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Clinical Medicine Master > Serum Chemistry (MR) > Flashcards

Serum Chemistry (MR) Flashcards

Clin Med Serum Chem Lectures

1
Q

Albumin is produced where? If it is low?

A

Liver. If low: Possibly impaired liver function

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2
Q

What are the 4 things on a Serum Chemistry that test Liver Function?

A

C-BAG: Cholesterol
BUN (not biliruben)
Albumin
Glucose

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3
Q

What do liver enzymes tell you about function?

A

Nothing

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4
Q

When I say Biliruben, you say?

A

Prehepatic, Hepatic, or Posthepatic

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5
Q

What causes hyperalbuminemia?

A

Dehydration

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6
Q

How do you calculate your globulins?

A

TP - Albumin

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7
Q

Big Ruleouts of Hypoalbuminemia? (9)

A 
Poor diet 
Diarrhea/PLE
Fever
Infection
Liver Dz
Burns
Vasculitis
Glomerulopathy/PLN
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8
Q

What type of enzyme is AST? AST is a marker for?

A

Mitochondrial Enzyme. Cellular Damage

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9
Q

Is AST specific for liver cellular damage?

A

NO

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10
Q

An elevation in AST is suggestive of? (4)

A

Liver damage Kidney Infection
Myocardial Infarction
Muscle Damage

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11
Q

Regarding ALT & AST what is the magnitude of increase required in dogs? Who is this NOT true for? Why?

A

2-3XC. Not true for ATS!

The t1/2 is very short in cats so if it does get high they pee it out

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12
Q

How small of a change in pH can start to kill things?

A

0.1

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13
Q

ALT is what type of enzyme?

A

Cytoplasmic Enzyme

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14
Q

What is ALT and indicator of?

A

Hepatocyte injury

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15
Q

How long post acute injury is AST at max level?

A

48 Hours

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16
Q

ALT t1/2 dogs?

A

3 days

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17
Q

ALT t1/2 cats?

A

6 hours

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18
Q

If you were to kick a dog in the liver which enzyme, ALT or AST would need a harder kick?

A

AST

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19
Q

Which of ALT & AST is more specific for liver damage? Why?

A

ALT, A lot of other tissues produce AST

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20
Q

Alkaline Phosphate is what type of enzyme? Where does it exist?

A

Membrane Bound, Bile Canicular Surface

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21
Q

What is alkaline phosphate (ALP) an indicator of?

A

Intra or Extrahepatic Cholestasis - backup of bile starts stretching out the bile canicular cells and membrane sticking off edge peels off and goes into blood

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22
Q

What elevations in ALP are concerning?

A

> 4X

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23
Q

ALP isoenzymes? (6)

A

Liver Bone
Pregnancy
Steroids (DOG) - endog or exog - can last weeks or months
Phenobarb

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24
Q

ALP t1/2?

A

Again, shorter in cats, any elevation is of concern

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25
Q

Who ALWAYS has elevated ALP? Why?

A

Puppies! Growing - Bone Isoenzymes

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26
Q

GGT is almost the same as what other enzyme? Difference in dogs?

A

ALP, dogs- Not as affected by steroids

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27
Q

GGT is what kind of enzyme? Where does it exist?

A

Membrane Bound, In Bile Duct Epithelium

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28
Q

If both GGT and ALP are elevated what is this suggestive of? What else is suggestive of this?

A

Hepatic Lipidosis. Also indicated by GGT normal with elevated ALP

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29
Q

Bilirubin: Prehepatic is?

A

Hemolytic Anemia

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30
Q

Bilirubin: Hepatic is?

A

Liver Dz or Injury

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31
Q

Bilirubin: Post Hepatic is?

A

Cholestasis

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32
Q

BUN/SUN is made where? Meaning?

A

Liver! Meaning it is a Liver Function Test!

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33
Q

What is a GI bleed considered?

A

A high protein meal!

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34
Q

BUN/SUN elevations are due to? (4)

A

High protein intake/GI bleed, Renal Dz,
Dehydration ,
Exercise

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35
Q

BUN/SUN decreases are due to? (4)

A

Poor diet/Restricted Diet, Malabsorption,
Liver Dz,
Diuresis

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36
Q

How much damage in kidney function is lost before Creatinine elevation?

A

75%

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37
Q

What is the earliest kidney function test?

