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224 Cards in this Set
- Front
- Back
BMP
|
Na, K, Cl, C02, BUN, creat, glu
|
|
TFT
|
TSH
T3 T4 |
|
Cholesterol panel
|
total cholesterol, LDL, HDL, TG
|
|
Cardiac Enzymes
|
CPK-MB, Trop I, LDH
|
|
Bun/Creat
|
Kid fx
|
|
Osmo
|
[serum] and [urine]--> assesses overall pt fluid status or kid fx
|
|
Therapeutic Drug Levels
|
dig, phenytoin, theophylline, pheobarb
|
|
Random and 24 hour urine
|
creatinine, protein, electrolytes, VMA
|
|
Factors that can influence K test
|
hemolysis
|
|
Tests that timing is a big factor of...
|
Cortisol
Blood Sugars |
|
Blood Urea Nitrogen is an _____.
|
end product of protein metabolism
formed in the liver and excreted in the urine. |
|
BUN NL
|
10-20mg/dL
|
|
Decreased BUN can be from...
|
liver dz, fluid overload, malnutrition, malabsorption, early pregnancy, nephrotic syndrome
|
|
Increased BUN can be from...
|
azotemia
|
|
Prerenal can be from
|
loss of volume or blood supply to the kidneys, CHF, sepsis, dehydration, high protein
|
|
BMP
|
Na, K, Cl, C02, BUN, creat, glu
|
|
TFT
|
TSH
T3 T4 |
|
Cholesterol panel
|
total cholesterol, LDL, HDL, TG
|
|
Cardiac Enzymes
|
CPK-MB, Trop I, LDH
|
|
Bun/Creat
|
Kid fx
|
|
Osmo
|
[serum] and [urine]--> assesses overall pt fluid status or kid fx
|
|
Therapeutic Drug Levels
|
dig, phenytoin, theophylline, pheobarb
|
|
Random and 24 hour urine
|
creatinine, protein, electrolytes, VMA
|
|
Factors that can influence K test
|
hemolysis
|
|
Tests that timing is a big factor of...
|
Cortisol
Blood Sugars |
|
Blood Urea Nitrogen is an _____.
|
end product of protein metabolism
formed in the liver and excreted in the urine. |
|
BUN NL
|
10-20mg/dL
|
|
Decreased BUN can be from...
|
liver dz, fluid overload, malnutrition, malabsorption, early pregnancy, nephrotic syndrome
|
|
Increased BUN can be from...
|
azotemia
|
|
Prerenal can be from
|
loss of volume or blood supply to the kidneys, CHF, sepsis, dehydration, high protein, hemorrhage, shock, trauma, increased protein metabolism
|
|
Post Renal can be from
|
Obstruction
|
|
Serum Creatinine NL range
|
0.5-1.2mg/dL
|
|
Creatinine is...
|
a product of creatine phosphate catabolism
more stable than BUN |
|
Creatinine doesn't rise until...
|
1/2 the nephrons lose fx
|
|
Drugs that may affect Serum Creatinine
|
NSAIDS, Levaquin, diurectics
|
|
elevated Scre can be from
|
decreased renal fx and/or renal blood flow, diabetic neuropathy, urinary tract obstruction, rhabdomyolysis, increased muscle mass
|
|
decreased Scre can be from
|
loss of muscle mass
|
|
BUN/Cre
BUN/Cre NL prerenal renal dz liver dz, low protein diets, dialysis |
10:1
>15:1 10:1 but elevated both <10:1 |
|
Na NL range
|
136-145mEq/L
|
|
Na is an...
|
extracellular cation that maintains the ECF volume
|
|
Factors that affect Na
|
Aldosterone
Natriuetic Hormone ADH |
|
Hyponatremia is the most common electrolyte imbalance in ________.
|
hospitalized patients
|
|
Na <125 S&S
|
weakness, confusion, lethargy
|
|
Na<115 S&S
|
stupor, coma
|
|
This is a risk if you replenish Na more than 12mEq/L/d
|
pontine myelinolysis
|
|
Hypovolemic Hyponatremia
|
N/V/d/diuretics
|
|
Hypervolemic Hyponatremia
|
CHF, edema, ascites, IV fluids
|
|
Euvolemic Hyponatremia
|
SIADH
|
|
Pseudohyponatremia is caused by
|
increased lipids, increased protein, severe hypoglycemia
|
|
Hypernatremia S&S
|
agitation, restlessness, thirst, mania, convulsions,dry mucous mbs, hyperreflexia,
|
|
Hypernatremia Causes
|
increased water loss, burns, diabetes inspidis, hyperaldosteronism, Cushing's syndrome
|
|
K+ NL range
|
3.5-5mEq/L
|
|
K+ is an...
