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DWT exam 3 > More clin path > Flashcards

More clin path Flashcards

1
Q

base

A

accepts proton
carbonate (HCO3-) = weak base

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2
Q

acid

A

donates proton
carbonic acid (H2CO3) = weak acid

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3
Q

Acidemia

A

Blood pH < 7.35
can be from acidosis

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4
Q

Alkalemia

A

Blood pH > 7.45
can be from alkalosis

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5
Q

normal blood pH

A

7.35 – 7.45

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6
Q

metabolic component of regulation of blood pH

A

Kidneys
* excrete H+
* retain HCO3-
* hours to days

blood buffers
* titrate H+
* seconds

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7
Q

respiratory of pH homeostasis

A

Lungs exhale CO2
minutes

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8
Q

bicarbonate buffer system

A

lungs and kidney manipulate H+
kidneys manipulate HCO3-
lungs manipulate CO2

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9
Q

blood gas pH testing gives info on:

A

give info on:
metabolic: pH and bicarb (HCO3-)
respiratory: pH, partial pressure of CO2 (pCO2)

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10
Q

biochemistry acid base testing

A

gives you metabolic indicators
* Total Carbon Dioxide (TCO2)
* Anion Gap (AG)
* Sodium vs. Chloride

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11
Q

urinalysis acid/base testing

A

metabolic indicators: urine pH

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12
Q

blood gas sample requirements

A

Heparinized whole blood
* Blood gas syringe
* Anaerobic

Rapid processing
must know Patient’s body temperature

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13
Q

“no fail” method to characterize acid-base status

A
  1. classify the pH (acidemia/alkalemia)
  2. classify the metabolic process (HCO3-)
  3. classify the respiratory process
  4. identify the primary process (match the -emia and -osis)
  5. identify the compesentory process (mismatch -emia and -osis)
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14
Q

respiratory acidosis

A

too much CO2
1. (-) Respiratory center
2. Upper airway obstruction
3. Pleural cavity disease
4. Respiratory muscles paralysis
5. Alveolar disease
6. Vascular disorders

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15
Q

Total CO2

A

Estimate of HCO3- (not pCO2)
Metabolic acid-base status

Increased TCO2 = metabolic alkalosis

Decreased TCO2 = metabolic acidosis
Causes:
1. Titration
2. Loss / secretional

TOTAL CO2 = HCO3- NOT pCO2

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16
Q

titrational metabolic acidosis

A

KLUE:
1. Ketones
2. lactate
3. uremic acids
4. ethylene glycol

increased anion gap

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17
Q

loss/secretional metabolic acidosis

A

loss of HCO3-
diarrhea
NOT increased anion gap

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18
Q

metabolic acidosis causes

A

increased total CO2
titrational: KLUE (ketones, lactate, uremic acid, ethylene glycol)
loss/secretional: loss of HCO3- (diarrhea)

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19
Q

calculating anion gap

A

UA + (HCO3 + Cl) = UC + (K + Na)
UA – UC = (Na + K) – (TCO2 + Cl)
AG = (Na + K) – (TCO2 + Cl)

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20
Q

increased anion gap

A

titrational metabolic acidosis
KLUE (ketones, lactate, uremic acid, ethylene glycol)
as anion gap goes up, bicarb (TCO2) goes down = titrational metabolic acidosis

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21
Q

Keto-acids

A

KLUE (titrational metabolic acidosis)
increases anion gap
Ketone bodies
* Acetone (waste)
* Acetoacetate (keto-acid)
* β-hydroxybutyrate

Fasting
* Adipose > Fatty acids > Liver > Ketone bodies
* Mobile lipid energy
* Muscle, Kidney

Definitions
* Ketosis
* Ketoacidosis
* Diabetic ketoacidosis

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22
Q

lactic acid

A

KLUE (titrational metabolic acidosis)
increases anion gap
Tissue hypoxia
* Aerobic to anaerobic metabolism
* Regenerate NAD for glycolysis

