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NUTR 476 Advanced Clinical > Week 3 Interpreting Common Lab Values > Flashcards

Week 3 Interpreting Common Lab Values Flashcards

1
Q

What are the common laboratory values that are taken?

A
  • Complete blood count
  • Urinalysis
  • Clinical Chemistry Panels
  • Hydration status
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2
Q

Labs from CBC

A
  • Hemoglobin (120-160 g/L)
  • Red blood cells (RBC) (3.8-5.2x 10^12/L)
  • Hematocrit (HCT): (0.36-0.46 L/L)
  • Mean cell volume (MCV): (78-100 fL)
  • Mean cell hemoglobin concentration (MCHC): (310-360 g/L)
  • RDW: Red blood cell distribution width (<15.6%)
  • White blood cell count (WBC) :4.5-13.5 x10^9/L.
  • Platlets: (140-450 x10^9/L)
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3
Q

normal range for hemoglobin

A

120-160 g/L

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4
Q

normal range for RBCs

A

3.8-5.2x 10^12/L

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5
Q

normal range for HCT

A

0.36-0.46 L/L

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6
Q

normal range for MCV

A

78-100 fL

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7
Q

normal range for MCHC

A

310-360 g/L

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8
Q

normal range for RDW

A

<15.6%

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9
Q

normal range for WBC

A

4.5-13.5 x10^9/L.

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10
Q

normal range for platelets

A

140-450 x10^9/L

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11
Q

What CBC blood values are important for IDA?

A
  • ↓ hemoglobin: <12 g/dL (120 g/L)
  • ↓ hematocrit (hypochromic): <0.35 L/L
  • ↓ MCV (microcytic): <80 fL

Various combinations; depending on severity of depletion

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12
Q

When might MCV be high

A

magoloblastic anemia
* B12/ folate issue

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13
Q

What are the white blood cells with differentials?

A

granulocytes
* neutrophils
* % eosinophils
* % basophiles

non-granulocytes
* lymphocytes
* monocytes

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14
Q

When might WBCs be increased/ decreased?

A
  • ↑ with infections ,inflammation, cancers, leukemias
  • ↓ with some autoimmune conditions, bone marrow suppression, and some medications like methotrexate
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15
Q

Importance of urinalysis in screening

A
  • To rule out a variety of disorders: infection, diabetes mellitus, renal disease, inborn errors of metabolism etc. Includes testing for presence of glucose, protein, RBC, bacteria etc.
  • To assess over all hydration: urine specific gravity, pH important
  • Can be prognostic for liver diseases when find high levels of bilirubin in urine
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16
Q

What is assessed in the urinalysis?

A
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17
Q

How doe specific gravity in the urinalysis change with dehydration?

A

dehydration = higher
* means higher concentration

18
Q

What values are assessed in the blood chemistry?

A
  • Electrolytes: Na+, K+, Cl-, HCO3 or total CO2
  • Glucose
  • Creatinine, Urea (BUN)
  • Will often include: AST/ALT, total bilirubin, calcium, phosphorus, magnesium
  • May include: cholesterol, TG and CRP
19
Q

What are the conditions of low/ high sodium?

A
  • hyponatremia (<130 mmol/L)
  • hypernatremia (>145 mmol/L)
20
Q

Describe hyponatremia

A

<130 mmol/L
* Can be due to ↑ sodium losses (renal, GI etc), fluid overload/retention (due to liver diseases),
* chronically low sodium intake (IV administration) and/or excessive fluid administration
* diuretic therapy that causes sodium wasting,
* excessive ADH secretion (common in head trauma) leading to fluid retention
* CF sweat a lot and so lose excessive sodium (diagnostic criteria)

21
Q

Describe hypernatremia

A

> 145 mmol/L
* Most typically occurs in dehydration; rarely in excessive intake (possible via IV administration).
* Other diseases: Cushing Syndrome or Diabetes Insipidus (affects cortisol and adrenal gland function)

22
Q

What are the conditions of low/high potassium?

A
  • Hypokalemia (< 3.5 mmol/L)
  • Hyperkalemia (> 5mmol/L)
23
Q

Describe hypokalemia

A

< 3.5 mmol/L
* ↑renal losses (diuresis)
* ↑GI losses (diarrhea, vomiting, fistula)
* K+ wasting meds (thiazide and loop diuretics, etc)
* Shift into cells (anabolism, refeeding syndrome, correction of glucosuria or diabetic ketoacidosis)
* Inadequate intake

24
Q

Describe hyperkalemia

A

> 5mmol/L (worried at 6 mmol/L)
* Decreased renal excretion as in acute or chronic renal failure
* Medications, e.g. potassium sparing diuretics, beta blockers, ACE inhibitors
* Shift out of cells (acidosis, tissue necrosis, GI hemorrhage, hemolysis)

25
Q

Describe urea

A

Reflective of hydrational status, renal function and recent protein intakes
* Typically elevated in renal disease (creatinine would also be elevated as well) or in dehydration
* May be high if fed lots of protein intake; may be low with chronically low intakes of protein

26
Q

Describe creatinine

A

High levels reflective of renal damage, recent skeletal protein breakdown (not chronic where levels would be low).

