DOCSLIB.ORG

Human Albumin Therapy in Hypoalbuminemic Dogs

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Human Albumin Therapy in Hypoalbuminemic Dogs OCTOBER 2006 VOL 8.9 Peer Reviewed Editorial Mission Human Albumin Therapy To provide busy practitioners with concise, peer-reviewed recommendations in Hypoalbuminemic Dogs on current treatment standards drawn from published veterinary medical literature. Michelle Savigny, DVM Resident, Emergency and Critical Care Douglass K. Macintire, DVM, MS, DACVIM, DACVECC This publication acknowledges that Professor standards may vary according to individual Department of Clinical Sciences experience and practices or regional College of Veterinary Medicine differences. The publisher is not responsible Auburn University for author errors. lbumin is a crucial protein in the body, comprising approximately half of the Reviewed 2015 for significant advances plasma total protein. Albumin is synthesized exclusively by the liver. Under in medicine since the date of original normal conditions, production occurs at one-third maximum capacity, meaning A publication. No revisions have been that in times of need, the liver has reserve capacity to increase albumin production. Stimulus for production is mainly the colloid osmotic pressure (COP) of the blood, made to the original text. but other factors, such as nutritional state, intracellular potassium, and certain hormones, also play a role. Synthetic substances such as hetastarch and dextrans can also be recognized by the Editor-in-Chief hepatic osmoreceptors and affect albumin synthesis. If these synthetic substances are Douglass K. Macintire, DVM, MS, used to increase COP to or above a normal level (20–40 mm Hg), they can actually DACVIM, DACVECC turn off the signal to the liver to produce more albumin. Degradation occurs at a rate directly related to concentration, with decreased degradation in times of hypo - Editorial Review Board albuminemia. Forty percent of the body’s albumin is intravascular; the remaining 60% Mark Bohling, DVM is interstitial. As albumin levels decrease, the intravascular supply is maintained at the University of Tennessee expense of the interstitial supply. However, as hypoalbuminemia begins to correct itself, the interstitial supply is replenished first. Harry W. Boothe, DVM, DACVS Albumin plays multiple physiologic roles in the body. It exerts 80% of the plasma Auburn University COP, helping to maintain vascular volume. Albumin also acts to maintain the integrity Derek Burney, DVM, PhD, DACVIM of the vascular endothelium. Interaction of its negative charge with the endothelial Houston, TX cells helps to decrease microvascular permeability. The coagulation system is influenced by albumin, with attenuation of platelet aggregation as well as a heparin-like acceleration Joan R. Coates, DVM, MS, DACVIM of antithrombin. The result is a trend toward decreased coagulation. The antioxidant University of Missouri effect of albumin is partially attributed to its sacrificial activity in binding free radicals Curtis Dewey, DVM, DACVIM, DACVS as well as bacterial toxins. It also binds iron to make it less available for certain redox Plainview, NY reactions, such as lipid peroxidation. Transport of many endogenous and exogenous substances is mediated by the albumin molecule. The structure of this protein allows it Nishi Dhupa, DVM, DACVECC to bind acidic, basic, and neutral substances. Bilirubin, fatty acids, and several drugs Cornell University (cephalosporin antibiotics, furosemide, digoxin, warfarin, NSAIDs) are all carried to a D. Michael Tillson, DVM, MS, DACVS substantial degree. Auburn University Hypoalbuminemia is a fairly common occurrence in many critically ill patients. Production is decreased because of a suboptimal nutritional state and the presence of liver disease and because albumin is a negative acute phase protein. Utilization is increased because these patients are typically in a catabolic state. Loss of albumin is enhanced in KEY TO COSTS certain disease states, including protein-losing nephropathies and enteropathies. $ indicates relative costs of any diagnostic and treatment regimens listed. OCTOBER 2006 VOL 8.9 Sequestration occurs in cases such as peritonitis, TABLE 1. Comparison of Colloid Use in Dogs pyothorax, and significant vasculitis. Hypoalbuminemia has been shown in multiple human and animal Dextran 70 Hetastarch 6% 25% Albumin studies to be correlated with an