Lactic acidosis
* Ischemia
* Shock
* Severe anemia
* Cardiopulmonary failure
* Strenuous exercise
* Dehydration

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23
Q

Uremic acids

A

KLUE (titrational metabolic acidosis)
increases anion gap
Failure to excrete acids
* Phosphates
* Sulfates
* Citrate

Uremic acidosis
* Decreased renal blood flow (dehydration)
* Decreased renal function
* Urinary tract obstruction/rupture

Definitions
* Azotemia (increased urea, creatinine)
* Uremia

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24
Q

ethylene glycol

A

KLUE (titrational metabolic acidosis)
increases anion gap
Antifreeze (Glycolic acid, Glyoxylic acid, Oxalic acid)
Calcium-oxalate complexes
* Acute renal failure
* Calcium-oxalate crystals (monohydrate)

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25
Q

H+ shifting with metabolic acidosis

A

extra H+ ions diffuse into cell
to balance charges, K+ moves out
K+ is elevated in plasma

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26
Q

metabolic alkalosis

A

TCO2 (HCO3-) increased
Cl- decreased
Anion gap = normal
Diseases/conditions:
* Stomach/Abomasum loss of HCl (vomiting, LDA, GDV)
* Primary respiratory acidosis -> (Met compensation)
* Hypokalemia
* HCO3- administration

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27
Q

H+ shifting with metabolic alkalosis

A

decreased H+
H+ diffuses out of cell
K+ moves into cell
decreased K+ in plasma (hypokalemia)

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28
Q

Normal urine pH

A

herbivore= alkaline >7
carnivore= acidic <7
normally mimics metabolic acid/base status in serum (TCO2)

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29
Q

TCO2 and urine pH mismatch

A

can reflect prior acid/base status
paradoxical aciduria

artifacts:
* urease producing bacteria (alkaline)
* delayed urinalysis (alkaline)

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30
Q

TCO2 and urine pH mismatch

A

can reflect prior acid/base status
paradoxical aciduria

artifacts:
* urease producing bacteria (alkaline)
* delayed urinalysis (alkaline)

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31
Q

Diuresis

A

non pathologic increased urine production
causes:
* increased water consumption,
* diuretic therapy
* fluid or steroid admin

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32
Q

polyuria

A

pathologic increased urine production
causes:
* acute/chronic renal dz
* diabetes mellitus
* diabetes insipidus
* chushings dz
* pyometra

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33
Q

oliguria

A

decreased urine production (<1ml/kg/hr in hydrated animal)
pathologic causes: dehydration, fever, acute renal failure, shock
non pathologic: increased ambient temp, increased panting

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34
Q

anuria

A

urine production <2ml/kg/day
causes:
* obstructive dz
* toxic nephrosis

35
Q

pollakiuria

A

increased frequency of urination, decreased amounts but normal daily volume
causes:
* bladder inflam
* bladder mass lesion
* pregnancy
* behavioral

36
Q

artifacts due to delayed urinalysis

A

increased bacteria
more alkaline
cloudy (crystals fall out of soln)

37
Q

colorless urine cause

A

very dilute urine

38
Q

dark yellow urine cause

A

concentrated, bilirubinuria

39
Q

red- brown urine cause

A

hematauria, hemaglobinuria, myoglobin, metHgb

40
Q

green urine cause

A

bilirubin

41
Q

cloudy urine causes

A

lots of causes- look at sediment
* Increased cells (RBC, WBC)
* Numerous crystals
* Bacteria
* Lipiduria (lipids often rise to the surface)
* Mucus (especially in horses)
* Semen
* Fecal contamination

42
Q

stong ammonia urine odor

A

consider bacterial UTI
(bacteria split urea to ammonia)

43
Q

acetone odor of urine

A

indicates ketones
ketosis

44
Q

urine specific gravity

A

high SG= reduced volume of urine being produced (conservation)
low SG= increased volume (waste)

