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Med/Serg > Lab Values > Flashcards

Lab Values Flashcards

1
Q

What are the four groups of lab values?

A
  • Biochemistry
  • Haematology
  • Urinalysis
  • Arterial Blood Gas
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2
Q

Why is chem 7 performed and what does it measure?

A

-Evaluates kidney function, acid/base balance, blood sugar levels

  • BUN: 7 to 20 mg/dL
  • CO2 (carbon dioxide): 20 to 29 mmol/L
  • Creatinine: 0.8 to 1.4 mg/dL
  • Glucose: 64 to 128 mg/dL
  • Serum chloride: 101 to 111 mmol/L
  • Serum potassium: 3.7 to 5.2 mEq/L
  • Serum sodium: 136 to 144 mEq/L
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3
Q

Functions of sodium?

A
  • normal range: 136-145 mEq/L
  • main cation
  • helps transmit nerve impulses
  • maintains acid/base balance
  • osmotic pressure balance
  • fluid balance
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4
Q

What is hyponatremia?

A

-loss of Na+ or ↑H2O in body

common causes:

  • excessive H2O intake
  • Na+ depletion
  • loss of Na+ through urine
  • vomiting/diarrhea
  • gastric suctioning
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5
Q

What is hypernatremia?

A

-loss of fluids or excess NaCl intake

common causes:

  • dehydration
  • overuse of IV NS solution
  • impaired renal function
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6
Q

Chloride functions?

A
  • main anion in ECF
  • normal range: 98-107 mmol/L
  • maintains osmotic pressure
  • water balance
  • acid base balance
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7
Q

What is hypochloremia?

A

-↓d Cl- intake, ↓d absorption or ↑d Cl- losses

common causes:

  • vomiting
  • gastric suction
  • diarrhea
  • diuretic use

** Decrease in cl- = increase in Na

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8
Q

What is hyperchloremia?

A

-↑d Cl- intake, ↑d absorption or Cl- retention

common causes:

  • ↑d NaCl intake
  • dehydration
  • renal failure
  • use of certain drugs

**Increase in cl- + decrease in Na

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9
Q

Potassium functions?

A
  • main cation in ICF
  • normal = 3.5–5 mmol/L
  • cardiac/skeletal muscle contractions
  • transmit nerve impulses
  • maintain cell electrical neutrality/osmolarity

*changes in K+ can affect neuromuscular and cardiac functioning

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10
Q

What is Hypokalemia?

A

-loss of or poor intake of K+

common causes:

  • diuretics
  • inadequate K+ intake
  • large does of corticosteroids
  • aftermath of tissue destruction or high stress
  • associated with metabolic alkalosis
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11
Q

What is Hyperkalemia?

A

-↓ K+ excretion or high intake

common causes:

  • renal failure
  • too-rapid IV KCl infusion
  • initial reaction to massive tissue damage
  • associated with metabolic acidosis
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12
Q

Bicarbonate (HCO3-) functions?

A

anion in blood
normal = 22-29 mmol/L or mEq/L
-maintains acid/base & electrolyte balance

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13
Q

Base Deficit results in?

A 
-Metabolic Acidosis:
due to loss of HCO3-, ↑d Cl-, or ↑d production of acids
common causes:
renal failure
severe dehydration
diabetic acidosis

-Resp Alkalosis:
compensating for low PaCO2

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14
Q

Base excess results in?

A 
-Metabolic Alkalosis:
due to loss of H+, low K+, or low Cl-
common causes:
loss of gastric contents
↑d intake of HCO3-

-Resp Acidosis:
compensating for high PaCO2 in pt with chronic lung disease

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15
Q

Magnesium (Mg2+) functions?

A
  • main cation in ICF after K+
  • normal = 1.8-3.0 mg/dL or 0.8-1.2 mmol/L
  • promote enzyme reaction in cell during carbohydrate metabolism
  • DNA and protein synthesis
  • Influence vasodilaiton and irritability/contractibility of cardiac muscles
  • helps Na/K cross cell membrane
  • mainly excreted by kidneys
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16
Q

What is hypomagnesium?