A

USG @ 66%

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38
Q

Elevations in Creatinine can be due to? (5)

A

Renal Dz (75% loss), Muscle degeneration or damage,
Drugs,
Dehydration,
Greyhounds - slightly

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39
Q

Who has lower normal range for Creatinine levels?

A

Puppies

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40
Q

What must be elevated to qualify as Azotemia?

A

Elevated BUN and/OR Creatinine

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41
Q

What kind of blood work would you like to run?

A

CBC,Chem,

UA - if not then at least USG

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42
Q

I say Azotemia, you say?

A

Pre-renal Renal

Post-renal

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43
Q

What MUST you evaluate along with your BUN and/OR Creatinine or you are wasting your time!

A

USG

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44
Q

What is more important for renal function USG or Creatinine? Why?

A

USG, It happens first! (66% loss)

45
Q

What does the liver do with Glucose? Making it a?

A

Makes, Metabolizes, and
Stores it
. Making Glucose it a Liver Function Test

46
Q

Elevations in Glucose are caused by? (6)

A 
Diabetes Mellitus Pancreatitis
HYPERadrenocorticism
Steroids
Hypothyroid
Postprandial
47
Q

Decreases in Glucose are caused by? (6)

A 
Liver Dz Chronic Infections
Sepsis
Pyometra
Insulinoma
Hepatomas & other certain tumors
48
Q

Calcium is regulated by?

A

PTH Calcitonin
Vit D
GI absorption
Renal Function

49
Q

Which regulator of Calcium levels is the “BIGGEST GUN”?

A

PTH

50
Q

TQ! How do you determin whether Ca2+ leverls are actually abnormal?

A

Evaluate Ionized

51
Q

What are the 3 forms of Ca2+?

A

Ionized Bound

Complexed

52
Q

What percentage of Ca2+ is Ionized? Bound? Complexed?

A

50% - Ionized 40% - Bound 10% - Complexed

53
Q

What is the best representation of free calcium?

A

Ionized

54
Q

What is Bound Ca2+ bound to?

A

Albumin

55
Q

What is complexed with Ca2+?

A

Phosphate Citrate
Sulfate
Lactate
Bicarb

56
Q

Is it appropriate to correct Ca2+ for Albumin?

A

NO!

57
Q

Cx of HYPOcalcemia? (8)

A 
Increases in excitability - lowers threshold, Nervousness
Behavior Changes
Facial Itchiness
Muscle Cramping
Stiff Gait
Tetany
Seizures
58
Q

Cx of HYPERcalcemia?(5)

A

Inhibits neurons & Mm cells - Decreases excitability (lowers threshold). Mineralization of tissues
Weakness
Vomiting
Constipation

59
Q

Parathyroid glands respond to?

A

Low Serum Ca2+

60
Q

Where does PTH go? Where does it then send messengers to?

A

Kidney. Messengers to Bone

61
Q

What does the gut absorb to enable Ca2+ absorption?

A

Vit D

62
Q

How does the endrocrine system control itself?

A

Negative Feedback

63
Q

What turns off the production PTH?

A

Increasing serum Ca2+ levels

64
Q

Rule Out List for Hypercalcemia?

A 
G.O.S.H.D.A.R.N.I.T:  Granulomatous Dz
Osteopathy/Osteolytic Dz
Spurious - lab abnormality
Hyperparathyroidism
D Hypervitaminosis
Addisons
Renal Dz
Neoplasia
Idiopathic - Cats
Temperature - Cats when they get cold (weird)
65
Q

What are the neoplasms associated with Hypercalcemia?

A

Lymphosarcoma - THE MOST. Anal Sac Adenocarcinoma

Multiple Myeloma

66
Q

Rule Out List for HYPOcalcemia?

A 
H.E.R.P.E.S.:  Hypoparathyroidism
Eclampsia
Renal Dz
Pancreatitis/Phosphorous (Never give a cat a phosphate enema)
Ethylene glycol
Spurious
67
Q

Low PTH and Low Calcium probably has?

A

1º Hypoparathyroidism

68
Q

High PTH and Low Calcium probably has? Why?

A

2º Hyperparathyroidism. Due to Diet

Renal

69
Q

What kind of enema will you NEVER give to a Cat?

A

Phosphate Enema.

70
Q

If Calcium is High what should PTH levels be?

A

ZERO OFF NADA

71
Q

High Calcium and Low PTH?

