Term
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Definition
-basic metabolic panel
-Na,K,Cl,bicarbonate,BUN,SrCr,Glu |
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Term
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Definition
-electrolyte status (altered can cause ADR)
-hydration status
-kidney function
-acid base balance |
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Term
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Definition
-most abundant cation in extracellular fluid
-major contributor to serum osmolality (controls movement of water b/w intra and extracellular spaces)
-kidneys are major organ for Na/water balance |
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Term
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Definition
-serum osmolality
-fluid status
-maintenance of transmembrane electrical potential for cardiac and neuromuscular function |
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Term
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Definition
-high/low sodium
-high-thirst,restlessness,irritable
-low-agitation,anorexia,apathy |
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Term
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Definition
| -most abundant intracellular cation (hard to measure) |
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Term
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Definition
-maintain proper electrical conduction and skeletal muscle
-influence on water balance
-acid base equilibrium |
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Term
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Definition
-kidneys (excretes 90% K, aldosterone)
-pH
-insulin
-catecholamines (beta agonists-stimulates movement of K into cell during hyperkalemia) |
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Term
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Definition
-inadequate intake
-laxative abuse
-diuretics (furosemide) |
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Term
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Definition
-ACEi/ARBs
-spironolactone
-low mineralcorticoid activity |
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Term
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Definition
-major inorganic ion extracellular space
-serum levels used to assess acid base status by calculating anion gap |
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Term
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Definition
-associated with acidosis/alkalosis (usually from diarrhea)
-due more to acid base disorders and fluid status not Cl |
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Term
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Definition
-CO2 content = HCO3 + CO2 dissolved in serum
-most important buffering system in body |
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Term
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Definition
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Term
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Definition
-flow rate of flitered fluid thru kidney
-rough measure of functioning nephrons
-normal men 127ml/min
-women 118ml/min |
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Term
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Definition
-blood urea nitrogen
-end product of protein metabolism
-produced solely by liver but excreted solely by kidneys
-may reflect renal function
-excellent screening function but cannot quantify extent of renal dysfunction |
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Term
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Definition
-urea production inc (high protein, Gi bleeding, some drugs)
-urine flow dec (low BP or dehydration)-more time to reabsorb filtered BUN
(inverse relationship between urine flow and serum levels of BUN) |
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Term
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Definition
-not as clinically significant
-could be malnourishment/liver damage |
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Term
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Definition
-released from muscle into plasma (formed constantly, level of production remains constant only if muscle mass remains constant)
-freely filtered at glomerulus (excreted almost exclusively by glomular filtration (GFR))
-rate of production typically equals excretion so blood level is typically constant |
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Term
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Definition
-high - dec filtration in glomerlus, drugs that prevent its secretion in the tubules
-low-low muscle mass resulting in decreased production, SrCr may be low or normal with decreased renal function |
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Term
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Definition
males((140-age)x IBW)/(72 x SrCr)
females x .85 |
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Term
| pt with low muscle mass/elderly |
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Definition
| -substitute 0.7 into SrCr if <1 |
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Term
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Definition
-greater than 20:1 indicates acute kidney injury due to suspected dehydration and resultant hypoperfusion of the kidneys (pre renal azotemia)
-greater than 36:1 indicates GI bleed |
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Term
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Definition
-levels come from carb digestion, hepatic glycogenolysis, gluconeogenesis
-"normal" glucose values refer to fasting state
-abnormal levels indicate problems in glucose metabolism |
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Term
| causes of hyper/hypoglycemia |
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Definition
-hyper-diabeters, thiazides
-hypo-insulin, malnutrition, Addison's disease, liver damage |
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Term
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Definition
| BMP+LFT+Ca+, protein and albumin |
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Term
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Definition
-AST
-ALT
-Alk phos
-GGT
-Albumin
-phenytoin and albumin
-Ca and albumin |
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Term
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Definition
-normal 8-42 IU
-found primarily in liver and cardiac muscle (kidneys, brain, pancreas and skeletal muscle too)
-elevated in heart attacks (8 hr post injury, peak 24-36 hr)
-markedly elevated in acute hepatitis
-mildly in cirrhosis and heart failure
-liver dysfunction |
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Term
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Definition
-3-30 IU/L
-more specific for hepatocellular diease
-less sensitive to liver injury
-abnormal levels persist longer |
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Term
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Definition
-normal 30-120 IU
-found in mostly liver/bone, also small intestines, kidney, placenta, leukocytes
-can be a sign of cholestasis (blockage) but is a non specific lab value
-can be elevated from a nonhepatic source
-should be assessed in conjunction with other lab parameters |
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Term
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Definition
-normal range 0-94 units/L
-biliary excretion enzyme
-inc parallels the increase in alk phos in obstructive jaundice and infiltrative diseases in liver
-sensitive indicator of recent ethanol exposure |
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Term
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Definition
-3.5-5.5g/dL
-produced in liver (low levels, if not secondary to nutritional deficiency or nephrotic syndrome, could be a marker of hepatic DYSFUNCTION not injury!)
