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Clinical Chemistry
Practice for Chemistry MLS
282
Chemistry
Not Applicable
04/26/2019

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Term
Protease
Definition

An enzyme that hydrolyzes and breaks proteins 

 

 (for example, an enzyme that breaks thyroglobin protein into Tyrosine, T2, T3, and T4 fragments)

Term
Dehydrogenase
Definition

An enzyme that reduces and oxidizes electron acceptors

 

(for example, reactions from NADH to NAD+ (and back to NADH), such as LD converting pyruvate and NADH to NAD+ and lactate--(causing acidosis of intense exercise)

Term
Transaminase
Definition

An enzyme that converts between amino-acids and keto-acids

 

 For example, AST catalyzes [Asp and alpha-ketoglutarate] to and from [Glu and oxaloacetate]

Term
Phosphatase
Definition
An enzyme that hydrolyzes a phosphate ion off of a compound (i.e. it dephosphorylates them)
Term
Hydrolase
Definition

an enzyme that breaks chemical bonds using a water molecule 

 

for example, lipases and phosphatases

Term
Kinase
Definition

An enzyme that takes phosophate from ATP, and gives it to (or 'phosphorylates') a substrate

 

For example, give the phosphate to Glucose --> it becomes Glucose-6-P

Term
Oxidase
Definition

an enzyme that reduces oxygen

 

for example  O2 --> H202

Term
Infrared
Definition
emits frequencies above 725 nm, in other words "low-energy emissions"
Term
Red
Definition

 

emits frequencies 600-725 nm

 

(note:  often a red-appearing substance is that which absorbs frequencies around ~400-500)

Term
Yellow
Definition

emission frequencies around 580-600 nm

 

yellow-appearing substance often absorbs around ~410

 

for example, yellow bilirubin absorbance is measured at 450

 

And, a very light yellow vanillin substance (which is a product of VMA, which is a product of epinephrine and norepinephrine) absorbance is measured at 360

Term
Green
Definition

Emission frequencies around 500-580 nm

 

note:  green solutions are absorbing around 400 and also 800

Term
Blue
Definition

Emits 440-500 nm 

 

absorbance ~600(commonly) 

 

for example, Methylene blue = has maximal absorbance at 668 and 609

Term
Violet
Definition

emits 380-440 nm

 

(absorbance commonly measured around 500-525)

Term
Ultra Violet UV
Definition
emission frequencies below 380 nm; in other words, 'high energy emissions'
Term
useful substance absorbance wavelengths
Definition
Red quinoneimine dye: 500

Bilirubin's natural yellow color absorption: 450

commonly used NADH absorption wavelength: 340

colorless NAD+ absorption: 280

hemoglobin Hb interference absorbance: <600

bilirubin interference and absorbance: <530


approximate turbidity light-scattering reading of CSF and urine protein: 415
Term
useful instrument wavelengths
Definition
wavelength range for hydrogen UV lamp: below 300 w/ known characteristic sharp emission line at 656

wavelength range for quartz-halogen (aka halogen, aka tungsten halide) lamp: 300 to infrared

wavelength range for xenon lamp's continuous emissions: 300-2000

stray light common cut-off filters wavelengths: approx. <380 and >680
Term
other wavelengths
Definition
ruthenium-label oxidation emission in chemiluminescence: 620

Didymum glass maximal absorbance sharp peak: 585

mercury lamp's high output line useful for fluorescence: 365

holmium oxide glass maximal absorbance, sharp peak: 361
Term
Methotrexate methods
Definition
cancer drug with many different protocols

temperature and light sensitive

sometimes very large dilutions are needed when on aggressive therapy
Term
Cyclosporin and Tacrolimus methods
Definition
50% of drug is bound to RBC's--therefore use EDTA-whole blood collection
Term
commonly used drug-level methods
Definition
EMIT (uses enzyme-labelled drug, antibodies, and substrates like glucose-6-P and NADPH)

can use ELISA (drug, sandwiched between IgG's, enzyme on one side, wash, and substrates such as nitroblue-T to measure ALP activity)

reaction rate is proportional to drug-level
Term
Cocaine methods
Definition
common to use chromatography methods

for urine samples, add organic alkali reagent to extract metabolites
Term
Ultrapure aromatic molecules methods
Definition
common to use liquid scintillation--a flash of light that occurs when compound is hit by beta particle (e-) emission (e.g. emission from a Tritrium probe)
Term
Unsaturated cyclic molecules methods
Definition
often detected using fluorometry--wherein a wavelength of excitation (higher energy wavelength that excites compound) and a wavelength of emission (lower energy emission from the previously-excited compound) are characteristic of the compound
Term
Phenilic groups (such as catecholamines--epinephrine and norepinephrine) methods
Definition
common to use HPLC-ECD--wherein HPLC separation is done first; and, then electrode is oxidized or reduced with a current proportional to concentration
Term
Drugs of abuse methods
Definition
common to use immunoassay as screens; but, then confirm by using GC-MS-- first, GC uses a mobile phase in the form of gas and separates compounds, and then MS to separate characteristic mass-charge fragments of compound
Term
Trace elements methods
Definition
common to use MS (mass spec), and using inductively charged plasma ionization to form the cations
Term
Amino and organic acids methods
Definition
Tandem mass spec using electrospray ionization for introduction and Argon-bombardment in the second chamber to form characteristic daughter ions
Term
Pb (lead) methods
Definition
Atomic absorption using graphite furnace for more sensitivity and Triton X-100 reagent to modify the matrix

