lab values Flashcards by J Pint

Normal Ionized calcium levels

4.5 to 5.5 mg/dL

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Normal phosphorus leve

2.8 to 4.5mg/dL

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normal magnesium

1.3 to 2.2mEq/dL

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Most cases of hypermagnesium are due to..

other cuases inclued

Mg greater than 2.2mEq/L are iatrogenic causes

DKA, Theophylline poison, kidney failure

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signs and symptoms of hyperMagnesemia include

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

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

prolonged QT, QRS, PR

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Treatment for hypermagnesemia

normal saline for renal excreation
calcium gluconate,
dialysis,

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Hypomagnesemia most common cause is

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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drugs that cause hypomagnesemia include

aminoglycosides, cyclosporin

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Signs and symptoms of hypomagnesemia

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

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diagnostic signs of hypomagnesemia

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

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treatment of hypomagnesemia in patient with renal failre

slow and low administration of magnesium administration with frequent checks

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

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

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

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

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

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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normal Anion Gap is

10 (+or - 2) mEq

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normal HCO3 is

24(+or-) 2 mEq/L

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normal CL levels

97 to 107 mEq/L

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PCO2 normal levels are

40 (+or-5) mEq/L

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causes of metabolic acidosis

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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metabolic acidosis is characterized by

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

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metabolic alkalosis characterized by

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

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respiratory acidosis characterized by

elevation of pCO2 from hypoventalation

respiratory alkalosis characterized by

decrease pCO2 from hyperventilation

Diagnosis of acid base balance

``` 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 ```

proxima type 2 Rta caused by

impaired proximal tube absorption | serum k low

Distal type 1 RTA cause by

``` impaired H Secreation hypercalcium autoimmune renal disorder amphotericin B ```

Distal Type 4 RTA (hyperkalemia) cause by

``` low aldosterone diabetes nSAIDS bblockers cyclosporin ```

treatment of metabolic acidosis ketoacidosis

treated the cause etoh, starvation, or dka

treatement of metabolic acidosis lactic acidosis

resove underlying cause | watch for rebound alkalosis

treatment of RTA type 1

oral HCO3

Can NaHCO3 be used to correct respiratory acidosis

NO | paradoxical worsens the ph and will increase the pCO2 causing hypercapnic situation

Gold standard for assessment of daily electrolyte excreation

24 hour urine collection

Explain fractional excretion

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

What is tonicity

osmolytes that are impermeable to cell membranes

what is essential in determining etiology of hyponatrememia

volume status and serum osmolality

hypotonic fluids can cause sodium to

decrease

low serum osmolality would be

<280 mOsm/kg

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

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

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

1) dehydration 2. diarrhea 3. vomiting

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

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

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

Edematous states 1. heart failure 2. liver disease 3. nephrotic syndrome 4. advanced kidney disease

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

1. hyper proteinemiea | 2. hyperlipidemia

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

1. hyperglycemia 2. mannitol 3. radiocontrast agents

most serious complication of hyponatremia

iatrogenic cerebral osmotic demyelination (central pontine myelonosis)

Treatment of Hyponatremia first step

limit free water intake, 1 to 1.5 L/day

Treatment of hypovolemic Hyponatremia

isotonic fluids

Treatment of hypovolemic cerebral salt wasting Hyponatremia

hypertonic solution and fludrocortisone

Treatment of hypervolemic Hyponatremia

diuretics, dialysis,

Treatment of euvolemic Hyponatremia

water restriction

Treatment of severe and symptomatic Hyponatremia

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

Treatment of severe and symptomatic acute Hyponatremia with neurologic manifestation

like exercise hyponatremia | 100ml 3% saline over 1min

Treatment of severe and symptomatic chronic Hyponatremia

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

Treatment of severe and symptomatic chronic Hyponatremia corrected too rapidly

DDAVP and iv dextrose 5%

when should patient with hypvolemic hyponatremia be refered

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

when should patient with hyponatremia be admitted

sign and symptoms of severe hyponatremia