Clin Dx
Terms
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- 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
- 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