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Adult Health I > Rischer Chapter 6: Fluid and electrolyte content > Flashcards

Rischer Chapter 6: Fluid and electrolyte content Flashcards

1
Q 
Basic Metabolic Panel (BMP)/Chemistries
ALWAYS RELEVANT (5)
A
  1. sodium
  2. potassium
  3. glucose
  4. Creatinine
  5. Glomerular filtration rate (GFR)
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2
Q

Potassium

A
  1. 5-5.0 mEq/L
    - essential to normal cardiac electrical conduction
    - tends to deplete more quickly with loop diuretic usage than magnesium
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3
Q

Sodium

A

135-145 mEq/L

  • foundational fluid balance electrolyte
  • fluid volume deficit due to dehydration –> sodium elevated
  • fluid volume excess –> sodium low
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4
Q

Glucose

A

fasting: 70-110 mg/dL
- required fuel for metabolism
- elevated levels post-op can increase risk of infection/sepsis

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5
Q

Creatinine
and
Glomerular filtration rate (GFR)

A

creatinine: 0.6-1.2 mg/dL
GFR: >60 mL/minute
-gold standard for kidney function and adequacy of renal perfusion
-elevated creatinine can indicate damage to fragile capillary membrane screen of the glomerulus, allowing protein and glucose to pass through

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6
Q 
CBC 
ALWAYS RELEVANT (4)
A
  1. WBC
  2. Neutrophils
  3. Hemoglobin
  4. Platelet count
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7
Q

WBC

A

4500-11,000/mm^3

-correlated with the presence of inflammation or infections

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8
Q

Neutrophils

A

50-70%

  • correlated with the presence of inflammation or infections
  • most common leukocyte (first responder to any bacterial infection within several hours)
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9
Q

Hemoglobin

A
  • male: 13.5-17.5 g/dL
  • female: 12.0 -16.0 g/dL
  • determines anemia or acute/chronic blood loss
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10
Q

Platelet count

A

150-450 x 103/ microliter

  • relevant when there is concern for anemia or blood loss or patient is on heparin
  • watch for thrombocytopenia in heparin patients
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11
Q 
Cardiac 
ALWAYS RELEVANT (3)
A
  1. troponin
  2. CPK-MB
  3. BNP (B-natriuretic peptide)
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12
Q

troponin

A

<0.4 ng/mL

  • ordered to rule out MI
  • can take up to 6 hours after attack to elevate
  • labs always ordered every 6-8 hours x3
  • can be slightly elevated and positive in heart failure and unstable angina
  • patients with renal disease (usually CKD III-IV) are unable to clear troponin by kidneys and will have baseline low positive (track the trending for theses patients)
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13
Q

CPK-MB

A

<5%

  • specific iso-enzyme for cardiac muscle
  • confirms presence of MI
  • used to confirm troponin based MI diagnosis
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14
Q

BNP

A

<100 ng/L

  • neurohormone secreted by myocytes in the ventricles
  • compensates for overstressed ventricles by being a vasodilator and diuretic
  • elevated in heart failure
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15
Q 
Coagulation 
ALWAYS RELEVANT (1)
A
  1. PT/INR
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16
Q

PT/INR

A
  1. 9 - 1.1 nmol/L
    - therapeutic: 2-3 nmol/L
    - measures time for firm fibrin clot to form and measures clotting cascade
    - dependent on vitamin K synthesis from the liver
    - elevated in liver disease (unless on warfarin/Coumadin to achieve therapeutic goal of INR 2-3)
    - extremely important for patients on warfarin!
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17
Q 
Misc Chemistries 
ALWAYS RELEVANT (2)
A
  1. Magnesium

2. Lactate

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18
Q

Magnesium

A
  1. 6 -2.0 mEq/L
    - essential to normal cardiac electrical conduction
    - too high or low –> can predispose to rhythm changes
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19
Q

Lactate

A
  1. 5-2.2 mmol/L
    - trend with any shock state (especially sepsis)
    - elevated level –> higher likelihood of death
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20
Q

Basic Metabolic Panel (BMP)/Chemistries

SITUATIONAL (5)

A
  1. chloride
  2. CO2
  3. Anion Gap
  4. Calcium
  5. BUN
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21
Q

Chloride

A

95-105 mEq/L

-Relevant if NG suction or frequent vomiting is present

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22
Q

CO2

A

22-28 mEq/L

-actually reflecting the amount of bicarbonate (HCO3-)

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23
Q

Anion Gap (AG)

A

7-16 mEq/L

  • difference between primary measured cations (Na+ and K+) and primary measured anions (Cl- and HCO3-) in serum
  • relevant to acid base concerns typically seen in renal failure
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24
Q

