FSC: Phys Chem Test 1
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| Reasons for biochemical tests | determine a disease with a metabolic basis
observe/monitor for biochemical changes that are caused by an ailment"
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| Biochemical Test Purpose | Diagnosis: identifying disease
Prognosis: likely course a treatment or disease might take
Monitoring: monitor treatment for appropriateness
Screening: mandatory a specific ages, during epidemic conditions and to determine subclinical ailments
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| Screening Tests | TB Test, PKU (phenylketonuria) - infants prior to hospital release, scoliosis - school children
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| Serum | straw colored fluid, obtained by letting blood stand and clot (no -anticoagulants added); does not have fibrinogen
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| Plasma | yellow fluid on top, anticoagulant added to blood which is centrifuged; has fibrinogen
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| Serum vs. Plasma | serum does not have fibrinogen or anti-coagulants, plasma has both
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| All extracted fluids must be accompanied by test order that has: | Pt. name, sex, dob, date and time of sample collection, type of test to be done, possible diagnosis, MD name/number, medications pt. is taking, if inpatient: room number, unit
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| Biochemical Tests can be run for | Glucose, CBC, BUN, creatinine clearance (blood and urine), total protein, lipid panel, vit c, minerals (iron, chloride, sodium)
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| Errors in Biochemical Analysis | Pre-analytical Stage, Analytical Stage, Post-Analytical Stage
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| Pre-analytical Stage Errors | sample collection affected - sample contamination, inappropriate chemical in collecting apparatus, sample transport issues
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| Analytical Stage Errors | errors in procedure by technicians, machine failure produces incorrect results
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| Post-analytical Stage Errors | calculating, and recording results errors - report the wrong results for the wrong patient
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| Interpretation of results | There is a stable range of results for different genders/age groups/ethnicities
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| H2O percentages: male | 60%
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| H2O percentages: female | 55%
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| H2O percentages: infant | 70%
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| Lean body mass H2O percentages | 75-80
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| ICF vs. ECF | 66% total body water ICF
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| Water in ECF | 7-8% makes up plasma volume, rest is synovial fluid, peritoneal fluid ect.
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| Water Balance | Amount of water intake should nearly equal amount of water lost
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| Sources of water intake | pure water, fluids (soup, juices, milk, etc.), foods (high in H2O: fruits and vegetables)
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| H2O release by oxidative metabolism | Glucose + O2 -> CO2 + H2O
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| Routes of H2O Output | "Respiratory: release of H2O vapors
Skin: sensitive and insensitive perspiration
Renal: urine
GI Tract: fecal matter, stool; (sick: vomiting/diarrhea)
Eyes: tears"
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| Factors that influence H2O balance | climate, disease/illness, cultural factors, availability of water or food, physical activity, medical treatment
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| Osmotic Concentration | "aka osmolality
-influence H2O movement into and of cell"
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| Osmotic Concentration contributing factors | "mineral concentration: K in ICF; NA, CL, HCO3, MG in ECF
other molecules: glucose, proteins (amino acids) outside of cell"
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| Oncotic Pressure | the fluid pressure produced by protein levels
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| Obligatory Loss | "1500mL/daily
Skin - sweat - 500mL
Lungs - gaseous H2O - 400mL
GI - fecal H2O - 100mL (enzyme & saliva - reabsorbed)
Kidney - urine - 500mL (min)"
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| Reasons for water excretion | excretion of water soluble waste, to maintain proper ECF and ICF osmotic balance
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| Obligatory Sources | "Oxidative metabolism - 400mL
Dietary Intake - 1100mL"
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| Amount of urine is produced in 24 hours | 1500-2000 mL
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| Dehydration: causes | decreased intake-rare-fasting, air travel, extreme cold temp; Increased loss - GI dist, High temp, excessive sweating, post-op, hyperventilation, diuretics(natural, medications), low BG(sweating), high BG(dilute urine produced), increased ETOH intake, DKA
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| Dehydration: symptoms | Thirst, Dryness of mouth/skin - decreased skin turgor, Oliguria(400-700mL), Hypotension, Tachycardia- heart muscle, Muscle weakness, cramps, dizziness, Weight loss
Extreme - cerebral dehydration - cerebral vessels can tear - resulting in hemorrhage
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| Dehydration: Management | increased oral intake, IV - 5
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| Gradual Rehydration | 2/3 of H2O balance in 1 day, important in cerebra edema; rapid cerebral rehydration can result in brain vessel rupture
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| Ways by which body tries to correct dehydration | "1. Hypothalamic thirst centers stimulated- feeling of thirst-pt. drinks fluid
2. ADH production (vasopressin) is increased- diuresis prevented-less urine excreted
3. Redistribution of H2O between ICF and ECF- H2O diffuses out -isotonic balance maintain
