 causes of hyperbilirubinemia from UNCONJUGATED bilirubin?

A
  • Hemolysis
  • HF (impaired hepatic bilirubin uptake)
  • Gilbert syndrome (impaired bilirubin conjugation)
65
Q

What are 4 causes of hyperbilirubinemia from CONJUGATED bilirubin?

A
  • Hepatitis
  • Drugs/toxins
  • Liver infiltration (TB)
  • Biliary obstruction
66
Q

What roles does Ca2+ play in the body?

A
  • Neurotransmission
  • Cardiac function
  • Muscle contraction
  • Blood clotting
67
Q

There is an inverse relationship between calcium and _____.

A

Phosphorus

68
Q

What percentage of calcium exists in bone?

A

99%

69
Q

What is the distribution of ECF calcium?

A

Ionized (FREE): 50%
Complexed: 10%
Protein-bound (albumin): 40%

70
Q

Which form of calcium is physiologically active and unaffected by serum albumin levels?

A

Ionized calcium

71
Q

Which liver test is most specific to the liver?

A

ALT (more specific than AST)

72
Q

What form of calcium is the most accurate measurement of serum calcium?

A

Ionized calcium

73
Q

In regards to protein-bound Ca2+, when serum albumin is low then:

A

calcium level will also be low

albumin and calcium should be measured simultaneously

74
Q

What is complex calcium often chelated with?

A

Citrate (prevents clotting)

75
Q

What is the equation for corrected Ca?

A

Corrected Ca = Total serum Ca + 0.8 x (4.0 - serum albumin)

76
Q

What 5 things influence renal physiology?

A
  • PTH
  • Calcitonin
  • Vitamin D
  • GI
  • Kidneys
77
Q

State what happens to the parathyroid gland, bones, gut, and kidney when Ca2+ levels are low.

A

PTgland: Releases PTH which causes:
Bones: release Ca2+
Kidneys: Increase Ca2+ uptake and activate Vit D
Gut: Vit D + PTH cause increased Ca2+ uptake

78
Q

State what happens to the thyroid gland, bones, gut, and kidney when Ca2+ levels are high.

A

Thyroid gland: Releases calcitonin which causes:

Bones: Ca2+ deposition
Kidneys: reduced Ca2+ uptake
Gut: reduced Ca2+ uptake in intestines

79
Q

What are the 2 primary causes of hypercalcemia? (90% of cases)

A

Hyperparathyroidism (most common) and malignancy

80
Q

Why does hyperparathyroidism cause hypercalcemia?

A

Bone resorption (Ca released from bone into blood)

81
Q

Describe what happens neurologically/MSK with hypercalcemia.

A

DECREASED neuromuscular excitability:

  • Muscle weakness
  • Loss of muscle tone
  • Lethargy
  • Stupor
  • Coma
82
Q

Describe the cardiovascular effects of hypercalcemia.

A

-EKG abnormalities (SHORTENING OF QT INTERVAL)

83
Q

Describe the renal effects of hypercalcemia.

A
  • Polyuria,
  • Polydipsia
  • NEPHROLITHIASIS (kidney stones made of Ca)
84
Q

Describe the GI effects of hypercalcemia.

A
  • Anorexia
  • N/V
  • CONSTIPATION
85
Q

What is the most common cause of hypocalcemia?

A

Hypoalbuminemia

86
Q

List 5 other causes of hypocalcemia (aside from hypoalbuminemia)

A
  • Hypomagnesemia (Mg def. inhibits PTH and Ca is not mobilized)
  • Hypoparathyroidism
  • Parathyroidectomy
  • Renal failure
  • Intestinal malabsorption/Vit D def.
87
Q

What is a positive Chvostek’s sign and Trousseau’s sign indicative of?

A

Hypocalcemia

88
Q

Describe what happens neurologically/MSK with hypocalcemia.

A

INCREASED neuromuscular excitability (tetany)

  • Paresthesias (peri-oral, extremities)
  • Hyperactive reflexes; caropedal spasms
  • Chvostek’s sign
  • Trousseau’s sign
89
Q

Describe the cardiovascular effects of hypocalcemia.

A
  • PROLONGED QT interval

- Arrhythmia

90
Q

What are some symptoms of tetany (related to hypocalcemia)?

A
  • Paresthesias: Numbness and tingling of lips, fingers, or toes
  • Contractions of hands and feet (carpopedal spasms)
91
Q

What is Chvostek’s sign?

A
  • Tapping facial nerve against the bone just anterior to the ear
  • Positive sign: contraction of facial muscles
92
Q

What is Trousseau’s sign?

A
  • Occluding brachial artery for 3 minutes with BP cuff

- Positive sign: Induced carpal spasms

93
Q

What is the management for hypocalcemia?

A

Mild: Oral Ca +/- Vit. D. supplementation
Severe/Sx: IV Ca gluconate
-Correct hypomagnesia if low

94
Q

Where is dietary phosphorus absorbed? What is the most important regulator of serum phosphate levels?

A

Absorbed in small intestine

Regulated by kidney

95
Q

There is an inverse relationship between phosphorus and _____.

A

Calcium

96
Q

List 4 causes of hyperphosphatemia.

A
  • Renal failure
  • Hypoparathyroidism
  • Hypocalcemia
  • Exogenous phosphorus
97
Q

List 5 causes of hypophosphatemia.

A
  • Malnutrition/malabsorption
  • Hyperparathyroidism
  • Chronic alcoholism
  • Severe vomiting/diarrhea
  • Cellular shift (electrolytes driven into cells too quickly; seen with insulin and refeeding syndrome)
98
Q

What is the clinical presentation of hypophosphatemia?

A

Severe levels = <1.0 mg/dL

  • Muscle weakness
  • Rhabdomyolysis
  • Seizures
99
Q

What is the management for hyperphsphatemia?

A
  • Treat underlying cause
  • Exogenous phosphorus restrictions
  • Dietary phosphate binders
  • Dialysis
100
Q

What is the management for hypophosphatemia?

A
  • Treat underlying cause

- Phosphate repletion regimens as appropriate

101
Q

Mg is intimately tied to:

A

Ca and K

102
Q

How does hypomagnesemia lead to hypocalcemia?

A

Inhibits PTH activity

103
Q

How does hypomagnesemia lead to hypokalemia?

A

Impairs ability of kidney to conserve K

104
Q

List 2 causes of hypermagnesemia.

A
  • Renal insufficiency (not properly excreted)

- Large Mg load (ingestion of Mg containing meds)

105
Q

List 4 causes of hypomagnesemia.

A
  • Malnutrition/malabsorption
  • Severe diarrhea
  • Alcoholism
  • Cellular shift
106
Q

What are the symptoms of hypermagnesemia?

A

Decreased DTRs, bradycardia, hypotension

107
Q

What are the symptoms hypomagnesemia?

A

Neuromuscular excitability (tetany), cardiac arrhythmias (torsades de pointes)

108
Q

How do you manage hypermagnesemia?

A
  • Cessation of magnesium-containing meds
  • Isotonic fluids + loop diuretics
  • Dialysis
  • IV calcium
109
Q

How do you manage hypomagnesemia?

A
  • Asymptomatic: oral Mg
  • Symptomatic: IV Mg
  • Correct Ca and K deficiences as well

Clin LAB Med (4 decks)

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