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92 Cards in this Set
- Front
- Back
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Electrolyte panel consists of... |
-sodium
-potassium -choride -CO2 -calcium (sometimes) |
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Basic Metabolic panel consists of..
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-glucose
-BUN -creatinine -calcium -sodium -potassium -choloride -CO2 |
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Renal function panel consists of...
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-BUN
-creatinine -sodium -potassium -phosphorus -glucose -calcium -albumin -chloride -CO2 |
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Hepatic Function panel consists of..
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-A/G ratio (albumin/globulin)
-ALP -AST -ALT -Albumin -bilirubin (direct and indirect) -total protein |
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Lipid Panel consists of...
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-cholesterol
-HDL -LDL -Tg -cholesteral/HDL ratio |
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Comprehensive Metabolic panel consists of...
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-A/G ratio
-albumin -ALP -ALT -AST -total bilirubin -BUN -BUN/creatinine -Calcium -CO2 -chloride -globulin (calculated) -Glucose -potassium -protein (total) -sodium |
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hepatic panel (acte with reflex) consists of...
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-Hep A antibody (IgM)
-Hep B surface antigen -Hep C core antiobody (igM) -Hep C antibody reflex - if something is positive, the lab will automatically do further testing |
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Thyroid panel
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-T3
-T4 -Free T4 (calculated) -TSH |
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Potassium is the major....
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MAJOR INTRACELLULAR CATION
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Importance of potassium...
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-controls cellular osmotic pressure
-important to cellular metabolism -activates enzymatic rxns -helps regulate acid/base balance (H+ ions are substituted for sodium and potassium in the renal tubule) -influence kidney filtration -maintains neuromuscular excitability |
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Potassiun: normal range
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3.5-5.3 mEq/L
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Where is K+ Secreted ?
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distale tubule
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K+ is screted from the distal tubule at a rate dependent on...
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-K+ intake
-presence of aldosterone -availbaility of Na+ for reabsorption -balance of H+ and K+ -acid base status -tubular flow rate |
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How does aldosterone effect K+?
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-under the influance of aldosterone, the kidneys conserve Na by wasting K+ (they exhange Na for K) even if both are in short supply
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Hypokalemia results from...
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-shifing K+ into cells
-k+ loss from GI tract -renal excretion -decreased intake |
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Causes of hypokalemia...
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-hyperaldosteronism
-renal diseasee -CHF -potent loop diuretics (furosemide) -loss of K+ (emesis, diarrhea, sweat) -starvation/malabsorption -insulin (causes shift of K+ into cells) |
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Excessive hypokalemia may lead to...
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-V fib
-other arrythmias (Torsades de pointes) -respiratory paralysis |
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EKG changes with hypokalemia...
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-ST depression
-flattened T wave -U wave -peaked P wave |
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Most common cuase of K+ defiency is...
(deficiency = normal/natural causes) |
-GI loss
-inadequate intake |
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Most common cause of K+ depletion is..
(depletion = external cuase) |
-IV fluids without adequate K+ supplementation
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Hyperkalemia results from...
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-K+ shift out of cells
-decreaed renal excretion -excessive intake |
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Causes of hyperkalemia include...
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-renal failure
-hemorrhagic shock -hemolysis -addisons disease (hypoadrenalism) -excessive IV supplementation -massive cell damage (burns, crush injury) -uncontrolled DM/decreased insulin -tranfusion of large quantities of stored blood |
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Symptoms of hyperkalemia..
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-weakness
-malaise -nausea -intestinal colic -muscle irritability -flaccid paralysis -obligurea -bradycardia |
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EKG changes with hyperkalemia...
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-wide QRS
-flat P wave -peaked T wave -ST depression -may lead to v-fib and cardiac arrest |
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Sodium is the major...
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EXTRACELLULAR CATION
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Importance of sodium..
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-maintenance of water distrubitution!!!
(account for 90% of osmostically acive solute in plasma and intersitial fluid) -maintenance of electric neutrality of serum -important to cell physiology |
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What do sodium levels test?
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-changes is water balance
(rather than changes in sodium balance) |
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Sodium levels are used to determine...
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-electrolyte balance
-acid base balance -water balance -water intoxication (dec Na) -dehydration (inc Na) |
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Sodium: normal values
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Adult: 135-145 mEq/L
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Sodium: Panic values
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90-105 mEq/L - severe neurologic sx
<120 mEq/L - weakness, dehydration >155 mEq/L - CV and renal sx >160 heart failure |
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Machanisms for sodium regulation include..