increase in morbidity and mortality. Size (kD) 70 450 69 Consequences of hypoalbuminemia are multiple. COP (mm Hg) 60 30–45 200 The coagulation system trends toward hypercoagula- bility in the absence of albumin. And of course, Dosage 10–50 10–50 * COP suffers in states of low albumin, leading to (ml/kg/day) edema of the interstitium, gut wall, brain, and Time to oncotic 12–24 >24 12–24 pulmonary parenchyma. This edema interferes with effect (hr) oxygen delivery to cells, potentially leading to organ Side effects Allergy Hypocoagulation Allergy dysfunction or failure. Hypoalbuminemia has been Hypocoagulation Renal dysfunction shown in multiple human and veterinary studies to be associated with an increased morbidity and *Dose under investigation; see text. mortality. Age Predisposition Human serum albumin (HSA) as a product is manufactured Varies depending on the underlying disease process. from pooled human plasma that is ultrafiltrated and heat Causes of hypoalbuminemia in young animals: sterilized. Two concentrations are available: isoncotic 5% at • — Liver failure associated with toxin exposure or congenital 308 mOsmol/L and hyperoncotic 25% at 1,500 mOsmol/L. portosystemic shunts. The COPs of the 5% and the 25% solutions are 20 and 200 — PLE seen with parvoviral enteritis, intestinal parasites, and mm Hg, respectively. In comparison, the COP of 6% het- astarch is 30 to 45 mm Hg, and that of dextran 70 is 60 mm pythiosis. Hg (normal plasma COP, 20–40 mm Hg) (Table 1). It is — Protein-losing nephropathy caus ed by amyloidosis in evident that 25% albumin has a significant oncotic advantage shar-peis. over the other synthetic colloids, especially important in • Causes of hypoalbuminemia in middle-aged to older animals: edematous states because of the low volume of “water” — Liver failure caused by neoplasia or cirrhosis. accompanying the albumin. An infusion of the 25% solution — PLE associated with inflammatory bowel disease, increases intravascular volume by as much as four to five times lymphangiectasia, or neoplasia. the infused volume. Additionally, one must consider the many — Protein-losing nephropathy caused by amyloidosis in benefits of giving a physiologically active and important older beagles. molecule such as albumin. Not only does its administration • Causes of hypoalbuminemia in animals of any age: have oncotic and volume expansion properties, but it also — Glomerulonephritis causing protein-losing neph ropathy, helps to maintain vascular endothelial integrity and has effects pyothorax, peritonitis, vasculitis or capillary leak, or other on coagulation, antioxidant properties, and transport function. acute illnesses. Breed Predisposition DIAGNOSTIC CRITERIA • Varies depending on underlying disease process. Historical Information • Liver failure: Many patients may benefit from the administration of HSA. — Chronic hepatitis: Bedlington terriers, cocker spaniels, One of the most important groups is patients with hypo- standard poodles, Doberman pinschers, West Highland albuminemia. Hypoalbuminemia may result from a variety white terriers. of disease processes: — Congenital portosystemic shunt: Yorkshire terriers, • Decreased production: Hepatic failure, inadequate intake, miniature schnauzers, Maltese, golden retrievers, Labrador malabsorption, or maldigestion. retrievers. • Increased loss: Protein-losing enteropathy (PLE), protein- — Toxicity: Labrador retrievers for carprofen toxicity. losing nephropathy, exudative cutaneous lesions, or whole • Protein-losing enteropathy: blood loss. — Soft-coated wheaten terriers. • Sequestration: Body cavity effusion, pleural, peritoneal, — Lymphangiectasia: Yorkshire terriers, Lundehunds. interstitial, or vasculopathy. — Parvovirus: Rottweilers, pit bull terriers, Doberman Patient history may vary depending on the underlying pinschers. disorder. — Inflammatory bowel disease:Shar-peis, Basenjis. 