rapid labs interpretation Flashcards
Anion gap causes
GOLDMARK glycols oxoprolin D lactate L lactate methanol asa renal failure ketoacidosis; AKA;DKA;STARVATION
Tylenol and anion gap
- can happen in therapeutical range in sick patients
- tylenol converted to pyroglutamic acid / send out 5 oxoprolin level/
difference between D-lactate and L-lactate
D lactate - fermentation in large bowel by bacterias e.g. short bowel syndrome
clinically post carbohydrate confusion
L lactic acidosis two types
type A - lack of oxygen - sepsis
type B - impaired krebs or electron transfer system
19 y/o runner coming with confusion and lactic acid 9
NSAIDS toxicity blocking metabolism of glucose - electron transferring system shifting glucose to lactic acid
eg using a lot of gel
hyperemesis gravidarum and lactic acidosis
lack of thiamin;
glucose unable to enter kreb’s cycle
alcoholism and lactic acidosis
lack of thiamin
diabetic with severe lactic acidosis
metformin block electron transferring system
HIV and lactic acidosis
AZT block electronic transfer system
cancer and lactic acidosis
cancer can metabolized to lactic acid glucose
house fire and down with lactic acidosis
cyanide toxicity - block electron chain
CO never found down
b12 deficiency
MMA elevation
homocystein elevation
folic acid elevation
homocysteine elevation only
pancytopenia with indirect hyperbilirubinemia
MCV 120
hypersegmental PMN
LDH up
b12 deficiency
81 y/o nondrinker MCV 120 ANEMIC
ATROPHIC GASTRITIS TEST INTRINSTIC FACTOR AB PARIETAL CELL AB GASTRIN
Which medication is causing B12 deficiency?
metformin
Which GI disease is associated with B12 deficiency
Crohn’s
terminal ileum absorption of b12
34 y/o rash, fatigue, low ferritin, low b12, low vitamin d 25OH
celiac disease
anemia ddx
blood lost anemia
bone marrow failure
hemolysis
low reticulocyte count –> bone marrow issue
ddx 5 groups
b12 deficiency, b1, b6, folate, iron, malnutrition myelophthisis sideroblastic anemia erythropoetin low endocrinne
endocrine dx. causing bone marrow failure
hypogonadism
adrenal insufficiency
hypothyroidism
sideroblastic anemia
- findings on peripheral smear
- findings on bone marrow aspirate
bone marrow ringed sideroblast / iron deposition/
peripheral smear pappenheimer bodies
etiology of sideroblastic anemia
- MDS
- copper deficiency
- alcohol
- linezolid
elderly with sideroblastic anemia
MDS
overload of Zn / lubricant for denture/ compete with Copper absorption
primary bone marrow problem
- myelophthisis infiltration of bone marrow by cancer - prostate, breast infection TB autoimmune peripheral smear LEUKOERYTHROBLASTIC - red cell with the nucleus myelocytes TEARDROP RBC bone marrow fibrosis MDS pancytopenia or pure RBC aplasia
hemolysis two types
congenital
acquired
congenital hemolysis
hemoglobinopathies - SS, thalassemia
G6P deficiency
hereditary spherocytosis
acquired hemolysis
1. autoimmune hemolysis .2MAHA 3hypersplenism; liver damage 4infection 5PNH 6copper excess
acquired hemolytic anemia autoimmune hemolysis
warm AIHA
cold agglutinins
PCH paroxysmal cold hemoglobinuria
alloimmune - transfusions reactions
hemolytic anemia MAHA
Micro or macro hemolytic anemia
prosthetic valve
AVM
TMA - MAHA and trombocytopenia
infectious hemolytic anemia
babesiosis
malaria
bartonella
clostridium perfringens
spur cell anemia
acquired hemolytic anemia with hypersplenism or liver damage
excess of what is causing acquired hemolytic anemia
copper Willson
leucoerythroblastic peripheral smear
myelephthisis eg prostate cancer
warm AIHA
- extravascular - spleen sequestration
- COOMBs POSITIVE DAT+
- Ig G
- PNC
- infection
- spherocytes
cold agglutinin disease
- intravascular hemolysis / dark urine/
- COMBs + DAT
- infectious
- malignancy
- C3 could be mediated
- IgM
- false increased MCV
G6PD deficiency
Heinz bodies - special staining
bite cells
PNH
dx
check on RBC CD55, and CD59 flow cytometry
episodic intravascular hemolysis
Which medication can cause a classic warm autoimmune hemolytic anemia?
PNC
BITE CELLS PATHOGNOMIC
G6PD
Why G6PD level can be normal?
Sick cells are hemolysed and only healthy ones are there.
Add on smear bite cells
add on special staining for Heinz bodies
what are late findings in urine for intravascular hemolysis?
urine hemosiderin
PNH
lack of CD55, CD59 causing complement induced intravascular hemolysis
Treatment for PNH
C5 antibodies ECULIZUMAB
Red kayak flowing through the tiny river. The current is strong. He does break down.Another kayak hit the sandy boulder and break down. Mud is clogging pieces of sand and water is clearer. Adam feels weak and sees Willendbrand putting more glue into the water. He calls an excavator which is far so he used dynamite Later Adam put a mash to avoid floating rocks to break his kayak.
