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Review of Lab Values – Dr. Carter1/14/19IntroductionDo not want to cause refeeding syndromethe potentially fatal shifts in fluids andelectrolytes that may occur in malnourished patients receiving artificial refeeding(whether enteral or parenterally5).The hallmark biochemical feature of refeedingsyndrome is hypophosphatemia.Laboratory values/ used to discover occult diseaseVancomycin normal therapeutic range 10-20mcg/mlOccult – not visible to the naked eyeReference Value/RangeA normal result in one lab may be abnormal in anotherNeed to know baseline(pretreatment) value before treatmentCockcroft gault Creatinine Clearance =(140-age) X IBW(Male)72xSrCr=0.85X(140-age) X IBW(Female)72xSrCrBaseline – pretreatment lab valuesThere is NO universal applicable lab reference valueRole of Kidneysresponsible for the maintenance of homeostasis by regulating urinary excretion ofwater, electrolytes, BUN, medications, and toxinsGlomerular Filtration– passive process by which water and small molecular weightsubstances that are usually less than 5-10kd molecules to diffuse across the glomerularcapillary membrane, into the bowman capsule and into the proximal tubule. GFR is adependent on many factors, typically proteins, assesses proteins, protein load andassess function of the nephronNephron – basic/functional unit of the kidneySingle nephron Glomerular filtration rate – as it increases in the unaffected nephron, thewhole kidney GFR remains close to normal…Some proteins (60+Kilodaltons) are too large to be filtrated via GFSecretionReabsorptionEndocrine FunctionoSynthesizes and secretes hormones involved in maintaining fluid and electrolytebalanceoSecretion of renin and production and metabolism of prostaglandins and kininsoProduces erythropoietin which promotes the formation of RBCs by the bonemarrowMetabolic functionoActivation of Vitamin D, gluconeogenesis, metabolism of insulin, steroids,xenobiotics
Serum Osmolality(primary determinant of sodium concentration glucose in blood and BUNwhich may contribute toNa. Cl, HC03 and other anions comprise more than 90% of the ECF osmolality andmaintained by the Na-K-ATPase pumpNormal serum osmolality 285-295m0sm/kgEquation used to estimate serum osmolalityoOsmolality= (2xserum Na) + (glucose/18) + (BUN/2.8)Causes of osmolar gap – SIADH, alcohol, ethanol, methanol, mannitol, propylene glycolIf more than 10, then pt has an Osmolar GapMeasure serum Na+ - every 2-4hrsMeasure K+ - every 4-6hrs; hypokalemia q30minSodium (Na)Homeostatic mechanism for H2O and Na+ involve67% TBW – Intracellular33% TBW – ExtracellularoIntravascularoInterstitialHyponatremiasymptoms start when levels are below 135mEq/L, most pts areasymptomaticpts generally start experiencing symptoms at 125Serum Osmolality decreases in direct proportion toH2O/Na?(she said water h20 first Nawhen repeated)As water movement into brain cells increase as serum osmolality decreasesHYPONATREMIA

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Term
Fall
Professor
N/A
Tags
Sodium, Diuretic

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