Anode-stripping voltometry has been used--wherein you plate the cathode using electrons and then oxidize it to produce a current proportional to concentration
Term
I-A elements (Na, K, Li, Rb, Cs, Fr) methods
Definition
Flame photometry--as elements return to ground-state, they release characteristic photons proportional to concentration
--sources of error include high temps and flow rates--so, use a dilution reagent internal standard, such as lithium sulfate or cesium nitrate
Term
Metals (not including I-A) methods
Definition
Atomic absorption photometry
--elements in ground-state absorb their corresponding photons (such as Ca absorbing Ca+-to-Ca emissions from a diluted, cooled, modulated cathode ray tube) proportional to concentration
Term
Na+ and K+ methods
Definition
ion-selective electrodes (ISE)--where an ionic potential is generated across a membrane that is proportional to concentration, as compared to a reference electrode with a fixed potential and a salt bridge for electron flow such as Calomel (Hg/HgCl2 paste)
Term
Cl- methods
Definition
a solid-state ISE with AgCl crystals in the membrane

Butcher-Cotlove coulometric titration--wherein a constant current is applied until complete oxidation--sources of error include other halogen radicals and premature termination of current due to dirty electrode

a colorimetric detection of iron thianocyanate red

schales and schales titration with a diphenylcarbozone indicator
Term
CO2 methods
Definition
severinghaus electrode where carbonic acid is formed and pH change is proportional to concentration

Malic dehydrogenase method that starts with bicarb and ends with NAD product
Term
H+ methods
Definition
ISE with salicate glass membrane and HCl buffer
Term
Na+ methods
Definition
ISE with glass membrane and NaCl buffer--one source of error is high-lipid samples that displace the ions and lower the values, especially with higher dilutions
Term
K+ methods
Definition
ISE with valinomycin-coated membrane and KCl buffer--note: this ion is 0.1 higher in serum than plasma

***note: during acidosis, H+ is high, pushed into cells, in exchange for K+--overall result of acidosis on K+ levels ==== increased K+ readings in plasma
Term
NH4+ methods
Definition
ISE with monactin and nonactin coated membrane and NH4Cl buffer
Term
Li+ methods
Definition
ISE with proprietary ionophore and LiCl buffer
Term
Ca2+ methods
Definition
Atomic absorption is the reference method--just remember to use lantham-oxide to chelate and remove phosphate from interfering

dye-binding methods--just make sure to buffer at proteins' pI to release it from proteins

ISE method with polymer-membrane that allows exchange with a dioctylphenyl cation

note: EDTA and K-oxalate/Na-fluoride tubes bind and chelate this ion---falsely lowering the result
Term
PO4- methods
Definition
Fiske-subbarow method that makes NH4-molybdophosphate blue
Term
O2 methods
Definition
clark electrode--using Ag/AgCl anode and a current for reduction; minimum decomposition potential depends on concentration
Term
TIBC-transferrin methods
Definition
saturate aliquot w/ excess iron, wash w/ magnesium carbonate, and run serum iron assay
Term
Iron methods
Definition
atomic absorption is reference method

dye-binding methods use HCl to remove it from transferrin, reactions with "-anthroline" ligands, ascorbic acid, and sodium metabisulfite

anode-stripping voltometry has been used

ranges are low (ug/dL range), so methods are subject to contamination
Term
Osmolality methods
Definition
freezing-point methods hyperfreeze sample, wait for temperature to plataeu and no current to flow (through wheatstone bridge); resistance being proportional to concentration

dew-point methods preferable for volatile compounds; high concentration causes less moisture in chamber and less VP depression
Term
Albumin methods
Definition
bromcresol green dye is most common reagent (purple at pH 5.2)

commassie blue starts as red concentrate and turns blue when bound to proteins; it is used for microalbuminuria because it is sensitive at low levels (3mg/dL)
Term
Serum total protein methods
Definition
biuret reagent, including copper sulfate, K-tartrate; interacts with tripeptides and larger (levels above 1 g/dL)
Term
Protein separation methods
Definition
Electrophoresis after centrifugation and concentration

permeated gel chromotrography separates proteins from other small particles that get stuck in the small pores
Term
A1-anti-trypsin methods
Definition
on agarose gel electrophoresis, it has it's own distinct band
Term
HIV antibodies methods
Definition
on polycacrylamide gel electrophoresis, shows high resolution
Term
Urine and CSF protein methods
Definition
turbidimetric light-scattering absorbance-like methods use very caustic trichloroacetic acid 13.5% or SSA 10% for precipitation; detect levels around 10-150 mg/dL
Term
HgbA1c methods
Definition
in HPLC w/ ion exchange, it has a weak charge (less attracted to negative stationary phase), so it elutes faster than S, D, E, C, but not quite as fast as F; S interferes and causes false increase
Term
carbohydrates methods
Definition
blood cells in specimen can lower glucose and increase lactic acid--whole blood is 10% lower glucose; high hematocrit associated with lower glucose values

copper reduction in stool indicates many reducing substances and intolerance during digestion
Term
Glucose methods
Definition
Glucose oxidase methods
-inhibited by ascorbic acid
-first step is specific to glucose
-glucose oxidase makes H202
-trinder reaction uses H202 and makes red quinoneimine dye
-or, there is a glucose oxidase polarographic O2 electrode that can measure consumption of O2 as glucose is oxidized

hexokinase method
-most specific, even in first step
-reference method
-requires Mg2+ (make sure there is enough Mg2+ and no anticoagulant-chelation of Mg2+)
-after kinase reaction, it uses glucose-6-phosphate dehydrogenase to produce NADH
-hemolyzed specimen can effect biochemical pathways and final NADH production and levels

point-of-care whole blood monitors use amperiometric methods that utilize glucose oxidase or glucose dehydrogenase
Term
xylose methods
Definition
O-Toluidine method
-old caustic method that requires heat; uses sugar to make schiff base; method still around because it can utilize these random sugars
Term
Lipids methods
Definition
-centrifuged and refrigerated serum can give initial observations
-alcoholism, smoking, progesterone, and patient that did not fast for 12 hours, can cause high TG values
-heparin can activate lipoprotein lipase in specimens and cause low TG values
Term
Cholesterol methods
Definition
Abell-Kendall is a reference method; uses saponification and oxidation to produce a color product