|
intracellular cation
Role in pH, cellular growth nucleic acid and protein synthesis |
|
K+ is excreted via the
|
kidney and colon
|
|
H and K+ trade places to...
|
buffer the pH in acid.base disturbances
|
|
______ exchanges K+ for Na+
|
Aldosterone
|
|
______ promotes K+ secretion
|
ADH
|
|
______ increase K+
|
ACEi
|
|
Acute respiratory Acidosis/
Alkalosis |
decreases K+ excretion/
increases K+ excretion |
|
Hypokalemia causes
|
dietary, cellular intake, renal loss, GL loss, skin loss (burns), alkalosis
|
|
if K+ <2.5=
|
dysrhythmias, check EKG for flat T and U waves
|
|
Clinical manifestations of Hypokalemia
|
NM, Cardiac, metabolic, renal
|
|
Hyperkalemia Causes
|
increased exogenous uptake, cell lysis, infection, acidosis, dehydration
|
|
HyperK+ affects _____-->____
|
skeletal and cardiac muscles--> weakness and paralysis
|
|
HyperK+ you should check the _______ for _______
|
EKG for peaked T waves, widened QRS, depressed ST and V fib
|
|
Pseudohyperkalemia is due to
|
hemolysis
|
|
Cl NL range
|
90-116mEq/L
|
|
CL is a major...
|
extracelluar anion
|
|
Cl is important in metabolic ________ when HCO3 moves ____ of the cell.
|
alkalosis, out
|
|
HypoCl causes
|
tetany, shallow breathing, metabolic alkalosis, chronic respiratory acidosis, muscle/nervous system hyperexcitability, vomitting, NG tube
|
|
HyperCl causes
|
lethargy, weakness, deepbreathing, metabolic acidosis, renal tubular acidosis, eclampsia
|
|
CO2 NL
|
23-30mEq/L
|
|
COs is an...
|
oxidative byproduct of CHO, fats and amino acids
|
|
CO2/HCO3 is regulated by the ______ and is ________ proportional to pH
|
kidneys, directly
|
|
PCO2/H2CO3 is regulated by the ______ and is ________ proportional to pH
|
lungs, inversely
|
|
Metabolic Acidosis is?
etiologies? |
low CO2
AG>16 HCO3 loss--> diarrhea, chronic loop diuretics, renal failure |
|
Respiratory deficiencies are?
etiologies? |
increased CO2 on lytes
increased pCO2 on ABGs metabolic alkalosis, NGT |
|
Anion gap NL range
|
8-12mEq/L
|
|
AG=Na-(Cl+CO2)
|
represents unmeasured anions
used to classify metabolic acidosis and mixed A-B disorders |
|
Mg NL range
|
1.7-2.7mg/dL
|
|
Mg is the second most common...
|
intracellular cation
|
|
Mg is found in
|
bone, muscle and extracellular
|
|
Mg is responsible for
|
activation of enzymes, hydrolysis of ATP, protein synthesis
|
|
Mg Homeostasis regulated through
|
intestines, bone and kidneys
|
|
HypoMg causes
|
decreased intake, decreased absorption, increased urinary loss
|
|
hypoMg is associated with
|
decreased K and dec Ca
|
|
Low Mg will lead to...
|
cardiac irriatbility and increased cardiac dysrrhythmias
30% of alcoholics are hypoMg |
|
HyperMg causes
|
renal dysfunction unless pt has been overloaded with Mg- antacids, edema
|
|
HyperMg will lead to
|
retard in NM conduction with cardiac slowing- wide PR, QT, QRS intervals, decreased DTR, respiratory depression
|
|
PO4 NL range
|
3.0-4.5mg/dL
|
|
PO4 found in
|
bone and teeth, doft tissues, extracellular fluid
|
|
Hyperparathyroidism
|
Ca--> increased in serum--> hypercalcimium--> PO4 goes down
|
|
Phosphorous homeostasis is maintained by
|
Ca metabolism, PTH, intestine, bone and kidney, gut absorption, renal excretion
|
|
This will decrease intestinal absorption of PO4
|
Antacids
|
|
PO4 is important in these two cellular processes
|
oxidative phosphorylation and mitochondrial respiration
|
|
HypoPO4 causes
|
hyperparathyroidism, increased Ca, ETOH, alkalosis
|
|
HypoPO4 will lead to
|
multiple organ dysfunction, neuro changes, confusion, coma, hypotn, rhabdomyolysis, hypoxia, decrease in menstruation, muscle weakness, arthralgia, hematologic dyfx
|
|
HyperPO4 causes
|
hyperparathyroidism, renal failure, decrease Ca acidosis
|
|
Ca NL ranges
|
9.0-10.5mg/dL
|
|
Ca is available in
|
hydroxyapatite, teeth, soft tissues, plasma, and cells.
