46 Electrolytes


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46 Electrolytes

  1. 1. Osteopetrosis (malignant) Pseudohypoparathyroidism type 1a Hypocalcaemia Pseudohypoparathyroidism type 1b Autosomal recessive conditions Links : http://www.diseasesdatabase.com/links1.asp?glngUserChoice=6412 Cystinosis "Reduction of the blood calcium below normal. Manifestations include Intestinal hypomagnesemia type 1 hyperactive deep tendon reflexes, Chvostek's sign, muscle and Metaphyseal dysplasia abdominal cramps, and carpopedal spasm. (Dorland, 27th ed)" Osteopetrosis (malignant) Vitamin D dependent rickets type 1 Vitamin D dependent rickets type 2a Nutritional conditions Cow milk, baby feed Malabsorption syndrome Vitamin D deficiency Endocrine conditions Hyperparathyroidism, secondary Hyperthyroidism Hypoparathyroidism Inflammatory conditions Pancreatitis, acute Hypocalcaemia may be caused by or feature of the following ... Bacteria and bacterial conditions _ Artifacts Neisseria meningiditis Citrated blood sample Iatrogenic conditions EDTA blood sample Oxalate blood sample Blood transfusion and complications Tumor lysis syndrome Miscellaneous syndromes Chemicals Malabsorption syndrome Ethylene glycol Osteomalacia Proximal renal tubular acidosis Drugs, hormones and mediators Renal failure, acute Renal failure, chronic Actinomycin D Rhabdomyolysis Alendronate Bumetanide Biochemical abnormalities Cinacalcet Dasatinib Hyperphosphataemia Edetate disodium Hypomagnesemia Ethotoin Foscarnet Mendelian inherited conditions Frusemide Gallium nitrate Kenny-Caffey-Linarelli syndrome Mithramycin Pamidronate Autosomal dominant conditions Phenytoin
  2. 2. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Potassium Serum Paraneoplastic Autoantibodies Parathyroid Hormone Parathyroid Hormone Introperative Potassium is the major intracellular cation, with a 20 fold greater concentration in the cells Parathyroid Related Protein than in the extracellular fluid. Only 2% of total body potassium circulates in the plasma. The Parietal Cell Antibodies sodium potassium ATPase pump is largely responsible for maintaining this important ratio. The Paroxysmal Nocturnal Hemoglobinuria kidneys are also important in regulating potassium balance. Proximal tubules reabsorb nearly Partial Thromboplastin Time all of the filtered potassium. Under the influence of aldosterone, additional potassium is Parvovirus B19 Antibodies secreted by the distal tubules and collecting ducts in exchange for sodium. Maintaining normal Penicillin Antibody potassium levels is important for regulation of neuromuscular excitability, cardiac contractility Peptide Nucleic Acid FISH for Blood and rhythm, extracellular volume, and acid base balance. Culture Identification Pernicious Anemia Malva S.A. Potassium Sorbate FCC pH Life Science Solutions Proteomics Genomics 25-kg boxes & other pack sizes call 877-KIC-Bulk Phenobarbital Transcriptomics for pricing Phenytoin www malva gr www KICchemicals com Phosphatidyl Glycerol Phosphorus Plasma Cell Enumeration by Flow Cytometry Hypokalemia is defined as a plasma potassium concentration less than 3 meq/L. The primary Plastic Blood Collection Tubes mechanisms are excessive GI or urinary loss of potassium, increased cellular uptake, or Platelet Aggregation inadequate dietary intake. GI loss results from vomiting, diarrhea, gastric suction, or intestinal Platelet Antibody fistula discharge. Diuretics, such as thiazides and furosemide, promote potassium secretion in Platelet Count the distal tubules. Kidney disorders, such as renal tubular acidosis, cause excessive urinary loss Platelet Function Screen of potassium. Hyperaldosteronism leads to excessive urinary secretion of potassium and Pneumococcus Urine Antigen metabolic acidosis. Hypomagnesemia causes hypokalemia by promoting both urinary and fecal Pneumocystis loss of potassium. Magnesium deficiency diminishes sodium potassium ATPase activity and Polycythemia enhances aldosterone secretion. Alkalemia and insulin are the two major causes of increased Porphyrins cellular uptake of potassium. Alkalemia promotes intracellular loss of hydrogen ion. To Potassium Serum preserve electroneutrality, both potassium and sodium enter cells. Plasma potassium decreases Potassium Urine by 0.4 meq/L for every 0.1 unit rise in pH. Insulin promotes the entry of potassium into muscle Prealbumin and hepatocytes. Reduced dietary intake of potassium is a rare cause of hypokalemia, but may Pregnancy Test be an important factor in patients taking diuretics. Preoperative Hemostasis Testing Preoperative Testing Hyperkalemia occurs frequently in hospitalized patients with a reported incidence of 1 to 10%. Primidone A recent article investigated the causes of 242 episodes of hyperkalemia in 206 inpatients at Procainamide & Nacetylprocainamide the University of Pittsburgh Medical Center between February 15 and June 30, 1996 (Arch Progesterone Intern Med 1998; 158: 917-24). Hyperkalemia was defined as a critical plasma potassium level Proinsulin of 6 meq/L or more. The incidence of hyperkalemia in this study was 2.3%. Approximately 2 Prolactin hyperkalemic episodes occurred per day during the study period. Most of the elevated Prostate Specific Antigen potassium levels fell between 6.0 and 7.1 meq/L, but a few values were as high as 9.0 meq/L. Prostate Specific Antigen Free Further investigation revealed that most cases of hyperkalemia were multifactorial in origin. Protein C Protein Electrophoresis Cause % of Cases Protein Electrophoresis Spinal Fluid Protein Electrophoresis Urine Protein S Renal failure 77 Protein Total Serum Protein Total Spinal Fluid Hyperglycemia 49 Protein Urine Quantitative Prothrombin Gene Mutation Potassium supplements/ TPN 15 Prothrombin Time Prothrombin Time Significant Change Medications 63 Psoriasis & T Cell Monitoring PTT or Plasma Thromboplastin Time Cyclosporine/ Tacrolimus 27 Pyruvate Kinase Screen RBC Beta Blockers 17 Trimethoprim 15 ICPbio International Ltd. ACE inhibitors 15 Plasma proteins from New Zealand Superior Digoxin 14 Quality and Performance www.icpbio.com NSAID 9
  3. 3. K sparing diuretics 5 Iron Overload Heparin 5 Learn How To Treat Elevated Blood Iron Amphotericin 2 Levels With Exjade® www.Exjade.com Succinylcholine 2 Pentamidine 1 LIF murine - 10µg for 70€ Penicillin G 1 Serum free, Endotoxin free Eukaryotic source, RBC transfusion 10 Fully functional www.orfgenetics.com Rhabdomyolysis 5 George King Bio- Medical Renal failure was present in more than two thirds of the patients. Hyperglycemia was the second most common contributor to hyperkalemia. Medications contributed to the development Coagulation and of hyperkalemia in 63% of cases. The drugs most often implicated are listed in the table. Hemostasis reagents Heparin causes hyperkalemia by suppressing aldosterone. Human Plasmas for Diagnostic Use Another recent study revealed that 194 of 1818 (11%) medical outpatients using angiotensin www.kingbiomed.com converting enzyme (ACE) inhibitors developed hyperkalemia, which was defined as a potassium level above 5.1 meq/L (Arch Intern Med 1998; 158:26-32). The majority of patients had potassium levels between 5.1 and 5.5 meq/L, but one fifth of the patients had higher levels. Proteome Independent risk factors for developing hyperkalemia included a serum creatinine level above Quantification 1.5 mg/dL, BUN greater than 18 mg/dL, congestive heart failure, and the use of long acting Sensitive and ACE inhibitors. Patients over the age of 70 with a BUN of 25 mg/dL or higher were more likely reproducible quantitative to develop severe hyperkalemia (potassium > 6.0 meq/L). proteome analyses Hyperkalemia can cause muscle weakness by decreasing the ratio of intra to extracellular www.proteomescience.de potassium, which alters neuromuscular conduction. Muscle weakness does not usually develop until plasma potassium reaches 8 meq/L. Hyperkalemia disturbs cardiac conduction, which can cause arrhythmias. Plasma potassium levels between 6 and 7 meq/L may alter the ECG, while levels greater than 10 meq/L may precipitate cardiac arrest. Factitious causes of hyperkalemia include: In vitro hemolysis Traumatic phlebotomy Too small bore of needle Butterfly needle w/ excessive syringe pressure Vacutainer tubes placed directly on large bore catheter Collection with syringe and injection into Vacutainer tubes Elevated platelet count 0.15 mEq/L increase for every 100,000 cells/uL increase Elevated leukocyte count Contamination with IV fluids Contamination with anticoagulant (K3EDTA concentration exceeds 15 mEq/L) Aged specimens More accelerated at 4oC than at 25oC Serum sitting on clot Respun serum separator tube Plasma is the preferred specimen for patients with platelet counts greater than 600,000/uL. Erroneously high potassium results are also produced by centrifugation of SST tubes in fixed angle centrifuges. Under these conditions, the separation gel does not form a complete barrier and potassium leaks out of red blood cells into the plasma during specimen storage. Reference range is 3.6 to 5.0 mEq/L (Vitros analyzer). Levels < 3.0 and > 6.0 mEq/L are considered critical values. Serum potassium levels run slightly higher (0.4 mEq/L) than plasma levels, even in patients with normal platelet counts. Specimen requirement is one SST tube of blood. Hemolysis should be avoided because it will cause false elevation of potassium. Malva S.A. Ion Channel Cell Lines Whey Processing Systems Life Science Solutions Proteomics Validated Ion Channel Cell Lines Whey Membrane Filtration Systems Genomics Transcriptomics from ChanTest add value to your waste product www.malva.gr bioscience.co.uk/cell-line www.geafiltration.com Advertise | Biography | Terms of Use | Privacy Policy | Site Map | Copyright © 2006 - 2009 by ClinLab Navigator, LLC.
