MISCELLANFOUS Scenario A: The emergency room patients that will be admitted. The
ID: 281179 • Letter: M
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MISCELLANFOUS Scenario A: The emergency room patients that will be admitted. The STAT work is drawn in a heparin vacutainer so that it can be processed quickly. The routine is collected in a red top vacutainer since rapid processing isn't necessary. The first set of chemistry results below is the STAT sample. The second set is the routine panel. The technologist who ran the STAT repeated and called the K since it was a critical value. The routine panel was reported several hours later. The physician called the lab demanding to know what was wrong with potassiums. He had started IV therapy to increase the critically low K. If the K was really 3.2 mmol/L, he wouldn't have started the IV. either sample and the controls were within acceptable ranges for both analyses.) usually orders a STAT and a routine chem on all (There is no observable hemolysis in OLLECTION ATE TIME GLUCNA K CL CO2 BUN CREAT AGAP CA MG PHOS RBC WBC HGB HCT PLT /23 1345 86 138 2.3 88 37 17 113 2.79 22.0 6.7 21.6 1024 1345 81 138 3.2 99 33 17 1.0 16 9.2 1.8 3.2 What explanation would you give the doctor for the difference in the K' levels between the two samples? (2 pts) 1. Scenario B: A diabetic was brought to the emergency room in a coma. The patient's serum K" level was 5.5. After insulin was administered the K' level was 4.6. 2. What explanation would you give the doctor for the difference in the K levels? (1 pt) Scenario C: The following sets of results were obtained: Ionized Calcium Phosphorus (1.16-1.31 mmol/L) (0.87-1.45 mmo/L) (13-64 ng/L) PTH Set X1.44 Set Y 1.08 Set Z 0.85 0.90 1.48 100 25 12 1.70 3. Which set of values is consistent with a diagnosis of primary hyperparathyroidism?Explanation / Answer
1. STAT requires immediate processing of the blood sample while in the routine test it is not the case.
Due to delayed processing in case of routine test, sufficient ATP is not produced because of inadequate amount of glucose. Na+/K+ ATPase pump is required to maintain a gradient across the membrane. Due to inadequate ATP(required for normal functioning of Na+/K+ ATPase pump) potassium will leak out of the cell causing increased levels of potassium in the plasma (pseudohyperkalemia.). However there is no leakage in case of STAT, plasma potassium is not increased and accounts for potassium only from on-RBC source.
2. Once insulin is administered to the patient, it facilitates the transport of Na+/K +ATPase pump on the surface of skeletal muscles which ultimately leads to transport of potassium inside the cell thereby decreasing the potassium concentration in plasma.
3. Set X
Parathyroid gland secretes PTH (Parathyroid hormone) which is responsible for controlling use of Calcium and Phosphorous in blood and bones. In hyperthyroidism, more PTH is released which causes excessive absorption of calcium from bones thereby increasing calcium concentration in plasma (Hypercalcuria). This condition is accompanied by increased phosphate removal in urine (phosphateuria) in which renal tubular reabsorption of phosphate is decreased
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