A

Hypercalcemia of Malignancy, Lymphosarcoma,
Anal Saac Carcinoma,
Multiple Myeloma

72
Q

Why are the kidneys important for calcium? (2)

A

PTH goes to the Kidney and tells it to save calcium: Kidney activates Calcidiol (25 Hydroxy - Vit D3) -> Calcitriol (1,25 Dihydroxy Vit D3)

73
Q

What is the active form of Vit D?

A

Calcitriol (1,25 Dihydroxy Vit D3)

74
Q

If your calcium goes up what is it?

A

Cancer: Either Hyperparathyroidism or Hypercalcemia of Malignancy

75
Q

Why do you get increased Phosphorous?

A 
Decreased GFR Renal Failure - 85%
Growth
Diet
Ethylene Glycol
Hypoparathyroidism
Hemolysis
76
Q

How much kidney function must be lost to show increased serum phosphorus due to renal failure?

A

85%

77
Q

What is phosphorous important for with bone growth?

A

ATP

78
Q

Which differential for hypophoshatemia gives CRAZY hight levels?

A

Ethylene Glycol

79
Q

Differentials for Decreases in Phosphorus?

A

Hyperparathyroidism, Humoral Hypercalcemia of Malignancy (HHM),
Eclampsia

80
Q

What is the Principal INTRAcellular Cation?

A

K+

81
Q

Differentials for Elevated Potassium?

A 
Renal Dz Hemolysis
Acidosis
Hypoadrenocorticism
Iatrogenic
DM (acidosis or lack of insulin)
82
Q

Which cation is more tightly regulated H+ or K+?

A

H+

83
Q

What is the principal EXTRAcellular Cation?

A

Na+

84
Q

Differentials for increased Na+?

A

Dehydration Vomitting
Dxa
Hyperaldosteronism

85
Q

Differentials for Decreas in Na+?

A

Vomitting Dxa

Hypoadrenocorticism

86
Q

What is the principal EXTRAcellular Anion?

A

Cl-

87
Q

If Cl- levels don’t follow Na2+ levels what should you evaluate?

A

Acid-base status. Getting chucked out by kidney to save Bicarb

88
Q

What does Cl- cary inversely with?

A

HCO3- (bicarb)

89
Q

Why would you see HYPERchloremia?

A

Low Bicarb = Acidosis

90
Q

Why would you see HYPOchloremia?

A

High Bicarb = Alkalosis

91
Q

Why is Mg2+ important (broad)?

A

When Mg2+ gets really low what exchanges with it? Cofactor for a ton of functions

92
Q

What is the biggest result of hypomagnesemia?

A

Arrhythmias

93
Q

What is the result of hypermagnesemia?

A

??? - slide missing

94
Q

How do you calculate Anion Gap?

A

Cations - Anions

95
Q

What are the differentails for Increased Anion Gap?

A

Metabolic Acidosis (Organic), Toxins

96
Q

List causes of Metabolic Acidosis (organic)?

A

Lactic Ketotic
Uremic
Massice Tissue Injury

97
Q

List toxins that would cause increased Anion Gap?

A

Ethylene Glycol, Methanol,

Metaldehyde (snail Bait)

98
Q

What are the differentials for a decreased Anion Gap?

A

Hypoalbuminemia

99
Q

What is going on with your anions in a decreased Anion Gap?

A

Increase in unmeasured anions (many carried by albumin)

100
Q

Creatine Kinase is what type of enzyme?

A

Muscle

101
Q

Why would you show elevated Creatine Kinase?

A

Myopathy Trauma

Hypothyroidism (later Stages)

102
Q

Checking CK for elevation due to elevated levels of AST helps differentiate what?

A

Damage in Liver vs Muscle

103
Q

Cholesterol is what type of test?

A

LIVER FUNCTION!!!

104
Q

Decreases in Cholesterol can be due to?

A

Hepatic Insufficiency

105
Q

Differentials for Elevations in Cholesterol?

A 
Dietary ***Hypothyroidism - 85%
Renal Dz - Nephrotic Syndrome
Hepatic Dz - not specific
Pancreatitis
DM
106
Q

What % of Dogs with Hypothyroid have elevated Cholesterol levels?

A

85%

107
Q

Amylase & Lipase elevation/decreases are significant for? (2)

A

Can have elevation or low and still have pancreatitis or renal dz. Neither sensitive nor specific - SHORT t1/2

108
Q

High Calcium and High PTH? 1º

A

Hyperparathyroidism

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