Liebermann-Buchard is a reference method that uses high heat and strong sulfuric acid to produce green product

Cholesterol-oxidase Trinder reaction is not reference due to enzymatic variability
--it requires Cholesterol-Ester-Hydrolase to remove ester from cholesterol
--then, use cholesterol oxidase to make H202 and a reduction reaction to produce red product
Term
HDL methods
Definition
reference method uses KBr and ultra-centrifugation for separation before applying Abell-Kendall reference method--i.e. saponification and oxidation to form color product

a cholesterol-oxidase method adds specific IgG antibodies (with cyclodextrin) to block LDL, VLDL, and chylomicron activity and separate HDL, as well as a hydrolase step to remove ester groups

common to use a precipitation step with heparin, chlorides, and/or salts, along with centrifugation step

one source of error is ApoB(LDL) not being removed--use dextran sulfate to remove ApoB protein

collection can be non-fasting (unlike TG or LDL)
Term
LDL methods
Definition
Freidewald formula
-total and HDL are done in the same procedure must be done in same procedure
Total = HDL+LDL+TG/5 (or TG/2 if using mmol/L)

one method of separation uses antibodies for VLDL, HDL, and chylomicrons and centrifugation with a mesh to block out antibody-bound particles

detergent-based methods can work as long as TG is lower than 700
--react HDL, VLDL, and chylomicrons in a non-color producing oxidase step; remove LDL cholesterol and react in a color-producing step
Term
Lecithin methods
Definition
Fluorescence polarization (FPOL)

TLC
L/S ratio (Sphengomyelin, S, is internal standard; ratio increases as fetal lung matures)
Term
Lp(a) (ApoB100 and protein(a)) methods
Definition
utilize immunoassays
Term
Bilirubin methods
Definition
bilirubinometers
-bilirubin itself is a yellow compound

transcutaneous methods
-use multi-wavelength reflectance photometry to correct for skin pigments

pH sensitive--use different pH for total vs. direct (pH 4)

specimens are light-sensitive--e.g. photo-oxidation can cause falsely low values

neonatal samples can get up to 12-30 mg/dL, and need a dilution to bring into linear range

hemolysis affects the total more than direct result

Hb interferes with product absorbance readings (below 600 nm), after the reaction, and causes false elevations; (but it can also inhibit the diazo reaction, during the method, and cause falsely low values)

bilirubin oxidase methods
-convert bilirubin back into biliverdin in decreasing absorbance reaction

diazo reactions with bilirubin produce a diazo-pigment-isomer

Evelyn-Malloy method
-based on solubility
-direct is soluble in water
-total soluble in ethanol
-use diazo reagent to produce purplish-red azobilirubin
-Hb can interfere with readings (<600 nm)

Jendrassic-grof method
-most common, based on pH
-direct, use HCl
-total, use caffiene to prepare
-use diazo reagent
-use Fehling's reagent to minimize Hb effects--shift from purplish-red to blue azobilirubin

Use bichromatic methods of detection to minimize Hb affects
Term
Ammonia methods
Definition
Glutamic dehydrogenase reaction
-produce glutamate and NAD(P)+

Nessler reaction
-produce NH4-dimercuric iodate--orange

Berthelot reaction
-produce indophenol

Keep on ice, prevent hemolysis (since RBCs contain deaminase enzymes that form ammonia), and don't use NH4-heparin tubes
Term
BUN methods
Definition
Diacteyl method
-produce diazine

Urease enzyme methods
-produce NH4+

Nessler method
-produce NH4-dimercuric iodate--orange

Glutamic dehydrogenase method
-produce glutamate and NAD(P)+
Term
Creatinine methods
Definition
urine--measured for every quantitative urine sample

blood--separate from cells and freeze, avoid pH extremes

Jaffe method
-old classic method
-rapidly produce red color
-not entirely, but 98% specific
-uses the explosive molecule ''trinitrophenol'' (aka TNP, aka Picric acid) and an alkaline solution (such as NaOH)

Creatinine hydrolase methods
-more expensive, less explosive
-produces lactic acid

creatinase methods
-produce NH4+ and measure w/ ISE
Term
Uric Acid methods
Definition
Henry-Caraway method
-use phosphotungstate reduction to produce tungsten blue

Uricase, aka urate oxidase, method
-most common
-produce H2O2 and then quinoneimine dye

urine specimen must be above pH 8; otherwise, will form microcrystals
Term
gamma-GT methods
Definition
produce glutamyl-glycyl-glycine and p-nitroalanine--yellow
Term
LDH methods
Definition
-converts between pyruvate/NADH and lactate/NAD--
detection can be done by decreasing absorbance methods
-this enzyme is part of glycolysis (EM) pathway, so serum is specimen of choice, but don't freeze
Term
CK methods
Definition
has sulfhydryl groups at active site that can be oxidized; or, can be inhibited by anticoagulants-hemolysis; therefore, serum is specimen of choice, frozen and protected from light
Term
AST methods
Definition
malate dehydrogenase method converts oxaloacetate to acetate and NAD in a decreasing absorbance reaction
Term
ALT methods
Definition
LDH method converts pyruvate to lactate and NAD in a decreasing absorbance reaction
Term
ALP (alkaline phosphatase) methods
Definition
Bessie-lowry-brock method converts p-npp to 4-npp--yellow

hemolysis and age of sample can cause false elevations (RBCs have some ALP)
Term
ACP (acid phosphatase) methods
Definition
Bessie-lowry-brock method buffered at pH 5

very heat-sensitive, pH-sensitive, and completely inhibition by tartrate salts
Term
Amylase methods
Definition
convert starch (dye-labelled) to blue dye-labelled glucose products
Term
Lipase methods
Definition
best methods are similar to trinder method (uses H202 to produce quinoneimine dye)

