Quiz 2: CMP Flashcards
1
Q
What is the second most frequently used test?
A
CMP
2
Q
When you think CMP you should think:
A
renal function, liver function, side effects/toxicities
3
Q
What’s in a CMP?
A
Sodium, potassium, chloride, CO2, anion gap, glucose, BUN, creatinine, calcium, bilirubin, total protein, albumin, alkaline phosphatase, Aspartate aminotransferase (AST), alanine aminotransferase (ALT)
4
Q
What part of the CMP is used to monitor electrolyte function and abnormalities?
A
sodium, potassium, chloride, CO2, anion gap, calcium
5
Q
What part of the CMP is used to monitor renal function?
A
BUN and creatinine
6
Q
What part of the CMP is used to monitor liver function?
A
bilirubin, alkaline phosphatase, AST, ALT
7
Q
What part of the CMP is used to monitor proteins?
A
albumin, total protein
8
Q
What part of the CMP is used for diabetes monitoring?
A
Glucose level
9
Q
What are the two types of body fluid?
A
extracellular fluid (interstitial fluid, plasma) and intracellular fluid
10
Q
The ICF is predominately?
A
potassium
11
Q
The ECF is predominately?
A
Sodium
12
Q
What is the major determinate of ECF osmolality (tonicity)
A
Sodium
13
Q
How does the body maintain sodium homeostasis?
A
regulating water intake or excretion in the kidneys
14
Q
Where do we find sodium receptors?
A
carotids, kidneys, or hypothalamus
15
Q
How does sodium regulation occur?
A
multiple hormones, including aldosterone and naturietic hormone, but primarily anti-diuretic hormone (ADH)
16
Q
Where is ADH produced?
A
hypothalamus
17
Q
Where is ADH released?
A
pituitary
18
Q
What is another name for ADH?
A
vasopressin
19
Q
ADH functions to increase?
A
renal free water reabsorption
20
Q
When there is an increase in renal free water reabsorption via ADH, it results in?
A
less diuresis
21
Q
Diuresis =
A
making more urine
22
Q
What two inputs result in the release of ADH?
A
1) osmoreceptors detect increased osmotic pressure 2) baroreceptors detect decreased blood pressure
23
Q
What is the ultimate outcome of ADH release?
A
increased BP and increased blood volume
24
Q
Describe the path of sodium regulation beginning with plasma water increases:
A
1) plasma water increases 2) sodium and osmolality decreases 3) ADH secretion decreases 4) collecting renal tubule becomes impermeable to water so water is not reabsorbed
25
Decreasing ADH increases?
urination (diuresis)
26
Describe the path of sodium regulation beginning with plasma water decreases:
1) plasma water decreases 2) sodium and osmolality increases 3) ADH secretion increases 4) collecting renal tubule reabsorbs more water
27
Increasing ADH decrease?
diuresis
28
Hypernatremia occurs in?
unreplaced water loss
29
Who is susceptible to hypernatremia?
Elderly patients with impaired mental faculties and may have diminished thirst stimulation, patients not given free access to water, given hypertonic saline solutions
30
Is hyponatremia from decreased oral intake of sodium common?
No, but can result from inadequate sodium IV fluids, especially if those fluids given to patient with GI loss of sodium
31
What medication can cause hyponatremia?
Thiazide diuretics used in the treatment of hypertension
32
Name two thiazide diuretics?
hydrochlorothiazide, chlorthalidone
33
Aside from medications, what else can cause hyponatremia?
Renal insufficiency--impaired free water excretion, retention of ingested water
34
Where are potassium levels higher? intracellular concentrations or serum potassium?
Intracellular concentration
35
When you draw blood you are assessing what potassium level?