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-renal blood flow
-carbonic anhydrase enzyme activity -aldosterone -renin -ADH -vasopressin |
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Where is sodium filtered, reabsorbed etc?
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-Filtered at glomerulus
-reabsorbed at proximal tubule and Loop of Henle, then again at distal tubule if aldosterone is present |
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Rate of Na reabsorption depends on..
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-level of K+
-balance of H+ and K+ -acid base status -tubular flow rate |
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Hyponatremia is the ....
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MOST COMMON electrolyte disorder!!
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Hypnatremia is caused by..
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-dueresis (sweating, vomiting, severe diarrhea, drugs)
-over hydration -inappropriate ADH syndrome -false hyponatremia (from IV) -sever burns -Addisons disease (impaired Na reaboroption) -diabetic hyperosmolarity (excess glucose) |
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Hypernatremia is caused by...
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-dehydration (dec water intake, exces water output, exciss skin output, excess GI output, high protein tube feeds)
-inability of kidneyy to conserve water (hyperaldosteronism, cushings dz, diabetes insipidis, solute diaresis (glucose, mannitol, urea)) |
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Chloride: normal values
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98-106 mEq/L
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Cholride: critical values
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<80 mEq/L
>115 mEq/L |
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Importance of cholride:
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-maintains electrical neutrality (mainly as a salt with sodoium - follows sodium losses and accompanies sodium excess to maintain neutrality)
-serves as buffer to assist in acid/base balance -gives indication of hydration status -major extracellular ANION |
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Does hyper or hypo cholremia usually occur alone?
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No, usually with a shift with sodium or bicarb
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Sx of hypocholeremia:
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-hyperexcitablity of nervouse system and muscles
-shallow breathing -hypotension -tetany |
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Sx of hypercholeremia:
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-lethargy
-weakness -deep breathing |
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Causes of hypercholeremia:
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-dehydration
-excessive infusion of normal saline -metabolic acidosis -renal tubular acidosis -Cushings syndrome -kidney disfunction -hyperparathyroidism -resp alkalosis |
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Casuses of hypochloremia:
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-SIADH
-CFH -vomiting and prolonged gastric suction -chronic resp acidosis -metaboic alkalosis -burns |
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Carbon dioxide: normals
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adult/elderly: 23-30 mEq/L
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Carbon dioxide: critical values
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<6 mEq/L
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What is actually measured to get CO2?
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HCO3
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Indication for CO2 test?
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-rough guide to acid/base balance
-evaluate pH -assist in evaluating electrolyte status |
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What three things does Serum CO2 measure?
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H2CO3
dissolved CO2 HCO3 BUT H2CO3 and dissolved CO2 are very low so serum CO2 is a relection of HCO3 content |
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Role of HCO2?
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-maintain electric neutrality along with choloride
-anion |
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HCO3 Increases in...
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-metabolic alakalosis
-severe vomiting -gastric suction -aldosteronism -COPD |
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HCO3 decreases in...
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-metabolic acidosis
-chonic diarhhea -diabetic ketoacidosis -starvation -shock -chornic use of loop diueretics |
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Osmolality
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-measures the number of dissolved particles in a solution (plasma)
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osmolality normals:
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Serum: 275-295 mOsm/kg H20
Urine: 300-900 mOsm/kg H20 |
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Other signs and monitors of fluid status:
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-vital signs (if no fluid, dec BP)
-perfusion -JVD/venous filling -skin turgor (dehydration dec resiliency) -Input and output -daily weight changes |
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BUN
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-Blood ureas nitrogen
-final breakdown product of protein metabolism -excreted at rate proportional to GFR -used as gross index of GFR rate (inversly proportional) -made in liver |
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BUN: normal
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7-18 mg/dl
panic >100 mg/dl |
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causes of increased BUN (azotemia):
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-rapid protein catabolism
-decreased kidney function -impaired renal fcn d/t CHF, shock, salt/water depletion, acute MI, Urinary tract obstruction |
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Causes of decreased BUN:
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-liver failure
-hepatitis -malnutrition -anabolic steroid use -nephrotic syndrome |
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Causes of Pre-renal azotemia:
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-shock
-dehydration -CHF -excessive protein catabolism |
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Causes of post-renal azotemia:
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-uretal or orethral pbstruction
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Synthesis of urea depends on ...
