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Uses of laboratory tests
  • assess compliance
  • monitor therapy
  • check for adverse effects
  • help determine the DOC
CBC consists of
  • WBC and differential
  • RBC = hemoglobin, hct, indicies
  • platelet count
Reticulocyte count
  • access bone marrow capability
  • maturity of RBC
Erythrocyte Sedimentation rate
  • Sed Rate/ESR
  • monitor for inflammation
  • nonspecific for inflammation
  • rheumatology
  • gout
  • lupus
RBC
  • Hemoglobin (HgB) main componenet of RBC and transports O2 and CO2
  • HcT volume of RBC as a percent of whole blood
  • if ratio of HgB:HcT is greater than 1:3 ratio indicates dehydration
Indicies
  • describes type of anemia
  • MCV
  • MCH
  • MCHC
  • large = B12 folate deficiency - alcoholics
  • small = iron deficiency anemia
WBC increases
  • acute infections
  • prednisone
  • lithium
  • leukemia
  • stressful events
WBC decreases
  • overwhelming bacterial infection
  • viral infections
  • sulfonamides
  • alcohol
  • chemotherapy
  • radiation
  • aplastic anemia
  • bone marow failure
Segs
  • mature
bands
  • immature
Lymphocytes increased
  • viral infections
  • TB
  • lymphocytic leukemia
Decreased lymphocyte
  • HIV
increase Monocytes
  • monocytic leukemia
  • TB
  • myeloproloiferative disorders
Eosinophil Increase
  • Allergy
  • Parasites
Basophil increase
  • CML
  • polycythemia
  • myeloid metaplasia
  • myeloproliferative leukemia
Increased platelet
  • thrombocytosis
  • Hemhorrhage
  • Polycythemia vera
  • leukemia
  • anemia (iron def)
  • tumor
  • essential thrombocythemia
  • lymphoma
  • epiniephrine
  • toxin
  • splenectomy
Sodium
  • Extracellular
  • cation
  • serum value does not reflect total body stores
caues of hypernatremia
  • infants
  • elderly
  • vomiting patients
Hyponatremia dilutional

  • excess body water
  • CHF, liver dx, nephrotic syndrome, edematous states
  • H2O restriction, diuretics
Hyponatremia depletion
  • excess loss of Na
  • saline solution
  • sodium deficit (140-measured Na)x wt (kg) .6
  • acute symptomatic correct rapidly
  • chronic symptomatic correct slower over a few days
Hyponatremia
  • drug induced (SIADH APAP and barbiturates)
  • dx induced - malignancy
  • causes altered mental status
Causes of altered sensorium
  • Vowels + tipps
  • Alcohol
  • encephalopathy
  • insulin
  • opiates and insulin
  • uremia
  • trauma
  • infection
  • poison
  • psychiatric
  • syncopy, seizure, sodium
Hypokalemia
  • decreased dietary intake
  • GI loss
  • cellular shift
  • urinary loss
  • drugs - aminoglycosides, cisplatin
Hyperkalemia
  • Renal insufficiency
Drugs that cause hyperkalemia
  • K sparing diuretics
  • ACEI
  • exogenous KCl
  • NSAIDs
Hyperkalemia treatment
  • CaGluconate IV - stabilizes heart membrane
  • Na Bicarb drives K into cells
  • insulin - stimulates hepatic and skeletal cell uptake of K
  • Kayexelate - exchanges Na for K in colon
Chloride
  • extracellular
  • anion
Carbon dioxide
  • bicarbonate ion of blood
  • acid base balance
  • will not tell us if the patient is in alkalosis or acidosis
Depressed CO2
  • metabolic acidosis
  • compensated respiratory alkalosis
Elevated CO2
  • metabolic alkalosis (thiazides)
  • compensated respiratory acidosis
Hyperglycemia
  • DM
  • stress
  • acute pancreatitis
  • hyperthyroidism
  • hyeradrenalism
  • nutrition support
Drug induced hyperglycemia
  • thiazide diuretics
  • furosemide
  • glucocorticoids
  • diazoxide
  • epinephrine
  • phenytoin
Hypoglycemia
  • adrenal insufficiency (addisons)
  • hypopituitarism
  • hyperinsulinemia
  • starvation
drug induced hypoglycemia
  • insulin
  • sulfonylureas
  • beta-adrenergic
  • salicylates
  • ethanol
Drug induced hypoglycemia
  • MAOI
  • pentamidine
  • clofibrate
  • anabolic steroids
Hypoglycemia s/sx
  • sweating - not masked by BB
  • tremor
  • tachycardia
  • confusion
BUN
  • indicator of renal function
  • high BUN indicates renal dx
  • low BUN indicitive of liver function
etiologies of elevated BUN
  • renal insufficiency (pre-renal azotemia) Cr will also be elevated
  • increased protein catabolism
  • nutritional support
  • GI bleeding - cr not elevated
serum creatinine
  • measure of renal function
  • more accurate than BUN
Etiologies of elevated creatinine
  • renal insufficiency
  • dehydration
  • muscle damage
etiologies of decreased creatinine
  • dilution
  • decreased muscle mass
  • decreased food intake
indicators of dehydration
  • elevated creatinine
  • elevated BUN
  • elevated Na
  • HgB:HcT ratio of greater than 1:3
increased Calcium
  • osteoporosis
  • malignancy
  • thiazide diuretics
  • metastatic dx
decreased calcium
  • hypoalbuminemia
  • furosemide
Bilirubin
  • increased in liver failure
  • decreased with insulin
  • direct indicator of liver function
  • Bili:Liver as Cr:kidney
LDH/LD increased
  • hepatotoxicity
  • heart attack
  • hemolysis
Tests effected by hemolysis
  • LDH
  • K
SGPT
  • ALT
  • shows damage to liver
  • hepatotoxicity
  • more specific than AST
SGOT
  • AST
  • heart
CPK/CK
  • MB - heart
  • BB - brain
  • MM - muscle
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