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Endocrine 1 > Lab Med - Endo Pancreas > Flashcards

Lab Med - Endo Pancreas Flashcards

1
Q

What is the purpose of the urine albumin-to-creatine ration (UACR)

A

Detect early kidney disease in those with diabetes or other risk factors such as HTN

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2
Q

What factors affect the results of UACR

A
  • Blood in the urine, UTI, vigorous exercise, other acute illness may cause false positive (not related to kidney disease)
  • Infection, fever, CHF, marked hyperglycemia, and marked HTN can all increase albumin levels
  • Repeat testing after conditions have resolved
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3
Q

What is normal UACR range

A

0-30 mg/g albumin excretion/day

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4
Q

What is abnormal UACR range

A

UACR > 30 mg/g

*marker for CKD

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5
Q

Explain the results of UACR

A
  • Moderately increased albumin levels in initial and repeat tests indicate person likely to have early kidney disease
  • Very high levels indicate kidney disease is present in a more severe form
  • Undetectable levels are an indication kidney function is normal
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6
Q

Purpose of A1C

A
  • Screen or dx diabetes or prediabetes in an adult

- Monitor response to therapy

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7
Q

What does A1C test?

A
  • Percent of glycated hemoglobin in the blood
  • Glycated hemoglobin is hemoglobin to which glucose is bound. It is increased with poorly controlled DM. Glucose stays attached to hemoglobin for the life of the red blood cell – level of glycosylated hb reflects average blood glucose level over the past 3 months
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8
Q

When to order A1C

A
  • Screening adults at risk for DM or preDM
  • Pt presents with sx of hyperglycemia
  • All adults >45 yo
  • Monitor response to therapy
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9
Q

A1C range for

  • non-DM
  • pre-DM
  • DM
A
  • Non-diabetic <5.7%
  • Prediabetes 5.7-6.4%
  • Diabetes >6.5%
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10
Q

What factors affect A1C results?

A
  • Hemoglobinopathies
  • Abnl hemoglobin turnover rate (sickle cell, hemolytic anemia)
  • Conditions associated with increased cell turnover (pregnancy)
  • Hemodialysis
  • Recent blood loss or transfusion
  • Erythropoietin therapy
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11
Q

What is purpose of oral glucose test?

A
  • To screen for or diagnose DM or preDM

- Screen for gestational DM during pregnancy

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12
Q

When order an OGTT

A
  • 24-28 weeks gestation

- If screening for DM or pre-DM and fasting plasma glucose and A1c are not available or produce equivocal results

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13
Q

Patient test prep for OGTT

A
  • Pt should be active and eat a regular diet that includes at least 150 g of CHO daily for 3 days prior to the test
  • Fast 8-14 hours prior to test
  • Discontinue any nonessential meds that affect glucose metabolism min 3 days before test
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14
Q

Describe the 2-step 2-hour OGTT for gestational diabetes

A
  1. First, perform the glucose challenge test as a screen
    • 50 g glucose drink, measure blood glucose in 1 hour
  2. If abnl, then perform 3 hour oral glucose tolerance test
    • Msr fasting glucose then drink 100 g glucose
    • Measure glucose at 1 hr, 2 hr, 3 hr
    • If 2 or more of the measurements (fasting, 1, 2, 3 hr) are abnl, dx of gestational DM
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15
Q

What is patient prep for c-peptide test

A

14-16 hour fast to get basal level

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16
Q

What does c-peptide test?

A
  • When insulin’s precursor molecule, proinsulin, is cleaved to make insulin, C-peptide is formed as a byproduct
  • Insulin and c-peptide as secreted in equimolar amounts and released into circulation via the portal vein
17
Q

Explain the c-peptide results

A
  • Elevated levels of c-protein indicate insulin resistance
  • Levels in the normal range in the face of hyperglycemia indicate a dysfunctional insulin release that cannot keep blood glucose in physiologic range
  • Expect to see levels at the low end of normal or less than normal in early DMI
18
Q

Normal osmolality range for people < 61 yo

A

275 – 295 mOsm/kg

19
Q

What lab findings might be found in a person who is dehydrated and has hyperglycemia?

A

high serum osmolality

20
Q

Three ketone bodies

A
  • acetone
  • acetoacetate
  • beta-hydroxybutyrate
21
Q

Why are ketones produced?

A
  • Ketones are produced by the body as an alternative to glucose
  • When the body has too little insulin, cells cannot take in enough glucose from the blood. To compensate, the body will break down fat to produce ketones (ketosis)
22
Q

When should ketones be ordered or patient advised to check for ketones

A
  1. Screen for, detect, and monitor DKA
    • Beta-hydroxybutyrate is the predominant ketone in severe DKA
    • Pts with DM are at higher risk for DKA when pregnant or sick
  2. In pt without DM to detect ketoacidosis dt a non-DM cause such as excessive ingestion of alcohol
  3. Order when glucose levels remain above 250-300 mg/dL (can be done at home with a urine strip)
23
Q

What is creatinine and why is it a good surrogate marker for estimating GFR

A
  • Creatinine is the dehydrate product of creatine (once formed, cannot be turned back into creatine).
  • Creatinine is formed at a relatively constant rate in muscle, it is freely filtered through the glomerulus, not appreciably reabsorbed or secreted by the renal tubules
  • Serum concentration of creatinine represents a balance between production and glomerular filtration rate. Assuming the production rate is constant, the clearance of creatinine is a good surrogate for GFR which can’t be directly measured
24
Q

What must be monitored in pts taking metformin long-term

A

B12

25
Q

What is the usual reference range for serum potassium

A

3.5-5.1 mEq/L

26
Q

What meds increase serum potassium

A

ACE inhibitors

ARBs

27
Q

What meds decrease serum potassium

A

diuretics

28
Q

What is the impact of acidosis on serum K levels and total body K

A
  • In acidosis, the H ion moves intracellularly, displacing potassium, which moves into the blood. Once in the blood, the kidneys excrete the potassium.
  • If long term acidosis, can lose a sig portion of the body’s potassium
  • If a person is in DKA and has normal serum potassium, a major potassium loss has occurred
29
Q

What are the sources of ALT

A

Liver and kidney

30
Q

What are the sources of AST

A
  • Liver and heart mostly

- Also muscle, RBC, pancreas, kidney, brain

31
Q

Why are AST and ALT monitored in people with DM?

A

due to risk of NASH and NAFLD

32
Q

What is normal serum glucose range

A

70-99 mg/dL

33
Q

What is a fasting glucose

A

no caloric intake in 8 hours

34
Q

State the ranges for

  • hypoglycemia
  • normal bs
  • hyperglycemia
A
  • Hypoglycemic is <70 mg/dL
  • Normal is 70-99 mg/dL
  • Hyperglycemic is >99 mg/dL
35
Q

What is the purpose of using fructosamine

A
  • Evaluate DM control over a shorter time period (1-3 weeks) than A1C (8-12 weeks)
  • Index of longer-term control than glucose levels, especially in pts with DM and abnormal hemoglobin
36
Q

When should fructosamine be ordered

A
  • When can’t order A1C

- When need shorter term assessment of glycemic control

Endocrine 1 (18 decks)

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