inhibted by anticoagulants and products of hemolysis
Term
CK-MM forms methods
Definition
separated by isoelectric electrophoresis
Term
myoglobin methods
Definition
related to hemoglobin, found in muscle cells

methods are being replaced by troponin-I assays
Term
Troponin methods
Definition
TN-I and TN-T are unique to cardiac muscle

more sensitive assays allow for earlier MI detection
Term
BNP methods
Definition
a molecule released by ventricles to lower blood pressure--may be elevated in CHF or renal failure--Biosite diagnostic test uses a fluroescent tag to measure this molecule and rule out CHF
Term
Free T4 methods
Definition
recommended screening test, especially hyper-thyroid screening
Term
total T3 methods
Definition
more sensitive than FT4; can be used as a follow-up test if FT4 is normal

T3 uptake test indicates current relationship between T and TBG
-measures radioactivity, proportional to saturation %; normal saturation is 25-37%
-not entirely reliable test to determine T levels, since TBG level is not always consistent--i.e. drugs that bind TBG--can cause false high saturation; pregnancy hormones that increase TBG synthesis--can cause falsely low saturation
Term
TSH methods
Definition
recommended for screening thyroid conditions

3rd generation method is a highly sensitive chemoluminescence assay, MEIA
Term
Thryoglobulin methods
Definition
leaks into blood from thryoid in different conditions, such as Grave's, Hashimotos, etc...

very useful disease marker, after diagnosis has been made
Term
PTH methods
Definition
c-terminal and mid-molecule fragments have longer half-life (2-4 hours), which makes them more sensitive indicators
Term
seratonin methods
Definition
colorimetric methods
-5 HIAA (urinary excretory form) react with nitrosonapthol--purple

HPLC

before testing, avoid foods like bananas, avacados, and cheese which can give false elevations
Term
catecholamines (epi- and norepinephrine) methods
Definition
useful during pheochromocytoma (adrenal medulla tumor)

colorimetric methods
-use sodium metabisulfite to break everything down to VMA
-VMA (urine excretory form) react with NaIO4--vanillin product

HPLC
-advantage: don't have to worry about food-products causing false elevations
Term
HVA methods
Definition
urine excretory product of dopamine (e.g. nerve tumors)

HPLC--best method
Term
Cortisol methods
Definition
glucoronic acid conjugates of this molecule are found in urine (such as 17-hydroxy and 17-keto forms)

porter-silber colorimetric methods
-react 17-OH form with phenylhydrazine--yellow

Zimmerman colorimetric methods
-react 17-keto form with m-dinitrobenzene--purple

HPLC

NOTE--durinal variations are significant--highest values seen in the morning
Term
Aldosterone methods
Definition
this molecule works to cause sodium-retention, increase blood volume

levels can depend significantly on posture--upright standing posture for 2 hours can increase results up to 3 times
Term
C-peptide methods
Definition
it is made from pro-insulin; has a longer half-life (20 min); doesn't react with antibodies during immunoassays; it is not found in external injections--in other words, it is more sensitive detector than insulin for insulin tumors
Term
glucose--Normal fasting
Definition
70-110 mg/dL
Term
glucose--normal neonatal
Definition
40-100 mg/dL (maternal-insulin is present in newborn)
Term
glucose--impaired fasting glucose
Definition
100-126 mg/dL
Term
glucose--diabetes concern
Definition
Fasting glucose > 126 mg/dL
Term
glucose--hypoglycemia concern
Definition
fasting <45 mg/dL
Term
glucose--impaired glucose tolerance
Definition
2-hour post glucose load 140-200 mg/dL
Term
glucose--diabetes confirmatory
Definition
fasting glucose >126 mg/dL (twice to confirm)

2-hour post glucose load >200 mg/dL

fasting-3-hour 100g test--2 values above >105,190,165,145

HbA1c >6.5%
Term
glucose--CSF normal
Definition
40-70 mg/dL and 2/3 of plasma level
Term
HbA1c(glycated Hb)--normal
Definition
about 5%
Term
lactic acid--normal
Definition
0.5-1.9 mmol/L
Term
lactic acid--level that indicates only 1% trauma patient survival
Definition
>15.0 mmol/L
Term
xylose--intestinal malabsorption indicator
Definition
5 hour urine level compared to oral intake <25%
Term
total cholesterol--optimal level
Definition
<200 mg/dL
Term
LDL cholesterol--optimal level
Definition
<100 mg/dL
Term
HDL--optimal level
Definition
>40 mg/dL
Term
triglycerides--optimal level
Definition
<150 mg/dL
Term
L/S ratio--mature fetal lungs
Definition
>2
Term
total bilirubin--normal
Definition
0.2-1.2 mg/dL
Term
direct bilirubin--normal
Definition
0.0-0.4 mg/dL
Term
total bilirubin--universal critical level
Definition
>20 mg/dL
Term
total bilirubin--normal newborn jaundice level between days 2 and 7
Definition
7.0-12.0 mg/dL
Term
ammonia--normal range
Definition
7-27 umol/L (notice: micromoles/liter)
Term
urea--normal range
Definition
15-38 mg/dL
Term
BUN--normal range
Definition
7-18 mg/dL