  4. 4. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Potassium Urine Paraneoplastic Autoantibodies Parathyroid Hormone Parathyroid Hormone Introperative In healthy individuals, nearly all potassium filtered by the kidney is reabsorbed. Potassium Parathyroid Related Protein excretion reflects distal tubule secretion of potassium, which is stimulated by aldosterone and Parietal Cell Antibodies the rate of potassium entry into the plasma from the diet and from cells. Urine potassium Paroxysmal Nocturnal Hemoglobinuria levels are generally helpful only in evaluation of patients with unexplained hypokalemia. Urine Partial Thromboplastin Time potassium levels between 0 and 10 mEq/L suggest the GI tract is the source of potassium loss, Parvovirus B19 Antibodies while levels >10 mEq/L suggest renal potassium loss. Penicillin Antibody Peptide Nucleic Acid FISH for Blood Reference range is 25 - 123 mEq/24 hr. Culture Identification Pernicious Anemia Specimen requirement is a 24-hour urine collection in a container without preservative. pH Specimen should be refrigerated during and after the collection. Phenobarbital Phenytoin Phosphatidyl Glycerol Phosphorus Plasma Cell Enumeration by Flow Cytometry Plastic Blood Collection Tubes Platelet Aggregation Platelet Antibody Platelet Count Platelet Function Screen Pneumococcus Urine Antigen Pneumocystis Polycythemia Porphyrins Potassium Serum Potassium Urine Prealbumin Pregnancy Test Preoperative Hemostasis Testing Preoperative Testing Primidone Procainamide & Nacetylprocainamide Progesterone Proinsulin Prolactin Prostate Specific Antigen Prostate Specific Antigen Free Protein C Protein Electrophoresis Protein Electrophoresis Spinal Fluid Protein Electrophoresis Urine Protein S Protein Total Serum Protein Total Spinal Fluid Protein Urine Quantitative Prothrombin Gene Mutation Prothrombin Time Prothrombin Time Significant Change Psoriasis & T Cell Monitoring PTT or Plasma Thromboplastin Time Pyruvate Kinase Screen RBC IgE and Autoimmmune EIA ICPbio International Ltd. Manage High Iron The right technology For your lab Plasma proteins from New Zealand Read About Exjade®: An Effective www.hycorbiomedical.com Superior Quality and Performance Iron Chelation Therapy www.icpbio.com www.Exjade.com
  5. 5. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Calcium Ionized C1 Esterase Inhibitor C Reactive Protein C Reactive Protein High Sensitivity Low ionized calcium levels are common in critically ill patients with sepsis, renal failure, cardiac CA 125 failure, pulmonary failure, post-surgery or burns. Monitoring of ionized calcium is particularly CA 153 important in the unconscious or anesthetized patient, in whom unrecognized changes in CA 19.9 calcium homeostasis may result in serious cardiovascular dysfunction with little of no prior CA 27.29 warning signs. Decreased ionized calcium levels between 3 and 4 mg/dL are usually well Caffeine tolerated, but the risk of cardiac arrest increases when ionized calcium levels approach 2.5 Calcitonin mg/dL. An ionized calcium level below 2.8 mg/dL is a reasonable threshold to begin calcium Calcium replacement therapy. Patients with hypotension or low cardiac output may require calcium Calcium Ionized replacement when ionized calcium falls below 3.2 to 3.6 mg/dL. Replacement therapy should Carbamazepine be monitored with Ionized calcium levels. Carbon Dioxide Carbon Monoxide New Stem Cell Treatment Exjade® Chelation Carcinoembryonic Antigen Fight your degenerative disease now Unique Reduce High Blood Iron levels With Exjade® Carcinoid Syndrome European clinic in Germany! Chelation Therapy Cardiac Marker Panel www xcell-center com www Exjade com Cardiovascular Risk Panel Carotene CCP Antibody CD4 Enumeration Measurement of ionized calcium may also be helpful in evaluating neonatal hypocalcemia, and Celiac Disease Panel for monitoring hypo- or hypercalcemia associated with malignancy and pancreatitis. Ionized Centromere Antibody calcium is valuable in establishing a diagnosis of hyperparathyroidism, especially in borderline Cephalothin Antibody cases where total calcium levels may be normal but ionized calcium increased. Cerebrospinal Fluid Ceruloplasmin In these clinical situations, total calcium is often difficult to interpret or misleading due to Chemistry Panels decreased albumin and other proteins, acid-base disturbances, and transfusion of citrated Chlamydia Detection blood. Alterations in serum albumin during an acute illness may change the total serum Chloride calcium by as much as 30%. Nomograms and formulas for indirect prediction of free calcium Cholesterol levels are inaccurate and may under-diagnose hypocalcemia. The percentage of protein bound Cholinesterase calcium may vary from 30 to 50% during illness. Acute acidosis decreases protein binding, Clindamycin Resistance while acute alkalosis increases it. Free fatty acids often increase during illness and after Clostridium Difficile administration of heparin, isproterenol and insulin. They increase calcium binding to albumin. Coagulation Factor Assays Changes in the concentration of anions such as phosphate, bicarbonate, and citrate also Coagulation Factor Inhibitor change ionized calcium levels. Transfusion of large numbers of blood components, containing Coagulation Screen excess citrate, may chelate calcium. Total calcium levels may only be slightly decreased, even Cold Agglutinin Titer though ionized calcium levels are markedly decreased. Colloid Osmotic Pressure Complement Profile High Ferritin Levels Detoxamin Complete Blood Count For Int'l MDs Only: Learn About Exjade® For the safe, gentle & proven chelation therapy Congenital Adrenal Hyperplasia Reducing Serum Ferritin alternative Cord Blood Gases www Exjade com www detoxamin com Cord Blood Studies Corticotropin Releasing Hormone Stimulation Test Reference range is 4.5 - 5.3 mg/dL. Critical values are < 3.5 mg/dL and >6.5 mg/dL. Cortisol Cortisol in Critical Illness Specimen requirement is one SST tube of blood. Tourniquet time should not exceed one Cortisol Salivary minute. The tube must remained capped and should be transported in wet ice. Hemolysis will Cortisol Urine Free falsely lower ionized calcium values. Cortrosyn Stimulation Test Cotinine Creatine Kinase Creatine Kinase MB Creatinine Creatinine Clearance Creatinine Kinase Isoenzymes Crossmatch CRP Cryoglobulin Cryptococcal Antigen Cryptosporidium Antigen Crystal Identification Cushing Syndrome Cyclosporine Cystic Fibrosis Cytogenetic Studies