Calcium

A
  1. 4-10.2 mg/dL
    - relevant with renal failure and ETOH abuse
    - Hypocalcemia can occur in the case of low albumin
    - Hypercalcemia can be seen with cancer
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25
BUN
7-25 mg/dl - relevant to renal failure (important to trend with creatinine) but can be elevated for other reasons - elevated with dehydration
26
Misc Chemistries | SITUATIONAL
1. Phosphorous 2. Ionized calcium 3. amylase 4. lipase 5. ammonia
27
Phosphorous
2. 5 -4.5 mg/dl - 85% stored in bone - primary intracellular anion - responsible for cellular metabolism and formation of bones and teeth - relevant to renal failure - will be increased due to decreased renal excretion
28
Ionized calcium
1. 05-1.46 mmol/L - Represents Ca++ that is metabolically avaliable compared to serum Ca++ that is more generalized - More accurate value for determining calcium
29
Amylase
25-125 U/l - digestive enzyme to break down complex carbs - primarily formed in pancreas - will leak into circulation with pancreatic inflammation - Relevant with pancreatitis/cholecystitis and obstruction of common bile duct
30
Lipase
3-73 units/L -Glycoprotein produced primarily in pancreas to break down fats -will leak into circulation with pancreatic inflammation Relevant with pancreatitis/cholecystitis and obstruction of common bile duct
31
Ammonia
20-100mcg/dL - comes from 2 sources 1. deamination of amino acids during protein metabolism 2. degradation of proteins by colon bacteria - liver converts ammonia in the portal blood to urea (excreted by kidneys) - High ammonia when liver function is impaired - potentially toxic to the CNS and causes confusion and altered mental status - contributing factor to hepatic encephalopathy in end-stage liver disease
32
CBC | SITUATIONAL
1. Hematocrit | 2. RBCs
33
Hematocrit
male 39-49% female 35-45% -elevation can confirm fluid volume deficit (will be elevated)
34
RBCs
male: 4.3-5.7 x10^8/microliter female: 3.8-5.1 x10^8/microliter - not as relevant as hemoglobin for anemia and blood loss
35
WBC Differential | SITUATIONAL
1. Band forms 2. Lymphoctyes 3. Monocytes 4. Eosinophils 5. Basophils
36
Band forms
3-5% - immature neutrophils - elevated in sepsis - >8 is a "shift to the left" = impending sepsis
37
Lymphocytes
23-33% | -relevant when there is known or suspected VIRAL infection
38
Monocytes
3-7% - phagocytes that are similar to neutrophils but less prevalent - not as relevant as neutrophils
39
Eosinophils
1-3% | -elevated with parasitic infection or allergic response
40
Basophils
0-1% - -phagocytes that are similar to neutrophils but less prevalent - not as relevant as neutrophils
41
``` Liver Panel (LFT) SITUATIONAL / RELEVANT when patient has GI or liver problem ```
1. albumin 2. total bilirubin 3. alkaline phosphatase 4. ALT 5. AST
42
Albumin
- 3.5-5.5 g/dL - Large colloid plasma protein made by the liver - low in malnutrition - can be contributing factor to ascites or edema
43
Total bilirubin
0. 1 - 1.0 // 0.0 -0.3 mg/dL - direct // indirect - broken down byproduct of heme protein in RBCs - Relevant to liver disease
44
Alkaline phosphate
male: 38-126 U/l female: 70-230 U/l - nonspecific hepatic iso-enzyme that has large concentration in liver - not as helpful as ALT and AST for primary liver disease
45
ALT
8-20 U/L - relevant with any primary liver disease - enzyme found in liver - released into circulation when liver cells are damaged - higher specificity to liver than AST
46
AST
8-20 U/L - relevant with any primary liver disease - enzyme found in liver - released into circulation when liver cells are damaged
47
Urinalysis | SITUATIONAL
1. color 2. clarity 3. specific gravity 4. protein 5. glucose 6. ketones 7. bilirubin 8. blood 9. nitrite 10. LET (leukocyte esterase)
48
Color
yellow - clear to pale yellow with aggressive diuresis - orange due to bilirubin in urine with liver disease - dark amber with dehydration or fluid volume deficit
49
Clarity
clear | -cloudy/containing sediment --> patient may have UTI
50
Specific gravity
1. 015 - 1.030 - measures kidney's ability to concentrate or dilute urine in relation to plasma - increased with dehydration - decreased with diuresis
51
Protein
negative - relevant when positive in any patient with renal disease - active young adolescent females can have higher protein in urine (1st void of day should be used)
52
Glucose
negative - relevant if diabetic - degree of presence in urine reflects poorly controlled diabetes - glucose should be filtered by glomerulus --> reflects kidney damage
53
Ketones
negative - ketones are formed from metabolism of fatty acids - most commonly seen in diabetic ketoacidosis (DKA) and dehydration
54
Bilirubin
negative | -may be positive with liver disease
55
Blood
negative | -will typically be positive if patient has UTI or renal calculi
56
Nitrite
negative - to rule out UTI (must be assessed with LET and WBC - nitrite by itself is not a predictable indicator of urinary infection) - positive indicates presence of gram-negative bacteria in urinary tract (ie e. coli)
57
LET (leukocyte esterase)
negative - enzyme that is present if WBCs are in the urine - to rule out UTI (must be assessed with nitrite and WBC - LET by itself is not a predictable indicator of urinary infection)
58
Urinalysis Micro | SITUATIONAL
1. RBC 2. WBC 3. Bacteria 4. Epithelia
59
RBC
<5 | -must be noted if UTI or renal calculi (correlates with severity)
60
WBC
<5 - GOLD STANDARD for UTI if patient is symptomatic - *many clinicians will even diagnose UTI at <5 if there are symptoms - amount indicates severity
61
bacteria
negative | -does not consistently correlate to presence of infection
62
Epithelial
negative | -skin cells are present (not particularly relevant?)
63
Cardiac | SITUATIONAL
1. CPK total
64
CPK total
male: 38-174 U/I female: 26-140 U/I - enzyme found in muscle fibers of body - used as a ratio to MB to identify if the ratio of CPK : (CPK - MB) is clinically significant and positive for a MI

Adult Health I (11 decks)

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