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Clinical Science > Quiz 2: CMP > Flashcards

Quiz 2: CMP Flashcards

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1
Q

What is the second most frequently used test?

A

CMP

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2
Q

When you think CMP you should think:

A

renal function, liver function, side effects/toxicities

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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)

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4
Q

What part of the CMP is used to monitor electrolyte function and abnormalities?

A

sodium, potassium, chloride, CO2, anion gap, calcium

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5
Q

What part of the CMP is used to monitor renal function?

A

BUN and creatinine

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6
Q

What part of the CMP is used to monitor liver function?

A

bilirubin, alkaline phosphatase, AST, ALT

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7
Q

What part of the CMP is used to monitor proteins?

A

albumin, total protein

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8
Q

What part of the CMP is used for diabetes monitoring?

A

Glucose level

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9
Q

What are the two types of body fluid?

A

extracellular fluid (interstitial fluid, plasma) and intracellular fluid

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10
Q

The ICF is predominately?

A

potassium

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11
Q

The ECF is predominately?

A

Sodium

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12
Q

What is the major determinate of ECF osmolality (tonicity)

A

Sodium

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13
Q

How does the body maintain sodium homeostasis?

A

regulating water intake or excretion in the kidneys

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14
Q

Where do we find sodium receptors?

A

carotids, kidneys, or hypothalamus

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15
Q

How does sodium regulation occur?

A

multiple hormones, including aldosterone and naturietic hormone, but primarily anti-diuretic hormone (ADH)

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16
Q

Where is ADH produced?

A

hypothalamus

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17
Q

Where is ADH released?

A

pituitary

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18
Q

What is another name for ADH?

A

vasopressin

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19
Q

ADH functions to increase?

A

renal free water reabsorption

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20
Q

When there is an increase in renal free water reabsorption via ADH, it results in?

A

less diuresis

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21
Q

Diuresis =

A

making more urine

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22
Q

What two inputs result in the release of ADH?

A

1) osmoreceptors detect increased osmotic pressure 2) baroreceptors detect decreased blood pressure

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23
Q

What is the ultimate outcome of ADH release?

A

increased BP and increased blood volume

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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

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25
Q

Decreasing ADH increases?

A

urination (diuresis)

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26
Q

Describe the path of sodium regulation beginning with plasma water decreases:

A

1) plasma water decreases 2) sodium and osmolality increases 3) ADH secretion increases 4) collecting renal tubule reabsorbs more water

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27
Q

Increasing ADH decrease?

A

diuresis

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28
Q

Hypernatremia occurs in?

A

unreplaced water loss

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29
Q

Who is susceptible to hypernatremia?

A

Elderly patients with impaired mental faculties and may have diminished thirst stimulation, patients not given free access to water, given hypertonic saline solutions

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30
Q

Is hyponatremia from decreased oral intake of sodium common?

A

No, but can result from inadequate sodium IV fluids, especially if those fluids given to patient with GI loss of sodium

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31
Q

What medication can cause hyponatremia?

A

Thiazide diuretics used in the treatment of hypertension

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32
Q

Name two thiazide diuretics?

A

hydrochlorothiazide, chlorthalidone

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33
Q

Aside from medications, what else can cause hyponatremia?

A

Renal insufficiency–impaired free water excretion, retention of ingested water

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34
Q

Where are potassium levels higher? intracellular concentrations or serum potassium?

A

Intracellular concentration

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35
Q

When you draw blood you are assessing what potassium level?

A

Serum potassium (much lower)

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36
Q

Potassium gradient across cells influences?

A

muscle and nerve excitability

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37
Q

Changes in serum potassium can have major effects on?

A

muscle contractility, especially cardiac muscles

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38
Q

What can falsely elevate lab potassium levels?

A

opening/closing hand during blood draw or hemolysis of specimen

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39
Q

Causes of increased potassium:

A

increased dietary or IV intake, ACE inhibitors (pril), crush injuries or infection

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40
Q

Causes of decreased potassium:

A

fluid and electrolyte loss, diuretics (hydrochlorothiazide, chlorthalidone), deficient dietary or IV intake

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41
Q

Glucose reading gives measurement of quantity of glucose in?

A

serum

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42
Q

What cells secrete insulin?

A

cells in the Islet of Langerhans in the pancreas

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43
Q

What increases glucose readings?