|
|
3 forms of Ca
|
free/ionized, bound to albumin, anions
|
|
Function of Ca
|
muscle and nerve contraction, enzyme activities, cardiac function, coagulation, cell growth
|
|
Role of Ca
|
monitor pts with renal failure, malignancies and hyperparathyroidism
|
|
Ca is absorbed in the
|
intestines, needs vitamin D 1,25 dihydroxycholecalciferol
|
|
These decrease/increase the absorption of Ca
|
Glucocorticoids/ calctrol
|
|
Alkalosis inc/dec ionized Ca?
|
inc
|
|
Acidosis inc/dec ionized Ca?
|
dec
|
|
Loop Diuretics inc/dec Ca excretion/absorption by the kidney?
|
increase, excretion
|
|
thiazide Diuretics inc/dec Ca excretion/absorption by the kidney?
|
increase, absorption
|
|
Albumin levels must be known as for each _____ gram of _____ there is a corresponding dec ____mg/dL in Ca
|
dec., Albumin, 0.8
|
|
HypoCa etiologies
|
dec PTH, dec vitD, dec GL absorption, inc renal excretion, dec Mg, pseudohypoparathyroidism
|
|
HypoCa S&S
|
tetany, Chvostek's sn, Trousseau's sn, cramps, seizures, cardiac dysrrhythmias, prolonged QT
|
|
HyperCa Causes
|
inc bone reabsorption
|
|
What is the second leading cause of HyperCa
|
malignancy
|
|
What are the causes of HyperCa?
|
hyperparathyroidism- leading cuase, kidney stones, bone pain, pagets, granulomatous diz
|
|
Glucose NL value
|
70-110mg/dL
|
|
Diabetic Fasting BS--
|
>126
|
|
impaired GT-
|
FBS 111-125mg/dL
|
|
factors that lead to elevated BS
|
increased stress, insulin def, hyperthyroidism, increased estrogen levels, acromegaly, Cushings, pheochromocytoma, pancreatitis, CRF, hyperaldosteronism, steroids, thiazide diuretics, niacin, OCP, infx, hypermetabolic states
|
|
Nonketotic hyperosmolar syndrome
|
glu 700-800 range ketones not increased
|
|
Hemoglobin a1c
|
AKA glycosylated hemoglobin
marker of glucose level over the past 3 months |
|
Ha1c 5% corresponds to a glu of ___. For every __% increase, add ___ to glucose.
|
90, 1, 30
|
|
GTT abNL
|
persistant elevated 2 hour levels are abNL
|
|
Hypoglycemia
|
insulin overdose
BS<50mg/dL with sx |
|
Fasting Hypoglycemia etiologies
|
tumore, liver dz, hypothyroidism, Addison's dz, chronic ETOH abuse
|
|
Postprandial hypoglycemia due to
|
exaggerated insulin response
dx with 5hr GTT, insulin and cortisol levels |
|
Bilirubin NL level
|
0.3-1.0mg/dL
|
|
Unconjugated, Indirect Bilirubin is...
|
bound to albumin in plasma for transport, can pass throught blood/brain barrier therefore > 15mg/dL in newborns require tx avoid brain damage
|
|
Conjugated, Direct Bilirubin is...
|
excreted in bile--> urobiliogen in intestines--> excreted in feces--> urobiliogen in urine
|
|
Jaundice pts have a level of ______ and _______urine and ________stools
|
>2.5mg/dL, dark, light
|
|
Babies that are jaundice have elevated level of _______, and are at risk for __________.
|
unconjugated bilirubin, kernicterus--> MR
|
|
Increased total Bili=
|
hepatic damage, hepatitis, biliary obstruction, hemolysis
|
|
increased direct, conjugated bili=
|
biliary obstruction, cholestasis
|
|
increased indirect, unconjugated bili=
|
hepatitis, sickle cell, hemolytic jaundice, transfusion rxn, gilberts dz, HDN
|
|
AST(SGOT) NL range
|
4-40U/L
|
|
AST(SGOT) is an enzyme in the
|
liver, myocardium, skeletal muscle, brain, and kidney
|
|
AST(SGOT) is elevated hou many hours after injury? When does it peak/ return to NL.