A

-chronic problem with ↓d Mg2+ intake over time

common causes:

  • chronic malnutrition
  • diarrhea
  • diuretics
  • diabetes
  • refeeding syndrome
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17
Q

What is hypermagnesium?

A

↑d Mg2+ intake

common causes:

  • renal failure
  • IV MgSO4
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18
Q

Functions of glucose?

Levels influenced by?

A
  • energy source for most cells of body
  • levels influenced by insulin,glucagon, carb intake

-Fasting Plasma Glucose
normal = 70-99 mg/dL

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19
Q

What is hypoglycemia?

A

-in diabetics:
too much insulin or too high dose of po antidiabetic agents
too little food
↑d exercise without additional food intake

-in pregnancy:
during first 3 mos
during labour

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20
Q

What is hyperglycemia?

A

-most common cause = Diabetes Mellitus (persistently high)

other possible causes:
-glucocorticoids
stress (epinephrine)
conditions that cause abn pituitary gland functioning ⇒ secretion of growth hormone
pregnancy
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21
Q

What is creatinine?

A

-by-product of muscle contraction

normal:

men: 0.6-1.5 mg/dL
women: 0.6-1.1 mg/dL

  • excreted by
    decreased: may indicate muscle tissue atrophy
    increased: renal damage
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22
Q

What is urea nitrogen (BUN)

A

-Waste product of urea which is formed in the liver

normal = 8-25 mg/dL

  • decreased: overhydration, ↑ADH, liver failure
  • increased: diseased/damaged kidneys, decreased renal perfusion, severe dehydration, diet high in protein
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23
Q

Liver enzymes?

A
  • alkaline phosphatase (alk phos/ALP)
  • found in tissues of liver, bone, intestine, kidneys, & placenta

-alk phos found in liver excreted in bile
normal:
Men: 45-115 U/L
Women: 30-100 U/L

alanine aminotransferase (ALT)
aspartate aminotransferase (AST)
largest concentrations found in liver tissue
ALT normal:
Men: 10-55 U/L Women: 7-30 U/L
AST normal:
Men: 10-40 U/L Women: 9-25 U/L

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24
Q

Decreased ALP (liver enzyme)?

A
  • in adults: scurvy (very low level), malnutrition, excessive vitamin D intake
  • in pre-pubescent child: lack of normal bone formation, genetic defect
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25
Q

Increased ALP (liver enzyme)?

A
  • during pregnancy
  • in infants & children
  • in non-pregnant adult, indicates bone or liver abnormality

common causes:

  • Paget’s disease
  • metastatic CA to bone
  • liver dysfunction
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26
Q

ALT (liver enzyme)?

A
  • decreased: unlikely
  • elevated: indicates possible liver tissue necrosis or liver damage from drugs

common causes:

  • severe hepatitis
  • infectious mononucleosis

other possible causes:
-shock, Reye’s syndrome, CHF, preeclampsia

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27
Q

AST (liver enzyme)?

A
  • decreased: unlikely
  • increased: indicates possible liver necrosis

-common cause:
hepatitis

-other possible causes:
shock, trauma, cirrhosis, Reye’s syndrome, pulmonary infarction

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28
Q

Bilirubin?

A 
-normal (adult):
bili uncongugated (BU) or indirect = 0.1-1.0 mg/dL 
bili conjugated (BC) or direct = 0.0-0.4 mg/dL

Total bili = 0.1-1.0 mg/dL

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29
Q

increase or decrease of bilirubin?

