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Normal sodium level?
135-145
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Normal Cr in females?
0.5-1.1
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Normal Cr in males?
0.6-1.2
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Normal WBC count?
5,000-10,000
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Normal Hgb in females?
12-16
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Normal Hgb in males?
14-18
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Normal Hct in females?
37-47%
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Normal Hct in males?
42-52%
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Normal platelets?
150,000-400,000
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Normal (total) Ca?
9.0-10.5
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Normal (ionized) Ca?
4.5-5.6
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Normal APTT?
30-40 seconds
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Normal PTT?
11 – 12.5 seconds
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Normal Pre-albumin?
20-40
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Target APTT for heparin infused patient?
45-100 seconds
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Target INR for warfarin patient?
1.5-3.0
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Normal pH of urine?
4.6-8.0
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Normal specific gravity of urine?
1.005 – 1.030
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Serum Osmolarity?
275-295
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Quick formula for Serum Osmolarity?
Na X 2
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Detail formula for Serum Osmolarity?
2(Na) + K + (BUN/3) + (Glucose/18)
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Anion Gap Formula
Na – (Cl+CO2)
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P in MUDPILES
Paraldehyde
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I in MUDPILES
Isoniazid/Iron
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L in MUDPILES
Lactic Acidosis
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E in MUDPILES
Ethylene Glycol
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S in MUDPILES
Salicylates
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Factors that increase Anion Gap?
MUDPILES
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Factors that decrease Anion Gap?
- Hypercalcemia
- Hypermagnesemia
- Hyperkalemia
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What do neutrophils respond to?
Bacterial infections
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What do eosinophils respond to?
Allergy or parasite
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What do basophils respond to?
Allergy
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What does an increase in bands represent?
A “shift to the left”
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What could be the cause of a decreased H&H?
Decreased blood count from hemorrhage, menses or anemic cause
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What could be the cause of an increased H&H?
Dehydration and malnutrition
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What do MCV and MCH refer to?
Size of an RBC
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What does MCHC refer to?
Color of an RBC
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What is an RDW greater than 15 indicative of?
Renal failure
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What is the result of increased MPV?
More immature platelets
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What could be the cause of a decreased MPV?
Decreased bone marrow production
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What does calcium have a direct relationship to?
Parathyroid
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What does calcium have an inverse relationship with?
PO4
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What can cause hypercalcemia?
- Hyperthyroid
- Addison’s / adrenal insufficiency
- Too much Ca or Vit. D intake
- Bone metastases
- Immobility
- Dehydration
- Pagets
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Symptoms and effects of hypercalcemia?
- Increase HR
- 3+ pulses
- Short ST segment
- Hypophosphatemia
- Decreased DTR
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What can cause hypocalcemia?
- Renal failure
- Hypoalbuminemia
- Thyroid dysfunction
- Vitamin D deficiency
- Excessive loss of Ca (diarrhea/wounds)
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Symptoms and effects of hypocalcemia?
- Decreased HR and contractility
- Prolonged QT and ST interval
- Increased DTR
- Chvostek and Trousseau’s sign
- Hyperphasphatemia
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What can lead to hypermagnesemia?
- Antacids/laxatives
- Addison’s (decreased aldosterone)
- Decreased renal excretion
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What ECG changes are evident in hypermagnesemia?
Wide QRS and increased PR interval
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Symptoms and effects of hypermagnesemia?
- Hypotension
- Bradycardia
- Cardiac Arrest
- Decreased DTR
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What can lead to hypomagnesemia?
- Diruetics
- DKA
- Alcoholism
- Crohn’s (insufficient intake/absorption)
- Increased intracellular movement
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What can cause increased intracellular movement of ions?
- Hyperglycemia
- Sepsis
- Alkalosis
- Insulin
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Symptoms and effects of hypomagnesemia?
- Tetany/Twitching
- Increased DTR
- Tachycardia
- Arrhythmia
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Causes of hyperphosphatemia?
- Hypoparathyroidism
- Renal Failure
- Bone metastases
- Hypocalcemia
- Rhabdomyolysis
- Acidosis
- Hemolytic anemia
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Causes of hypophosphatemia?
- •Inadequate intake
- •Hypercalcemia/Hyperparathyroidism
- •Chronic acid indigestion/Antacids
- •Diuretic use
- •Chronic alcoholism
- •Hyperinsulinemia
- •Alkalosis
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Effects of hypophosphatemia?
- Respiratory difficulty-spasm of diaphragm
- Weakness/slurred speech
- Decreased cardiac contractility
- Decreased DTR
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What can elevated ALP indicate in the presence of normal other LFTs?
Prostate cancer
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What LFTs are associated with pancreatitis?
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What is the treatment for too much ammonia?
Lactalose
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Causes of hypernatremia?
- Cushings
- Renal failure
- Hyperaldosterism
- Diabetes
- Diuresis
- Burns
- Diarrhea (fluid loss)
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Causes of hyponatremia?
- Addison’s disease
- Diuretics
- Vomiting/diaphoresis
- Wounds
- SIADH (too much fluid)
- HF/CHF – pulmonary edema
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Lethal symptoms of sodium imbalance?
- Na level below 110
- Neuro changes
- Thirst
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Causes of hyperkalemia?
- Renal failure
- Salt substitutes
- Medications (spironolactone, ACEI)
- Burns
- Acidosis
- Adrenal insufficiency
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ECG changes in hyperkalemia?
- Tall, peaked T-waves
- Widened QRS
- Flat P-wave
- Abnormal rhythm/ectopic beats
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Treatment for hyperkalemia?
- D50 + Insulin (IV)
- Dialysis, diuretics (lasix)
- Kayexelate
- CaCl
- Albuterol
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Causes of hypokalemia?
- Fluid resuscitation after burns
- GI loss
- Diuretics
- Secondary to renal artery stenosis
- Hyperinsulinemia (OD)
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ECG changes in hypokalemia?
- U wave (hallmark sign)
- ST depression
- Inverted T-wave
- Abnormal rhythms
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What is equivalent to Serum CO2?
Arterial HCO3
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What does increase CO2 cause?
Metabolic alkalosis
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What does decreased CO2 cause?
Metabolic acidosis
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What is target BUN:Creatinine ratio?
15.5:1
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What does increase Cr indicate?
Renal damage
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What does decreased Cr indicate?
- Decreased muscle mass
- Wasting syndrome
- Starvation
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