|
8hrs after injury, peaks 24-36 hrs, returns, to NL in 3-7 days
|
|
AST(SGOT) requires ______ as a cofactor for full enzymatic activity.
|
vitamin B6
|
|
AST(SGOT) is elevated in these conditions...
|
AMI, CHF, hypotn, hypoxic episodes, liver dz, Reye's syndrome, muscle trauma, pancreatitis, intestinal injury, renal infarction, and hepatocellular damage.
|
|
AST(SGOT) is decreased in these conditions...
|
severe diabetes with ketoacidosis, liver dz, chronic hemodialysis
|
|
ALT(SGPT) NL range
|
5-35U/L
|
|
ALT(SGPT) is specific to...
|
hepatocellular dz, small amount in heart, muscles, kidneys
more specific to the liver than AST |
|
ALT(SGPT) increased in
|
cirrhosis, hepatic ischemia/necrosis, hepatotoxic drugs, severe burn, MI, pancreatitis, mono, hypotn, CHF
|
|
ALT/AST ratio <1
|
ETOH cirrhosis, liver congestion, metastatic tumor
|
|
ALT/AST ratio >1
|
acute hepatitis
|
|
Alk Phos NL range
|
30-85U/L
|
|
Alk Phos used to
|
monitor/detect liver or bone dz, found in rapid
|
|
Alk phos can be heat fractionated to identify source of...
|
bone, kidney, placenta, liver
|
|
Ak Phos is a sensative marker for...
|
liver metastasis
|
|
Alk phos is increased in...
|
active bone formation, osteomalacia, pagets, rickets
|
|
Alk phos is excreted in _______ and is increased in... 4 things
|
bile, biliary cirrhosis, cirrhosis, intrahepatic duct, and extrahepatic duct disorders
|
|
Gamma-Glutamyl Transferase GGT is found in ________
|
hepatobiliary cells as well as epithelium of pancreas, kidney, spleen, heart, intestine, brain, prostate gland
|
|
GGT is an ______ enzyme
|
obstructive
|
|
GGT is an indicator of
|
ETOH use
|
|
Decreased osmotic pressure=
|
ascites, edema
|
|
Total Protein increased=
|
multiple myeloma, waldstrom's macroglobulinemia, lymphoma, chronic inflammatory dz, sarcoidosis, viral illness
|
|
Total Protein decreased=
|
malnutrition, inflammatory bowel dz, hodgekins, leukemias
|
|
Alk phos is excreted in _______ and is increased in... 4 things
|
bile, biliary cirrhosis, cirrhosis, intrahepatic duct, and extrahepatic duct disorders
|
|
Gamma-Glutamyl Transferase GGT is found in ________
|
hepatobiliary cells as well as epithelium of pancreas, kidney, spleen, heart, intestine, brain, prostate gland
|
|
GGT is an ______ enzyme
|
obstructive
|
|
GGT is an indicator of
|
ETOH use
|
|
Decreased osmotic pressure=
|
ascites, edema
|
|
Total Protein increased=
|
multiple myeloma, waldstrom's macroglobulinemia, lymphoma, chronic inflammatory dz, sarcoidosis, viral illness
|
|
Total Protein decreased=
|
malnutrition, inflammatory bowel dz, hodgekins, leukemias
|
|
Albumin half life
|
14-20d
|
|
PreAlbumin is more reflective of
|
acute process and widely used to check for malnutrition and hepatic dysfx
|
|
Globulins are
|
building blocks of Abs, glycoproteins, clotting factors, complement, acute phase reactant proteins
|
|
Globulins are made in the
|
liver and in the reticulo-endothelial system
|
|
Globulin levels will be increased in comparison to albumin in
|
diseases where capillary permeability is increased.
|
|
Albumin/Globulin Ratio NL
|
<1
|
|
Alb/Glob ratio is decreased in
|
cirrhosis, liver dz, nephrotic syndrom, chronic GN, cachexia, burns, myeloma, chronic infx/inflammation
|
|
Ammonia is used to dx or tx?
|
severe liver dz and hepatic encephalopathy
|
|
Ammonia is generated by
|
bacterial degeneration of protein in intestines which enters portal circulation and is narmally transformed into urea, however, in severe liver hepatocellular dysfx ammonia cannot be catabolized.
|
|
Inc in ammonia
|
seen in NL neonates w/i 48 hours of birth and in liver failure, portal HTN, GI bleed and Reyes Syndrome
|
|
Troponin increase
|
with heart injury but not specific to MI
|
|
Troponin does not cross react with...
|
skeletal isotopes
|
|
elevated troponins w/o elevated CKMB is consistent with...