2 OCTOBER 2006 VOL 8.9 • Protein-losing nephropathy: 0–1.3 mg/dl) may be normal to increased. Hypercholesterolemia — Glomerulonephritis: Doberman pinschers, Sam oy eds, (reference range, 68–224 mg/dl) is often seen with nephrotic Rottweilers, Bernese mountain dogs, soft-coated wheaten syndrome. terriers. • Pyothorax or peritonitis is evidenced by an exudative effusion — Amyloidosis: Beagles, shar-peis. with either an increased or decreased peripheral white blood cell count (reference range, 6,000–17,000/µl). Owner Observations • Patients with vasculitis typically show a transudative cavitary Vary depending on the underlying disease process, but general effusion with decreased circulating platelets (reference range, signs such as lethargy, inappetence, vomiting or diarrhea, polyuria 150,000–500,000). and polydipsia, tissue edema, a distended abdomen caused by ascites, and increased respiratory rate or effort are commonly seen. Other Diagnostic Findings Physical Examination Findings • Ultrasonographic examination $–$$ • Tissue edema, usually in dependent areas (ventrum, legs, — Liver: Nonspecific echogenic changes, microhepatica, mandible). hepatic nodules, ascites. • Distended abdomen (peritoneal effusion). — Intestinal: Thickened walls with loss of normal layering in • Fast, shallow breathing (pleural effusion). infiltrative diseases; often decreased
Load more

Recommended publications
  • Guidelines on the Diagnosis and Management of Pericardial
    European Heart Journal (2004) Ã, 1–28 ESC Guidelines Guidelines on the Diagnosis and Management of Pericardial Diseases Full Text The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Task Force members, Bernhard Maisch, Chairperson* (Germany), Petar M. Seferovic (Serbia and Montenegro), Arsen D. Ristic (Serbia and Montenegro), Raimund Erbel (Germany), Reiner Rienmuller€ (Austria), Yehuda Adler (Israel), Witold Z. Tomkowski (Poland), Gaetano Thiene (Italy), Magdi H. Yacoub (UK) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Joa~o Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway) Document Reviewers, Gianfranco Mazzotta, CPG Review Coordinator (Italy), Jean Acar (France), Eloisa Arbustini (Italy), Anton E. Becker (The Netherlands), Giacomo Chiaranda (Italy), Yonathan Hasin (Israel), Rolf Jenni (Switzerland), Werner Klein (Austria), Irene Lang (Austria), Thomas F. Luscher€ (Switzerland), Fausto J. Pinto (Portugal), Ralph Shabetai (USA), Maarten L. Simoons (The Netherlands), Jordi Soler Soler (Spain), David H. Spodick (USA) Table of contents Constrictive pericarditis . 9 Pericardial cysts . 13 Preamble . 2 Specific forms of pericarditis . 13 Introduction. 2 Viral pericarditis . 13 Aetiology and classification of pericardial disease. 2 Bacterial pericarditis . 14 Pericardial syndromes . ..................... 2 Tuberculous pericarditis . 14 Congenital defects of the pericardium . 2 Pericarditis in renal failure . 16 Acute pericarditis . 2 Autoreactive pericarditis and pericardial Chronic pericarditis . 6 involvement in systemic autoimmune Recurrent pericarditis . 6 diseases . 16 Pericardial effusion and cardiac tamponade .
    [Show full text]
  • Hepatic Hydrothorax Without Apparent Ascites and Dyspnea - a Case Report
    Case Report DOI: 10.7860/JCDR/2018/37185.12181 I nternal Medicine Hepatic Hydrothorax without Apparent S ection Ascites and Dyspnea - A Case Report JING HE1, RASHA HAYKAL2, HONGCHUAN COVILLE3, JAYA PRAKASH GADIKOTA4, CHRISTOPHER BRAY5 ABSTRACT A 78-year-old female with a past medical history of alcoholic cirrhosis was hospitalised with recurrent lower gastrointestinal bleeding due to rectal ulcers. The ulcers were successfully treated with cautery and placement of clips. However, a recurrent large right-sided pleural effusion without apparent ascites and dyspnea were found incidentally during the hospitalisation. The initial fluid analysis was exudate based on Light’s criteria with high protein. The fluid analysis was repeated five days later, after rapid reaccumulation which revealed transudates. Other causes of pleural effusion like heart failure, renal failure or primary pulmonary diseases were excluded. Hepatic hydrothorax was considered and the patient was started with the treatment of Furosemide and Spironolactone. The atypical presentation of hepatic hydrothorax may disguise the diagnosis and delay the treatment. Therefore, for a patient with recurrent, unexplained unilateral pleural effusions, even with atypical fluid characterisation and in the absence of ascites, hepatic hydrothorax should still remain on the top differential with underlying cirrhosis to ensure optimal treatment. Keywords: Cirrhosis, Light criteria, Liver, Pleural effusion CASE REPORT Haemogram Levels Normal range A 78-year-old Caucasian female, with a past medical history of alcoholic cirrhosis, admitted for recurrent rectal bleeding secondary WBC 6.9 (4.5-11.0 thousands/mm3) to rectal ulcers and was successfully treated with cautery and Neutrophils % 78 H (50.0-75.0 %) placement of clips.