A

-decreased: not of concern
BU
-increased: 2 possibilities
1. increased RBC hemolysis

-common causes: 
Sickle cell disease
autoimmune disease
hemorrhage
drug toxicity
transfusion reaction
Rh or ABO incompatibility in infant
  1. liver dysfuntion

-common causes:
cirrhosis
hepatitis
BC
increased: indicates obstruction of bile ducts
common causes: gallstones, tumour, scarring of bile ducts

30
Q

Amylase?

A

digestive enzyme: breaks down starch found in liver & pancreas

-decreased: kidney disease & pregnancy toxemia (pre-eclampsia)
-increased: indicates presence of condition affecting pancreas
common cause: pancreatitis

31
Q

Lipase?

A

digestive enzyme: metabolized by dietary fats

decreased: cystic fibrosis
increased: indicates presence of condition affecting pancreas
common causes: pancreatitis, pancreatitic duct obstruction, pancreatic CA

32
Q

Hameatology

A 
routine = Complete Blood Count (CBC)
components:
Hematocrit (Hct)
Red Blood Cells (RBC)
Hemoglobin (Hgb)
leukocyte or White Blood Cells (WBC)
Platelet count
Mean corpuscular volume (MCV)
Mean corpuscular Hemoglobin (MCH)
Mean corpuscular hemoglobin concentration (MCHC)
33
Q

Hematocrit (Hct)

A

useful if dehydration status of pt is normal

aka packed cell volume
% of RBCs in plasma
normal:
men: 37-49%
women: 36-46%
34
Q

Decreased hematocrit?

A
  • due to increase plasma volume or ↓ in RBCs

- common cause = massive blood loss

35
Q

Increased hematocrit?

A
  • due to any decrease in plasma volume

- common cause = dehydration

36
Q

RBC?

A 
count of no. of RBCs per cubic mm (mm3)
normal:
men: 4.5-5.3 x 106/mm3 
women: 4.1-5.1 x 106/mm3
erythropoietin stimulates production of RBCs
37
Q

Decreased RBC?

A 
can be due to:
abnormal erythrocyte loss
abnormal erythrocyte destruction
lack of essential elements/hormones for erythrocyte production
bone marrow suppression
38
Q

Increased RBC?

Polycythemia or Erthrocytosis

A

physiologic: move to high altitude or post ↑d physical training
primary: polycythemia vera
secondary: state of chronic hypoxia

*increase could be from COPD, would result in hypoxemia

39
Q

Hemoglobin (Hgb)?

A 
component of RBC
normal:
men: 13.0-18.0 g/100 mL
women: 12.0-16.0 g/100 mL
needed as part of assessment for anemia
40
Q

Decreased Hgb?

A

any condition that causes ↓ in RBC leads to ↓ in Hgb

-common causes:
blood loss
hemolytic anemia
bone marrow suppression

41
Q

Increased Hgb?

A

rare

42
Q

WBC?

A

-produced in: bone marrow and some mature lymph node

normal: 4 500 – 11 000/mm3
function:
helps to fight infection

43
Q

What is the cause of leukopenia?

A

bone marrow deficiency or failure
certain medications
disease of liver or spleen
radiation therapy or exposure

44
Q

What is the cause of leukocytosis?

A 
infection
inflammatory disease
anemia
bone marrow tumors
leukemia
45
Q

Function of platelets?

A
  • prevent bleeding
  • formed by bone marrow
  • removed by spleen
  • normal: 150 000 – 4500 000/mm3
46
Q

What is Thrombocytopenia? causes?

A

-idiopathic thrombocytopenic purpura=unknown cause of bruising

post viral infections, AIDS
systemic lupus erythematosus
some types of anemia or other hemolytic disorders
chemotherapeutic drugs or radiation
heparin
overactive or enlarged spleen
post autotransfusion or any type of extracorporeal bypass

47
Q

What are some causes of thrombocytosis?

A

malignant tumours or metastatic lesions
polycythemia vera
splenectomy

48
Q

What is PTT? (partial thromboplastin time)

A
  • detects presence of bleeding disorders, monitors effectiveness of heparin therapy
    range: normal: 22.1-34.1 s
49
Q

Decreased PTT?

