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test 2 > lab values > Flashcards

lab values Flashcards

1
Q

Normal Ionized calcium levels

A

4.5 to 5.5 mg/dL

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2
Q

Normal phosphorus leve

A

2.8 to 4.5mg/dL

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3
Q

normal magnesium

A

1.3 to 2.2mEq/dL

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4
Q

Most cases of hypermagnesium are due to..

other cuases inclued

A

Mg greater than 2.2mEq/L are iatrogenic causes

DKA, Theophylline poison, kidney failure

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5
Q

signs and symptoms of hyperMagnesemia include

A

weakness, fatigue, respiratory failure, cardiac failure, hypotension, tendor hyporeflexes

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6
Q

Mg levels of > 5-10 can cause what on ECG

A

prolonged QT, QRS, PR

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7
Q

Treatment for hypermagnesemia

A

normal saline for renal excreation
calcium gluconate,
dialysis,

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8
Q

Hypomagnesemia most common cause is

A 
Mg < 1.3mEq/L
commonly impaired digestion and 
proton pump inhibitors 
alcohol 
vomit/diarrhea
nasogastric aspiration
renal over excretion 
osmotic diuresis
resoving acute tubular necrosis 
loop diuretics
bartter and Gitleman syndrome
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9
Q

drugs that cause hypomagnesemia include

A

aminoglycosides, cyclosporin

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10
Q

Signs and symptoms of hypomagnesemia

A 
lethargy
confusion, tremor
fasciculations
ataxia
nystagmus,
tetany
seizures
arrhythmias ( especially with digoxin
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11
Q

diagnostic signs of hypomagnesemia

A

low K and Ca
urine magniesium excreation >24mg
ECG torsades de pointes**

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12
Q

treatment of hypomagnesemia in patient with renal failre

A

slow and low administration of magnesium administration with frequent checks

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13
Q

Treatment of asymptomatic mild hypomagnesemia (<1.3mEq/L), what to watch for»

A

240mg daily (MagOx 240mg, UroMg 84mg, SlowMg 64mg)
Watch for diarrhea and reflexes
Fluid shifts may be deceving

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14
Q

Treatment of asymptomatic severe hypomagnesemia (<1.3mEq/L), what to watch for»

A

720mg daily
watch for diarrhea, hyporeflexes
fluid shifts may be deceiving

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15
Q

Treatment of symptomatic severe hypomagnesemia (<1.3mEq/L), what to watch for»

A

1-2g Mg sulfate IV over 15minutes for 3-7 days maintain Mg level below 2.5mEq/L
watch for hyporeflexia
treatslow too fast leads to kidney excretion

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16
Q

normal Anion Gap is

A

10 (+or - 2) mEq

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17
Q

normal HCO3 is

A

24(+or-) 2 mEq/L

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18
Q

normal CL levels

A

97 to 107 mEq/L

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19
Q

PCO2 normal levels are

A

40 (+or-5) mEq/L

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20
Q

causes of metabolic acidosis

A 
ketoacids
methanol, ethylene glycol, salicylates
lactic acid (shock, drugs)
profound uremia
Non-gaP
diarrhea (nonrenal hco3 los)
renal bicarb los
decrease H secreation
hypoaldosteronism
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21
Q

metabolic acidosis is characterized by

A

decrease plasma HCO3 due to HCO3 loss or acucumlation of acid
eleveated AG mean metabolic acidosis

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22
Q

metabolic alkalosis characterized by

A

elevation in plasma HCO3 due to H+ loss or HCO3 gain

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23
Q

respiratory acidosis characterized by

A

elevation of pCO2 from hypoventalation

24
Q

respiratory alkalosis characterized by

A

decrease pCO2 from hyperventilation

25
Q

Diagnosis of acid base balance

A 
Step1: check arterial blood gas
step2; distinguish whether it was a change in PCO2 or HCO3 
Step3: determine in compensattion
step 4: determine anion gap
step 5: asses delta gap
26
Q

proxima type 2 Rta caused by

A

impaired proximal tube absorption

serum k low

27
Q

Distal type 1 RTA cause by

A 
impaired H Secreation
hypercalcium
autoimmune
renal disorder
amphotericin B
28
Q