  6. 6. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Calcium, Total C1 Esterase Inhibitor C Reactive Protein C Reactive Protein High Sensitivity Plasma calcium exists in the blood in three forms; 50% is ionized, 40-45% is protein bound, CA 125 and 5-10% is complexed to anions such as bicarbonate, citrate, sulfate, phosphate, and CA 153 lactate. Plasma ionized calcium is the biologically active moiety. Total calcium levels are CA 19.9 maintained between 8.8 and 10.2 mg/dL. Parathyroid hormone and vitamin D regulate normal CA 27.29 plasma calcium levels by their actions on kidney, intestine, and bone ion transport. Caffeine Calcitonin Cytokine Center Protein Evolution Calcium Recombinant cytokines, ELISPOT Kits ELISA Kits, Superior to Directed Evolution Next Generation Calcium Ionized related antibodies Technologies Carbamazepine www cellsciences com www bioatla com Carbon Dioxide Carbon Monoxide Carcinoembryonic Antigen Carcinoid Syndrome The main causes of hypercalcemia are primary hyperparathyroidism, malignant disease, and Cardiac Marker Panel chronic renal failure. The differential diagnosis of hypercalcemia depends on the clinical setting. Cardiovascular Risk Panel Overall, primary hyperparathyroidism and malignancy account for 80 - 90% of hypercalcemia Carotene cases. However, primary hyperparathyroidism is the cause of ~60% of ambulatory cases and CCP Antibody of ~25% of inpatient cases, whereas malignancy causes ~35% of ambulatory cases and 65% CD4 Enumeration of inpatient cases. Celiac Disease Panel Centromere Antibody Malignancies can raise serum calcium levels by either direct bone destruction or secretion of Cephalothin Antibody calcemic factors. Patients with squamous cell carcinoma of the lung, metastatic breast cancer, Cerebrospinal Fluid multiple myeloma, and renal cell carcinoma are most prone to hypercalcemia. These tumors Ceruloplasmin may produce PTH related protein (PTH-rp) which binds to PTH receptors, but is not detected by Chemistry Panels standard intact PTH immunoassays. Specific assays for PTH-rp are available. Chlamydia Detection Chloride The prevalence of hyperparathyroidism in the general population is 1 to 2 cases per 1000 Cholesterol people, but is more frequent in the elderly and in women. The most common pathological Cholinesterase lesion is a single parathyroid adenoma (85% of cases) or chief cell hyperplasia (10%). Clindamycin Resistance Parathyroid carcinoma occurs in 1 to 3% of cases. Hyperparathyroidism also occurs in multiple Clostridium Difficile endocrine neoplasia type 1 and 2A. Patients identified by laboratory screening are commonly Coagulation Factor Assays asymptomatic. Presentation with kidney stones is unusual today, but 5% of patients with Coagulation Factor Inhibitor kidney stone disease have primary hyperparathyroidism. Finding an elevated PTH level in a Coagulation Screen patient with hypercalcemia makes the diagnosis. Cold Agglutinin Titer Colloid Osmotic Pressure The signs and symptoms of hypercalcemia are summarized in the following table. Complement Profile Complete Blood Count Mental Neurological & Skeletal GI & Urological Congenital Adrenal Hyperplasia Cord Blood Gases Cord Blood Studies Fatigue Reduced muscle tone Nausea Corticotropin Releasing Hormone Stimulation Test Obtundation Muscle weakness Vomiting Cortisol Cortisol in Critical Illness Cortisol Salivary Apathy Myalgia Polyuria Cortisol Urine Free Cortrosyn Stimulation Test Lethargy Pain Polydipsia Cotinine Creatine Kinase Confusion Deep tendon reflexes Dehydration Creatine Kinase MB Creatinine Creatinine Clearance Disorientation Anorexia Creatinine Kinase Isoenzymes Crossmatch Coma Constipation CRP Cryoglobulin Cryptococcal Antigen Cryptosporidium Antigen Evaluation of hypercalcemia usually begins with measurement of total calcium. If total calcium Crystal Identification is markedly elevated, an ionized calcium level is usually not needed. Slightly to moderately Cushing Syndrome elevated total calcium should be confirmed by measurement of ionized calcium. The patient's Cyclosporine history may indicate the cause, such as; immobilization for more than a week, drug therapy, Cystic Fibrosis hyperthyroidism, adrenal insufficiency, or familial hypocalciuric hypercalcemia. If time permits, Cytogenetic Studies
  7. 7. total calcium levels should be repeated two more times to rule out a transient cause of Cytomegalovirus Antibody hypercalcemia before undertaking a complete work-up. If hypercalcemia is still evident, serum Cytomegalovirus Culture albumin and total protein should be determined. Calcium levels should be corrected for Cytomegalovirus PCR Qualitative elevated albumin levels (see below). If total protein is high, but albumin is normal or low, a Cytomegalovirus PCR Quantitative monoclonal gammopathy should be ruled out by serum protein electrophoresis. Serum chloride, phosphorus and intact PTH are also useful in diagnosing the most frequent causes of hypercalcemia; malignancy and hyperparathyroidism. Serum chloride is mildly elevated in primary hyperparathyroidism. Serum IgE v. skin Test Hyperparathyroidism Malignancy testing Practical information For Total calcium (mg/dL) <12.4 >12.4 healthcare professionals www.hycorbiomedical.com Chloride (meq/L) >103 <103 Phosphorus normal to low normal Calcium Phosphate Chloride : phosphorus ratio 29 or greater <29 Powders, Solids, Coatings for Dental, Intact PTH elevated suppressed Medical, Laboratory Uses www.himed.com PTH-rp normal elevated Renal Epithelials - Calcitriol elevated low Normal ATCC Primary Cell Solutions™ LGC Hypocalcemia most commonly results from PTH deficiency or failure