Clinical Lab: Chem panels
Terms
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- Electrolyte panel consists of...
-
-sodium
-potassium
-choride
-CO2
-calcium (sometimes) - Basic Metabolic panel consists of..
-
-glucose
-BUN
-creatinine
-calcium
-sodium
-potassium
-choloride
-CO2 - Renal function panel consists of...
-
-BUN
-creatinine
-sodium
-potassium
-phosphorus
-glucose
-calcium
-albumin
-chloride
-CO2 - Hepatic Function panel consists of..
-
-A/G ratio (albumin/globulin)
-ALP
-AST
-ALT
-Albumin
-bilirubin (direct and indirect)
-total protein - Lipid Panel consists of...
-
-cholesterol
-HDL
-LDL
-Tg
-cholesteral/HDL ratio - Comprehensive Metabolic panel consists of...
-
-A/G ratio
-albumin
-ALP
-ALT
-AST
-total bilirubin
-BUN
-BUN/creatinine
-Calcium
-CO2
-chloride
-globulin (calculated)
-Glucose
-potassium
-protein (total)
-sodium - hepatic panel (acte with reflex) consists of...
-
-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 - Thyroid panel
-
-T3
-T4
-Free T4 (calculated)
-TSH - Potassium is the major....
- MAJOR INTRACELLULAR CATION
- Importance of potassium...
-
-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 - Potassiun: normal range
- 3.5-5.3 mEq/L
- Where is K+ Secreted ?
- distale tubule
- K+ is screted from the distal tubule at a rate dependent on...
-
-K+ intake
-presence of aldosterone
-availbaility of Na+ for reabsorption
-balance of H+ and K+
-acid base status
-tubular flow rate - How does aldosterone effect K+?
- -under the influance of aldosterone, the kidneys conserve Na by wasting K+ (they exhange Na for K) even if both are in short supply
- Hypokalemia results from...
-
-shifing K+ into cells
-k+ loss from GI tract
-renal excretion
-decreased intake - Causes of hypokalemia...
-
-hyperaldosteronism
-renal diseasee
-CHF
-potent loop diuretics (furosemide)
-loss of K+ (emesis, diarrhea, sweat)
-starvation/malabsorption
-insulin (causes shift of K+ into cells) - Excessive hypokalemia may lead to...
-
-V fib
-other arrythmias (Torsades de pointes)
-respiratory paralysis - EKG changes with hypokalemia...
-
-ST depression
-flattened T wave
-U wave
-peaked P wave -
Most common cuase of K+ defiency is...
(deficiency = normal/natural causes) -
-GI loss
-inadequate intake -
Most common cause of K+ depletion is..
(depletion = external cuase) - -IV fluids without adequate K+ supplementation
- Hyperkalemia results from...
-
-K+ shift out of cells
-decreaed renal excretion
-excessive intake - Causes of hyperkalemia include...
-
-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 - Symptoms of hyperkalemia..
-
-weakness
-malaise
-nausea
-intestinal colic
-muscle irritability
-flaccid paralysis
-obligurea
-bradycardia - EKG changes with hyperkalemia...
-
-wide QRS
-flat P wave
-peaked T wave
-ST depression
-may lead to v-fib and cardiac arrest - Sodium is the major...
- EXTRACELLULAR CATION
- Importance of sodium..
-
-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 - What do sodium levels test?
-
-changes is water balance
(rather than changes in sodium balance) - Sodium levels are used to determine...
-
-electrolyte balance
-acid base balance
-water balance
-water intoxication (dec Na)
-dehydration (inc Na) - Sodium: normal values
- Adult: 135-145 mEq/L
- Sodium: Panic values
-
90-105 mEq/L - severe neurologic sx
<120 mEq/L - weakness, dehydration
>155 mEq/L - CV and renal sx
>160 heart failure - Machanisms for sodium regulation include..
-
-renal blood flow
-carbonic anhydrase enzyme activity
-aldosterone
-renin
-ADH
-vasopressin - Where is sodium filtered, reabsorbed etc?
-
-Filtered at glomerulus
-reabsorbed at proximal tubule and Loop of Henle, then again at distal tubule if aldosterone is present - Rate of Na reabsorption depends on..
-
-level of K+
-balance of H+ and K+
-acid base status
-tubular flow rate - Hyponatremia is the ....
- MOST COMMON electrolyte disorder!!
- Hypnatremia is caused by..
-
-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) - Hypernatremia is caused by...
-
-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)) - Chloride: normal values
- 98-106 mEq/L
- Cholride: critical values
-
<80 mEq/L
>115 mEq/L - Importance of cholride:
-
-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 - Does hyper or hypo cholremia usually occur alone?
- No, usually with a shift with sodium or bicarb
- Sx of hypocholeremia:
-
-hyperexcitablity of nervouse system and muscles
-shallow breathing
-hypotension
-tetany - Sx of hypercholeremia:
-
-lethargy
-weakness
-deep breathing - Causes of hypercholeremia:
-
-dehydration
-excessive infusion of normal saline
-metabolic acidosis
-renal tubular acidosis
-Cushings syndrome
-kidney disfunction
-hyperparathyroidism
-resp alkalosis - Casuses of hypochloremia:
-
-SIADH
-CFH
-vomiting and prolonged gastric suction
-chronic resp acidosis
-metaboic alkalosis
-burns - Carbon dioxide: normals
- adult/elderly: 23-30 mEq/L
- Carbon dioxide: critical values
- <6 mEq/L
- What is actually measured to get CO2?
