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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
H+ shifting with metabolic acidosis
extra H+ ions diffuse into cell to balance charges, K+ moves out K+ is elevated in plasma
26
metabolic alkalosis
**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
27
H+ shifting with metabolic alkalosis
decreased H+ H+ diffuses out of cell K+ moves into cell decreased K+ in plasma (hypokalemia)
28
Normal urine pH
herbivore= alkaline >7 carnivore= acidic <7 normally mimics metabolic acid/base status in serum (TCO2)
29
TCO2 and urine pH mismatch
can reflect **prior acid/base status** **paradoxical aciduria** artifacts: * urease producing bacteria (alkaline) * delayed urinalysis (alkaline)
30
TCO2 and urine pH mismatch
can reflect **prior acid/base status** **paradoxical aciduria** artifacts: * urease producing bacteria (alkaline) * delayed urinalysis (alkaline)
31
Diuresis
non pathologic increased urine production causes: * increased water consumption, * diuretic therapy * fluid or steroid admin
32
polyuria
pathologic increased urine production causes: * acute/chronic renal dz * diabetes mellitus * diabetes insipidus * chushings dz * pyometra
33
oliguria
decreased urine production (<1ml/kg/hr in hydrated animal) pathologic causes: dehydration, fever, acute renal failure, shock non pathologic: increased ambient temp, increased panting
34
anuria
urine production <2ml/kg/day causes: * obstructive dz * toxic nephrosis
35
pollakiuria
increased frequency of urination, decreased amounts but normal daily volume causes: * bladder inflam * bladder mass lesion * pregnancy * behavioral
36
artifacts due to delayed urinalysis
increased bacteria more alkaline cloudy (crystals fall out of soln)
37
colorless urine cause
very dilute urine
38
dark yellow urine cause
concentrated, bilirubinuria
39
red- brown urine cause
hematauria, hemaglobinuria, myoglobin, metHgb
40
green urine cause
bilirubin
41
cloudy urine causes
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
stong ammonia urine odor
consider bacterial UTI (bacteria split urea to ammonia)
43
acetone odor of urine
indicates ketones ketosis
44
urine specific gravity
high SG= reduced volume of urine being produced (conservation) low SG= increased volume (waste)
45
Dog/cat/LA specific gravity that shows sufficient kidney function
Canine: >1.030 Feline: >1.035 Large animals: >1.025
46
urine pH is affected by:
carnivores: acidic ruminants: alkaline post prandial alkaline tide: after eating carnivores = more alkaline age: older= more alkaline bacteria: more alkaline
47
acidic urine pH causes
Increased protein metabolism Metabolic or respiratory acidosis Paradoxical aciduria
48
alkaline urine pH causes
Low protein diet Metabolic/respiratory alkalosis Bacterial cystitis Prolonged storage at room temp
49
protein in urine
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
urine protein/creatinine ratio
< 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
glucose in urine
**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
ketones in urine
Uncontrolled **diabetes mellitus** Ovine **pregnancy** toxemia Bovine ketosis **Starvation**
53
urine hemoprotein
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
urine hemoprotein
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
urine bilirubin
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
urine sediment RBCs
57
urine sediment WBC
58
Calcium oxalate monohydrate (ethylene glycol, deadly)
59
Calcium carbonate incidental in horses
60
Calcium oxalate dihydrate incidental
61
Ammonia biurate liver failure
62
bilirubin cholestasis
63
Triple phosphate incidental
64
urine sediment casts
more than 2-3 per view (10x) tubular injury
65
Renal dz vs insufficiency vs failure
**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
azotemia
increases in blood urea and/or creatinine classification: (need specific gravity to differentiate) * pre renal * renal * post renal
67
uremia
increases in blood urea and/or creatinine + clinical signs of renal dysfunction…anorexia, vomiting, diarrheal etc
68
Isosthenuria
[urine sg] = [plasma sg] Sp. Gr. = **1.008-1.012** **Normal hydration**
69
Hyposthenuria
[urine sg] < [plasma sg] Sp. Gr. =**1.001-1.007** Working to excrete excess free water **Over-hydrated**
70
Hypersthenuria
[urine sg] > [plasma sg] Sp. Gr. **> 1.012** Working to conserve free water **Under-hydrated** Adequately vs inadequately
71
Glomerular Filtration Rate
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
increased urea causes
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
decreased urea causes
Diuresis / **increased plasma volume** **Decreased hepatic** function
74
increased/decreased creatinine
similar to urea but more specific for kidney Decreased GFR * **Dehydration**/hypovolemia (prerenal) * **Glomerular disease** (renal) * **Outflow obstruction** (postrenal) Decreased values: Diuresis
75
SDMA
Symmetric dimethylarginine: Methylated form of the amino acid arginine **Increases suggest impaired GFR** Detects as little as **25% loss of function**
76
prerenal azotemia
Decreased GFR Increased Cr and or urea **Adequate urine concentration** Causes: Any cause of **dehydration** / hypovolemia
77
renal azotemia
Decreased GFR Increased urea and or creatinine **Isosthenuria or inadequately concentrated urine** Indicates **> 75% loss of functioning nephrons** **Renal dysfunction/failure** (acute / chronic)
78
renal azotemia
Decreased GFR Increased urea and or creatinine **Isosthenuria or inadequately concentrated urine** Indicates **> 75% loss of functioning nephrons** **Renal dysfunction/failure** (acute / chronic)
79
renal azotemia
Decreased GFR Increased urea and or creatinine **Isosthenuria or inadequately concentrated urine** Indicates **> 75% loss of functioning nephrons** **Renal dysfunction/failure** (acute / chronic)
80
postrenal azotemia
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
early pre-azotemic renal insufficiency
**1/4 - 2/3 nephrons lost** Not azotemic Maybe increase Pr : Cr ratio **Increased SDMA** USPG can be adequality concentrated
82
later pre-azotemic renal insufficiency
**2/3 -3/4 nephrons lost** Not azotemic Maybe increase Pr : Cr ratio **Increased SDMA** **USPG can not be adequately concentrated**
83
cats renal failure differences
cats may develop azotemia before SPG goes up glomerulotubular imbalance looks like pre-renal azotemia
84
acute renal failure
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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