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Lab values beyond the numbers

Objectives. Ability to interpret a blood gasRecognition of abnormal Lab valuesTreatment of some of the more critical values. . . Overview. Blood GasesChemistriesCBC'sCSF. . . Blood Gases. pHPCO2PO2Base ExcessO2 Sat. . . Blood Gases. pHNormal : 7.35 - 7.45??pH = acidosis; ??pH = alkalosis.

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Lab values beyond the numbers

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    1. Lab values beyond the numbers Toni Petrillo, MD

    2. Objectives Ability to interpret a blood gas Recognition of abnormal Lab values Treatment of some of the more critical values

    3. Overview Blood Gases Chemistries CBCs CSF

    4. Blood Gases pH PCO2 PO2 Base Excess O2 Sat

    5. Blood Gases pH Normal : 7.35 - 7.45 ??pH = acidosis; ??pH = alkalosis

    6. Blood Gases PCO2 Normal 35-45mmHg Increased PCO2 Respiratory Acidosis Compensated metabolic alkalosis Decreased PCO2 Respiratory Alkalosis Compensated metabolic acidosis PO2 80-100mmHg at sea level and RA

    7. Blood Gases Base Normal -3 to +3mMol/L Base excess indicates too much (metabolic alkalosis) Base deficit indicates too little buffer (metabolic acidosis)

    8. Blood Gases: Metabolic Acidosis Metabolic Acidosis for every drop of ????meq/l in HCO3 pH will decrease by 0.15 if respiratory compensation will have a ??in PCO2

    9. Blood Gases: Metabolic Acidosis Causes Renal losses of HCO3 GI Losses of HCO3 Uremia DKA Ingestion Aspirin ETOH

    10. Blood Gases: Respiratory Acidosis PCO2 increased ?PCO2 by 10mmHg will ??PH?by??????units If metabolic compensation occurs will have ??HCO3 Causes Brain Depression: sedative, CHI Neuromuscular : Myasthenia, Gullian Barre Lungs: Pulmonary Edema, FB, Pneumonia, Pneumothorax, atelectasis Other: Abdominal distention

    11. Blood Gases: Metabolic Alkalosis HCO3 increases for every ?? ???meq/L will ? pH by 0.15 units If respiratory compensation PCO2 Related to conditions that have hypokalemia or loss of hydrogen Ion Causes Hypokalemia GI: vomiting, Pyloric stenosis Urine Loss: diuretics, antibiotics, ?Mg

    12. Blood Gases: Metabolic Alkalosis Causes cont Loss Of H+ vomiting Hypercalcemia chloride losing diarrhea

    13. Blood Gases: Respiratory Alkalosis PCO2 ? For every PCO2 ?????mmHg ??pH 0.08 If metabolic compensation ? HCO3 Caused by excessive removal of CO2

    14. Blood Gases: Respiratory Alkalosis Causes Respiratory Center Stimulation CNS (tumor, Infection) Anxiety/Stress Drugs Hypermetabolic States Fever Thyroid Mechanical Ventilation

    15. Blood Gases: Examples 7.56 / 20/ 88/ -2 7.24/ 60/ 88/+2 7.55/ 40/88/ +15 7.12/ 40 /88 / -20

    16. Blood Gases: Examples 7.30 / 60 / 88 / + 20 7.20/ 15 / 88/ -25

    17. Chemistries (Basics) Sodium (Na+) Potassium (K+) Chloride (Cl-) Bicarb (HCO3-) BUN Creatinine (Cr) Glucose Calcium (Ca+)

    18. Chemistries: Na+ Sodium Normal range 135-145mmol/L Life threatening < 120 >155 Can cause seizures, venous sinus thrombosis, CNS hemorrhage,

    19. Chemistries : Na+ Hyponatremia Excessive H2O Cirrhosis, CHF Hypoalbuminemia Nephrotic Malnutrition Vomiting/ Diarrhea Diuretics SIADH Cerebral Salt Wasting False Hyperglycemia Na+ decrease 1.6 meq/l for each increase in glucose over 100 hyperlipidemia Na decrease by .002 x lipid (mg/dl

    20. Chemistries : Na+ Hypernatremia Diabetes Insipidus Diarrhea Dehydration Hypercalciuria Diabetes Hyperaldosteronism

    21. Chemistries : Na+ Treatment is based partially on the causes if hypernatremic do not want to correct Na+ more than 10-15 meq per day will increase risk of cerebral edema 3-4 cc/kg of free water will decrease serum Na+ by 1 Meq/L for acute symptomatic hyponatremia may use hypertonic saline 5-10 cc /kg

    22. Chemistries: K+ Potassium Normal 3.4 - 4.7mmol/L Life threatening < 2.5 >6.5 Major complications Arrhythmia and EKG changes, weakness

    23. Chemistries: K+ Hypokalemia Diuretics hypomagnesium Licorice RTA V/D Pyloric Stenosis DKA Antibiotics (ie: AmphoB) Hyperkalemia Acidosis Renal Failure Muscle necrosis Blood Transfusions Hemolysis CAH

