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165 Cards in this Set
- Front
- Back
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Cardiac enzymes
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myoglobin
CPK MB fraction Toponoin LDH |
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BUN/Creat
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Blood urea nitrogen
Creatinine |
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Osmo
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osmolality
Serum Urine |
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GFR
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amount of filtrate that your kidneys can filter in a minute
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Normal BUN
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Greater than 60
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Things that will decrease BUN
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liver disease
fluid overload malnutrition/malabsorption early pregnancy nephrotic syndrome |
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Things that will increase BUN
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High protein diet
UGI bleed corticosteroids tetracycline azotemia third spacing conditions |
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BUN
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`
measures proteins-amino acids ammonia from the liver excreted from the kidneys |
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Normal creatinine
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0.5-1.2 mg/dl
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Critical serum creatinine
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>4
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More stable than BUN and more direct reflection of kidney function
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Serum creatinine
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When does creatinine rise?
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Doesnt rise until approx 1/2 nephrons lose fuctions
more chronic than BUN |
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Things that may increase creatinine
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decreased renal function &/or renal blood flow, diabetic nephropathy, urinary tract obstruction, rhabdomyolysis, increased muscle mass
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Things that may decrease creatinine
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loss of muscle mass
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Normal BUN/Creatinine Ratio
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10:1
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BUN/Creatinine Ratio that indicates prerenal causes
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>15:1 ratio
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If BUN/Creatinine ratio is <10:1...
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look for liver disease, low protein diets, dialysis
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Normal electrolytes
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Na, K, Cl, CO2
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Normal Sodium
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136-145 mEq/L
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Critical values for Sodium
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<120 or >160
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Relationship of sodium to water
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Inversely related
Loss in water--> hypernatermic |
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Most common electrolyte distrubance in hospital patients
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Hyponatremia
due to IV fluids |
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Pontine myelinolysis
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Na replenished more than 12mEq/L/day
Pt unnessicarily given hypertonic saline |
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Most important reason to dialyize patients
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Electrolyte balance
particularly K+ |
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Hyponatremia level
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<136 mEq/L
symptoms begin at <125 |
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First S&S of Hyponatremia
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weakness
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Other sx of hyponatremia
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anorexia/nausea, muscle cramps
lethargy/apathy disorientation agitation/delirium seizures obtundation/coma cerebral herniation and respiratory arrest |
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Hypernatremia
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agitation, restlessness, thirst, mania, convulsions
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Causes of hypernatremia
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Inc. water losses
burns DI hyperaldosteronism Cushings |
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PE of hypernatremia
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dry mucus membranes
hyperreflexia |
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Normal K+ range
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3.5-5.0 mEq/L
very low therapeutic level!! |
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redominant intracellular cation
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K+- potassium
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Biggest thing effected by K+ imbalance
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cardiac muscle
smooth muscle |
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Sodium reabsorption:
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as Na+ is reabsorbed K+ is lost
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At K+ < 2.5 what will you see?
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dysrrhythmias--- check EKG for flat T waves and U waves
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Why might you see pseudohyperkalemia?
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Hemolysis
Tourniquet too tight Bore of needed too small |
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Normal Chloride range
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990-116mEq/l
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Major extracellular anion
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Chloride
follows Na+ and attempts to maintain electrical neutrality |
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S&S of Hypochloremia
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Tetany
Shallow breathing Metabolic alkalosis Chronic respiratory acidosis Muscle/ nervous system Hyperexcitability Vomiting |
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S&S fo Hyperchloremia
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Lethargy
Weakness Deep breathing Metabolic acidosis Renal tubular acidosis |
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Normal CO2 Range
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23-30 mEq/L
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Increased CO2
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metabolic alkalosis, NGT
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Decreased CO2
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chronic loop diuretics, diarrhea, renal failure
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Normal Anion Gap
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8-12 mEq/L
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AG=
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Na+ -- (Cl-+HCO3-)
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Clinical use of anion gap
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Acid base balances
Find metabolic acidosis |
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Causes of Hypophosphatemia
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Hyperparathyroidism
Inc Ca ETOH alkalosis |
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Causes of Hyperphosphatemia
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Hypoparathyroidism, renal failure (esp. ESRD on dialysis), decreased Ca, acidosis
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Normal Ca
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9.0-10.5 mg/dl
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Where is Ca found?
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99% in the bone
1% in teeth, soft tissue, plasma, cells |
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1/2 total Ca exhists in blood in free form
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1/2 protein bound (albumin)
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What vitamin do you need to absorb Ca?
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VItamin D
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For every gram of albumin that is lost...