to produce 1,25 dihydroxy Standards partnered with vitamin D. The most common causes of hypoparathyroidism are parathyroid or thyroid surgery ATCC and parathyroid infiltration by cancer, sarcoid, amyloid or hemochromatosis. Acute illnesses www.lgcstandards-atcc.org such as pancreatitis, hepatic failure, sepsis, and various medications can also cause hypocalcemia. The normal response to a fall in the plasma ionized calcium level is increased PTH secretion and 1,25 dihyroxy vitamin D synthesis, leading to increased calcium absorption Iron Toxicity from the intestine and increased resorption from bone and kidneys. Read The Benefits Of Prescribing Exjade® Some drugs are associated with hypocalcemia. Gentamicin and cisplatin cause renal For Oral Chelation magnesium loss, which leads to hypocalcemia. Heparin therapy releases fatty acids that bind calcium ions and cause transient hypocalcemia. Anticonvulsants such as dilantin and Therapy phenobarbital induce the microsomal oxidase pathway which accelerates inactivation of vitamin www.Exjade.com D. Loop diuretics such as furosemide enhance renal calcium excretion. Phosphate salts bind up calcium ions causing hypocalcemia. Cytokine Center The laboratory evaluation of a low total plasma calcium level should include measurement of Recombinant cytokines, ionized calcium, magnesium, and phosphorus levels. Low ionized calcium rules out artefactual causes of hypocalcemia, such as hypoalbuminemia. Abnormally high or low magnesium levels ELISPOT Kits ELISA should be excluded because they can inhibit PTH secretion. A low serum phosphorus level is Kits, related antibodies consistent with vitamin D deficiency, while a high level suggests chronic renal failure or www.cellsciences.com pseudohypoparathyroidism. Measurement of intact PTH levels helps to differentiate between conditions caused by PTH and vitamin D defects. The demonstration of an inappropriately low intact PTH level in the presence of hypocalcemia is consistent with the diagnosis of hypoparathyroidism. Serum 25-hydroxyvitamin D levels can be measured to confirm vitamin D deficiency. Total calcium levels are effected by changes in plasma protein concentrations. Most of the protein bound fraction of calcium is bound to albumin; each 1 g/dL of albumin binds 0.8 mg/dL of calcium. Three formulas have been used to correct calcium for decreased serum albumin levels: %Calcium bound = 8 (albumin) + 2(globulin) + 3 Corrected calcium = measured Calcium /0.6 + [total protein/8.5] Corrected calcium = Calcium - albumin + 4 Each formula will give a slightly different value for corrected calcium. A better approach is to directly measure ionized calcium levels. Two of the four approved gadolinium based magnetic resonance (MR) imaging contrast agents, gadodiamide (Omniscan) and gadoversetamide (OptiMARK), have recently been shown to interfere with calcium measurements on some chemistry analyzers, resulting in falsely low values. Patients with normal renal function may have spuriously low calcium measurements up to 24 hours after administration of these contrast agents, but patients with renal insufficiency may be affected for up to 4.5 days. However, the Vitros chemistry analyzers used throughout the Saint Luke's Health System are not adversely affected (Am J Clin Pathol 2004;121:282- 92). Reference range is 8.8 - 10.2 mg/dL. Calcium levels less than 6.0 mg/dL or greater than 13.0 mg/dL are considered critical values.
  8. 8. Specimen requirement is one SST tube or one green top (heparin) tube of blood. Prolonged venous stasis should be avoided because it can produce artefactual hypercalcemia. Calcium carbonate Cytokine Center Atherosclerosis testing Ground calcium carbonate (GCC) fillers & Recombinant cytokines, ELISPOT Kits Coronary artery disease Stroke Risk Novel extenders...CaCO3 ELISA Kits, related antibodies CVD marker. Serum ELISA assay www.imerys-perfmins.com/ www.cellsciences.com www.cvdefine.com Advertise | Biography | Terms of Use | Privacy Policy | Site Map | Copyright © 2006 - 2009 by ClinLab Navigator, LLC.
  9. 9. Home About Compilation MyAccount Index Search! Advertisement Nephrology Book Urine Calcium Pathology and Aka: Hypercalciuria, Hypocalciuria Laboratory Medicine Chapter Acid and Base I. Normal Disorders A. Women: Urine A-a Gradient Calcium <250 mg ABG Interpretation per 24 hours Renal Epithelials -Normal Anion Gap B. Men: Urine Arterial Blood Gas ATCC Primary Cell Solutionsâ„¢ LGC Calcium <300 mg Base Excess Standards partnered with ATCC per 24 hours www.lgcstandards-atcc.org Calculated PaCO2 Excess Anion Gap II. Increased Chemical producer info Fractional Excretion of Bicarbonate A. Associated Directory World Chemical Producers PaO2 Hypercalcemia Worldwide producers - 101 countries Urinary Anion Gap 1. Primary www.chemicalinfo.com calcium chloride of china Calcium Disorders Manufacturer of Calcium Chloride high Serum Calcium quality, honest service Urine Calcium www.wfxdy.com Chloride Disorders Serum Chloride Urine Chloride Advertisement Hyperparathyroidism Endocrinology 2. Hypervitaminosis D Fluid Deprivation Test 3. Sarcoidosis Hare-Hickey Test 4. Bone metastases 5. Multiple Myeloma Magnesium 6. Corticosteroids Disorders 7. Prolonged immobilization 8. Paget's Disease Serum Magnesium B. No Associated Hypercalcemia 1. Increased Calcium intake Miscellaneous 2. Idiopathic hypercalciuria Hyperuricemia 3. Renal tubule acidosis Serum Aldolase 4. X-Linked Hypercalciuria (Dent's Disease) Uric Acid Urine Uric Acid III. Decreased A. Hypoparathyroidism B. Pseudo-Hypoparathyroidism Organ Failure C. Vitamin D Deficiency Blood Urea Nitrogen D. Low Calcium diet Creatinine Clearance Renal Function E. Familial hypocalciuric Hypercalcemia Serum Creatinine F. Renal osteodystrophy Urine Creatinine G. Medications 1. Thiazide Diuretics 2. Oral Contraceptives Phosphorus Disorders Serum Phosphorus Hypercalciuria (C0020438) Potassium abnormally high calcium in the urine; may be due to Definition Disorders hyperabsorption of calcium, with the formation of (CSP) Fractional Excretion calcium oxalate or calcium phosphate renal stones. of Potassium Definition Excretion of abnormally high level of CALCIUM in the Serum Potassium (MSH) URINE, greater than 4 mg/kg/day. Transtubular Potassium Gradient Concepts Disease or Syndrome (T047)