Serum potassium (much lower)
36
Potassium gradient across cells influences?
muscle and nerve excitability
37
Changes in serum potassium can have major effects on?
muscle contractility, especially cardiac muscles
38
What can falsely elevate lab potassium levels?
opening/closing hand during blood draw or hemolysis of specimen
39
Causes of increased potassium:
increased dietary or IV intake, ACE inhibitors (pril), crush injuries or infection
40
Causes of decreased potassium:
fluid and electrolyte loss, diuretics (hydrochlorothiazide, chlorthalidone), deficient dietary or IV intake
41
Glucose reading gives measurement of quantity of glucose in?
serum
42
What cells secrete insulin?
cells in the Islet of Langerhans in the pancreas
43
What increases glucose readings?
diabetes, acute stress response, pancreatitis, corticosteroid therapy
44
What decreases glucose readings?
Insulinoma, insulin overdose, starvation
45
What is the main filtering structure of the kidney?
glomerulus
46
Glomerular filtration rate:
number of milliliters of body fluid cleared by the kidneys per unit of time
47
BUN stands for?
blood urea nitrogen
48
Urea formation occurs primarily in the?
liver
49
Urea formation occurs as a result of?
catabolism of protein into amino acids, which forms free ammonia in the process
50
Ammonia molecules combine to form?
urea
51
Approximately x% of urea is reabsorbed in renal tubule and the rest is excreted in urine?
50%
52
BUN reflects the X and X?
metabolic functioning of the liver, excretory function of the kidneys
53
Increased BUN levels:
high protein diets, GI bleeding, dehydration
54
Decreased BUN levels
low protein diets, starvation, overhydration
55
Creatinine is byproduct of?
catabolism of creatine phosphate
56
Creatinine is filtered by?
glomerulus of kidney
57
Creatinine is secreted by the kidneys at what rate?
constant
58
Since creatinine is excreted entirely by the kidneys, it's not affected by
liver function
59
Which is more accurate at estimating kidney function: BUN or creatinine?
creatinine
60
Generally, creatinine levels are X in absence of disease and with stable muscle mass and consistent dietary intake
Constant
61
Production of creatinine is dependent on?
muscle mass
62
When does creatinine tend to increase in the process of renal disease? Why?
Increases in creatinine tend to occur later in renal disease because some of the creatinine secreted is secreted by the renal tubules (as much as 10-20%)
63
A doubling in serum creatinine generally reflects a x% decrease in GFR
50%
64
Diets high in X can increase serum creatinine
meat
65
Creatinine increase:
disorders of renal function, urinary tract obstruction, diabetic nephropathy, rhabdomyolysis, gigantism/acromegaly
66
Creatinine decrease:
debilitation, decreased muscle mass
67
Why does a urinary tract obstruction cause increased creatinine levels?
urine starts to backflow and damages kidneys over time.
68
What is rhabdomyolysis?
severe muscle breakdown which releases toxins, gets filtered through kidneys, damages them
69
Why does gigantism/acromegaly cause increased creatinine levels?
a lot more muscle mass
70
Why might creatinine look normally in an elderly patient with kidney damage?
Low muscle mass
71
Where is calcium more abundant? ICF or ECF?
ECF
72
Calcium is involved in? 4 things
muscle contraction, cardiac function, neural transmission, clotting cascade
73
Calcium exists in three forms:
protein-bound (mostly albumin, but also alpha, beta 1&2, gamma globin), complex (with phosphate, citrate, bicarbonate, sulfate), ionized (free calcium)
74
What % of protein is bound to protein?
40%
75
Calcium levels are regulated by?
Parathyroid hormone (PTH) and calcitonin
76
Where is PTH secreted from?
Parathyroid glands
77
Where are parathyroid glands located?
On the thyroid gland
78
Calcitonin is produced by?
thyroid gland
79
As calcium levels decrease, what happens to PTH?