    [Show full text]
  • Evaluation of Abnormal Liver Chemistries
    ACG Clinical Guideline: Evaluation of Abnormal Liver Chemistries Paul Y. Kwo, MD, FACG, FAASLD1, Stanley M. Cohen, MD, FACG, FAASLD2, and Joseph K. Lim, MD, FACG, FAASLD3 1Division of Gastroenterology/Hepatology, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA; 2Digestive Health Institute, University Hospitals Cleveland Medical Center and Division of Gastroenterology and Liver Disease, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA; 3Yale Viral Hepatitis Program, Yale University School of Medicine, New Haven, Connecticut, USA. Am J Gastroenterol 2017; 112:18–35; doi:10.1038/ajg.2016.517; published online 20 December 2016 Abstract Clinicians are required to assess abnormal liver chemistries on a daily basis. The most common liver chemistries ordered are serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase and bilirubin. These tests should be termed liver chemistries or liver tests. Hepatocellular injury is defined as disproportionate elevation of AST and ALT levels compared with alkaline phosphatase levels. Cholestatic injury is defined as disproportionate elevation of alkaline phosphatase level as compared with AST and ALT levels. The majority of bilirubin circulates as unconjugated bilirubin and an elevated conjugated bilirubin implies hepatocellular disease or cholestasis. Multiple studies have demonstrated that the presence of an elevated ALT has been associated with increased liver-related mortality. A true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females and levels above this should be assessed. The degree of elevation of ALT and or AST in the clinical setting helps guide the evaluation.
    [Show full text]
  • Total Bilirubin in Athletes, Determination of Reference Range
    OriginalTotal bilirubin Paper in athletes DOI: 10.5114/biolsport.2017.63732 Biol. Sport 2017;34:45-48 Total bilirubin in athletes, determination of reference range AUTHORS: Witek K1, Ścisłowska J2, Turowski D1, Lerczak K1, Lewandowska-Pachecka S2, Corresponding author: Pokrywka A3 Konrad Witek Department of Biochemistry, Institute of Sport - National 1 Department of Biochemistry, Institute of Sport - National Research Institute, Warsaw, Poland Research Institute 2 01-982 Warsaw, Poland Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, Poland 3 E-mail: Department of Biochemistry, 2nd Faculty of Medicine, Medical University of Warsaw, Poland [email protected] ABSTRACT: The purpose of this study was to determine a typical reference range for the population of athletes. Results of blood tests of 339 athletes (82 women and 257 men, aged 18-37 years) were retrospectively analysed. The subjects were representatives of different sports disciplines. The measurements of total bilirubin (BIT), iron (Fe), alkaline phosphatase (ALP), alanine aminotransferase (ALT) and gamma-glutamyltransferase (GGT) were made using a Pentra 400 biochemical analyser (Horiba, France). Red blood cell count (RBC), reticulocyte count and haemoglobin concentration measurements were made using an Advia 120 haematology analyser (Siemens, Germany). In groups of women and men the percentage of elevated results were similar at 18%. Most results of total bilirubin in both sexes were in the range 7-14 μmol ∙ L-1 (49% of women and 42% of men). The highest results of elevated levels of BIT were in the range 21-28 μmol ∙ L-1 (12% of women and 11% of men). There was a significant correlation between serum iron and BIT concentration in female and male athletes whose serum total bilirubin concentration does not exceed the upper limit of the reference range.
