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34 Cards in this Set
- Front
- Back
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Ammonia
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Normal = 10-80 mcg/dL (adult)
1. Used to support the diagnosis of severe liver diseases (hepatitis or cirhosis) and for the diagnosis and follow-up of hepatic encephalopathy. 2. Ammonia is a by-product of protein catabolism. 3. By way of the portal vein, it goes to the liver, where it is normally converted into urea and then secreted by the kidneys. 4. Ammonia cannot be catabolised in the presence of severe hepatocellular dysfunction. |
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Drugs that cause increased ammonia levels include:
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1. Acetazolamide
2. Alcohol 3. Ammonium Chloride 4. Barbiturates 5. Diuretics (loop, thiazide) 6. Narcotics 7. Parenteral nutritian |
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Drugs that cause decreased ammonia levels include:
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1. Broad-spectrum (neomycin), lactobacillus, lactulose, Levodopa, and potassium salts.
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Amylase (General Info)
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Normal Findings 60-120 Somogyi units/dL
1. CRITICAL VALUE = more than 3x the upper limit 2. Used to detect and monitor the clinical course of pancreatitis 3. Frequently ordered when a patient presents with acute abdominal pain 4. Test most specific for pancreatitis |
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Amylase (Detailed Info)
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- Normally secreted from pancreatic acinar cells into the pancreatic duct and then into the duodenum.
- Once in the intestine it aids in the catabolism of carbohydrates to their component simple sugars. - Damage to the pancreatid acina cells causes an outpouring of this enzyme into the intrapancreatic lymph systaem and the free peritoneum. - Can be caused by nonpancreatic diseases such as: - Bowel perforation, Penetrating Peptic Ulcer, Duodenal Obstruction |
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Drugs that may increase Amylase levels
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1. Asprin
2. Corticosteroids 3. Ethy alcohol 4. Contrast media 5. Loop diuretics 6. Methyldopa 7. Narcotic Analgesics 8. Oral Contraceptives 9. Prednisone |
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Drugs that cause decreased Amylase levels
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1. Citrates
2. Glucose 3. Oxalates |
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Hematocrit (General Info)
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NORMAL LEVELS
1. Male: 42% - 52% 2. Female: 37% - 47% 3. Pregnant female: >33% CRITICAL VALUES 1. <15% or >60% |
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Hematocrit (description)
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1. An indirect measurement of RBC number and volume
2. This is used as a rapid measurement of RBC count. 3. Plays an integral part of the evaluation of anemic patients 4. Plays a role in deciding if a blood transfusion is needed. Not needed if Hct >24% or Hgb >8g/dL. |
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Hemoglobin (Levels)
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NORMAL LEVELS
1. Male: 14-18 g/dL 2. Female: 12-16 g/dL 3. Pregnant Female: >11 g/dL CRITICAL VALUES 1. < 5g/dL or >20g/dL |
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Hemoglobin (description)
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1. Hgb serves as a vehicle for oxygen and carbon dioxide transport.
2. The oxygen carrying capacity of the blood is determined by the Hgb concentration. 3. Also considered as an important acid-base buffer. |
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Lipase (Levels)
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NORMAL FINDINGS
1. 0 - 160 units/L |
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Lipase (description)
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1. Test used in the evaluation of pancreatic disease.
2. The most common cause of elevation = acute pancreatitis 3. Lipase is an enzyme released by the pancrease into the duodenum to break down triglycerides into fatty acids. |
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Magnesium (Levels)
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NORMAL FINDINGS
1. Adult: 1.3 - 2.1 mEq/L CRITICAL VALUES 1. Below 0.5 mEq/L 2. Above 3 mEq/L |
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Importance of Magnesium
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1. Most of Mg is bound to an ATP molecule and is important to the creation of energy within the body (ATP).
2. Mg acts as a cofactor that modifies the activity of many enzymes. (Carbohydrate, protein, and nucleic asid synthesis and metabolism depend on Mg) 3. Most organ functions, including neuromuscular tissue, also depend on Mg. 4. It is important to monitor Mg levels in cardiac patients |
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Effects of High an Low levels of Magnesium
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HIGH LEVELS
1. Retards neuromuscular conduction and is demonstrated as: a. Cardiac conduction slowing b. Diminished deep tendon reflexes c. Respiratory depression LOW LEVELS may: 1. Increase cardiac irritability 2. Aggravate cardiac arrhythmias |
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Drugs that INCREASE Mg levels
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1. Antacids
2. Aminoglycoside Antibiotics 3. Calcium containing medication 4. Laxatives 5. Lithium 6. Loop diuretics 7. Thyroid medication |
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Drugs that DECREASE Mg levels
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1. Some antibiotics
2. Diuretics 3. Insulin |
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Reasons for Increased levels of Magnesium
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1. Renal Insufficiency (Mg is excreated by the kidneys)
2. Addison Disease (Aldosterone enhances Mg excreation. With reduced aldosterone, Mg excreation is diminished) 3. Antacids 4. Hypothyrodism |
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Reasons for decreased levels of Magnesium
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1. Malnutriton
2. Malabsorption (main source of Mg is dietary intake and absorption from intestines) 3. Hypoparathyroidism (Ca levels are low = Mg absorbed with be reduced) 4. Alcoholism (ethanol increases Mg losses in urine) 5. Diabetic Acidosis |
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Calcium (Levels)
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NORMAL LEVELS
1. Adults = 4.5 - 5.6 mg/dL CRITICAL VALUES 1. Total Calcium < 6 or > 13 mg/dL |
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Calcium (Indicates?)