45
Q

Dog/cat/LA specific gravity that shows sufficient kidney function

A

Canine: >1.030
Feline: >1.035
Large animals: >1.025

46
Q

urine pH is affected by:

A

carnivores: acidic
ruminants: alkaline
post prandial alkaline tide: after eating carnivores = more alkaline
age: older= more alkaline
bacteria: more alkaline

47
Q

acidic urine pH causes

A

Increased protein metabolism
Metabolic or respiratory acidosis
Paradoxical aciduria

48
Q

alkaline urine pH causes

A

Low protein diet
Metabolic/respiratory alkalosis
Bacterial cystitis
Prolonged storage at room temp

49
Q

protein in urine

A

Always interpret in light of specific gravity
Normal urine contains no protein
Trace protein can occur in very concentrated urine
Dipstick is qualitative
Many false positives
* Alkaline urine
* Increased contact time

Physiologic causes:
* Convulsions, excess muscular exertion
* Very high protein diet

Pathologic causes:
* Prerenal: Hgb, Mgb
* Renal: Glomerular disease, Tubular disease
* Post renal: Hemorrhage, Inflammation

50
Q

urine protein/creatinine ratio

A

< 0.2 normal in health
0.2 - 0.5 borderline
0.5 - 3.0 tubular disease (globulins)
> 3.0 glomerular disease (albumin)
NOT useful if
* Pyuria
* Hemorrhage
* Hemoglobin
* Myoglobin

51
Q

glucose in urine

A

Glucosuria + Hyperglycemia
* Diabetes mellitus (ketone +)
* Enterotoxemia
* Epinephrine or steroids

Glucosuria + normoglycemia
* Transient - epinephrine
* Persistent - tubular dysfunction

False Positives (peroxidases)
False Negatives (Vit C, tetracyclines)

52
Q

ketones in urine

A

Uncontrolled diabetes mellitus
Ovine pregnancy toxemia
Bovine ketosis
Starvation

53
Q

urine hemoprotein

A

Hematuria (intact RBCs)
* Red urine color clears on centrifugation

Hemoglobinuria:
* Red plasma color

Myoglobinuria:
* Normal plasma color

Hemoglobinuria & myoglobinuria
* Does not clear on centrifugation
* Very dilute urine may cause lysis of RBCs

54
Q

urine hemoprotein

A

Hematuria (intact RBCs)
* Red urine color clears on centrifugation

Hemoglobinuria:
* Red plasma color

Myoglobinuria:
* Normal plasma color

Hemoglobinuria & myoglobinuria
* Does not clear on centrifugation
* Very dilute urine may cause lysis of RBCs

55
Q

urine bilirubin

A

Positive:
* Male dogs (usually 1+)
* Hepatobiliary disease/cholestasis
* Urine color may cause false positive

False negative
* UV light (converts to biliverdin)
* Vitamin C (inhibits reaction)
* Aged samples (hydrolyzes to unconjugated)

56
Q

urine sediment RBCs

A
57
Q

urine sediment WBC

A
58
Q
A

Calcium oxalate monohydrate
(ethylene glycol, deadly)

59
Q
A

Calcium carbonate
incidental in horses

60
Q
A

Calcium oxalate dihydrate
incidental

61
Q
A

Ammonia biurate
liver failure

62
Q
A

bilirubin
cholestasis

63
Q
A

Triple phosphate
incidental

64
Q

urine sediment casts

A

more than 2-3 per view (10x)
tubular injury

65
Q

Renal dz vs insufficiency vs failure

A

Renal dz: something isnt right (not always failure)
renal insufficiency: reduction in renal function but not yet azotemia (loss of ~66% of nephrons)
* LOSE ABILITY TO CONCENTRATE URINE

renal failure: reduction in renal function leading to azotemia, loss/dysfunction of >75% nephrons

66
Q

azotemia

A

increases in blood urea and/or creatinine
classification: (need specific gravity to differentiate)
* pre renal
* renal
* post renal