the nitrogen part of Urea; a bit less than half of urea by weight
Term
creatinine--normal
Definition
0.5-1.2 mg/dL
Term
creatinine--normal 24-hour urine
Definition
600-1800 mg
Term
creatinine clearance--normal
Definition
~90-140 ml/min
Term
BUN/creatinine ratio--pre-renal (lack of perfusion) azotemia
Definition
>24
Term
BUN/creatinine ratio--intrarenal (internal damage to nephrons) azotemia
Definition
<15
Term
uric acid--normal
Definition
2-7 mg/dL
Term
total protein--normal
Definition
6-8.2 g/dL (notice units: grams/deciliter)
Term
albumin--normal range
Definition
3.5-5.2 g/dL
Term
Albumin,a1-globulin,a2-globulin,B-globulin,gamma-globulin--approximate fractions of total protein
Definition
57%,3.5%,11.5%,12.5%,15.5%
Term
albumin/globulin ratio--in common disease states
Definition
<1
Term
protein in CSF--normal
Definition
15-40 mg/dL
Term
protein in CSF--viral meningitis
Definition
70-150 mg/dL
Term
protein in CSF--in bacterial meningitis
Definition
100-1,000 mg/dL
Term
protein in urine--normal 24-hr urine level
Definition
~50-150 mg
Term
albumin in urine--24 hour urine--in microalbuminuria
Definition
~30-300 mg
Term
C-reactive protein (a highly sensitive beta globulin)--normal range
Definition
<0.5 mg/dL, however, if value is trending up--indicates disease state
Term
CK-MB/total CK ratio--in AMI
Definition
>6%
Term
AST and ALT--specific indicator of liver disease (as opposed to vague indicator of other types of disease)
Definition
>20% of normal
Term
AST and ALT--hepatic 'necrosis' indicator (as opposed to just hepatic 'stress')
Definition
ALT>AST (ALT comes from mitochondria--more damage than just cytoplasmic leakage)
Term
PSA(prostate specific antigen)--normal
Definition
<4.0 ng/mL
Term
troponin TN-I--normal
Definition
<0.4 ng/mL
Term
troponin TN-I--very specific diagnostic indicator of AMI
Definition
>2.0 ng/mL
Term
BNP--can't rule out CHF (congestive heart failure) level
Definition
>100 pg/mL
Term
T3--normal % free (--not bound to TBG, albumin, and pre-albumin)
Definition
~0.4 (more active form)
Term
T4--normal % free (--not bound to TBG, albumin, and pre-albumin)
Definition
0.04 (more abundant form)
Term
TBG saturation--somewhat indicative of normal thyroid function
Definition
25-37%
Term
TSH--normal range
Definition
0.4-4.8 mIU/L
Term
ions higher serum than inside cells--approximated values
Definition
Na+ (142--10), Ca2+ (5--0), Cl- (103--2), and HCO3- (27--8)
Term
ions higher inside cells than serum--approximated values
Definition
K+ (4--160), Mg2+ (3--35), phosphate (2--140), and proteins (16--55)
Term
Na+--normal range
Definition
135-145 mmol/L
Term
K+--normal range
Definition
3.5-5.1 mmol/L
Term
Ca2+--normal range
Definition
about half of total, which is 8.4-10.2 mg/dL
Term
Cl- --normal range
Definition
96-106 mmol/L
Term
Cl- in sweat--normal
Definition
5-35 mmol/L
Term
Cl- in sweat--diagnostic of cystic fibrosis
Definition
>60
Term
phosphate--normal range
Definition
1.0-1.5 mmol/L
Term
Mg2+--normal range
Definition
.65-1.05 mmol/L
Term
iron--normal range
Definition
~5-30 umol/L or 25-55% saturation
Term
bicarb--normal range
Definition
23-29 mmol/L
Term
pO2 arterial--normal range
Definition
80-100 mmHg
Term
CO2--normal
Definition
22-29 mmol/L--mostly just reflect bicarb level
Term
pCO2--normal range
Definition
35-45 mmHg
Term
bicarb/carbonic acid ratio--normal
Definition
20; HCO3/((0.03)x(pCO2))
Term
pH--normal
Definition
7.4 = 6.1 + log(20)
Term
Lithium--therapeutic range just below dangerous toxicity
Definition
0.7-1.5 mmol/L
Term
osmolality--normal serum
Definition
289-308 mOsm/kg
Term
osmolality--normal urine
Definition
300-900 mOsm/kg
Term
osmolality--urine/plasma ratio indicative of pyelonephritis
Definition
<2
Term
osmolality--urine/plasma ratio indicative of dehydration
Definition
>3
Term
anion gap --normal level
Definition
7-16 mEq/L i.e. normal amount of anions, not named bicarb or chloride (value = sodium minus (bicarb + chloride))
Term
osmolal gap--normal
Definition
0-20 mmol/L i.e. normal amount of contributors to concentration, not named Na, glucose, or BUN (value = measured osm value minus (2Na + Glucose/20 + BUN/3))
Term
K+--grossly hemolyzed level
Definition
>8
Term
K+--contamination or wrong-tube level (K-3-EDTA or K-2-Oxalate tube)
Definition
>15
Term
K+--how much does it change during acidosis
Definition
.6 mmol/L increase for each .1 pH decrease
Term
Cl- --normal change per unit of bicarb change
Definition
1 to 1 ratio; if bicarb goes down, Cl- goes up (shifts out of cell) by same amount
Term
Anion gap--name 5 causes of insufficient Cl- shift (large gap)
Definition
Lactic Acid (Lactate)
Diabetes (Ketonate)
Methanol (Formate)
Antifreeze (Oxalate)
Aspirin overdose (salicylate)
Term
Hyperkalemia--general symptoms
Definition
weakness, flatline EKG
Term
hypokalemia--general symptoms
Definition
fibrillation, cramping
Term
hyponatremia--general causes
Definition
edema, burns, adrenal insufficiency
Term
hypernatremia--general causes
Definition
sodium retention

Conn's disease, Cushing's syndrome, renal failure
Term
Nernst equation--how much does potential change if concentration is changed by a factor of 10 (for example, pH decreases by 1 unit)?
Definition
~60 mV for a one-electron reaction
~30 mV for a two-electron reaction
Term
metabolic acidosis
Definition
low pH caused by low bicarb (e.g. vomiting)