A

diabetes, acute stress response, pancreatitis, corticosteroid therapy

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44
Q

What decreases glucose readings?

A

Insulinoma, insulin overdose, starvation

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45
Q

What is the main filtering structure of the kidney?

A

glomerulus

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46
Q

Glomerular filtration rate:

A

number of milliliters of body fluid cleared by the kidneys per unit of time

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47
Q

BUN stands for?

A

blood urea nitrogen

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48
Q

Urea formation occurs primarily in the?

A

liver

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49
Q

Urea formation occurs as a result of?

A

catabolism of protein into amino acids, which forms free ammonia in the process

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50
Q

Ammonia molecules combine to form?

A

urea

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51
Q

Approximately x% of urea is reabsorbed in renal tubule and the rest is excreted in urine?

A

50%

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52
Q

BUN reflects the X and X?

A

metabolic functioning of the liver, excretory function of the kidneys

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53
Q

Increased BUN levels:

A

high protein diets, GI bleeding, dehydration

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54
Q

Decreased BUN levels

A

low protein diets, starvation, overhydration

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55
Q

Creatinine is byproduct of?

A

catabolism of creatine phosphate

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56
Q

Creatinine is filtered by?

A

glomerulus of kidney

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57
Q

Creatinine is secreted by the kidneys at what rate?

A

constant

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58
Q

Since creatinine is excreted entirely by the kidneys, it’s not affected by

A

liver function

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59
Q

Which is more accurate at estimating kidney function: BUN or creatinine?

A

creatinine

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60
Q

Generally, creatinine levels are X in absence of disease and with stable muscle mass and consistent dietary intake

A

Constant

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61
Q

Production of creatinine is dependent on?

A

muscle mass

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62
Q

When does creatinine tend to increase in the process of renal disease? Why?

A

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%)

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63
Q

A doubling in serum creatinine generally reflects a x% decrease in GFR

A

50%

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64
Q

Diets high in X can increase serum creatinine

A

meat

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65
Q

Creatinine increase:

A

disorders of renal function, urinary tract obstruction, diabetic nephropathy, rhabdomyolysis, gigantism/acromegaly

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66
Q

Creatinine decrease:

A

debilitation, decreased muscle mass

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67
Q

Why does a urinary tract obstruction cause increased creatinine levels?

A

urine starts to backflow and damages kidneys over time.

68
Q

What is rhabdomyolysis?

A

severe muscle breakdown which releases toxins, gets filtered through kidneys, damages them

69
Q

Why does gigantism/acromegaly cause increased creatinine levels?

A

a lot more muscle mass

70
Q

Why might creatinine look normally in an elderly patient with kidney damage?

A

Low muscle mass

71
Q

Where is calcium more abundant? ICF or ECF?

A

ECF

72
Q

Calcium is involved in? 4 things

A

muscle contraction, cardiac function, neural transmission, clotting cascade

73
Q

Calcium exists in three forms:

A

protein-bound (mostly albumin, but also alpha, beta 1&2, gamma globin), complex (with phosphate, citrate, bicarbonate, sulfate), ionized (free calcium)

74
Q

What % of protein is bound to protein?

A

40%

75
Q

Calcium levels are regulated by?

A

Parathyroid hormone (PTH) and calcitonin

76
Q

Where is PTH secreted from?

A

Parathyroid glands

77
Q

Where are parathyroid glands located?

A

On the thyroid gland

78
Q

Calcitonin is produced by?

A

thyroid gland

79
Q

As calcium levels decrease, what happens to PTH?

A

PTH is released and calcium is reabsorbed by the kidneys, released from bone and absorption from GI tract increased

80
Q

If calcium levels increase too much, what is released?

A

calcitonin

81
Q

If patient has elevated calcium, it is recommended to?

A

order additional tests: ionized calcium, PTH, albumin levels

82
Q

What is the second most common cause of hypercalcemia?

A

malignancy (bone metastasis, and cancer produces at PTH-like substance)

83
Q

Ionized calcium is not impacted by?

A

albumin levels

84
Q

Increased calcium:

A

hyperparathyroidism, vitamin D intoxication, tumors, acromegaly

85
Q

Decreased calcium:

A

hypoparathyroidism, vitamin D deficiency, hypoalbuminemia, malabsorption

86
Q

Vitamin D promotes

A

absorption of calcium

87
Q

Bilirubin is formed by?