    [Show full text]
  • Normal Rangesа–А
    Effective August 2007 5361 NW 33 rd Avenue Fort Lauderdale, FL 33309 954-777-0018 NORMAL RANGES – fax: 954-777-0211 ADULT MALE FEMALE CBC WBC 3.6 – 11.0 K/UL 3.6 – 11.0 RBC 4.5 – 5.9 M/UL 4.5 – 5.9 HEMOGLOBIN 13.0 – 18.0 G/DL 12.0 – 15.6 HEMATOCRIT 40 – 52 % 36.0 – 46.0 MCV 81 – 97 FL 81 ­ 93 MCH 26 – 34 PG 26 ­ 34 MCHC 31 – 37 gm/dl 31 ­ 37 RDW 11.5 – 15 % 11.5 – 15.0 PLATELET CT 150 – 400 K/UL 140 ­ 400 PLT VOL 7.4 – 10.4 FL 7.4 – 10.4 NEUTROPHIL % 36 – 66 36 ­ 75 LYMPHOCYTE % 23 – 43 27 ­ 47 MONOCYTE % 0.0 – 10 0.0 ­ 10 EOSINOPHIL % 0 – 5.0 0.0 – 5.0 BASOPHIL % 0 – 1.0 0.0 – 1.0 RETIC 0.4 – 1.9 0.4 – 1.9 COMPREHENSIVE METABOLIC PROFILE /LIVER PROFILE SODIUM 135 – 145 MMOL/L 135 ­ 145 POTASSIUM 3.5 – 5.5 MMOL/L 3.5 – 5.5 (OUTREACH) CHLORIDE 95 – 110 MMOL/L 95 ­ 110 CO2 19 – 34.MMOL/L 19 ­ 34 GLUCOSE 70 – 110 MG/DL 70 ­ 110 BUN 6 – 22 MG/DL 6 ­ 22 CREATININE 0.6 – 1.3 MG/DL 0.6 – 1.3 MG/DL CALCIUM 8.4 – 10.2 MG/DL 8.4 – 10.2 TOTAL PROTEIN 5.5 – 8.7 G/DL 5.5 – 8.7 ALBUMIN 3.2 – 5.0 g/dl 3.2 – 5.0 BILI TOTAL 0.1 – 1.2 MG/DL 0.1 – 1.2 BILI DIRECT 0.0 – 0.3 MG/DL 0.0 – 0.3 BILI INDIRECT 0.2 – 1.0 MG/DL 0.2 – 1.0 ALKALINE PHOS 20 – 130 U/L 20 ­ 130 AST/SGOT 10 – 40 U/L 10 ­ 40 ALT/SGPT 7 ­ 55 U/L 7 ­ 55 AST/ALT RATIO 0.5 – 0.9 RATIO 0.5 – 0.9 AMYLASE 25 – 115 U/L 25 – 115 U/L LIPASE 114 – 286 U/L 114 – 286 U/L CRP 0 – 0.9 MG/DL 0 – 0.9 MG/DL PREALBUMIN 18.0 – 35.7 mg/dL 18.0 – 35.7 mg/dL Revised 8­07 MAGNESIUM 1.8 – 2.4 mg/dL 1.8 – 2.4 mg/Dl LDH 100 – 200 Units /L 100 – 200 Units/L PHOSPHOROUS 2.3 – 5.0 mg/dL 2.3 – 5.0 mg/dL LACTIC ACID 0.4
    [Show full text]
  • Laboratory Test Reference Ranges
    Laboratory Test Reference Ranges Central Zone Always refer to the laboratory report for appropriate reference ranges at the time of analysis. This document lists the test reference ranges that were established for the analysis methodologies used only by Nova Scotia Health Central Zone (Central Zone) Department of Pathology and Laboratory Medicine facilities. Anatomical Pathology Blood Tests Name of Test Specimen Units Low High Critical Type Anti-Cardiac Muscle Antibody Serum (SST) Qualitative N/A N/A N/A Anti-Skeletal Muscle Antibody Serum (SST) Qualitative N/A N/A N/A Anti-Pemphigoid Antibody Serum (SST) Qualitative N/A N/A N/A Anti-Pancreatic Islet Cell Antibody Serum (SST) Qualitative N/A N/A N/A Anti-Smooth Muscle Antibody Serum (SST) Qualitative N/A N/A N/A Anti-Liver Kidney Microsomal Antibody Serum (SST) Qualitative N/A N/A N/A Clinical Chemistry Blood Tests Name of Test Gender Age Units Low High Critical Acetaminophen M/F >0min µmol/L >350 Interpretive