CO2 may be low--but this is only compensatory (pay attention to both pH and CO2--low pH indicates it is an acidosis--NOT a respiratory alkalosis due to low CO2)
Term
metabolic alkalosis
Definition
high pH

root cause is high bicarb (e.g. overdose on tums)
Term
Ca2+ --symptoms of high calcium
Definition
weakness, kidney stones
Term
Ca2+ -- symptoms of low calcium
Definition
tetany, muscle spasms
Term
muscle weakness--associated with which 3 ions
Definition
high K+, high Ca2+, high Mg2+
Term
rickets--which ion is low?
Definition
Calcium
Term
hyperparathyroid--high PTH
Definition
high Ca2+

low phosphate
Term
hypoparathyroid--low PTH
Definition
history of thyroidectomy

low Ca

high phosphates
Term
Cushing's disease
Definition
can be caused by ACTH from pituitary tumor

high cortisol

Na+ retention
Term
Addison's disease
Definition
adrenal cortex fail

low cortisol

low aldosterone

(high ACTH may be compensatory)

Na+ excretion

K+ retention

abnormally low anion gap due to low Na+
Term
Conn's disease
Definition
high aldosterone

high Na+

low K+

can be caused by high renin in fibromuscular hyperplasia
Term
high sodium levels--general effects
Definition
Hypertension

high osmolality of blood
Term
late renal failure--notable ion levels
Definition
low sodium, high K

however, there is a large anion gap caused by low Cl-, low bicarb
Term
anion gap--in ketoacidosis of diabetes type I
Definition
low Na, high K

however, very large anion gap is indicative of many ketones (anions) in blood --reflects on metabolic panel as low Cl- and low bicarb
Term
anion gap--in ketoacidosis of diabetes type II
Definition
similar pattern as type I, but not quite as pronounced
Term
CSF Cl- levels--trend in bacterial meningitis
Definition
Cl- levels decrease as lactate anions increase
Term
Cystic Fibrosis
Definition
thick mucous (pneumonia, bronchitis), malabsorption, sweat chloride 60-200
Term
Iron--common causes of high levels
Definition
hemolytic anemia
megaloblastic anemia (heme synthesis blockage)
severe hepatitis
iron intoxication (kids)
Term
Iron--common causes of low levels
Definition
chronic blood loss (most common)
pregnancy
malabsorption
Term
TIBC (transferrin)--common causes of high levels
Definition
pregnancy
iron deficiency
chronic bleeding
Term
TIBC (transferrin)--common causes of low levels
Definition
infections/inflammation (less production)
renal conditions (loss)
Term
Iron vs. TIBC--in Iron Deficiency Anemia
Definition
low iron, high TIBC
Term
Iron vs. TIBC--in (chronic) iron poisoning (hemochromatosis; chronic hemolysis, etc...)
Definition
high iron, low TIBC
Term
Iron vs. TIBC--in acute hemolytic conditions (acute hemolysis)
Definition
high Iron, high TIBC
Term
Wilson’s Disease
Definition
liver cannot make Ceruloplasmin

copper gets deposited in the tissues

Copper “halo” in Iris of eyes
Term
hyponatremia--general effects
Definition
Edema

Hypotension
Term
osmolal gap--trend in ketoacidosis
Definition
gap increase

in other words, osm detection is much higher than the estimated osm calculation-- because the osm calculation only takes into account Na, Glucose, and BUN (2Na + G/20 + BUN/3)
Term
respiratory acidosis
Definition
-low pH (acidic) blood

-high CO2 levels (lack of ventilation; insufficient breathing)
Term
respiratory alkalosis
Definition
pH is increased, caused by low CO2 levels (hyper-ventilation of CO2 out of the body)
Term
pheochromocytoma
Definition
adrenal medulla tumor

sporadically elevated catecholamines (epi, norepi)

detect VMA in urine
Term
neuro- or ganglioblastoma
Definition
nerve cell tumors
high dopa, dopamine
detect HVA in urine
Term
Hirsutism
Definition
high androgen levels in female
male characteristics (infertility)
caused by issue in adrenal cortex (hyperplasia) or gonads (polycystic ovaries)
Term
pregnancy indicators
Definition
bHCG peaks in first trimester

HPL elevates until delivery

Estriol elevates

progesterone elevates
Term
Menopause
Definition
Starts with high FSH, no FSH after it is over

low estradiol

no LH peak
Term
trophoblastic choriocarcinoma of the fetus
Definition
not common, but very serious
high bHCG
low HPL
Term
hyperthyroid--generalized symptoms
Definition
anxiety
weight loss
mild hyperglycemia
Term
hyperthyroid--primary
Definition
high free T4
low TSH
Term
hyperthyroid--secondary
Definition
high free T4
high TSH

additional testing, such as T3 suppression, need to distinguish it from tertiary
Term
hypothyroid--general symptoms
Definition
mild hypoglycemia
feels cold
sleepy fatigue
Term
hypothyroid--primary
Definition
low free T4
high TSH
Term
hypothyroid--secondary
Definition
low free T4
low TSH

additional testing needed, like TRH stimulation test, to distinguish it from tertiary
Term
cretinism
Definition
neonatal
primary hypothyroid
cat-like cry
treated with T4
Term
myxedema
Definition
common adult condition
primary hypothyroid
treated with T4
Term
hashimoto's disease
Definition
auto-immune destruction of thyroid
primary hypothyroid
Term
endemic goiter
Definition
iodine deficiency
primary hypothyroid
Term
grave's disease
Definition
auto-immune activation of TSH receptors
primary hyperthyroid
exopthalmus eyes
Term
goiter thyrotoxicosis
Definition
benign tumors
nodular, un-symmetric growth
primary hyperthyroid
Term
normal urine--most abundant protein
Definition
tamm-horsfall protein