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there is a 0.8 mg/dl decrease in Ca
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Most common reason for hypercalcemia in malignancy
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Mets to the bone/bone destruction
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Normal Glucose
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70-110 mg/dl
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What controlls glucose
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insulin and glucagon
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Lytes
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Na, K, Cl,CO2
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GFR < 60
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kidney failure
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Things that will decrease BUN
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liver dx
fluid overload malnutrition early pregnancy nephrotic syndrome |
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Things that will increase B UN
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high protein diet
UGI bleed corticosteroids tetracycline azotemia thrid spacing coniditions |
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ADH
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controls reabsorption of H20 at distal tubules
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Renin-angiotensin-aldosterone systems
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kidneys reabsorb NA
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ANF
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increases renal loss of NA
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Hyperkalemia on EKG
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peaked T waves
need to dialyze |
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low anion gap
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metabolic alkalosis
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high anion gap
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metabolic acidosis
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Magnesium is responsible for
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activation of enzymes
hydrolysis of ATP protein synthesis |
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Dec MG associated with
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Dec K
Dec Ca |
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Hypomagnesium seen mostly in...
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alcoholics from increased urinary loss of Mg
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Cause of hypermagnesium
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renal dysfunction
overload of Mg- antacids or enemas |
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Two things not included in BMP
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Ca2+ and PO4
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Primary cause of hypercalcemia
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hyperparathyroidism
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Causes of hypocalcemia
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dec in albumin
dec PTH dec vit D dec GI abs inc renal excretion dec Mg pseudohyperparathyroidism |
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What levesl constitute diabetes
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> 126 on two occations
>200 with clinical sx |
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Type 1 Diabetes
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Beta cells (islets of langerhans) in the pancreas are not producing insulin
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Type 2 Diabetes
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Decreaed function of beta cells caused by obesity, disease, or inflammation of the pancreas
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Marker of glucose levels over the past 3 months
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Hemoglobin A1c
only a screening tool-- not for diagnosing |
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Best measure of insulin
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C-peptide
serum insulin levels longer half life than insulin so easier measured |
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Non Diabetic HbA1c
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2.2-4.8%
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Fair HbA1c
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6%-8%
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Poor HbA1c
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> 8%
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For every 1% increase in HbA1c
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add +30 to the glucose
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Positive GTT
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If after 2 hours the pt still has a glucose level of over 200 they are either pre-diabetic or diabetic
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O'Sullivan Test for pregnant women
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at 24-28 weeks gestation
Give 50 mg of glucose if BS of over 140 after 2 hours, do a full GTT for r/o gestational diabetes |
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Diabetic Ketoacidosis
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Hyperglycemia >250
Acidodic- blood pH <7.3 Serum bicarb <15 + Ketones Tx: insulin, fluids |
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Hyperglycemic Hyperosmolar state
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Hyperglycemia >600
Serum osmolalityi >310 No blood acidosis Serum Bicarb >15 Normal Anion gap Neg Ketones Tx: Insulin will not help, give LOTS of fluids Due to dehydration |
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Most common medical complication of pregnancy
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Gestational Diabetes
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Hypoglycemia
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BS <50 with symptoms
diaphoretic, confusion, halucinations, seizure coma, death |
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Fasting hypoglycemia is almost always pathologic
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tumors,
liver dx hypothyroidism Addisons ETOH |
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Liver Panel tests
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Albumin
Total Protein Alanine aminotransferase Alkaline Phosphattase Aspartate aminotranferase Direct and Indirect bilirubin |
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Total protein
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pre-albumin
albumin globulin combined |
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Most significant contributor to osmotic pressure
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Protein
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increased total protein
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Multiple myeloma
Waldenstroms macroglobulinemia Lymphoma Chronic inflammatory dx Sarcoid |
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Decreaed total protein
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Malnutrition
IBD Hodgkins Leukemias Viral illness |
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Used to check for malabsorption and hepatic dysfuction
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Pre-albumin
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Acute process will show change in
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pre-albumin
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Where are globulins mostly made?
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reticulo-enothelial system
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Where do you see a decreaed Albumin: Globulin ratio
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SLE and Chronic liver dx
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Enzyme used to monitor diseases of hte bone or liver
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Alk Phos
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ALP1
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more specific to liver and is heat stable
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ALP2
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mroe specific to bone and is inactivated by heat
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Normally elevated Alk Phos levels
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growing children
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ALP and 5'nucleotidase increaed
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liver disease
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ALP inc and 5' normal
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bone disease
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Most sensitive liver enzyme for detecting biliary obstruction, cholangitis, cholecystitis
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GGT
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GGT increased in 75% of pts who...
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chronically drink ETOH
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Better indicator of liver dx than AST
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ALT
aLt=Liver |
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AST tests for...