67
Q

uremia

A

increases in blood urea and/or creatinine + clinical signs of renal dysfunction…anorexia, vomiting, diarrheal etc

68
Q

Isosthenuria

A

[urine sg] = [plasma sg]
Sp. Gr. = 1.008-1.012
Normal hydration

69
Q

Hyposthenuria

A

[urine sg] < [plasma sg]
Sp. Gr. =1.001-1.007
Working to excrete excess free water
Over-hydrated

70
Q

Hypersthenuria

A

[urine sg] > [plasma sg]
Sp. Gr. > 1.012
Working to conserve free water
Under-hydrated
Adequately vs inadequately

71
Q

Glomerular Filtration Rate

A

volume of plasma cleared of a specific substance per minute
best indicator of renal function
Actual measurement of GFR difficult
Estimated by: urea (BUN), creatinine, SDMA, SPG

72
Q

increased urea causes

A

Decreased GFR
* Dehydration/hypovolemia (prerenal)
* Glomerular disease (renal)
* Outflow obstruction (postrenal)

Increased protein digestion
* GI hemorrhage, high protein diets

Increased protein catabolism
* Fever, burns, corticosteroids, starvation

Must lose 75% of renal function before urea increases

73
Q

decreased urea causes

A

Diuresis / increased plasma volume
Decreased hepatic function

74
Q

increased/decreased creatinine

A

similar to urea but more specific for kidney
Decreased GFR
* Dehydration/hypovolemia (prerenal)
* Glomerular disease (renal)
* Outflow obstruction (postrenal)

Decreased values: Diuresis

75
Q

SDMA

A

Symmetric dimethylarginine: Methylated form of the amino acid arginine
Increases suggest impaired GFR
Detects as little as 25% loss of function

76
Q

prerenal azotemia

A

Decreased GFR
Increased Cr and or urea
Adequate urine concentration
Causes:
Any cause of dehydration / hypovolemia

77
Q

renal azotemia

A

Decreased GFR
Increased urea and or creatinine
Isosthenuria or inadequately concentrated urine
Indicates > 75% loss of functioning nephrons
Renal dysfunction/failure (acute / chronic)

78
Q

renal azotemia

A

Decreased GFR
Increased urea and or creatinine
Isosthenuria or inadequately concentrated urine
Indicates > 75% loss of functioning nephrons
Renal dysfunction/failure (acute / chronic)

79
Q

renal azotemia

A

Decreased GFR
Increased urea and or creatinine
Isosthenuria or inadequately concentrated urine
Indicates > 75% loss of functioning nephrons
Renal dysfunction/failure (acute / chronic)

80
Q

postrenal azotemia

A

Occurs due to obstruction of urine outflow> decreased GFR
Increased Urea and creatinine
Urine SG variable
Hematuria, casts and renal cells on sediment exam depending on lesion location or duration
Clinical signs of oliguria, anuria, straining to urinate
The classic accompanying electrolyte pattern:
↓Na, ↓Cl, ↑K, ↑P (urinary bladder rupture)

81
Q

early pre-azotemic renal insufficiency

A

1/4 - 2/3 nephrons lost
Not azotemic
Maybe increase Pr : Cr ratio
Increased SDMA
USPG can be adequality concentrated

82
Q

later pre-azotemic renal insufficiency

A

2/3 -3/4 nephrons lost
Not azotemic
Maybe increase Pr : Cr ratio
Increased SDMA
USPG can not be adequately concentrated

83
Q

cats renal failure differences

A

cats may develop azotemia before SPG goes up
glomerulotubular imbalance
looks like pre-renal azotemia

84
Q

acute renal failure

A

rapid (hours to days)
causes:
* nephrotoxin
* infectious dz
* ischemia/infarct
* UTI

urine volume: oliguric to anuric
prognosis: immediately life threatening but reversible
kidneys enlarged

DWT exam 3 (14 decks)

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