(albumin not supposed to be in normal urine)
Term
high protein content in urine
Definition
hypertension--albumin
acute glomerulonephritis--albumin, globulins, RBCs
nephrotic syndrome--albumin, globulins, fat droplets
multiple myeloma--bence-jones light-chain gamma globulin
Term
electrophoresis errors
Definition
buffer evaporates: reduced separation
too much sample: tailing
old stain: unsatisfactory staining
bent applicator wires: bow-tie pattern
over-application: globulin too high; (albumin low)
dry, uneven blotting: distorted protein zones
no power or wicks: no band movement
wrong side of plate: no bands
Term
electrophoresis--multiple myeloma (early)
Definition
high beta
low gamma (immunocompromised)
Term
electrophoresis--multiple myeloma (late)
Definition
large spike in gamma region--bence jones light chains
Term
electrophoresis--acute inflammation
Definition
high alpha-1 (a-1-antitrypsin)
high alpha-2 (haptoglobin)
Term
electrophoresis--alpha-1-antitrypsin deficiency
Definition
low alpha-1

associated with high risk of lung and liver disease
Term
electrophoresis--hypogammaglobinemia
Definition
low gamma

associated with recurrent infections
Term
electrophoresis--nephrotic syndrome
Definition
low albumin
low gamma
high alpha-2 (macroglobulin)
Term
electrophoresis--chronic liver disease
Definition
high beta-gamma bridge (no drop-off between beta and gamma region)
Term
electrophoresis--multiple sclerosis
Definition
high gamma (Ig) in CSF
Term
spina-bifida of fetus--protein biomarker
Definition
high AFP after 5 weeks

(it is normally present in first 5 weeks of pregnancy)
Term
C-reactive protein is in range, but trending up
Definition
indicates worsening conditions

normal range is below 5 mg/dL, but changes in level are a highly-sensitive indicator of disease trends
Term
protein that can sometimes be used as a general wellness, nutrition, or recovery from disease indicator
Definition
pre-albumin

transports thyroid hormone

low during malnutrition
Term
electrophoresis--high L1 and LD2
Definition
associated with blood cells and heart conditions
Term
electrophoresis--LD flip
Definition
LD1>LD2

LD1 elevation is more specific to heart disease
Term
electrophoresis--high LD 3
Definition
lung disease (e.g. embolism or infarct)
Term
electrophoresis--high LD4 and LD5
Definition
liver issues, and/or skeletal muscle issues
Term
ALP, besides placenta, can indicate what types of disease?
Definition
Bone disease
Term
ACP (acid phosphatase)
Definition
marker for prostate gland cancer--as opposed to benign PSA elevations

also, useful in rape investigations
Term
insecticides common effect
Definition
can inhibit cholinesterase (SChE) enzyme that is needed to break down muscle relaxant succinyl choline
Term
early acute myocardial infarction
Definition
CK-MB is very sensitive (if not specific)

Troponin-I (TN-I) is very sensitive and specific
Term
AMI progression--5 types of enzyme elevations
Definition
TN-I elevation --rules it in

CK peak: Day 1 (starts at 2 hours, ends at 2 days)

AST peak: Day 2 (starts at 5 hours, ends at 5 days)

LD peak: Day 3 (starts at 12 hours, ends at 12 days)