  10. 10. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Magnesium Macrocytosis Magnesium Malaria Blood Smear Magnesium is the fourth most abundant cation in the body, behind sodium, potassium, and Manganese calcium. It is the second most prevalent intracellular cation after potassium. The normal body Mean Platelet Volume magnesium content is approximately 1000 mmol or 25 g, of which about half is in bone and Menorrhagia Coagulation Workup the other half is intracellular in soft tissue and muscle. Less than 1% of the total body Mercury magnesium is present in blood. Magnesium is essential for the function of many important Metanephrines for Pheochromocytoma enzymes, including reactions involving ATP synthesis and DNA replication and transcription. Metapneumovirus Magnesium is also required for cellular energy metabolism, membrane stabilization, nerve Methanol Poisoning conduction, calcium channel activity and ion transport. Magnesium deficiency results in a Methemoglobin variety of metabolic abnormalities and clinical consequences. Methicillin Resistant Staphylococcus Aureus No-Risk Prenatal Test Magnesium Sulphate-Turkey Methotrexate Paternity test- mother's blood only Call Now Toll Fertilizer & Industrial MgSO4-7H2O Over 20 years Metyrapone Test Free 1-877-R-U-MY-DAD experiance Microalbumin www dnaplus com www akdaskimya com Microsomal Antibodies Minimum Bactericidal Concentration Minimum Inhibitory Concentration Mitochondrial Antibody GI absorption and renal excretion regulate total body magnesium levels. The average daily Monoclonal B Cell Lymphocytosis dietary intake is about 325 mg and intestinal absorption is inversely proportional to the amount Multiple Sclerosis Panel ingested. Most magnesium is absorbed in the ileum and colon. Cereal, grains, nuts legumes, Mumps Virus IgG & IgM Antibodies and chocolate are relatively rich in magnesium. Vegetables, fruits, meats and fish have Mycobacteria DNA Sequencing intermediate amounts and dairy products are low in magnesium. The kidney is the major Mycobacterial Blood Cultures excretory organ for magnesium. Approximately 70% of plasma magnesium is filtered through Mycoplasma Pneumoniae Antibody the glomerular membrane. Only about 6% of filtered magnesium (120 mg) is excreted daily Mycoplasma Pneumoniae PCR into the urine, because of reabsorption in the Loop of Henle. The major regulator of tubular Myeloperoxidase Antibodies reabsorption is the plasma magnesium concentration. Hypermagnesemia inhibits and Myeloproliferative Disorders hypomagnesemia stimulates renal transport. Myoglobin Myoglobin Urine Serum magnesium exists in three states: approximately 60% is ionized (free), 33% is protein bound, and 7% is complexed to phosphate, citrate, and other anions. Approximately 75% of the protein bound fraction is bound to albumin and 25% to globulins. Serum magnesium concentration does not correlate very well with tissue magnesium levels. Serum levels are useful for assessing acute changes in magnesium states, especially in patients with cardiac arrhythmias, acute onset of seizures, and diabetic ketoacidosis. Serum IgE v. skin testing Hypomagnesemia is found in 12 to 20% of hospitalized patients and up to 65% of patients in Practical information For intensive care units. The usual reason is loss of magnesium from the GI tract or the kidney. The causes of magnesium depletion can be remembered as the "D" factors: healthcare professionals www.hycorbiomedical.com Diarrhea: Lower GI secretions are rich in magnesium. Diarrhea, malabsorption, bowel resection, steatorrhea and acute pancreatitis are common causes of magnesium depletion. Diuretics: Loop diuretics can rapidly induce magnesium wasting. Long term thiazide Manage High Iron diuretics can also cause hypomagnesemia. Read About Exjade®: Diabetes: This is the most common cause probably due to glycosuria and osmotic An Effective Iron diuresis. Drugs: mostly nephrotoxic drugs such as aminoglycosides, amphotericin B, cyclosporine, Chelation Therapy cisplatin, foscarnet, pentamidine. www.Exjade.com Delivery: Magnesium normally declines by 10% in pregnancy and further during labor. Severe depletion is associated with eclampsia. Denuded Skin: Burns are associated with a general loss of electrolytes. offer magnesium Dietary: Hypomagnesemia becomes evident after 7 days of dietary magnesium restriction. Clinical signs are observed after 42 days. sulfate Drinking: Alcohol inhibits renal tubular reabsorption of magnesium. Thirty percent of manufacture magnesium alcoholics admitted to the hospital have low magnesium. sulfate aluminum sulfate, monensin sodium Hypocalcemia is common in patients with severe hypomagnesemia, usually appearing when the www.jinxingchem.com serum magnesium level is less than 1.0 mEq/L. PTH levels are usually low and rise rapidly following magnesium replacement. Hyokalemia also frequently accompanies hypomagnesemia. It does not respond to potassium replacement until the magnesium deficit is corrected. Magnesium Source Hypermagnesemia is rare and usually iatrogenic. The most common causes are IV magnesium High Purity Magnesium and magnesium containing cathartics or antacids. Patient most at risk are the elderly and those Metal, Grains with bowel disorders or renal insufficiency. Clinical manifestations include hypotension,
  11. 11. Magnesium Sulphate, bradycardia, respiratory depression, depressed mental status, and ECG abnormalities. Alloys + www.strategic-metal.com Reference range is 1.4 - 2.0 mEq/L.. Levels below 1.0 mEq/L are considered critical values. Specimen requirement is one SST tube of blood. Zechstein magnesium Pure natural magnesium chloride out of the best source in the world www.zechsteininside.com Advertise | Biography | Terms of Use | Privacy Policy | Site Map | Copyright © 2006 - 2009 by ClinLab Navigator, LLC.