27
Q

normal values for urea and creatinine

A
  • urea: 3.7 mmol/L
  • creatinine: 40-110 mmol/L
28
Q

low versus high hydration status

A
  • Dehydration: a state of negative fluid balance caused by decreased intake, increased losses, or fluid shifts
  • Overhydration or edema: increase in extracellular fluid volume; fluid shifts from extracellular compartment to interstitial tissues
29
Q

Symptoms of dehydration

A
  • dry skin and mucous membrane, poor skin turgor, sunken eyeballs
  • orthostatic hypotension, central venous and pulmonary pressures all ↓
  • ↑HR/ ↓Cardiac output
  • rapid weight loss (may be several kg)
  • ↓ urinary output/ ↑ urine specific gravity
  • elevated serum osmolality; ↑serum sodium, ↑urea
  • cool & clammy
30
Q

Clinical conditions where dehydration may occur

A
  • rapid blood loss with trauma
  • high output fistulas in GI in short bowel patients
31
Q

treatment for dehydration

A

Fluid resuscitation: with fluids of similar concentration to restore blood volume/blood pressure
* Usually isotonic fluid like normal saline or lactated Ringer’s solution given IV
* consider electrolyte status (Na+, K+, Cl- ) in choice of solution.
* TPN or enteral nutrition is NEVER USED to TREAT!

32
Q

What can lead to overhydration or edema?

A
  • Caused by increase in capillary hydrostatic pressure or permeability
  • Decrease in colloid osmotic pressure
  • Physical inactivity (need PA to help push fluid in the venous system)
33
Q

fluid retention versus excessive intake with overhydration

A

Results from retention or excessive intake of fluid or sodium or shift in fluid from interstitial space into the intravascular space
* Fluid retention: renal failure, CHF, cirrhosis of the liver, corticosteroid therapy, hyperaldosteronism
* Excessive intake: IV replacement tx using normal saline or Lactated Ringer’s, blood or plasma replacement, excessive salt intake (big issue in renal or liver disease)

34
Q

Symptoms of overhydration

A
  • Generalized edema/Pitting edema: leaves depression in skin when touched
  • Rapid weight gain (> 2-3 kg in short period of time)
  • Pulmonary edema: crackles on auscultation
  • Patient SOB with tachypnea, systemic BP may rise and then fall with cardiac failure.
  • Labs: low hematocrit, normal serum sodium, lower K+ and BUN (or if high, may mean renal failure)
35
Q

What does ND set with overhydration?

A

MD will set very tight TFI (may be 80 or 90% maintenance or lower)

36
Q

Sodium lab value changes with hydration status

A
  • hypovolemia: typically ↑ but can be normal or ↓
  • hypervolemia: ↓
  • other factors influencing result: Serum sodium generally reflects hydrational status; not sodium balance or overall status (need urine collections for this).
37
Q

urine sp. gravity changes with hydration status

A

normal: 1.010-1.025
* hypovolemia: ↑
* hypervolemia: ↓

38
Q

urine osmolality changes with hydration status

A

normal: 200-1200 mosm/kg
* hypovolemia: ↑
* hypervolemia: ↓

other factors influencing result:
* Low: diuresis, hyponatremia, sickle cell anemia;
* High: SIADH, azotemia,

39
Q

BUN changes with hydration status

A

normal: 3-7 mmol/L
* hypovolemia: ↑
* hypervolemia: ↓

other factors influencing result:
* Low: inadequate dietary protein, severe liver failure
* High: pre-renal failure; excessive protein intake, GI bleeding, catabolic state, glucocorticoid therapy
* creatinine may also rise in severe hypovolemia (but not good marker)

40
Q

serum albumin changes with hydration status

A

normal:
* hypovolemia: ↑
* hypervolemia: ↓

other factors influencing result:
* Low: malnutrition; acute phase response, liver failure
* High: rare except in hemoconcentration

41
Q

HCT changes with hydration status

A

normal: M-42-52%; F-37-47%
* hypovolemia: ↑
* hypervolemia: ↓

other factors influencing result:
* Low: anemia, hemorrhage with subsequent hemodilution (occurring after approximately 12 hours)
* High: chronic hypoxia (chronic pulmonary disease, living at high altitude, heavy smoking, recent transfusion)

NUTR 476 Advanced Clinical (23 decks)

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