A
  • not clinically significant

- normal in pregnancy

50
Q

Increased PTT?

A

bleeding disorder

common = hemophilia (hereditary disorder)

51
Q

Heparin therapy levels for PTT?

A
  • control: 25-37 s

- therapeutic: 1.5-2.3 times control

52
Q

What is PT/INR?

A
  • Prothrombin Time
  • prothrombin/factor II: protein produced in liver
  • International Normalized Ratio: comparison of animal thromboplastin to human source of thromboplastin
53
Q

Decreased PT/INR?

A

not clinically significant

54
Q

Increased PT/INR?

A

common:
advanced liver cirrhosis
bile duct obstruction

55
Q

PT/INR levels for Oral Anticoagulant Therapy?

A
  • control PT: 12-15 s
  • control INR: 1.0
  • therapeutic INR: 2.0-3.0
56
Q

What is Hemoglobin A1C?

A 
-Hgb A1 = glycosylated part of Hgb
monitors control of glucose level for past 2 – 3 months
reference values:
4-5.6%	without diabetes
5.7%		prediabetes
6.5%		diabetes
57
Q

What is urinalysis?

A

screening test of urine
result(s) may indicate need for further assessment

-colour:
normal: light yellow to dark amber
changes may be due to concentration, meds, foods, infection

58
Q

Character of Ua?

A

-normal: clear

changes may be due to presence of purulent matter, blood, bilirubin or protein

59
Q

Ph values for Ua?

A

-normal: 4.5-8.0
changes with food & metabolic state
lower (acidic): diet that includes meat & eggs
higher (alkaline): meatless diet, UTI

60
Q

what are specific gravity values?

A
  • part of fluid balance assessment
    normal: 1.015-1.025
    decreased: over hydration, diuretics
    increased: dehydration, ↑d secretion of ADH
61
Q

glucose in Ua?

A

-normal: negative

increased (glycosuria): hyperglycemia, ↓d renal threshold for glucose (present if it passes body’s threshold)

62
Q

ketones in urine?

A

-normal: negative
due to ↓d availability of glucose
causes: diabetes, starvation, vomiting, fasting or all protein diet

63
Q

Protein in urine?

A
  • normal: negative to trace
    causes: diabetes, renal dysfunction

*don’t test for protein if pt is stressed or there is a UTI infection present

64
Q

Nitrites in urine?

A

-normal: negative

presence may indicate UTI, but not always

65
Q

Leukocyte Esterase in urine?

A

normal: negative

presence may indicate UTI

66
Q

Leukocutes + nitrites in urine indicate what?

A

presence of UTI

67
Q

Blood gas?

A

-purpose: to monitor resp status or acid-base balance

-normals:
pH =7.35-7.45
PaCO2 = 35-45 mmHg
PaO2 = 80-100 mmHg
HCO3 = 22-25 mEq/L
68
Q

Ph values of blood gas?

A

is it 7.45?

then, alkalotic

69
Q

partial pressure of carbon dioxide values for blood gas?

A

look at PaCO2 :
is it abnormal?

if not, then go to step 3

if yes, did it go up or down?
if it went up or down, did pH seesaw with it?
if yes, then resp problem.

70
Q

Bicarbonate values for blood gas?

A

look at HCO3-:

is it abnormal?

if not, then not metabolic problem.

if yes, did it go up or down?

if it went up or down, did pH take same elevator?

if yes, then metabolic problem.

if no, then metabolic function compensating for resp problem.

71
Q

Partial pressure of 02 values for blood gas?

A

PaO2 interpreted directly
PaO2 70 to 80 mmHg = mild hypoxemia
PaO2 60 to 70 mmHg = moderate hypoxemia
PaO2 less than 60 mmHg = severe hypoxemia

Med/Serg (10 decks)

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