    24. Chemistries: K+ and changes in EKG Hyperkalemia peaked T waves Widening of QRS loss of P wave ST segment depression bradycardia ventricular arrhythmias Hypokalemia prominent u wave ST segment depression ventricular arrhythmias

    25. Chemistries: K+ Treatment of Hypokalemia: KCL bolus 0.3 - 1 meq / kg no more than 0.6 meq/kg/hour Treatment of Hyperkalemia: Insulin and Glucose NaHco3 Ca+ Kayexalate Lasix Albuterol

    26. Chemistries: Cl - Chloride Normal 95-105mEQ/L Hypochloremia Metabolic Alkalosis Respiratory Acidosis CHF Burns Hyperchloremia Metabolic Acidosis Respiratory Alkalosis Dehydration RTA

    27. Chemistries: HCO3- Sodium Bicarbonate Normal: 20-26 mEQ / L Increased in Metabolic Alkalosis and Compensated Respiratory Acidosis Decreased in Metabolic Acidosis and Compensated Respiratory Alkalosis Causes previously discussed in blood gas section

    28. Chemistries: BUN Blood Urea Nitrogen Normal: 5-20 mg/dl Elevated Tissue Necrosis Gi Bleed High Protein Diet Steroids Shock Dehydration Diarrhea Burns Tissue Necrosis Decreased Anabolic Steroids Malnutrition Liver Dz Pregnancy

    29. Chemistries: Cr Creatinine Normal: Child usually less than 1 Increased: Renal Dz Muscle necrosis hypovolemia

    30. Chemistries: Glucose Glucose Normal: 60-115mg/dl (infants >40) Hyperglycemia (AMS, Kusmal breathing) diabetes Pancreatitis Cushing's dz Pheochromocytoma drugs (ie: Steroids, Epi) Hypoglycemia (jitters, Sz, Sweating) Malaria liver dz Malignancy enzyme deficiency Malnutrition

    31. Chemistries: Glucose Treatment of Hypoglycemia Neonate or child: 0.5 to 1 gram / kg if using D25 would be 2-4 cc / kg dilute D50 1:1 with sterile water if using D10 5-10 cc / kg dilute D50 1:4 Adult: ampule of D50

    32. Chemistries: Glucose Treatment of Hyperglycemia Fluid bolus 10cc/kg NS insulin 0.05u - 1 unit/kg If diabetic in DKA be very judicious of fluid administration and no NHCO3 unless cardiac instability

    33. Chemistries: Ca+ Calcium Normal 8-11mg/dl Panic Value:<7 or > 12 (tetni, Sz, arrhythmia) Hypercalcemia (CHIMPS) C= Cancer H= Hyperthyroid I= Iatrogens M= Multiple Myeloma P= Primary Hyperparathyroid S= Sarcoid

    34. Chemistries: Ca+ Hypocalcemia renal failure hypoparathyroid pseudohypoparathyroid magnesium deficiency anticonvulsants Rickets Pancreatitis Blood transfusions

    35. CBCS White Blood cell = WBC Differential Segs / polys Lymphocytes Eosinophils Monocytes Basophils Bands Hemoglobin Hematocrit Platelets

    36. CBC: WBC

    37. CBC: WBC Increased neutrophils physiologic newborn,pregnancy Pathologic acute infection inflammatory dz metabolic disorder tissue necrosis drugs stress Decreased neutrophils Infection bacterial typhiod septicemia Viral Hepatitis mono flu measles myeloid hypoplasia drugs

    38. CBC: WBC Increased Lymphocytes Infection Viral: Hepatitis mono CMV HSV Bacterial Pertussis mumps Chronic Inflammation Metabolic Hematologic ALL Decreased Lymphocytes Increased Corticosteroids immunodeficiency miliary Tb Lupus

    39. CBC: WBC Monocytes Elevated mumps malaria lymphomas Eosinophils Elevated Parasitic dz T-Cell leukemia allergies lupus

    40. CBC: Hemoglobin / Hematocrit Hemoglobin Normal 1 week: 13-20 1 month: 11-17 6months 10.5-14.5 1 year: 11-15 10years: 11-16 15years: 14-18M 12-16F Hematocrit Normal 14-90d:35-49 6m-1yr:30-40 4-10yr: 31-43 Adult:42-52M 37-47F

    41. CBC: H/H Increased Hct Polycythemia Heart Dz Chronic Hypoxia High Altitude Hemoconcentration Surgery Burns Dehydration Decreased Hct Anemia Iron Deficiency Malabsorbtion HgSS Toxin/drugs Lead Infection Malaria CMV Cancer

    42. CBC: Platelets Platelets Normal: 150-450 thousand Decreased platelets Decreased production Marrow Depression: Aplastic Anemia, Radiation Marrow infiltration: Leukemia Congenital: Wiskott Aldrich, immune deficiencies Increased destruction autoimmune: ITP, Mono, SLE Coagulopathies: DIC, HUS, TTP Drugs

    43. CBC: Platelets Increased Platelets Reactive thrombocytosis infection splenectomy surgery/stress Inflammatory dz. Thrombocythemia myeloproliferative disorder Chronic granulocytic leukemia

    44. CSF

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