PTH is released and calcium is reabsorbed by the kidneys, released from bone and absorption from GI tract increased
80
If calcium levels increase too much, what is released?
calcitonin
81
If patient has elevated calcium, it is recommended to?
order additional tests: ionized calcium, PTH, albumin levels
82
What is the second most common cause of hypercalcemia?
malignancy (bone metastasis, and cancer produces at PTH-like substance)
83
Ionized calcium is not impacted by?
albumin levels
84
Increased calcium:
hyperparathyroidism, vitamin D intoxication, tumors, acromegaly
85
Decreased calcium:
hypoparathyroidism, vitamin D deficiency, hypoalbuminemia, malabsorption
86
Vitamin D promotes
absorption of calcium
87
Bilirubin is formed by?
the breakdown of red blood cells
88
The breakdown of RBC occurs mostly in the?
spleen and reticuloendothelial system
89
When RBCs are broken down, they form:
heme + globin
90
Heme is catabolized and forms
biliverdin, which then becomes bilirubin
91
Unconjugated bilirubin becomes conjugated once in the ?
liver
92
Bilirubin becomes conjugated with x to become conjugated bilirubin
glycuronide
93
In order to determine the cause of the elevated bilirubin, we need to measure?
direct (conjugated) and indirect (unconjugated) bilirubin
94
Total bilirubin =
direct + indirect
95
If the defect occurs prior to conjugation with glycuronide, then
unconjugated hyperbilirubinemia results
96
Jaundice occurs when bilirubin levels are
too high
97
Jaundice can occur when total serum bilirubin exceeds?
2.5 mg/dL
98
Why do newborns experience jaundice?
their liver may not have adequate levels of conjugating enzymes so bilirubin remains unconjugated
99
Which bilirubin has the ability to pass through the blood-brain barrier?
unconjugated bilirubin
100
If unconjugated bilirbuin levels are too high, what can result?
mental retardation and encephalopathy
101
What level of bilirubin is critical?
>15 mg/dL
102
Causes of indirect (unconjugated) hyperbilirubinemia
hepatocellular dysfunction (hepatitis, cirrhosis, neonatal hyperbilirubinemia), any disease process that increases RBC destruction (transfusion reaction, sickle cell anemia, hemolytic anemia), many medications
103
Causes of direct (conjugated) hyperbilirubinemia
gallstones, obstruction of extrahepatic ducts by tumor or other cause, liver metastases (obstruction)
104
Unconjugated (indirect) bilirubin is normally what percent of total bilirubin?
70-85%
105
Conjugated (direct) bilirubin is normally what % of total bilirubin?
15-30%
106
If indirect bilirubin is greater than X% think liver injury, RBC hemolysis, medications:
85%
107
If direct bilirubin is greater than x% think obstructive cause:
50%
108
Serum protein reflects the:
synthesis and maintenance of the total amount of protein in the circulation
109
The main components of the serum protein are:
Albumin and globulins
110
What is the most abundant serum protein?
albumin
111
What percent of the serum protein is albumin?
60%
112
Globulins are composed of:
a1, a2, B, and y globulins
113
Almost all of the serum proteins are composed in the:
liver
114
In healthy kidney tissue, most filtered protein is:
reabsorbed by the renal tubules
115
In renal disease, the glomerulus becomes less able to filter proteins and overwhelms the ability of the renal tubules to reabsorb proteins, results in
loss of protein in urine
116
Patients with low serum protein should have?
a urinalysis to check for protein in the urine
117
Hyperproteinemia:
dehydration (increased concentration of proteins), malignancy (overproduction of immunoglobulins), infection (overproduction of immunoglobulins)
118
Hypoproteinemia:
hepatic failure or disease, malnutrition states, malabsorption states, renal failure or disease
119
Where is albumin synthesized?
liver
120
What are the functions of albumin?
important regulator of osmotic balance between intravascular and interstitial spaces (albumin "pulls" water into circulatory system), act as transporter for many things
121
Half life of albumin:
12-18 days
122
The long half life of albumin makes it a poor indicator of?
nutritional status (prealbumin is better), liver disease (won't manifest until later)
123
Disease that cause damage to the kidney result in what to albumin?