Data: Therapeutic range: 66-199 umol/L Toxic level: Refer to Rumack Matthew nomogram. Acetaminophen results can be falsely low for patients undergoing treatment of N- acetylcysteine (NAC). Adrenocorticotropic M/F >0min pmol/L 2.3 10.1 hormone Interpretive Data: Adrenocorticotropic Hormone (ACTH) reference ranges are based on (ACTH) samples collected prior to 10 AM. Albumin M/F 0-1yr g/L 25 46 >1yr 35 50 Alcohol M/F >0min mmol/L None Detected >54 Interpretive Data: The method is intended for clinical purposes only. Medical-legal specimens should be analyzed by gas chromatographic method for confirmation of results.
    [Show full text]
  • Determination of Reference Ranges for Selected Clinical Laboratory Tests for a Medical Laboratory in Namibia Using Pre-Tested Data
    DETERMINATION OF REFERENCE RANGES FOR SELECTED CLINICAL LABORATORY TESTS FOR A MEDICAL LABORATORY IN NAMIBIA USING PRE-TESTED DATA by CORNELIA DE WAAL-MILLER Student no: 197084516 Thesis submitted in fulfillment of the requirements of the degree Master of Technology: Biomedical Technology in the Faculty of Health and Wellness Sciences at the Cape Peninsula University of Technology Supervisor: Professor A.J. Esterhuyse Co-Supervisor: Professor B. Noden Bellville March 2015 CPUT copyright information The thesis may not be published either in part (in scholarly, scientific or technical journals), or as a whole (as a monograph), unless permission has been obtained from the University. (i) Declaration I, Cornelia de Waal-Miller, declare that the content of this thesis represents my own unaided work, and that this thesis has not previously been submitted for academic examination towards any qualification. Furthermore, this thesis represents my own opinions and not necessarily those of the Cape Peninsula University of Technology. 12th March 2015 Signed Date 2 | of 84 Pages (ii) Abstract Aim: The aim of the study was to compile pre-tested laboratory results stored in the laboratory database of the Namibia Institute of Pathology (NIP). The study also aimed to assess the usefulness and validity of using retrospective laboratory results of different patients in varying degrees of health and which were produced using various methods in different laboratories in Namibia. Methods: 254,271 test results (female: 134,261, male = 117,091, unknown gender= 2,919) consisting of Haemoglobin, serum Urea, serum Creatinine, plasma Glucose (fasting and random), serum Cholesterol, serum Triglycerides and serum Uric Acid was extracted from NIP Laboratory Information System over a period of four years and of the 13 different regions of Namibia were analyzed.
