0
Q
Hypercalemia causes:
A
- Malignancy
- Primary Hyperparathyroidism: adenoma of the PT gland
- Other cause:
1
Q
Hypercalcemia Sx:
A
Sx:
-Mental status changes
-N/V
-Cardiac Arrest
(decreased concentration)
2
Q
Malignancies that cause hypercalemia:
A
a.Tumor metastasis to bone
(ie: Prostate CA)
b.Paraneoplastic Syndromes
(Ectopic PTH; Lung CA)
c. Primary malig. of bone or marrow
(Myeloma- plasma cell in bone
marrow tumor
(Leukemia- ALL, CLL, AML, CML)
3
Q
Other causes of Hypercalcemia:
A
a. Excess Vit. D
b. Decreased BP/ Hyponatremia- causes excessive Na+ excretion
causes excessive Ca+ reabsorption
c. Acidosis/cellular release-
increased H+= increased K+= and Ca2+
d. Paget’s Dz- excessive bone reabsorption-> Sr
e. Lithium- stimulates PTH secretion
f. Thiazides diuretics - causes Na excretion and ca+ reabsorption
g. Sarcoidosis- if in bone
4
Q
Calcium Range:
A
8.5- 10.5 mg/ dL
5
Q
Hypercalcemia:
A
[Sr] > 10.6 mg/dL
*** Emergency Tx is indicated for pt with moderate hypercalcemia 12-13.9mg/dL or severe which is even higher
6
Q
Hypocalcemia Sx:
A
- Tetany
- Cardiac Arrhythmias
7
Q
Hypocalcemia Causes: (6)
A
- Hypoparathyroidism- thyroidectomy
- Burns:
Sarcopenia occurs (breakdown of
muscle and bone)
hypoalbuminemia decreased
binding capacity+ decreased vital
skin to activate Vit. D - Malabsorption syndromes-
decreased vital skin to activate
Vit. D. - Alkalosis
- Increased BP + hypernatremia-
Excessive Na reabsorption causes
Excess Ca++ excretion - Vitamin D deficiency
8
Q
Calcium Functions (6):
A
- Bone formation and growth
- Skeletal and cardiac muscle
Contraction- Troponin - Smooth muscle Contraction
Binds to Calmodulin - Activation of Coag. factors
- Activation of enzymes and activity
- Transmission of neural impulses.
9
Q
Serum Calcium: (forms)
A
- Bound to albumin
- Free (unionized)
- Bound to anions
10
Q
BUN range:
A
Children: 5-18 mg/dL Adult: 5-20 mg/dL Elderly: 8-21 mg/dL
11
Q
Major categories if Elevated BUN:
A
1) Pre-renal
2) Intra-renal
3) Post-renal
4) non-Renal causes
12
Q
Pre-renal causes of ^ BUN:
A
A. Decreased profusion to glomerulus
Due to decreased CO
- Severe sepsis
- Shock
- CHF
- Dehydration
- Burns
B Liver Dz ( cirrhosis & hepatitis)
13
Q
Intra-renal causes of ^ BUN:
A
A. Glomerulus-> glomerular nephritis
B. Tubules-> pyelonephritis
C. Vasculature -> HTN & athrosclerosis
D. Interstitial-> Polycystic Kidney Dz
14
Q
Post-renal causes if ^ BUN:
A
A. Obstruction and backup:
Azotemia: BUN > 115 mg/dL
1) renal calculi
2) upper and lower UTIs
15
Q
Non-renal causes:
A
A. GI bleeding -> bacteria in gut breaks
down blood products into urea N.
