Clin Lab Test 1

135-145 mEq/L (BMP Order Set)

3.5 - 5.0 mEq/L (BMP Order Set) Directly related to Mg

24-30 mEq/L (BMP Order Set)

96-106 mEq/L (BMP Order Set)

70-110 mg/dL (BMP Order Set)

8.5-10.8 mg/dL (BMP Order Set) Inversely related to PO4

1.5-2.2 mEq/L (Individually ordered) Directly related to K

2.6-4.5 mg/dL (Individually ordered) inversely related to Ca

males 4.5-5.9 X 10^6 cells/uL (CBC order set)

females 4.1-5.1 X 10^6 cells/uL (CBC order set)

males 14-17.5 g/dL (CBC order set)

females 12.3-15.3 g/dL (CBC order set)

males 42-50% (CBC order set)

females 36-45% (CBC order set)

males 1-15 mm/hr (individually ordered)

females 1-20 mm/hr (individually ordered)

4.4-11.3 X 10^3 cells/mm^3 (CBC order set)

150,000-450,000 cells/uL (CBC order set)

10-13 seconds (coags order set)

1.00-2.00 ratio (coags order set)

22-38 seconds (coags order set)

substance being measured

ability to identify the % of patients who actually have the disease, portion of true positives ex. Sensitivity = 100% = test is positive in every patient who has the disease

Sensitivity = {(True Positive / (True Positive + False Negative)}X100

ability of test to identify patients who do NOT have the disease, determines the portion of true negatives. higher the specificity = lower chance of a false positive

Specificity = {(True Negative / (True Negative + False Positive)}X100

proportion of people with positive tests

proportion of people with negative tests

PPV = {TP / (TP+FP)} X 100

NPV = {(TN / (TN+FN)} X 100

= {(TP+TN)/#of samples tested}X100

The assay reproducibility, agreement of results when speciman assayed many times

+/- 2 standard deviations from the mean lab value

lab values far enough outside normal range to indicate morbidity or mortality

acute weight loss. SE = tachycardia, orthostatis, BUN/Scr>20, dry mouth, skin, skin turger. Causes = diuretics, diarrhea, vomitting

acute weight gain (~4lbs). SE = edema in extremities and pulmonary, ascites (liver failure), anasarca (nephrotic syndrome).

Na > 145 mEq/L; weight gain; excessive hypertonic saline fluids; Treat= Fluid restriction, discontinue hypertonic saline fluids

Na > 145 mEq/L; no change in weight; Diabetes Insipidus or reduced ADH secretion via head trauma or CNS tumor or Resistance to ADH due to Li, Phenytoin Demeclocycline; Treat= Fluid restriction, remove tumor/discontinue or lower medication dosage

Na > 145 mEq/L; weight loss; inability to access water, vomitting, diarrhea, increased sweating, fatigue; Treat: Fluid repletion

Na < 135 mEq/L; weight loss; ability to access water or excessive doses of thiazide or loop diuretics; Treat: Fluid repletion, discontinue/lower medication dosage

Na < 135 mEq/L; no change in weight; Increased ADH secretion via tumor/CNS disorder or sensitization to ADH due to Carbamazepine, Cyclophosamide, NSAIDs, SSRIs, or HYPOthyroidism, polygenic polydipsia, Addison's Disease; Treat: Fluid restriction, remove tumor/discontinue or lower medication dosage/treat undelying disease states

Na < 135 mEq/L; weight gain; Fluid retentive disease states (Ascites, Anasarca, Peripheral/Pulmonary edema - heart failure); Treat= Fluid restriction, Treat underlying disease states

K>5.0 mEq/L; Mg>2.2 mEq/L; Excessive intake and decrease output (renal failure, drugs - K+ sparing diuretics) K=Metabolic Acidosis

• K<3.5 mEq/L; Mg<1.5 mEq/L; decreased intake and increased output
• (renal failure, drugs - K+ sparing diuretics) K=Metabolic Alkalosis

Bone: Increase Ca; Stomarch: Increase Ca; Kidney: Increase Ca; Chronic Renal Disease (decreased vit D3 activation and decreaseds response to PTH): Decrease Ca

Bone: Increase Ca; Stomarch: Increase Ca; Kidney: Increase Ca and Decrease PO4; Chronic Renal Disease (decreased vit D3 activation and decreaseds response to PTH): Decrease Ca and Increase PO4

125 = Nausea and Vomitting

115-120 = Headache, tremors incoordination, lethargy, deliruium, obtundation

110-115 = seizures, coma

signs start to appear at 160 mEq/L, cerebral dehydration - thirst, lethargy, restlessness, hyperreflexia, irritability, muscle twitching, seizure, coma