    [Show full text]
  • Assessing Acute Collapse for Presentation Powerpoint and Handouts
    “I’ve Fallen and [email protected] I Can’t Get Up” Assessing Acute Collapse For Presentation PowerPoint and Handouts: http://wendyblount.com Wendy Blount, DVM Kinds of Shock [email protected] Anaphylactic Shock •Obstructed airway •Acute allergic reaction •Lung Disease •Mast Cell Tumor Degranulation •Pleural air or effusion Cardiovascular Shock Neurogenic shock •Arrhythmia •Forebrain and brainstem - For Presentation PowerPoint •Left Heart Failure decreased consciousness •Right Heart Failure •Spinal cord – flaccid paralysis and Handouts: •Pericardial Disease Septic Shock http://wendyblount.com Hypovolemic Shock •Overwhelming infection •Dehydration Traumatic Shock •Hemorrhage •Due to pain •Hypoproteinemia Toxic Shock Hypoxic Shock •Due to inflammatory mediators, •Anemia endogenous and exogenous •Hemoglobin Pathology toxins Collapse Other Than Shock Assessment of Inability or Unwillingness to get up Collapse Profound Weakness Ataxia – lack of coordination •Metabolic weakness •Vestibular ataxia Quick Assessment •Hypercalcemia •Cerebellar ataxia Life Saving Treatment •Hypokalemia •Sensory ataxia •Hypoglycemia Paresis - loss of voluntary Physical Exam •Neurotoxins motor Emergency Diagnostics •Polyneuropathy •Lower Motor Neuron •Junctionopathy •CNS Lesion at level of History •Myopathy paresis Pain •Flaccid paresis In House Diagnostics •Spinal Cord/Nerve Pain •Upper Motor Neuron •Orthopedic Pain •CNS Lesion above paresis •Muscular Pain •Spastic paresis 1 Assessment of Assessment of Collapse Collapse Quick Assessment Life Saving Treatment
    [Show full text]
  • Calcium, Plasma, Total
    Division of Laboratory Medicine Biochemistry Calcium, plasma, total Calcium is the most abundant mineral element in the body with about 99 percent in the bones primarily as hydroxyapatite. The remaining calcium is distributed between the various tissues and the extracellular fluids where it performs a vital role for many life sustaining processes. Among the extra skeletal functions of calcium are involvement in blood coagulation, neuromuscular conduction, excitability of skeletal and cardiac muscle, enzyme activation, and the preservation of cell membrane integrity and permeability. Calcium levels and hence the body content are controlled by parathyroid hormone (PTH), calcitonin, and vitamin D. To maintain calcium homeostasis, we require sufficient intake, normal metabolism and appropriate excretion. An imbalance in any of these modulators leads to alterations of the body and circulating calcium levels. Increases in serum PTH or vitamin D are usually associated with hypercalcemia. Increased calcium levels may also be observed in multiple myeloma and other neoplastic diseases. Hypocalcemia may be observed e.g. in hypoparathyroidism, nephrosis, and pancreatitis. Total Calcium is reported as direct and after adjustment for plasma albumin level. Adjusted total calcium has the same reference interval as total calcium and is a surrogate for ionised calcium. General information Collection container: Adults – serum (with gel separator, 4.9mL brown top Sarstedt tube) Paediatrics – lithium heparin plasma (1.2mL orange top Sarstedt tube) Type and volume of sample: The tubes should be thoroughly mixed before transport to the lab. 1mL whole blood is required as a minimum volume. Specimen transport/special precautions: N/A Laboratory information Method principle: Calcium ions react with 5‑nitro‑5’‑methyl‑BAPTA (NM‑BAPTA) under alkaline conditions to form a complex.
    [Show full text]
  • Lab Dept: Chemistry Test Name: VENOUS BLOOD GAS (VBG)
    Lab Dept: Chemistry Test Name: VENOUS BLOOD GAS (VBG) General Information Lab Order Codes: VBG Synonyms: Venous blood gas CPT Codes: 82803 - Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation) Test Includes: VpH (no units), VpCO2 and VpO2 measured in mmHg, VsO2 and VO2AD measured in %, HCO3 and BE measured in mmol/L, Temperature (degrees C) and ST (specimen type) Logistics Test Indications: Useful for evaluating oxygen and carbon dioxide gas exchange; respiratory function, including hypoxia; and acid/base balance. It is also useful in assessment of asthma; chronic obstructive pulmonary disease and other types of lung disease; embolism, including fat embolism; and coronary artery disease. Lab Testing Sections: Chemistry Phone Numbers: MIN Lab: 612-813-6280 STP Lab: 651-220-6550 Test Availability: Daily, 24 hours Turnaround Time: 30 minutes Special Instructions: See Collection and Patient Preparation Specimen Specimen Type: Whole blood Container: Preferred: Sims Portex® syringe (PB151) or Smooth-E syringe (956- 463) Draw Volume: 0.4 mL (Minimum: 0.2 mL) blood Note: Submission of 0.2 mL of blood does not allow for repeat analysis. Processed Volume: 0.2 mL blood per analysis Collection: Avoid using a tourniquet. Anaerobically collect blood into a heparinized blood gas syringe (See Container. Once the puncture has been performed or the line specimen drawn, immediately remove all air from the syringe. Remove the needle, cap tightly and gently mix. Do not expose the specimen to air. Forward the specimen immediately at ambient temperature. Specimens cannot be stored. Note: When drawing from an indwelling catheter, the line must be thoroughly flushed with blood before drawing the sample.