B. Steroids-> induced proteolysis in a
hypermet. state & dehydration
C. Severe Sepsis-> decreased afferent
Flow
D. Antibiotics that are nephrotixic->
-Tetracyclines
- Aminoglycosides
- Amphotericin B
16
Q
BUN/ Cr ratio more sensitive to varying pathology:
A
- > 20 :1 PRE-renal cause
- 10-20:1 POST-renal
- <10:1 INTRA-renal
17
Q
Azotemia Sx:
A
- N/V
- Stupor
- Coma
- Acidosis
18
Q
Cr Range (female):
A
0.6-1.1 mg/dL
19
Q
Cr Range (male):
A
0.8-1.3 mg/dL
20
Q
Causes of ^ Cr: (6):
A
- Exercise ( ^ muscle breakdown)
- Pregnancy
- Dehydration
- Reduced Renal perfusion
• Sepsis
• Shock
• CHF - Acute or Chronic renal failure
• UTI obstruction
• Nephritis - Rhabdomyolysis
21
Q
Causes of decreased Cr:
A
- Malnutrition
- Debilitation
( not as concerning as elevated Cr )
22
Q
Components of Cr Clerance:
A
- Urine Cr concentration
- Serum Cr concentration
- Volume of Urine
- Time period of collection (24hrs)
23
Q
Benefits of the Cr test:
A
- BEST way to quantify proteinuria
(Distinguish between nephritic and
nephrotic syndrome) - Can get Sr from a venous stick
24
Nephrotic syndrome:
Loss of a lot of protein
Proteinurea (>3.5g in 24hrs)
++++ Protein
Urine looks frothy
Tip: Nephrotic & Protein both have an “O” which may help you remember!
25
Nephritic syndrome:
Loss of a lot of blood- Haematuria
+++ Blood – May be microscopic or macroscopic haematuria
Red cell casts – distinguishing feature, form in nephrons & indicate glomerular damage
Podocytes develop large pores which allow blood & protein through
26
Preparation Instructions:
A Do not do strenuous activity for up to
2 days before
B Do not eat high meat meals the day
before
C Drink fluids
D Don't drink caffeine (diuretic)
27
GFR (Cr clearance) reference ranges
| (Female):
60- 115 mL/ min
*** if GFR < 60 mL/min,
CANNOT receive contrast dye
28
GFR (Cr clearance) reference ranges
| (Male):
70-135 mL/ min
29
PE findings with Chronic Renal failure: (CRF)
```
- Bloody urine (seen when cysts
rupture in Polycystic kidney dz)
- peripheral edema (poor fluid
excretion)
-Oliguria (making a small amt. of urine)
-HTN
-Back/ flank pain
-Early findings: mild hematuria with
decreased GFR
-Late findings: moderate proteinuria
with granular and waxy casts
```
30
Potassium Range:
3.5- 5.3 mEq/L
31
Hyperkalemia ( ^ K+) Potassium:
Main consequences:
1. Myocardial contractility issues
(Arrhythmias, Arrest)
2. Acid- Base Disturbances
32
When you see hyperkalemia consider:
1. Is this a hemolysis specimen of blood (pseudohyperkalemia)?
- Artificially elevated; needs redrawn
2. What is the renal function?
- look at BUN/ Cr
(in conjunction w/ PE findings)
33
Causes of pseudohyerkalemia:
```
I. Excessive vacuum suction
II. Small gauge needle
III. Delay of specimen processing
IV. Excessive tube shaking
V. Excessive time w/ tourniquet on
```
34
Causes of HYPERkalemia (4):
```
1. Hemolysis
A. Hemolytic anemia:
B. Artifactual ( pseudohyperkalemic)
2. Excessive K+ Intake (KCl subs)
3. Potassium- Sparing diuretic
4. Metabolic acidosis
```
35
5 Hemolytic Anemias that can cause hyperkalemia:
1. G6PD
2. Thalassemia
3. Hemolytic Dz of Newborn
4. Autoimmune
5. Hereditary spherocytosis
38
Potassium naturally in body:
Most in intracellular fluid gained by diet
39
Potassium function:
1. Cellular H2O balance (acid- base)
| 2. Electrical muscle cell contraction
40
Na+ range:
135- 145
41
Cl range:
95-105
42
HCO3 range:
21-29
43
Hgb range:
| Female
12-16
44
Hgb range:
| Male
14-18
45
WBC range:
4.5 - 11 thousand
46
Hct range:
| Female
37-47%
47
Hct range:
| Male
42-52%
48
Plt range:
150-450 thousand
49
Indications for monitoring K+: (5)
1. Cardiac dysrhythmias
2. Renal dysfun
- restricted diet
- NaHCO3 Tx
3. Mental confusion
4. GI distress: prolonged diarrhea or
vomiting ( loss of K+)