A

the breakdown of red blood cells

88
Q

The breakdown of RBC occurs mostly in the?

A

spleen and reticuloendothelial system

89
Q

When RBCs are broken down, they form:

A

heme + globin

90
Q

Heme is catabolized and forms

A

biliverdin, which then becomes bilirubin

91
Q

Unconjugated bilirubin becomes conjugated once in the ?

A

liver

92
Q

Bilirubin becomes conjugated with x to become conjugated bilirubin

A

glycuronide

93
Q

In order to determine the cause of the elevated bilirubin, we need to measure?

A

direct (conjugated) and indirect (unconjugated) bilirubin

94
Q

Total bilirubin =

A

direct + indirect

95
Q

If the defect occurs prior to conjugation with glycuronide, then

A

unconjugated hyperbilirubinemia results

96
Q

Jaundice occurs when bilirubin levels are

A

too high

97
Q

Jaundice can occur when total serum bilirubin exceeds?

A

2.5 mg/dL

98
Q

Why do newborns experience jaundice?

A

their liver may not have adequate levels of conjugating enzymes so bilirubin remains unconjugated

99
Q

Which bilirubin has the ability to pass through the blood-brain barrier?

A

unconjugated bilirubin

100
Q

If unconjugated bilirbuin levels are too high, what can result?

A

mental retardation and encephalopathy

101
Q

What level of bilirubin is critical?

A

> 15 mg/dL

102
Q

Causes of indirect (unconjugated) hyperbilirubinemia

A

hepatocellular dysfunction (hepatitis, cirrhosis, neonatal hyperbilirubinemia), any disease process that increases RBC destruction (transfusion reaction, sickle cell anemia, hemolytic anemia), many medications

103
Q

Causes of direct (conjugated) hyperbilirubinemia

A

gallstones, obstruction of extrahepatic ducts by tumor or other cause, liver metastases (obstruction)

104
Q

Unconjugated (indirect) bilirubin is normally what percent of total bilirubin?

A

70-85%

105
Q

Conjugated (direct) bilirubin is normally what % of total bilirubin?

A

15-30%

106
Q

If indirect bilirubin is greater than X% think liver injury, RBC hemolysis, medications:

A

85%

107
Q

If direct bilirubin is greater than x% think obstructive cause:

A

50%

108
Q

Serum protein reflects the:

A

synthesis and maintenance of the total amount of protein in the circulation

109
Q

The main components of the serum protein are:

A

Albumin and globulins

110
Q

What is the most abundant serum protein?

A

albumin

111
Q

What percent of the serum protein is albumin?

A

60%

112
Q

Globulins are composed of:

A

a1, a2, B, and y globulins

113
Q

Almost all of the serum proteins are composed in the:

A

liver

114
Q

In healthy kidney tissue, most filtered protein is:

A

reabsorbed by the renal tubules

115
Q

In renal disease, the glomerulus becomes less able to filter proteins and overwhelms the ability of the renal tubules to reabsorb proteins, results in

A

loss of protein in urine

116
Q

Patients with low serum protein should have?

A

a urinalysis to check for protein in the urine

117
Q

Hyperproteinemia:

A

dehydration (increased concentration of proteins), malignancy (overproduction of immunoglobulins), infection (overproduction of immunoglobulins)

118
Q

Hypoproteinemia:

A

hepatic failure or disease, malnutrition states, malabsorption states, renal failure or disease

119
Q

Where is albumin synthesized?

A

liver

120
Q

What are the functions of albumin?

A

important regulator of osmotic balance between intravascular and interstitial spaces (albumin “pulls” water into circulatory system), act as transporter for many things

121
Q

Half life of albumin:

A

12-18 days

122
Q

The long half life of albumin makes it a poor indicator of?

A

nutritional status (prealbumin is better), liver disease (won’t manifest until later)

123
Q

Disease that cause damage to the kidney result in what to albumin?

A

Increased albumin levels in urine, because it impairs kidney’s ability to reabsorb albumin

124
Q

Hyperalbuminemia:

A

dehydration

125
Q

Hypoalbuminemia

A

malnutrition, pregnancy, hepatic disease/failure, renal damage

126
Q

Life enzyme tests include:

A

ALP, AST, ALT

127
Q

Liver function tests abnormalities can be caused by:

A

injury to hepatocytes from alcohol, fatty deposits in liver, viruses (such as hepatitis)

128
Q

Alkaline phosphatase is essential for?