Distal Type 4 RTA (hyperkalemia) cause by

A 
low aldosterone
diabetes
nSAIDS
bblockers
cyclosporin
29
Q

treatment of metabolic acidosis ketoacidosis

A

treated the cause etoh, starvation, or dka

30
Q

treatement of metabolic acidosis lactic acidosis

A

resove underlying cause

watch for rebound alkalosis

31
Q

treatment of RTA type 1

A

oral HCO3

32
Q

Can NaHCO3 be used to correct respiratory acidosis

A

NO

paradoxical worsens the ph and will increase the pCO2 causing hypercapnic situation

33
Q

Gold standard for assessment of daily electrolyte excreation

A

24 hour urine collection

34
Q

Explain fractional excretion

A

can be used in place of 24 hour urine collection for faster results
low fraction mean high avidity or electroly retention
high fraction mean low avidity or electrolyte wasting

35
Q

What is tonicity

A

osmolytes that are impermeable to cell membranes

36
Q

what is essential in determining etiology of hyponatrememia

A

volume status and serum osmolality

37
Q

hypotonic fluids can cause sodium to

A

decrease

38
Q

low serum osmolality would be

A

<280 mOsm/kg

39
Q

Hyponatremia with low serum osmolality (<280 mOsm/kg) with euvolemic volume status could be due to

A
  1. SIADH
  2. post operative hyponatremeia
  3. hypothyroidism
  4. . psychogenic polydipsism
  5. beer potomania
  6. idiosyncritic drug reactio
  7. endurance exercise
  8. adrenocorticotropin deficiency
40
Q

Hyponatremia with low serum osmolality (<280 mOsm/kg) with hypovolemic volume status and Uring Na of <10mEq/L (extrarenal loss) could be due to

A

1) dehydration
2. diarrhea
3. vomiting

41
Q

Hyponatremia with low serum osmolality (<280 mOsm/kg) with hypovolemic volume status and Uring Na of >20mEq/L (renal loss) could be due to

A
  1. diuretics
  2. ACE inhibitor
  3. Nephropatheis
  4. mineralocorticoid deficiency
  5. cerebral sodium wasting syndrome
42
Q

Hyponatremia with low serum osmolality (<280 mOsm/kg) with hypervolemic volume status could be due to

A

Edematous states

  1. heart failure
  2. liver disease
  3. nephrotic syndrome
  4. advanced kidney disease
43
Q

Hyponatremia with normal serum osmolality (280 to 295 mOsm/kg) could be due to

A
  1. hyper proteinemiea

2. hyperlipidemia

44
Q

Hyponatremia with high serum osmolality (<295 mOsm/kg) could be due to

A
  1. hyperglycemia
  2. mannitol
  3. radiocontrast agents
45
Q

most serious complication of hyponatremia

A

iatrogenic cerebral osmotic demyelination (central pontine myelonosis)

46
Q

Treatment of Hyponatremia first step

A

limit free water intake, 1 to 1.5 L/day

47
Q

Treatment of hypovolemic Hyponatremia

A

isotonic fluids

48
Q

Treatment of hypovolemic cerebral salt wasting Hyponatremia

A

hypertonic solution and fludrocortisone

49
Q

Treatment of hypervolemic Hyponatremia

A

diuretics, dialysis,

50
Q

Treatment of euvolemic Hyponatremia

A

water restriction

51
Q

Treatment of severe and symptomatic Hyponatremia

A

4-6 mEq/L
calculate sodium deifcite and give 3% saline
.25ml/kg/h

52
Q

Treatment of severe and symptomatic acute Hyponatremia with neurologic manifestation

A

like exercise hyponatremia

100ml 3% saline over 1min

53
Q

Treatment of severe and symptomatic chronic Hyponatremia

A

correction rates are low (like 6mEq/L over 24hr)

54
Q

Treatment of severe and symptomatic chronic Hyponatremia corrected too rapidly

A

DDAVP and iv dextrose 5%

55
Q

when should patient with hypvolemic hyponatremia be refered

A

servere symptomatic, refractory, or complicated hyponatremia,
aggressive therapy liek hypertonic sline demeclocycline, or vasopressin antagonist or dialysis mandate specialist
endstage liver or heart disease

56
Q

when should patient with hyponatremia be admitted

A

sign and symptoms of severe hyponatremia

test 2 (13 decks)

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