    [Show full text]
  • Uric Acid 7D76-20 30-3928/R4
    URIC ACID 7D76-20 30-3928/R4 URIC ACID This package insert contains information to run the Uric Acid assay on the ARCHITECT c Systems™ and the AEROSET System. NOTE: Changes Highlighted NOTE: This package insert must be read carefully prior to product use. Package insert instructions must be followed accordingly. Reliability of assay results cannot be guaranteed if there are any deviations from the instructions in this package insert. Customer Support United States: 1-877-4ABBOTT Canada: 1-800-387-8378 (English speaking customers) 1-800-465-2675 (French speaking customers) International: Call your local Abbott representative Symbols in Product Labeling Calibrators 1 and 2 Catalog number/List number Concentration Serial number Authorized Representative in the Consult instructions for use European Community Ingredients Manufacturer In vitro diagnostic medical device Temperature limitation Batch code/Lot number Use by/Expiration date Reagent 1 ABBOTT LABORATORIES ABBOTT Abbott Park, IL 60064, USA Max-Planck-Ring 2 65205 Wiesbaden Germany +49-6122-580 July 2007 ©2002, 2007 Abbott Laboratories 1 NAME SPECIMEN COLLECTION AND HANDLING URIC ACID Suitable Specimens Serum, plasma, and urine are acceptable specimens. INTENDED USE • Serum: Use serum collected by standard venipuncture techniques The Uric Acid assay is used for the quantitation of uric acid in human into glass or plastic tubes with or without gel barriers. Ensure serum, plasma, or urine. complete clot formation has taken place prior to centrifugation. When processing samples, separate serum from blood cells or SUMMARY AND EXPLANATION OF TEST gel according to the specimen collection tube manufacturer’s Uric acid is a metabolite of purines, nucleic acids, and nucleoproteins.
    [Show full text]
  • Bilirubin Reference Range for Adults
    Bilirubin Reference Range For Adults Epidotic Puff levels or elates some semicircle dismally, however ship-rigged Hilton glom unashamedly or spared. Which Saundra disproved so pinnately that Ambrosius discomposed her cackles? Park ethicizing slowly. How do complete conjugation process and ast and from where it is free subscriptions for you can be encountered on laboratory results along with missing data. Looking for later Physician? It indicates the ability to graduate an email. Bilirubin is ultimately processed by her liver and allow its elimination from such body. Have you got a diagnosis of liver disease or symptoms. Indirect Bilirubin University Hospitals. Do not filtered from a type is for getting checked out, questions about all students with metabolic syndrome, drugs that it is collected by highly elevated. How do normal values for bilirubin in a newborn compare for those in fact adult Levels are higher in the newborn The total bilirubin in a 3-5 day was full term. In newborns, bilirubin levels are higher for the loan few days of life. Thanks for rich feedback! There is converted into a hierarchical coding system management, allergic reaction that affect lab profiles can eat radishes or equilibrium. Drugs may be less useful information on liver profile shows that entered my alcohol. Differential Diagnosis Physical Examination Evaluation References. Name for a sensitive imaging scans are slightly different gp practice committee on my dog with. It school a very senior level of bilirubin and flow the digest of hyper Adults Total BilirubinmgdL Normal Reference Range 03 to 10 mgdLmmolL Normal. Physiological jaundice results for adults unless otherwise normal laboratory test different lab tests run? Bilirubin is then removed from the body through their stool feces and gives stool its normal color.
    [Show full text]