A

bone mineralization

129
Q

Highest concentrations of alkaline phosphatase are found?

A

in liver, biliary tract, bone

130
Q

Alkaline phosphatase functions better at what pH levels?

A

higher

131
Q

Alkaline phosphatase plays an import role in detection of?

A

bone and liver disorders

132
Q

ALP is present in what cells in the liver and biliary tract?

A

Kupffer cells

133
Q

ALP is secreted into:

A

bile

134
Q

ALP increases in: (liver)

A

cirrhosis, obstruction of the biliary tract, liver tumors, drugs that are toxic to liver

135
Q

ALP decreases in: (liver)

A

malnutritional states

136
Q

ALP is elevated in: (bones)

A

cancers that metastasize to the bone, primary cancer of the bone, post-fracture, hyperparathyroidism, growing children

137
Q

AST is an enzyme found in:

A

highly metabolic tissue within the body, such as heart, liver, skeletal muscle

138
Q

Cell inflammation, injury and death =

A

increased AST

139
Q

AST elevated in:

A

liver disease, tumors involving liver, infectious mononucleosis, skeletal muscle disease or trauma

140
Q

Elevation of the ALT points to the liver as the source instead of RBC hemolysis in the x patient?

A

Jaundiced

141
Q

ALT is found primarily in the:

A

liver, but can be found in smaller amounts in other tissue

142
Q

If liver damage occurs, then ALT is found?

A

in circulation

143
Q

Is ALT or AST more specific for liver?

A

ALT (think LLLLLL for liver)

144
Q

ALT increased in :

A

hepatitis (major increase), hepatotoxic drugs (moderate increase), cirrhosis (moderate increase), myositis (mild increase), MI (mild increase)

145
Q

If AST or ALT are 3x normal think:

A

bad habits (obesity, alcohol), toxicity (tylenol), illness or injury to liver

146
Q

AST: ALT ratio >1:

A

alcoholic cirrhosis (frequently >2), metastatic tumor of the liver

147
Q

AST: ALT ratio <1:

A

viral hepatitis, mononucleosis

148
Q

What is the basic metabolic panel?

A

includes 7 or 8 tests included in the CMP

149
Q

What’s special about BUN/Creatinine ratio?

A

Not included in CMP, but can be manually calculated

150
Q

If both the BUN and Creatinine are normal is it necessary to calculate ratio?

A

nO

151
Q

Azotemia:

A

increase in nitrogen containing compounds in blood

152
Q

Pre-renal:

A

results from abnormalities in systemic circulation that decrease blood flow to the kidney (diabetes, ischemia)

153
Q

Intra-renal

A

results from abnormalities within the kidneys themselves (PKD)

154
Q

Post-renal

A

results from obstruction of collecting system of kidneys (kidney stone)

155
Q

Pre-renal BUN/Cr ratio:

A

greater or equal to 20:1

156
Q

Pre-renal conditions:

A

volume depletion of any cause (dehydration), sepsis, hypotension, CHF

157
Q

Intrarenal BUN/Cr ratio:

A

less than or equal to 10:1

158
Q

Intra-Renal conditions:

A

Any disease affecting the renal parenchyma, such as glomerulonephritis

159
Q

Post-renal BUN/cr ratio:

A

Early: greater than or equal to 20:1
Late: less than or equal to 10:1

160
Q

Post renal conditions:

A

urinary tract obstruction, nephrolithiasis, prostatic hyperplasia, metastatic disease

161
Q

Why do is there a change in post-renal ratios depending on early/late?

A

If you have an obstruction, it’s probably okay at first but then will result in backflow of urine damaging kidneys.

162
Q

GGT =

A

Gamma-glutamyl transpeptidase

163
Q

GGT is involved in:

A

amino acid transport

164
Q

GGT is present in many tissues including,

A

kidneys, pancreas, liver, spleen, heart, brain, seminal vesicles

165
Q

Why is a CMP-GGT test useful?

A

It’s not expressed in bone, but ALP is. If ALP is elevated, order GGT test to further differentiate as liver and kidneys

166
Q

Increased GGT

A

hepatitis, cirrhosis, alcoholic liver disease, liver cancer/metastasis

Clinical Science (7 decks)

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