a-HBD: same as LD pattern
Term
quick estimate of perfect renal function (100% clearance)
Definition
130 mL/min (130/1 = urine/plasma)
Term
Hyperammonemia
Definition
-causes a metabolic alkalosis
-toxic to nerves
-can occur in hepatic disease (since liver is only organ able to detoxify ammonia)
Term
Azotemia
Definition
-Elevated blood levels of nitrogen waste products (BUN, Creatinine, Uric Acid)
-low creatinine clearance = creatinine level rises in blood and lowers in urine
Term
pre-renal azotemia
Definition
-kidneys not perfused with blood; may be caused by shock, trauma, or CHF
-BUN rises faster than creatinine in the blood (BUN/Creatinine ratio > 24)
Term
Renal (intra-renal) Azotemia
Definition
-Intrinsic kidney damage, e.g. nephritis conditions
-Creatinine rises in blood faster than does BUN (BUN/creatinine ratio <15)
Term
Post-Renal Azotemia--causes, results
Definition
-urethral obstructions; kidney stones
-if not removed, may shutdown kidney (<12 creatinine clearance)
Term
Uric Acid—potential causes, results, and treatment
Definition
-can be caused by cell-proliferation conditions (product of purine (found in DNA) metabolism)
-can cause gout, kidney stones (it isn’t very soluble)
-can be treated with allopurinol (which inhibits xanthine oxidase’s breakdown of purines)
Term
Normal jaundice in newborns
Definition
-starts around day 2 or 3 (up to ~7 mg/dL)
-peaks around day 5 (up to ~12 mg/dL)
-goes away after about day 30 (when liver is mature)(up to ~1 mg/dL)
Term
Pre-Hepatic Jaundice
Definition
-a.k.a. Hemolytic Jaundice
-high unconjugated (indirect) bilirubin
-direct/total ratio is less than 0.2--- direct bilirubin isn't really affected that much
-Urine Bilirubin = Negative
-Urine Urobilinogen = Positive
Term
Kernicterus
Definition
-occurs after albumin gets saturated with insoluble bilirubin
-free (insoluble, unconjugated, or indirect) bilirubin can cross the blood brain barrier and cause neurological problems
Term
Hepatocellular Jaundice
Definition
-e.g. hepatitis jaundice
-indirect bilirubin (high)
-direct bilirubin (high)
-Urine Bilirubin = Positive
Term
Post-Hepatic Jaundice
Definition
-i.e. obstructive or hepatobiliary jaundice
-ratio of direct/indirect is greater than 1 to 1-- direct bilirubin is high
-urine bilirubin = positive
Term
lucey-driscoll syndrome
Definition
-normal neonatal jaundice doesn’t go away
-due to presence of a maternal UDP-gluc-transferase inhibitor in newborn
Term
Gilbert’s Syndrome
Definition
-decreased bilirubin uptake leading to decreased bilirubin diglucoronide (conjugated bilirubin) formation
-a pre-hepatic jaundice
Term
Crigler-Najar syndrome
Definition
-UDP-glucuronyl transferase deficiency
-a pre-hepatic jaundice
Term
Dubin-Johnson Syndrome
Definition
-bilirubin not secreted in bile ducts
-a post-hepatic jaundice
Term
Atherosclerosis--potential cause, risk factors, and decreased risk factor
Definition
-Injury to Endothelial Cells (possibly caused by hypertension) leading to calcified plaques, leading to clots, thromboses, and infarcts (blockages of blood vessels)
-Increased risk in males, diabetes, smokers, obesity, hypertension, and Lp(a) protein (a complex of apo-B100 (LDL) and protein (a))
-Decreased risk associated with apo A-1 proteins (HDL)
Term
Hyperlipoproteinemia--type I
Definition
-lipoprotein lipase deficiency
-dietary TG high (dark chylomicron band; at top; furthest from albumin)
-creamy layer at top of refrigerated serum
Term
Hyperlipoproteinemia--type IIa
Definition
-most common type
-cholesterol (LDL; beta) increase
-dark LDL (apoB100) band (usually the largest band anyway)
-can be caused by apoB-100 receptor defect
-“familial hypercholesterolemia”
-refrigerated serum is clear
Term
Hyperlipoproteinemia--type IIb
Definition
-like type IIa but includes somewhat increased TG (VLDL; pre-beta band)
-refrigerated serum is faintly turbid
Term
Hyperlipoproteinemia--type III
Definition
-everything increased
-includes an IDL increase -- floating band between beta (LDL) and pre-beta (VLDL)
-“familial beta dyslipoproteinemia”
-refrigerated serum is faintly turbid and faint creamy layer at top
Term
Hyperlipoproteinemia--type IV
Definition
-significant triglyceride increase (VLDL)
-very dark pre-beta band
-refrigerated serum is turbid (VLDL, i.e. endogenous triglycerides)
Term
Hyperlipoproteinemia--type V
Definition
-combination of type I and type IV
-chylomicron band and pre-beta band
-refrigerated serum is both dark creamy layer at top (chylomicrons, i.e. dietary triglycerides) and turbid (VLDL, i.e. endogenous triglycerides)
Term
Apo-B deficiency
Definition
-apo-B genetic defect
-very low LDL levels
-reduced risk of coronary artery disease; however, increased risk of CNS damage
hemolytic anemia
- “abetalipoprotenemia”
Term
Tangier disease
Definition
-a Apo A-I deficiency
-mutation in ATP-binding cassette gene
-characteristic low HDL levels
Term
defective lipid degradation ---name 4 lysosomal disorders
Definition
-niemman-pick disease (sphingomyelinase deficiency)
-tay-sachs (N-acetyl-beta-hexosaminadase A deficiency in leukocytes---causes increased levels of GM2-ganglioside—leads to seizures, inability to sit up)
-fabry (sex-linked)
-gaucher disease (b-glucocerebrosidase A def)
Term
lactose intolerance
Definition
-lactase deficiency (a.k.a beta-galactosidase def) in small intestine
-lactose fermented by bacteria in colon
Term
lactate dehydrogenase deficiency
Definition
-a glycogen storage disease
-can't recycle byproducts of carbohydrates
-causes elevation in pyruvate,lactate
-painful exercise symptoms
Term
von geirke's disease
Definition
-G-6-P phosphate deficiency; G-6-P can't be removed from the liver
-glycogenolysis is inhibited
-causes hypoglycemia
-increase in fats and lactic acidosis
-epinephrine test is diagnostic--in normal patient, epinpehrine should stimulate glycogenolysis
Term
signs of bacterial meningitis (as opposed to viral) in CSF
Definition
low glucose
high lactate
Term
indicator inversely related to trauma or burn patient survival
Definition
-lactate levels (a product of anaerobic glycolysis)
-an example of a metabolic acidosis
Term
ketone body formation--in presence of glucose
Definition
-i.e. increased levels of things like acetoacetic acid and beta-OH-butyric acid
-an example of metabolic acidosis
Term
ketone body formation--in starvation when glucose is absent
Definition
CNS utilizes them
Term
diabetes--two different physiological causes; same result
Definition
-mellitus --insulin pathway defect causes high glucose levels, which causes dehydration

-insipidus --ADH pathway defect causes lack of water retention by kidneys, which causes dehydration
Term
diabetes mellitus type I
Definition
-autoimmune destruction of insulin-producing beta cells
-develops earlier in life, less common but more serious
-very clear, not borderline, glucose results
-symptoms range from no insulin (hyperglycemic ketoacidosis) to insulin shock (hypoglycemic coma)
Term
diabetes mellitus type II
Definition
-insulin process not working properly (e.g. stretched-receptor theory)
-less serious, more common; starts later in life, after 40 usually, with more borderline glucose results; may need insulin therapy, but may be managed by diet and exercise
Term
hyperglycemia--name 5 associated conditions besides diabetes
Definition
-pregnancy
-cushing's (elevated cortisol increases gluconeogensis)
-grave's (TSH receptor activation; elevated T)
-pheochromocytoma (epi- and norepi-nephrine sporadic elavations; adrenal medulla; increases glycogenolysis)
-acromegaly (growth hormone; adult form of gigantism; flat bones enlarged; increased gluconeogensis)
Term
insulin-producing tumor
Definition
-pancreatic tumor
-intermittent hypoglycemia
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