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Inflammatory disorders
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AST inc in
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AMI, CHF
Hypotension Hypoxia Liver dx Reyes syndrome Pancreatitis hepatocellular damage |
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AST dec in
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DKA
Pregnancy Acute renal dx Chronic hemodialysis |
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AST:ALT ratio >1
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ETOC cirrhosis, liver congestion and metasitatic tumor of the liver
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AST:ALT ratio <1
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acute hepatitis, viral hepatitis, infectioius mono
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Bilirubin >2.5
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jaundiced patients- dark urine- light stools
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Indirect bilirubin
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unconjugated bilirubin
Cannot be resolved surgically- functional Babies! usually a problem in the liver |
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Direct bilirubin
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Conjugated bilirubin
usually from a biliary obstruction can be resolved surgically by removing the obstuction |
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Amylase
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detect and monitor pancreatitis
less specific than lipase secreted from acinar cells into pancreatic duct then into duodenum |
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Lipase
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much more specific to the pancreas than amylase
stays elevated through the course of the disease |
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Ammonia
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needs to be kept on ice so levels done increase
causes confusion in ESRD support dx of liver disease and hepatic encephalopathy |
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Which cardiac enzyme peaks fastest in teh blood
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myoglobin
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Most specific cardiac marker
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Troponin I and T
I used most often in clincial setting |
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CKMB
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Increased in cardiac muscle damage
Used to diagnose MI |
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LDH
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not specific to the heart
More common for chronic cardiac conditions 5 isoenzymes |
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Which cardiac marker stays elevated the longest?
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LDH- stays elevated 12-21 days post MI
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BNP- brain natriuretic protein
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differentiate between MI and CHF
Specific to LV heart failure |
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BNP correlates well to...
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Left ventricular pressure and sevarity of failure
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CRP- C reactive protein
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Indicates an inflammatory illness
enables acurate assays at even lower levels |
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Triaglyerides are elevated in
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pancreatitis
alcoholism poorly controled DM |
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Thyroid releasing hormone TRH
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released from hypothalamus
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Thyroid stimulating hormone
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released from pitutary
used mainly |
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most specific test of thyroid function
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TSH
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TSH in hyperthyroidism
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decreased
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TSH in Primary Hypothyroidism
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Increased
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If T3/T4 and TSH levels are low
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Secondary hyperthyroidism
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Primarily used to diagnose hyperthyroidism
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T3
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Accounts for nearly all thyroid hormone in blood scream
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T4
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Primary Hypothyroidism
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Inc TSH/TRH
Dec T3,T4 |
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Secondary Hypothyroidism
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Dec TSH.TRH
Dec T3,T4 |
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Hyperthyroidism
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Dec TSH/TRH
Inc T3,T4 |
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Most common cause of Hyperthyroidism
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Graves Disease
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Deposits of Uric acid in soft tissue
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Tophi
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Respresents the largest quantity of iron-binding protein
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Transferrin
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TIBC
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measures all protein available to bind to mobile iron
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What is not invoved in TIBC?
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Ferritin becuae it binds stored iron
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Most sensitive test to determine iron deficiency anemia
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Serum ferritin
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How long does it take to replenish the RBC after you give blood
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2-4 weeks
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What is the appropriate H/H levels to give blood?
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Hgb--12.5
Hct-- 38% |
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What is collected when you donate blood
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Whole blood
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What is a NL unit of blood?
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Packed RBCs
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Cryoprecipitate
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concentrated clotting factors
comes from thawing FFP |
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Shelf life of packed reds
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35 days is kept cold
42 days wtih preservatives |
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Plasma shelf life
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Frozen within 8 hrs lasts for a year
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Platelet shelf life
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5 days at room temp
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Cryoprecipitate shelf life
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1 year at -18C
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When do you transfuse?
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Hgb <7 in healthy pt
Hgb <10 in pts wtih CV dx, sepsis or hemoglobinopathy Platlets <10,000 in adults, <50,000 in neonates INR >6 INR>2 if bleeding or bedside procedure |
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1 L of packed RBCs will increaed Hgb by
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1g
Hct will increase by 3% |
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1 dose=
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2 units
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most common cause of Hemolytic Disease of the newborn
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D antigen
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Indirect Coomb's test
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testing for alloantibodies
Usually IgG antibodies |
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Direct Coombs test
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Identifies IgG or compliment bound in vivo
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+ Direct coombs test
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Hemolytic dx of the newborn
Auto-immune hemolytic anemia Drug induced hemolyic anemia Transfusions reactions |
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Most common delayed antigents
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Kell and Rh antigents
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most common WBC reactions
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Febrile-nonhemolytic
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Kleihauer-Betke test
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antitate amount of fetomaternal hemmorhage
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Most common antibodies involved with HDN until RhoGam
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anti-Rh esp. anti-D
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Most common antibodies in Hemolytic disease of Newborn now
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Anti-Kell
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