10.8-13 = asymptomatic

13-15 = polyuria, nocturia, polydipsia, nausea, vomitting, constipation

>15 = lethargy, obtundation, psychosis, coma, death, acute renal failure, soft tissue calcification (Ca X PO3 >55), nephrolithiasis, CRI, atherosclerosis

Asymptomatic until less than 2.0 = weakness, numbness, parasthesias, myalgia, rhabdomyolysis, Card + Resp failyre, confusion, obtundation, hallucination, delirium, seizures, coma, hemolysis, WBC + platelet dysfunction

Arrhythmas

Ischemia

an umbrella term referring to symptoms associated with myocardial ischemia - significant reductions in blood flow to heart muscle linked to heart disease, reduction in blood flow may/may not lead to an acute MI

Unstable Agina UA, Non ST segment elevation MI NSTEMI, or ST segment elevation MI STEMI

Electrocardiography and Biochemical Markers

Cannot distinguish between UA, NSTEMI, or STEMI. but 1. 75% or patients will have chest pain (substernal, pressure sensation, fullness, sqeezing, occurs on exertion) and Radiating pain (to jaw, neck, shoulder, arms, or back) 2. 1/3 of patients will have shortness of breath and epigastric discomfort 3. Hypotension, new 3rd heart sound, jugular venous distention, rales on auscultation

Depolarization of the atria (P wave) and ventricles (QRS complex)

Repolarization of the ventricles (T wave)

produce a sagittal and frontal view

produce a horizontal view

Presence of myocardial ischemia, injury, or infarction; location of infarction; site of occlusion in the coronary artery involved

T wave inversion = Ischemia

ST wave depression = Ischemia

ST segment elevation = Infarct (complete occlusion)

Appearance of Q waves = Infarct

1. High sensitivity and specificity 2. Rapid release into blood after injury, without rapid clearance 3. Strong correlation between concentration and extent of tissue damage 4. Assay is readily available, easy to perform, inexpensive, and rapid

1-4 hours

6-7 hours

24 hours

Heme protein found in cardiac and skeletal muscle

Highly sensitive (>85% at 5 hours), but lacks specificity

Excellent Sensitivity 98%, but poor specificity 67%

3-12 hours

24 hours

2-3 days

Enzyme that stimulates the transfer of high energy phosphate groups

CK-MM = in skeletal muscle, CK-BB = in brain, CK-MB = most in myocardium, some in skeletal muscle

Trauma, skeletal muscle injury, surgical procedures involving GI tract, uterus, or prostate

skeletal muscle damage, trauma, renal failure

Less than 6 hours from onset of chest pain

Less than 6 hours from onset of chest pain

Greater than 6 hours from onset of chest pain

used to distinguish cardiac and noncardiac sources of CK-MB elevations

• RI = (measured CK-MB / Total CK Activity) X 100
• RI>2 - suggestive of AMI

protein complex located along the thin filaments of myofribrils, regulate Ca mediated interaction of actin and myosin, Troponin C expressed in myocardial and skeletal muscle is identical

3-12 hours

CTnI = 24 hours; CTnT = 12-48 hours

CTnI = 5-10 days; CTnT = 5-14 days

Both very high, in an AMI = levels increase 20 times; in severe occlusion and unstable plaque = low elevated levels

heart failure, pulmonary embolism, renal failure, rhabdomyolysis

Risk-stratification, Reinfarction, Post Intervention

increases post MI (likely due to stress)

increases post MI likely due to increased cortisol levels

Increase due to inflammation

decreases for upwards of 6-8 weeks

Test to assist in diagnosis of HF, Monitors response to therapy, and Established prognosis of HF

0-100 pg/ml, 74%, 91%

High Risk is greater than or equal to 5

Cardiac Catherization with coronary angioplasty

Cardiac Stress Test

Cardiac Catherization with coronary angioplasty

Noncardiac origin

NSTEMI - evaluate risk stratification for coronary occlusion

Identification of >75% stenosis of large coronary arteries

Exercise Induced Stress or Pharmacologic Induced Stress (Adenosine - vasodilator; Dipyridamole - vasodilator; Dobutamine - Contractility and HR)

Technitium is injected at rest followed by a gamma camera scan, patient is then stressed, technitium injected after stress, gamma camera rotated around patient

Radiactive element concentrates in necrotic tissue, myocardial uptake of technitium directly proportioned to coronary patency

Diagnostic = assess myocardial integrity and blood flow, assess coronary artery patency; Therapeutic = used to conduct coronary angioplasty or place a stent

Thin catheter inserted in bloeed vessel of arm or leg, passed through either right or left side of heart, contrast media injected through catheter to visualize heart

high frequency soundwaves projected, ultrasonic echoes produced as they strike tissues of different densities to produce image

Assess myocardial integrity and motion defects; mostly walls, valves, chamber blood