MAHA - micronangiohemolytic anemia
MAH and thrombocytopenia eg TTP
ADAMSTS3 breaks down vW factor thus blocking clotting. Autoantibodies against Adam can be eliminated by adding more adam
- FFP
-steroids dynamite
-plasmapheresis mash
The only way to find out is to check how many Adams kayaks.
Confused Adam kayaks and get burned by the sun.
Petechia and confusion -TTP.
Adam is drunk from gin and tonic. He kayaks in tiny river. It turns to tomato color without sunscreen.
Is this really Adam? Plex is Adam girlfriend.
Adam start to poop like crazy. What is his issue??
Adam has sex with Plex. She got pregnant and she becomes tomato. Plex is swollen like a balloon.
Drug-induced TMA.
ADAMS AB. NEGAT.
Supportive care but start PLEX before you know.
HUS causes TTP
Complement mediated TMA - AKI - HD unless treated early.
PORTOFINO DRIP
- PAIN - PHARMACY- PAIN KILLER
-DIARRHEA
-TIRED FROM FLIGHT
-LOST U TURN
-RED WINE - HANGOVER - WATER WITH SUGAR
- OLD HOUSE
Angie visited Portofino. She loves it. Her trip is spoiled by pains. She buys PAIN MEDICATIONS. She was just fine yesterday. She is weak and boyfriend is upset. Why do you have belly pain for years? She wants to be in bed only. She finally got to beach. Her skin is like bubble wrapper. She has to go to a doctor. Angie did you need to take U turn to come here.
Angie is poor and stay in old house from 1920s painted in pink.
Her pipi is red. OMG did I drink too much of Italian red wine?
Her pipi is red always. You can check it randomly
She wants her urine be while so she drinks water with sugar hoping to get stronger and have nice yellow pipi again.
She is surprise when pipi turn white after drinking pure red grape juice
AIP.
Acute intermittent porphyria. Weakness, neuropathic pain,
and hyponatremia.
Check random /spot/ urine Portobilinogen /porfobilinogen/. If oxidized urine is red.
D10/W infusion while waiting for hematin.
Andy Loeffler turns green and get chest pain. He felt strong till he get diarrhea and skin is like sandpaper. He travelled to Asia for a trip. Forgot water and drink from a stream.
Loeffler eosinophilic endocarditis cough dyspnea rash eosinophilia
ANDY GOES TO LAOS AFTER GOT HIS NEW KIDNEY.
Andy goes to 1.Laos. He eat fat dinner and 2 chest hurts him. Next day on a beach his pale skin became 3 black and he feels3 dizzy. He is 4sweating in the night and can not 5swallow his breakfast. He lost a lot of weight. He did drink a a 6water from farm. Andy had 6kidney transplant so finally can travel.
He has 7lumpy neck and developed diarrhea with blood.
Andy get anxious and can not breath and forgot his 8inhaler. He put his earphones on and relax with classical music - 8Strauss. Then he goes to pray to a 8churg. Oh my Got I can not even 8walk and can not breath. Finally he 3black out and woke up in hospital. He is fat and chest hurts and goes to cath lab. Then he is even greener. He looked like 9marble statue. His urine is like coca cola.
9He screams Fuck it I do have a lot of allergies and can not breath
- skin dark on the sun
- stomach in the evening after fat foot
-bad luck got cold and is sweaty and wheezy
-neck is lumpy skin is sweaty
-classic music
-sudden involuntary fuck
Eosinophilia ddx
- cancer - lymphoma, gi
- parasites - strongyloides check ABs if diarrhea and transplant
- tissue damage esophigitis
- CHURG- STRAUS disease, eosinophilia, granulomatous process lung, dyspnea, dark urine
- adrenal insuficiency - dark skin and hypotension
- Allergic bronchopulmonary Asperg-ilosis / asperger /
ALKATRAS YELLOW SKINNY, COUGHING PRISONER ESCAPED.
Alkatras fecal waste with a lot of urine has thick mash. Prisoners can not escape. If he goes through will be yellow. He found out huge wall blocking outlet. Later he sees part of the wall is pressing the narrow passage. He was sick and doctor recently gave him pill.
There is a low of shit on the ground with some stones on the ground. Finally exist has a huge boulder.
Yellow strips on his prisoner uniform are now whole yellow. He was in prison and lost weight. His cell was cold and he is coughing. He send encrypted massage as part of his histo- ry to a friend.
He is tired and itchy. He has lump in his neck hurting him despite of pills. He is yellow but catacomb looking straight.
He has belly pain and is yellow like a lemon and catacomb looks lumpy.
CHOLESTASIS
- sludge
- stone
- tumor - head of pancreas
- tumor of the ampulla
- sarcoid
- TB
- CHF right side
- crypto
- histo
- AMOX
- PSC primary sclerosing cholangitis - jaundice, abdominal pain, funny shaped duct, MRCP pearl shaped
- PBC primary biliary cirrhosis MRCP neg, biopsy
-
Fat movie star living hedonystic lifestyle sitting with his Budd on a chair.
Yellow fat movie star. He loves party with a lot of girls and drinks. Flying high is fun. He tries to go to mountain and drink orange healing water after big night out. I need to loose weight. Legs are like a balloon. Maybe my pains in the belly will help. He drinks hard and heart is skipping. His joints hurting him since being a yongster.
- alcohol
- hp B
- hp C
- NASH
- hemochromatosis
- amiodarone
- MTX
- RUQ pain Budd Chiary
- PSC
- PBC