- HCO3
- Indication for CO2 test?
-
-rough guide to acid/base balance
-evaluate pH
-assist in evaluating electrolyte status - What three things does Serum CO2 measure?
-
H2CO3
dissolved CO2
HCO3
BUT H2CO3 and dissolved CO2 are very low so serum CO2 is a relection of HCO3 content - Role of HCO2?
-
-maintain electric neutrality along with choloride
-anion - HCO3 Increases in...
-
-metabolic alakalosis
-severe vomiting
-gastric suction
-aldosteronism
-COPD - HCO3 decreases in...
-
-metabolic acidosis
-chonic diarhhea
-diabetic ketoacidosis
-starvation
-shock
-chornic use of loop diueretics - Osmolality
- -measures the number of dissolved particles in a solution (plasma)
- osmolality normals:
-
Serum: 275-295 mOsm/kg H20
Urine: 300-900 mOsm/kg H20 - Other signs and monitors of fluid status:
-
-vital signs (if no fluid, dec BP)
-perfusion
-JVD/venous filling
-skin turgor (dehydration dec resiliency)
-Input and output
-daily weight changes - BUN
-
-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 - BUN: normal
-
7-18 mg/dl
panic >100 mg/dl - causes of increased BUN (azotemia):
-
-rapid protein catabolism
-decreased kidney function
-impaired renal fcn d/t CHF, shock, salt/water depletion, acute MI, Urinary tract obstruction - Causes of decreased BUN:
-
-liver failure
-hepatitis
-malnutrition
-anabolic steroid use
-nephrotic syndrome - Causes of Pre-renal azotemia:
-
-shock
-dehydration
-CHF
-excessive protein catabolism - Causes of post-renal azotemia:
- -uretal or orethral pbstruction
- Synthesis of urea depends on ...
-
liver (functional liver)
So liver disease causes dec BUN - Serum Creatinine
-
-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) - Serum creatinine: normal
-
0.5-1.5 mg/dl
panic >10 mg/dl - Causes of increased creatinine:
-
-impaired renal function
-chornic nephritis
-Urinary tract obstruction
-muscel disease
-dehydration
-CHF
-shock
-rhabdomyolysis
-some drugs including cephalosporins - Causes of decreased creatinine:
-
-small stature
-decreased muscle mass
-advanced and sever liver disease - BUN:Creatinine ratio
-
normal 10:1 to 20:1
values anbove 20:1 suggest dehydration (give IV fluids) - Creatinine vs BUN
-
-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 - Role of Caclium
-
-coagulation
-nerve transmission
-excitability of cardiac/skeletal muscle
-skeletal growth - Where is calcium found?
-
99% in bone
1% serum
1/2 of serum calcium is bound to albumin, the other 1/2 is unionized (active) - What regulated Calcium levels?
-
-Parathyroid hormone
-vitamin D
-closely related to albumin levels
-closely tied to bone metabolism - Calcium: normal values
- 8.4 - 10.2 mg/dl
- Calcium: panic values
-
<6 mg/dl (tetany, convulsions, seizures)
>13 mg/dl (cardiotoxicity, arrythmias, coma) - Causes of Hypocalcemia...
-
-hypoparathyroidism
-vitamin D deficiency
-pancreatitis
-pseudohypocalcemia
-malabsorption
-renal failure
-alchoholism
-excess IV fluids may mimic hypocalcemia - Causes of Hypercalcemia...
-
-bone turnover
-metastatic CA
-multiple myelome
-primary bone tumors
-hyperparathyroidism - Roles of Magnesium
-
-helps with neuromuscular tranmission and muscle contraction
-role in muscle relaxation
-protein synthesis
-enzyme activation
-oxidative phosphorylation - Where is magnesium found?
-
1-3% extracellular
rest is intracellular - Magnesium: normal values
- 1.2-2.6 mg/dl
- Magnesium: panic values
-
<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) - What regulates magnesium?
-
-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)
- - Causes of decreased magnesisum?
-
-decreased absorption (malabsoprtion, bowel resection)
-excessive elimination (alcoholism, malignancy, dieretics, prolonged NG suction, diabetic acidosis)
-hypercalcemia - Sx of decreased magnesium?
-
-hyperactive reflees
-muscle tremors
-tetany
-lethargy - Causes of increased magnesium?
-
-excessive intake or inadequte excretion
-renal failure
-dehydration
-hypthroid
-anatacids with magnesium - Sx of increased magnesium?
-
-hypotension
-flushing
-sweating
-flaccid paralysis
-weak/absent DTRs
-hypothermia
-fatigue
-slow weak pulse
-n/v
-respiratory paralysis
-cardiac arrest - Where is Phosphate found?
- 85% is combined with calcium in bone
- What is phohpate associated with?
- INVERSELY related to calcium levels
- What regulates phosphate?
- parathyroid hormone
- Causes for Hyperphosphatemia...
-
-kidney dysfcn
-uremia
-hypoparathyroidism
-hypocalcemia - Causes for hypophosphatemia...
-
-hyperparathyroidism
-rickets
-hyperinsulinemia
-liver disease
-acute alcoholism - Uric Acid
-
-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 - Uric acid: normal values
-
men 3-7 mg/sl
women 2.6-6.0 mg/dl - Causes of increaed uric acid
-
-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