  12. 12. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Sodium Urine Sd70 Antibody Secretin Provocative Test Semen Analysis Dietary intake greatly influences the urinary excretion of sodium. The rate of sodium excretion Severe Acute Respiratory Syndrome during the night is only one fifth of the peak rate during the day, indicating a large diurnal Sickle Cell Screen variation. Measurement of urinary sodium is helpful in the differential diagnosis of Smith Antibody hyponatremia and hypernatremia. Smooth Muscle Antibody Sodium Excessive Sweating Cure Royce International Sodium Urine Discover how people have reduced excessive Sodium Hydrosulfite-Local Inventory available. SSA & SSB Antibodies hands and body sweating Blending Capabilities. Stenotrophomonas Maltophilia ronda8064 sweatawaytoday com www royceintl com Stool Cultures Strep Screen Streptococcus Group B Antigen Sweat Chloride Urine Sodium Concentration in Patients with Hyponatremia Synovial Fluid Analysis Fluid Volume Urinary Sodium Causes Syphilis Serology Hypovolemia >20 Renal losses due to diuretics, aldosterone deficiency, salt losing nephropathy, osmotic diuresis, ketonuria, RTA Renal Epithelials - Normal <20 Extra renal losses due to vomiting, diarrhea, third spacing of fluids from burns, pancreatitis, trauma ATCC Primary Cell Solutions™ LGC Euvolemia >20 Cortisol deficiency, hypothyroidism, stress, drugs, SIADH Standards partnered with ATCC Hypervolemia >20 Acute or chronic renal failure www.lgcstandards-atcc.org <20 Nephrotic syndrome, cirrhosis, cardiac failure Oilfield Produced Water Need clean water? VSEP can turn produced Urine Sodium Concentration in Patients with Hypernatremia water into boiler feed! www.vsep.com/adwords/produced Fluid Volume Urinary Sodium Causes Hypovolemia <20 Excess sweating, burns, diarrhea, fistulas Control Urine Leakage >20 Renal disease, urinary tract obstruction, osmotic or loop Use Dribblestop® Male diuretics Urinary Incontinence Clamps. Buy Online! Euvolemia Variable Diabetes insipidus, hypodipsia, Insensible losses, respiratory, www.DribbleStop.com dermal Hypervolemia >20 Primary hyperaldosteronism, Cushing's syndrome, hypertonic dialysis, hypertonic sodium bicarbonate, sodium chloride tablets Sulfo Isophthalic Acid Sulfo Isophthalic Acid Sodium Salt Professional chemistry distribution Reference range is 43 - 217 mEq/24 hours. www.schmidt-chemie.de Specimen requirement is a 24 hour urine collection in a container without preservative. Specimen should be refrigerated during an after the collection. Detoxamin the safe, gentle & proven chelation therapy alternative www.detoxamin.com
  13. 13. Buy Our Book | Home | Contact Us | Links Test Interpretations Transfusion Quality Control Utilization Method Evaluation Test Significant Change Q&A Blog Sodium, Serum Sd70 Antibody Secretin Provocative Test Semen Analysis Sodium is the most abundant cation in the extracellular fluid. Serum sodium with its Severe Acute Respiratory Syndrome accompanying anions accounts for most of the osmotic activity of the plasma. Serum sodium Sickle Cell Screen and osmolality are controlled by two separate but related systems. Serum sodium is Smith Antibody maintained by a feedback loop involving the kidney and adrenal glands. A decrease in serum Smooth Muscle Antibody sodium concentration or in blood pressure results in the release of renin by the kidney. Renin Sodium catalyzes the conversion of angiotensinogen to angiotensin I, which in turn is converted to Sodium Urine angiotensin II by angiotensin converting enzyme in the lung. Angiotensin II stimulates the SSA & SSB Antibodies distal convoluted tubule in the kidney to retain sodium and water, thereby removing the Stenotrophomonas Maltophilia stimulus to renin secretion. Stool Cultures Strep Screen Sodium Deoxycholate Royce International Streptococcus Group B Antigen Large or small volumes, GMP quality Manufacturer Sodium Hydrosulfite-Local Inventory available. Sweat Chloride and Exporter Blending Capabilities. Synovial Fluid Analysis www nzp co nz www royceintl com Syphilis Serology Serum osmolality is maintained by a feedback system involving the hypothalamus, pituitary gland, and the kidney. An increase in serum osmolality is sensed by osmoreceptors located in the anterior hypothalamus resulting in release of antidiuretic hormone (ADH) from the posterior Manage High Iron pituitary gland. ADH acts on the distal nephron to cause retention of water, which reduces Read About Exjade®: serum osmolality and removes the stimulus to ADH secretion. Conversely, a decrease in serum An Effective Iron osmolality inhibits ADH release, and excess water is excreted in the urine until serum osmolality returns to normal. Chelation Therapy www.Exjade.com Hyponatremia is the most common electrolyte abnormality in hospitalized patients and is defined as a serum sodium concentration less than 135 mEq/L. Symptoms are due to the relative excess of water that results in overhydration of cells. The severity of symptoms depends on the degree of hyponatremia and the rate at which it develops. A patient with mild Sulfo Isophthalic Acid hyponatremia (sodium >125 mEq/L) may be asymptomatic or experience malaise and nausea. Sulfo Isophthalic Acid As the hyponatremia worsens, headaches, lethargy, confusion, and a decreasing level of Sodium Salt Professional consciousness may develop. Seizures and coma usually occur only if there is a sudden decrease in sodium to less than 120 mEq/L. chemistry distribution www.schmidt-chemie.de Hyponatremia can be categorized by its effect on blood volume. The initial evaluation of hyponatremia should include measurement of plasma osmolality, electrolytes, glucose and BUN. When serum osmolality is reduced, the next step is to determine the extracellular fluid volume of the patient. If it is reduced, hyponatremia is defined as depletional. The patient has Buy DCA lost sodium and water, and the sodium loss is proportionately greater than the water loss. Measurement of urinary sodium concentration helps to identify the site of sodium and fluid Sodium Dichloroacetate loss. Urinary sodium concentration greater than 20 mEq/L indicates renal loss of sodium while Ships Immediately urinary sodium concentration less than 20 mEq/L indicates extrarenal loss. The most common