|
ACS
|
|
CPK does...
|
catalyzes phosphate group transfer btw creatine phosphate and ADP resulting in ATP
|
|
CPKBB
|
brain and smooth muscle- increased in brain injurt and pulmonary infarction
|
|
CPKMM
|
skeletal muscle- usually accounts for 100% of circulating CPK
|
|
CKMB
|
primarily used to dx AMI
|
|
When is CPK ordered
|
q8hours x3
|
|
Increased CKMB is seen...
|
after cardiac surgery, pericarditis and myositis
|
|
LDH is the essential enzyme in interconversion of...
|
lactate and pyruvate- found mostly in heart, liver, RBCs, kidneys, skeletal muscle, brain, lungs
** Testing is greatly affected by hemolysis** |
|
LDH1
|
heart
|
|
LDH2
|
reticuloendothelial system, most abundant
|
|
LDH3
|
Lungs
|
|
LDH4
|
kidney, placenta, pancreas
|
|
LDH5
|
liver, muscle
|
|
BNP
|
hormone produced by heart, correspons to workload of the heart
Levels directly correspond to severity of failure |
|
BNP affected by...
|
diuretics, kidney failure, MI
|
|
Cardio C- reactive protein
|
indicative of inflammation
overnight fast preferred to avoid excessive turbidity due to lipemic serum specimens |
|
Total cholesterol is a major biological significane b/c it is a
|
building block in cell mb, hormones, bole acids, metabolites
|
|
Total cHolesterol is elevated in
|
hypercholesterolemia, biliary obstruction, nephrosis, hypothyroidism, pancreatic dz,pregnancy, and OCP
|
|
Total Cholesterol is decreased in
|
liver dz, hyperthyroidism, malnutrition, chronic anemias, steroid therapy, AMI
|
|
LDL contains the majority of
|
plasma cholesterol
|
|
diets high in saturated fats and cholesterol ________ LDL levels
|
increase
|
|
HDL is approximately ____% of circulating cholesterol
|
25
|
|
HDL does this
|
takes cholesterol from tissues back to the liver
|
|
Tangiers Dz
|
HDL deficient state resulting in extensive cholesterol deposition in tissues
|
|
HDL can be increased w/
|
exercise, and moderate ETOH use
|
|
TG are stored in
|
adipose tissues for readily available lipids to be used in gluconeogensis
|
|
Nonfasting TG are found in ________ whereas fasting TG are found in ________
|
Chylomicrons, VLDL
|
|
TG are increased in
|
pancreatitis, alcoholism and poorly controlled DM
|
|
TSH-
|
most specific test for thyroid fx
|
|
TSH is produced in the _______ after stimulation by _________.
|
AP gland, TRH
|
|
TSH is increased in
|
primary hypothyroidism and thyroiditis
|
|
TSH is decreased in
|
hyperthyroidism, jsecondart thypothyroidism, pituitary dysfx
|
|
T4- Thyroxine
|
nearly all the thyroid hormone circulating in the blood
nearly all is bound to protein Free is metabolically active |
|
T4 id decreased in
|
hypothyroidism, pituitary insufficiency
|
|
T3- Triiodothronine
|
more active form
used to dx hyperthyroidism |
|
Amylase
secreted from? |
pancreatic acinar cells in to pancreatic duct, cholecystokinin stimulates its release from pancreas
|
|
Amylase is produced in
|
salivary glands and pancreas
|
|
Amylase in intestines...
|
aids in breakdown of CHO into simple sugars
|
|
Amylase is sensitive for
|
pancreatic disorders
|
|
Amylase is increased in
|
almost all pancreatic disorders although some salivary gland inflammations could be the culprit
|
|
Two tumors that can release amylase
|
Serous Ovarian tumor
Lung Carcinoma |
|
Lipase
|
enzyme that cleaves TG into FA and glycerol
FOund exclusively in pancreas excreted by kidneys |
|
increased lipase in
|
acute or chronic pancreatitis, pancreatic duct obstruction, fat embolus syndrome, renal failure and dialysis
|
|
Uric Acid
|
endproduct of purine metabolism, synthesized primarily by liver, excreted by kidneys
Organ meats, legumes, yeasts= high in purines |
|
elevated uric acid =
|
cell turnover i.e. leukemia, ca
|
|
increase uric acid
|
thiazide diuretics, low dose ASA, ETOH, lactic and ketoacidosis, renal failure
|
|
Fe, TIBC, Ferritin
|
evaluation of microcytic, hypochromatic anemia
|
|
Fe
|
most abundant trace element in body
needed for RBC production |