-contributes 80% serum colloid osmotic pressure
-transports amino acids from liver to tissues
-transports poorly soluble organic and inorganic ligands
-binds numerous hormones, anions, drugs, and fatty acids (important in the PK of certain highly protein bound drugs and electrolytes like Phenytoin and Calcium) |
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Term
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Definition
-most assays measure total conc of drug (bound and unbound)
-only UNBOUND drug is active!
-hypoalbuminemia alters free fraction of drug
-target TOTAL phenytoin conc. is 10-20 mcg/ml
-target free phenytoin 1-2mcg/ml
-Sheiner-Tozer formula |
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Term
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Definition
-with albumin 4g/dl, w/o 8.8-10.2mg/dl
-44% is in bone (reservoir to maintain Ca)
-40% in extracellular fluid is bound to albumin
-for every 1gm/dl decrease in albumin 0.8gm/dl of Ca should be added to lab result |
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Term
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Definition
| -more than 2 gm/day and limit ethanol consumption |
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Term
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Definition
-valuable in diagnosing ethanol liver disease
-both typically under 300
-but AST is typically at least 2x ALT
-add to above parameters, if GGT is high too= consider ethanol use |
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Term
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Definition
-RBCs taken up and destroyed in spleen
-Hb is released and broken down into unconjugated bilirubin (water insoluble)
-bilirubin is bound to albumin and transported to liver
-unconj. bili is taken up by liver and conj with glucoronic acid
-conj bili (water soluble) is excreted into the bile and gut
-there it is broken down into urobilinogen and some is reabsorbed and excreted again by the liver in gut or kidneys
-remaining conj bili is excreted in feces |
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Term
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Definition
-tbili 0.3 -1mg/dl
-direct 0-0.2 mg/dl
-Hgb breakdown product
-inc bili-elimination defect (direct), metabolism defect(unconj), may result in jaundice |
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Term
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Definition
-0.2-0.7 mg/dl
-pts with primary unconj hyperbilirubinemia often have no s/s of liver disease and have normal aminotransferase
-conditions associated with inc unconj bilirubin (prehepatic):
-hemolysis
-gilbert's syndrome
-crigler-najjar
-neonatal jaundice |
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Term
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Definition
-0.1-0.3mg/dl
-usually associated with elevation of other hepatic enzymes, reflects underlying hepatic disease
-elevated direct bili+elevated transferases = hepatitis or cirrhosis
-elevated direct bili + elevated ALP +GGT = cholestatic disorder (posthepatic, gallstones, drugs,etc) |
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Term
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Definition
-primary interference with the metabolism or secretion of bilirubin
-anywhere from its initial production in hepatocytes to its secretion into the duodenum |
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Term
| cholestatic disease parameters to assess |
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Definition
-bilirubin inc
-ALP inc
-GGT |
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Term
| tests to evaluate synthetic FUNCTION of liver |
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Definition
-albumin (prod by liver)
-prothrombin or protime-measure vit K dep coagulation factors 2, 7, 9, and 10 produced by the liver
-high levels indicate liver disease or anticoag therapy with Warfarin typically |
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Term
| int'l normalized ratio (INR) and relationship to Prothrombin time |
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Definition
-developed to standardize PT for Warfarin monitoring
-conversion from PT to INR requires sensitivity of agent to be known
-usually INR is 2-3 for most Warfarin indication sometimes 2.5-3.5
-typical baseline INR? |
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Term
| tests to asses if liver damage is present |
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Definition
-AST,ALT,indirect bili
-ONLY indicate if damage is present
-do not necessarily correlate with disease severity |
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Term
| tests to assess function or synthetic capacity |
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Definition
-albumin
-coag studies (PT/INR) |
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Term
| tests for exc function of liver (ex. looking for cholestatic blockage in liver) |
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Definition
-bilirubin - total and direct
-GGT
-alk phos |
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Term
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Definition
-conc of different cellular and noncellular elements of blood
-RBC,WBC,Hb,Hct,mean cell volume
-mean cell Hb,mean cell Hb conc, reticulocyte count, RBC distribution width, platelet count, mean platelet volume)
-asses infection to anemia and bleeding probs |
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Term
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Definition
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Term
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Definition
-inc wbcs
-infections, stress, inflam conditions, drugs (prednisone, lithium)
-caution in elderly, chemotherapy, overwhelming sepsis pts |
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Term
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Definition
-dec wbc
-bone marrow failure
-cancer, toxic rxn to meds |
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Term