5. IV K+ replacement
(Can usually go up to 10 mEq/L K+)
50
Causes of HYPOkalemia: (4)
1. Starvation (ETOH, Malnut, Anorexia)
2. GI loss (Vomiting/Diarrhea)
3. Renal losses:
-SE of diuretics
-Hyperaldosteronism- aldosterone
secreted when receptors detect
low blood volume -> hyper ->
Excessive Na+ reabsorption & K+
excretion
4. Intracellular shifts:
-Alkalosis
51
Glucose Range:
60-100
52
RBC range: (male)
5.5 x10^6 mL
53
RBC range: (female)
4x10^6 mL
54
MCV range:
Mean cell volume
| 80-100 fl
55
MCH range:
Mean corpuscular hemoglobin
| 26-34 pg
56
MCHC range:
[Mean corpuscular Hemoglobin]
| 33- 36 %
57
RDW range:
Red cell distribution width:
| <14.5 - variation in cell size
58
Plt range:
150-450 thousand
59
Ret range:
Reticulocyte count:
| 0.5- 2
60
Neutrophil range:
50-70%
| Abnormal = anemia
61
Lymphocyte Range:
25-35%
| Abnormal= Viral infection
62
Monocyte Range:
4-6%
63
Eosinophils range:
1-3%
| Abnormal= Allergies
64
Basophil range:
0.4-2%
Abnormal = Bacterial infection or
Parasitic infection
65
Low RBC and Hgb are indicative of?
Anemia
66
WBC are made where?
| Abnormal count can indicate?
Bone marrow
| Count up or down can indicate infection
67
Absolute Neutrophil count (ANC) is the measure of the amount of neutrophil granulocytes present in the blood
The fraction of neutrophils to the while WBC count dropping indicates?
Concerning pathology
| neutropenic pathway
68
Mild Neutropenia range:
Moderate:
Severe:
Severe Moderate. Mild
| 500 500- 1000-1500 microL
69
If WBC is abnormal always look at?
It will tell you if there is a ____ problem or ______ problem.
Next look at _____ to see if they are low.
Differential
Determine production vs. destruction problem
**Look at RBC/ Plts, see if they are low
70
Indications for bone marrow aspiration
1. Pancytopenia
| 2. Suspected Malignancy
71
Pt neutropenic, do ___ next.
CXR to r/o
| Lung infection
72
Low WBC count, make sure you do what
Get a culture
*** could be fatal if delay in culture ***
73
^ WBC look at what
Band cells to see if they are being produced
74
If H&H are low look immediately at ____!!!
MCV to see if there is anemia
75
Low MCV = _____ seen in:
Microcytic Anemia seen in:
* Iron def. anemia
* Thalassemia
* Anemia of Chronic Dz
* Sideroblastic Anemia
76
MCHC
Low:
Normal:
Low: Hypochromic
Normal: Normochromic
77
To determine if GI bleed:
- Stool occult test
| - Iron tests
78
Serum Iron:
Iron in blood
79
Ferritin
Stored iron in the body
80
TIBC:
Total binding iron capacity
| All protein available to bind to iron
81
Transferrin:
% Of transferrin that is saturated w/ iron
- made in liver, will be low in liver dz
82
UIBC:
Unsaturated Iron Binding Capacity:
Portion of transferrin that is NOT bound to iron
83
Iron deficiency Anemia iron study shift:
Fe: decreased -> deficiency
Ferritin: decreased -> low stores used up
Transferrin: increased ->
binding affinity increases as stores and supply are low
TIBC: increased -> as less available to be bound proteins open to be bound with
**Fe and transferrin inversely proportional
84
To determine if a pt needs transfused look at hemoglobin
Transfuse uncomplicated pt if hemoglobin reaches 7
85
Transfuse Pts with comorbid irises before Hgb reaches 7 like:
- COPD
- heart dz
- CHF
- sickle cell anemia
* all effect the ability of the body to oxygenate tissue so more sensitive to decreased profusion from anemia
86
If need iron give: ( not I severe cases 1st )
- iron rich foods
- iron folate
- follow up make sure Reticulocyte counties ^ing
87
Peripheral smear shows:
Shape and color of RBCs
88
Hemolytic anemias
- sickle cell
- thalassemias
- hemolytic anemia of newborns
- hereditary spherocytosis
- G6 BD
Diagnostic Test Interpretation
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