Lab studies for the TPN patient
* Base Line: * On the 1st day, obtain a random Blood glucose 6-8 hr after beginning infusion; * First Week * Routine Labs Original Text by Clifford R. Wheeless, III, MD.
* Base Line: * On the 1st day, obtain a random Blood glucose 6-8 hr after beginning infusion; * First Week * Routine Labs Original Text by Clifford R. Wheeless, III, MD.
– CBC – TPN – LFT’s (AST) – PT – Serum Fe and Fe binding capacity – Cholesterol – Triglycerides ( < 200) – Osmolality, serum – Urine Analysis – CXR – EKG
– See Rx of UTI – Routine cultures will fail to dx: Chlamydia, GC, and TB; – LE & Nitrite – In and Out Cath: any growth is considered UTI; – Clean Catch Urine: – about 85% accurate in women and uncirc’ed men; – positive culture is > 100,000 bacteria/ml… or – positive culture is … Read more
– Discussion: – Urine pH less than 6 is common in pre-renal azotemia and unusual in acute tubular necrosis; – Acid: – High Protein, Ammonium Chloride, Mandelic Acid & Chlorothiazide Acidosis, ketoacidosis (Starvation, DKA), COPD; – Uric acid, cyytine and calcium oxalate stones precipitate in acid urines; – Meats and cranberry juice makes the urine … Read more
Positive: Diabetes mellitus. Pancreatitis, Pancreatitic ca Pheochromocytoma, Cushing’s dz Shock Burns Pain Steroids, Hyperthyroidism Renal Tubular dz Iatrogenic causes; Common after heavy meals Ascorbic acid overdose – Misc: – large amount of ketones will give False Negatives; – precise timing is essential or dipstick color change is meaningless, & over timing by only 1-3 seconds … Read more
– Detects primarily Acetone & AcetoAcetic Acid, not Beta-Hydroxybutyric acid; – Positive: Starvation, High Fat Diet, DKA (See Hyperglycemia) Vomiting Diarrhea Hyperthyroidism, Pregnancy, Fever – Misc: – precise timing is essential or dipstick color change is meaningless & over timing by only 1-3 seconds will cause false elevation; – carbohydrate free diets as well as … Read more
– Discussion: – Persistent proteinuria by dipsick should be quantified by 24hr; – Positive: pyelonephritis, glomerulonephritis, Kimmelstiel-Wilson dz Nephrotic syndrome, Myeloma, Postural causes, Pre-eclampsia, Inflammation and Malignancies of Lower Urinary Tract, Functional causes (Fever, Stress, Heavy Exercise, Malignant Hypertension)
– See: Urine Culture – Conversion of nitrates to nitrite; – Positive: infection (negative test does not rule out infection since some organisms such as Strep faecalis & other gram positive cocci will not produce nitrite, & note that urine must also be retained in bladder for several hours to allow the reaction to take … Read more
Diagnostic Indexes in Acute Renal Failure PreRenal PostRenal Renal Acute GN ————— U/P osm > 1.5 1.0 – 1.5 1.0 – 1.5 1.0 – 1.5 Urine Na, mEq/l … Read more
– Indium 111 – Technetium 99m – Triphasic Bone Scan – Gallium Scan – Bone Scans in THR – Bone Scans in Avascular Necrosis – Nuclear Medicine Teaching Files References Review Articles: The Scintigraphic Diagnosis of Osteomyelitis. Comparison of indium-labeled-leukocyte imaging with sequential technetium-gallium scanning in the diagnosis of low-grade musculoskeletal sepsis. A prospective study. … Read more