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liver (functional liver)
So liver disease causes dec BUN |
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Serum Creatinine
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-final breadown product of creatine phosphate in msuscle
-daily generation of creatinine is constant and kidneys excrete it very well (virtually 100% first pass excretion) |
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Serum creatinine: normal
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0.5-1.5 mg/dl
panic >10 mg/dl |
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Causes of increased creatinine:
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-impaired renal function
-chornic nephritis -Urinary tract obstruction -muscel disease -dehydration -CHF -shock -rhabdomyolysis -some drugs including cephalosporins |
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Causes of decreased creatinine:
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-small stature
-decreased muscle mass -advanced and sever liver disease |
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BUN:Creatinine ratio
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normal 10:1 to 20:1
values anbove 20:1 suggest dehydration (give IV fluids) |
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Creatinine vs BUN
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-BUN correlates better with symptoms of uremia than creatine levels
-BUN levels rise more rapidly and sharply -Creatinine is a better indication of kidney function -creatinine is more specific and more sensitive indicator of kidney dz than BUN |
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Role of Caclium
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-coagulation
-nerve transmission -excitability of cardiac/skeletal muscle -skeletal growth |
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Where is calcium found?
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99% in bone
1% serum 1/2 of serum calcium is bound to albumin, the other 1/2 is unionized (active) |
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What regulated Calcium levels?
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-Parathyroid hormone
-vitamin D -closely related to albumin levels -closely tied to bone metabolism |
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Calcium: normal values
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8.4 - 10.2 mg/dl
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Calcium: panic values
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<6 mg/dl (tetany, convulsions, seizures)
>13 mg/dl (cardiotoxicity, arrythmias, coma) |
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Causes of Hypocalcemia...
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-hypoparathyroidism
-vitamin D deficiency -pancreatitis -pseudohypocalcemia -malabsorption -renal failure -alchoholism -excess IV fluids may mimic hypocalcemia |
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Causes of Hypercalcemia...
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-bone turnover
-metastatic CA -multiple myelome -primary bone tumors -hyperparathyroidism |
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Roles of Magnesium
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-helps with neuromuscular tranmission and muscle contraction
-role in muscle relaxation -protein synthesis -enzyme activation -oxidative phosphorylation |
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Where is magnesium found?
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1-3% extracellular
rest is intracellular |
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Magnesium: normal values
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1.2-2.6 mg/dl
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Magnesium: panic values
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<1 mg/dl (tetany)
5-10 mg/dl (CNS depression, n/v, fatigue) 10-15 mg/dl (EKG changes, respiratory paralysis) >30 mg/sl (heart block, cardiac arrest) |
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What regulates magnesium?
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-KIDNEY (serum concentration of Mg provides feedback inhibition so inc Mg, less absorption in loop of henle/distal tubules)
-intake -absorption in small intestine -excretion via glomerular filtration -closely tied to calcium (Mg needed for absoprtion of Ca) - |
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Causes of decreased magnesisum?
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-decreased absorption (malabsoprtion, bowel resection)
-excessive elimination (alcoholism, malignancy, dieretics, prolonged NG suction, diabetic acidosis) -hypercalcemia |
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Sx of decreased magnesium?
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-hyperactive reflees
-muscle tremors -tetany -lethargy |
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Causes of increased magnesium?
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-excessive intake or inadequte excretion
-renal failure -dehydration -hypthroid -anatacids with magnesium |
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Sx of increased magnesium?
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-hypotension
-flushing -sweating -flaccid paralysis -weak/absent DTRs -hypothermia -fatigue -slow weak pulse -n/v -respiratory paralysis -cardiac arrest |
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Where is Phosphate found?
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85% is combined with calcium in bone
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What is phohpate associated with?
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INVERSELY related to calcium levels
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What regulates phosphate?
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parathyroid hormone
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Causes for Hyperphosphatemia...
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-kidney dysfcn
-uremia -hypoparathyroidism -hypocalcemia |
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Causes for hypophosphatemia...
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-hyperparathyroidism
-rickets -hyperinsulinemia -liver disease -acute alcoholism |
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Uric Acid
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-formed from breakdown of necleic acids
-end product of purine metabolism -produced in liver -constantly produced bc purine turnover is constant -2/3 excreted in urine; 1/3 excreted in stool |
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Uric acid: normal values
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men 3-7 mg/sl
women 2.6-6.0 mg/dl |
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Causes of increaed uric acid
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-gout
-increased dietary purines (organ meat, veggies, achovies) -leukemia -lymphoma -cytologic tx of malginancies (inc cell breakdown) -renal failure -alcohol intake -ketoacidosis -multiple myeloma -hypothyroidism -metastatic CA |
