4Why do blood tests? Haematinics Nutritional status Exposure to toxic substancesMarkers of infectionHydration statusRenal functionBaseline before treatmentEtc…
5What blood tests are available to us? Full blood countRed cells, white cells, plateletsUrea and electrolytesSodium, potassium, urea, creatinineLiver function testsBilirubin, total protein, albumin, ALP,ALT,GGTInflammatory markersCRP, ESRThyroid function testsTSH, T4,T3
6Others Troponin I Calcium/magnesium/phosphate Glucose Amylase Clotting/INR/APTT
7Patterns in disease Infective process e.g. Strep Pneumonia Anaemia WCC - neutrophilliaCRPAnaemiaMacrocytic - High MCVMicrocytic - Low MCVNormocytic - Normal MCV
9Liver function Thyroid disease Clotting Jaundice Prehepatic - conjugated bilirubin, CoombsHepatic - ALTPost hepatic - ALP/GGTThyroid diseaseHyperthyroidism - Low TSH, High T4Hypothyroidism - High TSH, Low T4
10Arterial Blood Gases Procedure Results pH 7.35 - 7.45 PCO kPaPOHCOBase excessA low HCO3- or negative base excess indicates metabolic acidosis, a high HCO3- or high positive base excess, metabolic alkalosis.
12Metabolic acidosis - pH , CO2 (N) HCO3 With respiratory compensation, CO2 may be Metabolic alkalosis - pH , CO2 (N), HCO3 With respiratory compensation, CO2 may be Respiratory acidosis - pH , CO2 HCO3 (N)With metabolic compensation, HCO3 may be Respiratory alkalosis - pH , CO2 , HCO3 (N)With metabolic compensation, HCO3 may be
13Case studies A 60 year old man was admitted with an exacerbation of chronic obstructivepulmonary disease. His arterial bloodgases on air showed:pHPaCO2 8.5 kPaPao2 8.0 kPaHCO mmol/lWhat is the acid-base disturbance and what is the management?
14Treatment is nebulisers/steroids/NIV Respiratory AcidosisType 2 failureTreatment is nebulisers/steroids/NIV
15A 45 year old lady with previous peptic ulcer disease was admitted with persistent vomiting. She looked dehydrated. Her blood results weresodium 140 mmol/lpotassium 2.5 mmol/lpHPaco2 6.0 kPaPao2 14 kPaHCO3 40 mmol/lWhat is the acid-base disturbance and why? Howwould you treat this patient?
16This patient had alkalosis due to a high standard bicarbonate-metabolic alkalosis. The PaCO2 was appropriately low in compensation. This was hypokalaemic hypochloraemic metabolic acidosis because of potassium and chloride loss from vomiting. Treatment was of the underlying cause (pyloric stenosis) and intravenous sodium chloride with potassium.
17What would you do now? How would you manage this lady? A 58 year old lady recently underwent a left hemicolectomy for cancer. 4 days later she complained of substernal abdominal pain,was nauseous and sweaty. Her gases showed:pHPCOPOHCOBEWhat would you do now? How would you manage this lady?
19Practice questions79 year old man started on diuretics for hypertension 2 weeks ago presents with a seizure. Bloods:FBC, Ca2+ (N)U+EsNa 107K 3.1U 7.2Cr 122Diagnosis?Hyponatraemia secondary to diuretic use
2017 year old presents with confusion, dehydration, fever. T39 17 year old presents with confusion, dehydration, fever. T39.5, HR 120, BP 100/50.BloodsFBC: Hb 13.0, WCC 19.2, Plt 180U+Es: Na 147, K 5.1, U 26.2, Cr 208Gluc: 34.9Diagnosis?Diabetic Ketoacidosis
2147 year old lady presents with abdominal pain 47 year old lady presents with abdominal pain. Lost 3 stones over 6 months. On examination she has a palpable gallbladder. BloodsFBC - Hb 8.1, MCV 69, WCC 7.5U+Es - Na 135, K 3.4, U 7.2, Cr 145LFTs - Bili 190, ALP 360, ALT 55, GGT 450Diagnosis?Obstructive Jaundice likely secondary to malignancy
2228 year old Nigerian man presents to casualty jaundiced with vomiting, diarrhoea. History of flu like symptoms 2 weeks previously.LFTs - bilirubin 43, ALP 96, ALT 1522, GGT 45. INR 1.2Diagnosis?Hepatitis A most likely
2361 year old arteriopath presents having recently been started on ACE inhibitors, with confusion and pruritis.FBC normalU+Es - Na 130, K 7.4, Ur 37, Cr 841Diagnosis?Renal artery stenosis
2435 year old presents with diarrhoea, sweating and palpitations. FBC (N)U+E (N)TFTs: TSH 0.01, T4 250Diagnosis?Hyperthyroidism- Graves disease