| WBC differential (most to least) granulocytes |
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Definition
-neutrophils
-bands
-eosinophil
-basophils |
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Term
| WBc differential nongranulocytes |
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Definition
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Term
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Definition
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Term
| allergic or toxic rxn to meds |
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Definition
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Term
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Definition
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Term
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Definition
-most common WBC
-in response to infection leave bloodstream and enter tissue to defend against pathogens
-response blunted in elderly/septic pts |
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Term
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Definition
-low wbc count
-less than 2k
-can occur due to overwhelming infection, viral, drug rxn
-absolute neu count is less than 1k cells/ml (predisposes pt to fungal and bacterial infections) |
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Term
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Definition
-inc neu
-infection
-trauma
-neoplasm
-corticosteroids |
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Term
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Definition
-parasitic infections
-elevated hypersensitivity reaction (HSR) may last 3 weeks to 6 months |
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Term
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Definition
-immediate and delayed release HSR
-chronic inflam and leukemia as well |
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Term
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Definition
-cell immunity vs virus/tumors
-cell mediated immunity
-delayed hypersensitivity (skin tests TB,mumps)
-rejection of organ transplants
-defense vs fungal/viral infections |
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Term
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Definition
-antibody production
-Ag presenting cells
-humoral immunity
-recognize foreign substances |
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Term
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Definition
-amount of Hb per volume of whole blood
-oxygen carrying compound found in RBC
-provides direct indication of oxygen transport capacity in blood
-low values could be loss of RBCs or dec quantity of Hb |
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Term
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Definition
-packed cell volume
-39-49% men
-33-43% females
-actual volume of RBC in a unit volume of whole blood
-usually 3x hb |
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Term
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Definition
anemia
bleeding
BM supp
genetic alterations (sickle cell)
hemolysis
over hydration |
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Term
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Definition
dehydration (hemoconcentration)
polycythemia vera (bone marrow disease) |
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Term
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Definition
-evaluation of anemias, polycythemia, and nutritional disorders
-assess size and Hb content of rbcs
-calculated from Hg, Rbcs and HCT |
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Term
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Definition
-assess RBC size
-macrocytic-vit b12 and folate deficiency
-microcytic - Fe deficiency |
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Term
| MCV can be falsely high with |
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Definition
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Term
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Definition
-iron def anemia
-NOT specific of IDA
-found in factor deficient anemia (iron, folate, vit b12) |
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Term
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Definition
-baby rbcs
-indirect measure of rbc production
-in c prod may be response to blood loss
-dec number suggest possible aplastic anemia or other bone marrow failure
-used to monitor response to vit and iron supp in anemia (should inc in 5-7 days) |
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Term
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Definition
-tests to evaluate hemostasis
-thrombocytosis (meds can lower)
-thrombonemia (platelet transfusions) |
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Term
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Definition
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Term
| factors altering normal range |
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Definition
-specimen collection - blood or csf
-population studies mdrd
-demographics
-assay used and analyte studied
-nutritional status |
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Term
| factors influencing lab data |
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Definition
-pt demographics
-time of day
-time of last meal
-type of specimen
-institution-spec assays
-drugs
-inherent variability of testing |
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Term
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Definition
-ability to show a positive result in pt who actually have disease
-higher the sensitivity the lower the chance of false negative result |
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Term
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Definition
-% of negative results among ppl who do not have the disease in question
-high spec are best for confirming a diagnosis b/c it is rarely positive in the absence of disease |
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