www.buyDCA.com/ causes are thiazide diuretics; prolonged vomiting or diarrhea; third spacing of fluids secondary to burns, pancreatitis or trauma; potassium depletion, and aldosterone deficiency. Euvolemic hyponatremia is the most commonly encountered sodium disorder in hospitalized LianXing Chemical patients. It typically indicates a problem with water balance. The most common etiologies are Co.,Lt inappropriate ADH secretion, severe hyperglycemia, polydipsia, adrenal (cortisol) insufficiency, and pregnancy. The syndrome of inappropriate ADH secretion (SIADH) is the commonest cause The main Product is of hyponatremia in hospital patients and is associated with malignancies, pulmonary disease, Sodium Hypopho- sphite CNS disorders, and HIV infection. Hyponatremia is common after surgery and is characterized (quantity is 5000MT/year) by high levels of circulating ADH. Hyperglycemia accounts for 15% of hyponatremia in www.lianxingchem.com inpatients. Plasma sodium falls by 1.6 mEq/L for every 100 mg/dL increase in plasma glucose. Drug induced hyponatremia can be caused by drugs that stimulate the release of ADH or potentiate its action. Drugs causing hyponatremia include psychoactive agents (fluoxetine, sertraline, thiothixene, haloperidol, and amitriptyline), some anti-cancer agents (vincristine, Kidney Failure Cure vinblastine, and high dose cyclophosphamide), and carbamazepine, bromocriptine, lorcainide, Your Kidney Failure. . . chlorpropamide, and IV vasopressin. Absolutely Gone Forever. . . Never To Return. Hypervolemic hyponatremia is nearly always a problem of water overload, which causes www.TheKidneyDiseaseSolution.c edema. Total body sodium is increased, but total body water is increased even more. The most common causes are congestive heart failure, cirrhosis, advanced renal failure, and nephrotic syndrome. In congestive heart failure, impaired perfusion of the kidney causes retention of sodium and water, with water retained in excess of sodium. In renal failure, the impaired
  14. 14. kidney is unable to excrete normal amounts of water. Hypoalbuminemia due to cirrhosis or nephrotic syndrome decreases oncotic pressure and causes water to leave the intravascular space, resulting in decreased blood pressure. Homeostatic mechanisms lead to retention of water in the extracellular fluid compartment. Approach to Diagnosis of Hyponatremia Pseudohyponatremia is an artifactual hyponatremia most commonly caused by severe hypertriglyceridemia (>1500 mg/dL), or less often, by severe hyperproteinemia (>10 g/dL). Sodium is most commonly measured with an ion specific electrode (ISE). Two types of ISE exist; indirect and direct. Sodium is dissolved only in the water portion of plasma. When triglyceride or protein levels are extremely high, they occupy more space in a given volume of plasma, resulting in a decreased in the percentage of water with its sodium content. Consequently, an artifactually low sodium concentration is obtained because less sodium is present in a given volume of plasma, even though the concentration of sodium in the water phase is unaltered. Pseudohyponatremia can occur when sodium is measured with an indirect ISE, which is the method used by most automated chemistry analyzers. This phenomenon is not seen when sodium is measured with an instrument that uses direct ISE, such as point of care instruments and blood gas analyzers. These instruments use whole blood, instead of plasma, and do not require predilution of the sample. Pseudohyponatremia can be confirmed by measuring sodium on an instrument using direct ISE and also measuring serum osmolality and comparing the result to a calculated osmolality. In a patient with hyponatremia, an increased osmolal gap suggests the presence of pseudohyponatremia. Hypernatremia is far less common than hyponatremia. Patients at highest risk include infants, elderly patients, patients with altered mental status, uncontrolled diabetics, and hospitalized patients receiving hypertonic infusions, tube feedings, osmotic diuretics, lactulose, or mechanical ventilation. Hypernatremia always reflects a hyperosmolar state so CNS symptoms are prominent. The signs and symptoms include; altered mental status, lethargy, irritability, restlessness, seizures, muscle twitching, hyerreflexia, spasticity, fever, nausea, labored respiration, and intense thirst. In adults, a plasma sodium level above 160 mEq/L is associated with a 60 to 75% mortality. Hypernatremia usually results from excessive loss of water relative to sodium. Loss of hypotonic fluid may be secondary to kidney disease or profuse sweating or diarrhea. The renal concentrating mechanism is the first line of defense against water depletion and hyperosmolarlity. Thirst is an important backup defense. Measurement of urine osmolality is helpful in evaluating the cause of hypernatremia Urine osmolality is normal or low after renal loss and increased after extrarenal losses. Patients fall into three broad categories. Urine osmolality < 300 mOsm/kg Diabetes insipidus (central or nephrogenic) Urine osmolality 300 to 800 mOsm/kg Defect in ADH release - Diuretics Osmotic diuresis Urine osmolality >800 mOsm/kg Excess intake of sodium Insensible water loss - infants, dementia, fever, burns, heat exposure GI loss of hypotonic fluid Loss of thirst Sodium levels above 160 mEq/L are unusual and may be due to a preanalytical error. Vacutainer tubes containing a sodium based anticoagulant such as sodium heparin, sodium
  15. 15. fluoride, sodium citrate, or sodium EDTA can markedly elevate plasma sodium levels. Cardiac patients whose specimen are collected from catheters containing benzalkonium heparin can also have falsely elevated heparin levels. Reference range is 134 - 144 mEq/L. Sodium concentrations < 120 mEq/L or >155 mEq/L are considered critical values. Specimen requirement is one SST tube of blood. Royce International Sodium hydride Lignosulphonate Sodium Hydrosulfite-Local Inventory CAS No. 7646-69-7 UK based Russain origin, powder appearance available. Blending Capabilities. company. Global reach. Competitive prices, any volume! www.royceintl.com www.chemisphere.co.uk www.ChemiRu.com Advertise | Biography | Terms of Use | Privacy Policy | Site Map | Copyright © 2006 - 2009 by ClinLab Navigator, LLC.