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| Electrolyte | substance whose solution conduct electricity
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| Ionic substances separate into | "positive ions - cations
negative ions - anions"
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| Positive Ions | Cations - potassium (K+), sodium (Na+)
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| Negative Ions | Anions - Chloride (Cl-), Bicarbonate (HCO3-), Potassium Sulfate (SO4 2-), HPO4-
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| ECF Ions | Sodium, chloride, Bicarbonate
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| Hyponatremia: causes | More often due to excessive sodium lost the decreased intake; burns, excessive sweating, increased physical exercise, V/D, overfunction of hormonal function
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| US Sodium Intake/output | Intake: 100-200mmol/L , Output: <100mmol/L
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| Hyponatremia: symptoms | thirst, dryness of skin, loss of skin tone, weight loss, muscular weakness/cramping, altered cardiac function
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| Hyponatremia: Treatment | "Treat underlying cause: DM, hormonal malfunctions, renal causes
Saline IV- observe while administering"
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| Hypernatremia: Causes | increased sodium intake
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| Hypernatremia: Symptoms | thirst (because H2O follows salt), water retention, high b/p, hypertension, dyspnea, abnormal EKG - can lead to cardiac arrest
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| Potassium: Role | neuromuscular control, maintains ICF osmolality
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| Hyperkalemia: Causes | protein malnutrition, vomiting, excessive sweating (excretes sodium in sweat - kidney reabsorbs sodium and excretes potassium)
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| Hypokalemia: Treatment | oral supplements, IV- monitor closely, rapid absorption can cause alterations in heart function
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| Hydrogen Ion Concentration | results form respiration and metabolism influence the pH of the body
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| Normal pH range | 7.35-7.45
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| Buffer | combination of a weak acid and its salt or a weak base and its salt that resists the pH change
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| Buffer system: H2CO3 | /HCO3- (carbonic acid/bicarbonate ion)
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| Buffer system: H3PO4 | /PO4-3 (phosphoric acid/phosphate ion)
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| pH scale | decides acidity/alkalinity in a system
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| Acidic pH | 0
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| Neutral pH | 7
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| Alkaline pH | 14
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| Respiratory acidosis/alkalosis causes | hypo or hyperventilation
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| Metabolic acidosis/alkalosis causes | dealing with oxidative products of metabolism
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| Process of alkalosis/acidosis | more H+ = acidosis, more HCO3- = alkalosis
normal: hydrogen ion produced = ion excreted by lungs/kidneys, imbalance results in alkalosis or acidosis
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| Body chemistry equations | CO2+ HCO3 = H2CO3 = H+ +HCO3-
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| Metabolic Acidosis: Defined | increased H+ production and decreased H+ excretion
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| Metabolic Acidosis: Causes - Excessive H+ | acidic food in diets, increased: ketoacidosis (DM, starvation, ETOH), lactoacidosis (exercise + dehydration), drugs (salicylates, diuretics), sulfur containing amino acids (via parenteral admin, lysine, arginine, histidine or cysteinie), diarrhea
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| Metabolic Acidosis: Causes - Decreased H+ excretion | renal failure, increased sensation of pancreatic juices and enterokinal (small intestine) secretions that produce alkalinity
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| Metabolic Acidosis: Management | rehydration, treat underlying cause, medications: insulin therapy for DM, chelates to remove salicylates; extreme conditions: HCO3- supplements given under careful monitoring
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| Respiratory Acidosis: Defined | CO2 is being retained and it converts to H2CO3 = H+ and HCO3-
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| Respiratory Acidosis: Causes | Hypoxia, anxiety, fear, trauma to brain/diaphragm, infection (pulmonary edema ie bronchitis, asthma, COPD), drug intoxication, lack of neuromuscular control
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| Respiratory Acidosis: Management | air passages need to be dilated; medications: inhalers (vasodilators), antibiotic therapy; Extreme cases- ventilators (O2 support)
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| Metabolic Alkalosis: Causes | removal of H+ (GI disturbances - V/D/Gastric aspirations, congenital chloride loosing diarrhea), hormonal disturbances (promote diuresis), increased intake of some drugs (over dependence on antacids)
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| Metabolic Alkalosis: Management | correction of gastro disturbances; potassium therapy - monitor closely
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| Respiratory Alkalosis: Defined | excess CO2 is being exhaled
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| Respiratory Alkalosis: Causes | hyperventilation due to anxiety, fear, excitement; severe anemia, high altitude, excessive exercise, cerebral trauma
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| Respiratory Alkalosis: Management | Breath into paper bag, rebreathe exhaled CO2
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| Hypokalemia: Symptoms | muscle aches/weakness/cramping, dizziness, generalized apathy
Extended Deficiency: EKG changes, cardiac malfunction
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