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1. Used to evaluate:
a. Parathyroid function b. Pts with renal failure c. Pts with renal transplantation d. Hyperparathyroidism |
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Hyercalcemia can be and indicatation for?
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1. Hyperparathyroidsim
2. Hyperthyroidism 3. Nonparathyroid PTH producing tumor 4. Metastatic tumor or bone 5. Paget disease of bone 6. Vitamin D intoxication 7. Addison Disease 8. Acromegly |
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Hypocalcemia can be and indicatation for?
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1. Hypoparathyroidism
2. Renal failure 3. Rickets 4. Vitamin D deficiency 5. Osteomalacia 6. Malabsorption 7. Pancreatitis 8. Fat embolism |
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Sodium
(Normal and Critical Levels) |
Normal = 136 - 145 mEq/L
Critical - less than 120 mEq/L greater than 160 mEq/L |
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Indications for Sodium Test
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1. This is part of routine labs when "serum electrolytes are ordered."
2. Test is used to evaluate and monitor fluid and electrolyte balance therapy. |
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Sodium: TEST EXPLANATION
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Sodium is the major cation in the extracellular space, in which ther are serum levels of approximately 140 mEq/L. The concentration of Na intracellularly is only 5 mEq/L. Therefore Na salts are the major determinants of extracellular osmolarity. The Na content in the blood is a result of a balance between dietary Na intake and renal excretion.
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Factors that Regulate Sodium Balance
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1. Aldosterone - causes conservation of Na by stimulationg the kidneys to reabsorb Na and decreasing renal losses.
2. Natriuretic Hormone - Decreases renal absorption and increases renal losses of sodium. 3. Antidiuretic Hormone (ADH) - Controls the reabsorption of water at the distal tubules of the kidney, affects Na serum levels by dilution or concentration. |
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Physiology of SODIUM and WATER
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Water and Na are closely related.
1. As fee body water is increased, serum Na is diluted and the concentration may decrease. The kidney conpensates by conserving Na and excreating water. 2. If free body water were to decrease the serum Na concentration would rise, the kidney would then respond by conserving free water. |
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Sodium Levels: INTERFERING FACTORS
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The following (1-3) are b/c renal flow is decreased.
1. Recent trauma 2. Surgery 3. Shock 4. Renin and Angiotensin - stimulate the secreation of aldosterone, which stimulates increased renal absorption of sodium. 5. Drugs |
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Sodium: Drugs that INCREASE Levels
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1. Anabolic steroids
2. Antibiotics 3. Carbenicillin 4. Clonidine 5. Corticosteroids 6. Cough medicines 7. Estrogens 8. Laxatives 9. Methyldopa 10. Oral contraceptives |
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Sodium: Drugs that DECREASE Levels
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1. Angiotensin-Converting Enzyme (ACE) Inhibitors
2. Captopril 3. Carbamazepine 4. Diuretics 5. Haloperidol 6. Heparin 7. NSAIDs 8. Na free IV fluids 9. Tricyclic Antidepressants 10. Vasopressin |
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Causes of HYPERNATREMIA
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INCREASED SODIUM INTAKE
1. Increased dietary intake 2. Excessive sodium in IV fluids DECREASED SODIUM LOSS 1. Cushing Syndrome 2. Hyperaldosteronism EXCESSIVE FREE BODY WATER LOSS 1. Excessive sweating 2. Excessive thermal burns 3. Diabetes insipidus 4. Osmotic diuresis |
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Causes of HYPONATREMIA
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DECREASED SODIUM INTAKE
1. Deficient dietary intake 2. Deficient Na in IV fluids INCREASED SODIUM LOSS 1. Addison disease 2. Diarrhea, Vomiting and nasogatric aspiration 3. Intaluminal bowel loss 4. Diuretic administration 5. Chronic renal insufficiency INCREASED FREE BODY WATER 1. Excessive oral water intake 2. Hyperglycemia 3. Excessive IV water intake 4. Congestive Heart Failure 5. Peripheral Edema |