Increased albumin levels in urine, because it impairs kidney's ability to reabsorb albumin
124
Hyperalbuminemia:
dehydration
125
Hypoalbuminemia
malnutrition, pregnancy, hepatic disease/failure, renal damage
126
Life enzyme tests include:
ALP, AST, ALT
127
Liver function tests abnormalities can be caused by:
injury to hepatocytes from alcohol, fatty deposits in liver, viruses (such as hepatitis)
128
Alkaline phosphatase is essential for?
bone mineralization
129
Highest concentrations of alkaline phosphatase are found?
in liver, biliary tract, bone
130
Alkaline phosphatase functions better at what pH levels?
higher
131
Alkaline phosphatase plays an import role in detection of?
bone and liver disorders
132
ALP is present in what cells in the liver and biliary tract?
Kupffer cells
133
ALP is secreted into:
bile
134
ALP increases in: (liver)
cirrhosis, obstruction of the biliary tract, liver tumors, drugs that are toxic to liver
135
ALP decreases in: (liver)
malnutritional states
136
ALP is elevated in: (bones)
cancers that metastasize to the bone, primary cancer of the bone, post-fracture, hyperparathyroidism, growing children
137
AST is an enzyme found in:
highly metabolic tissue within the body, such as heart, liver, skeletal muscle
138
Cell inflammation, injury and death =
increased AST
139
AST elevated in:
liver disease, tumors involving liver, infectious mononucleosis, skeletal muscle disease or trauma
140
Elevation of the ALT points to the liver as the source instead of RBC hemolysis in the x patient?
Jaundiced
141
ALT is found primarily in the:
liver, but can be found in smaller amounts in other tissue
142
If liver damage occurs, then ALT is found?
in circulation
143
Is ALT or AST more specific for liver?
ALT (think LLLLLL for liver)
144
ALT increased in :
hepatitis (major increase), hepatotoxic drugs (moderate increase), cirrhosis (moderate increase), myositis (mild increase), MI (mild increase)
145
If AST or ALT are 3x normal think:
bad habits (obesity, alcohol), toxicity (tylenol), illness or injury to liver
146
AST: ALT ratio >1:
alcoholic cirrhosis (frequently >2), metastatic tumor of the liver
147
AST: ALT ratio <1:
viral hepatitis, mononucleosis
148
What is the basic metabolic panel?
includes 7 or 8 tests included in the CMP
149
What's special about BUN/Creatinine ratio?
Not included in CMP, but can be manually calculated
150
If both the BUN and Creatinine are normal is it necessary to calculate ratio?
nO
151
Azotemia:
increase in nitrogen containing compounds in blood
152
Pre-renal:
results from abnormalities in systemic circulation that decrease blood flow to the kidney (diabetes, ischemia)
153
Intra-renal
results from abnormalities within the kidneys themselves (PKD)
154
Post-renal
results from obstruction of collecting system of kidneys (kidney stone)
155
Pre-renal BUN/Cr ratio:
greater or equal to 20:1
156
Pre-renal conditions:
volume depletion of any cause (dehydration), sepsis, hypotension, CHF
157
Intrarenal BUN/Cr ratio:
less than or equal to 10:1
158
Intra-Renal conditions:
Any disease affecting the renal parenchyma, such as glomerulonephritis
159
Post-renal BUN/cr ratio:
Early: greater than or equal to 20:1
Late: less than or equal to 10:1
160
Post renal conditions:
urinary tract obstruction, nephrolithiasis, prostatic hyperplasia, metastatic disease
161
Why do is there a change in post-renal ratios depending on early/late?
If you have an obstruction, it's probably okay at first but then will result in backflow of urine damaging kidneys.
162
GGT =
Gamma-glutamyl transpeptidase
163
GGT is involved in:
amino acid transport
164
GGT is present in many tissues including,
kidneys, pancreas, liver, spleen, heart, brain, seminal vesicles
165
Why is a CMP-GGT test useful?
It's not expressed in bone, but ALP is. If ALP is elevated, order GGT test to further differentiate as liver and kidneys
166
Increased GGT
hepatitis, cirrhosis, alcoholic liver disease, liver cancer/metastasis
