chem12.17 Flashcards
Protein soluble in water
albumin
What diff proteins from carb/lipid
nitrogen
conjugated protein
protein plus prosthetic grplipo, glyco/muco, nucleo
5 plasma proteins
albumin, alpha 1, alpha 2, beta, gamma
Primary protein structure
amino acids
Secondary protein structure
alpha helix, beta pleated sheets
Tertiary protein structure
3D
Quaternary protein structure
2+ polypeptide chains
Enzyme deficiency with decreased enzymes leading to buildup of ketoacids decreased branched-chain ketoacid dehydrogenase enzyme activity(LIV)
maple syrup disease
Aminoacidpathy caused by defiency in the enzyme to metabolize phenylalaninemousy urine
Phenylketonuria, PKU
Aminoacidopathy due to enzyme deficiency due to lack of enzyme to break down tyrosine/phenylalanine leading to buildup of homogentistic aciddeficiency of a single enzyme called homogentisate 1,2 dioxygenaseblack urine
Alkaptonuria
CystinuriaTyrosinemia
inherited metabolic,excessive amount of undissolved cysteine, doesn’t get reabsorbed by kidney, kidney stonesTyrosine/metabolites excreted in urine
Deficiency in enzyme needed to metabolize methionine Increased levels of this amino causes stroke, CVD, alzheimers, osteoporesis, nutrional def
Homocystinuriabuild up of methionine and homocysteine (metabolite of methionine)
4 causes of hypoproteinemia
Not getting/making enough:malnutritionliver disease(doesn’t make protein)Protein loss: burns(protein loss thru wound)nephrotic syndrome(loss thru urine)
3 Causes of hyperproteinemia
dehydrationMultiple myeloma, Waldenstroms
5 immunoglobulin
G,A,M,E,D
4 measurements of TPTP g/dL
BiuretDye bindingKjeldahlRefractometryTP 6.4-8.3 g/dL
TP g/dLalbumin g/dLmicroalbumin in urine mg/24hr
TP 6.4-8.3g/dLAlbumin 3.5-5 g/dL (about 60% of TP) rest is globulinsmicroalbumin 50-200 mg/24hr
Calculation of A/G ratio
Albumin/TP-albumin
Total protein method that reacts with >= 2 peptide bonds in proteins
Biuret
Biuret reaction for TP uses…which forms what color complex
copper salts which forms a purple color
4 dyes in dye binding for TP
Bromophenol Blue Coomassie brilliant bluePonceau SAmido black
Reference method for TP, not used often
Kjeldahl
TP method that measures nitrogen
Kjeldahl
This reaction follows Beers law for a reasonable range of proteinDepends on presence of at least two peptide linkagesIs insensitive to low protein in urine
Biuret reaction
3 things that can interfere with Biuret method for TP
hemoglobin, hemolysis and lipids can interfere
Two dyes used in dye binding method for albumin
BCPBCGBromcresol
BCP/BCG is used in what method…are used to determine…
Dye-binding methodfor albumin
Principle of protein measurement calledpHcolor change from,tofalse pos seen in what pH
protein error of indicatorspH 3.0yellow to greenalkaline urine
Breakdown of protein in liver produces…and also produces…
ureaammonia
B2 microgobulin used as a marker for
marker for reduced GFR
CSF protein
15-45mg/dL
3 Methods for Urine/CSF protein, BAD acronym
BiuretAcid: SSA precipitationDye: Coomassie brillant blue
Increased CSF protein in these 3
meningitis, tramatic tap, MS
Protein in Spina bifida
AFPalpha fetoprotein
CEA stands for, is a
carcino-embryonic antigenoncofetal antigen
CEA nonspecific for
colorectal carcinoma/colon cancer
AFP
alpha fetoproteintumor associated; secreted by fetal liver
Increased AFP 4 conditions
liver/heptocellular cancerneural tube defects(spina bifida)ovariantesticular cancer
Decreased AFP in
Down syndrome
HCGMade by…Has…
human chorionic gonadotropinmade by placenta after implantation by trophoblastic cellsalpha+beta subunits
HCG seen in these two cancers
ovariantesticular
PSAMade by…Seen in..
prostate specific antigenmade by prostatic epi cellsprostatic cancer
CA-125
ovarian cancer
CA19-9
pancreaticGI, adenocarcinoma
CA15-3, 27.29
mestatic breast
Two markers in breast cancer
CA27-29, CA15-3
Thyroglobulin marker for
thyroid
All proteins carry a net…charge due to protein being a higher pH than its isoelectric pointand travel towards
net negative, anode
Fastest/smallest protein toward anode
albumin
Which globulin migrates to cathode due to electroendosmosis
gamma
pH of electrophoresis
8.6
Anode
positively charged electrode
Cathode
negatively charged electrode
Protein in highest concentration and made in liver% of plasma protein
Albumin60%
Method of detection for albumin and reagents used
dye binding, methyl orange, bromcresol purple
Albumin function
transport/binds proteinosmotic pressure
Albumin decreased in these 3 things
malnutritionliver diseasenephrotic syndrome/renal loss/kidney disease
Albumin increased in this
dehydration
Another name for prealbumin and used to assess…
trans-thy-retinnutrional status
Liver makes these 4 globulins and RE/plasma cells make this
liver: albumin, alpha 1/2, betaRE/plasma: gamma
two alpha 1 globulins
AAT: alpha1 antitrypsininhibits the neutrophil elastase activity in the lung and hence can protect it from proteolytic damage.AFP: alpha fetoprotein
AAT increased, decreased in
increased in acute phase/prego(Action of Neutrophils cause AAT to try to keep it from damaging tissue)decreased in emphysema(Def means neutrophil byproducts are damaging tissue)
AFP increased, decreased in
increased in neural tube defects liver cancerovarian/testiculardecreased in Downs
Globulin increased in acute inflamation
alpha 2
Large globulin made in liver, inhibits trypsin/pepsin/plasminincreased in pregonephrotic/kindey disease diabetes, lupus
alpha 2 macroglobulin
three alpha 2 globulins
alpha 2 macroglobulinHaptoglobinceruplasmin
Alpha 2 globulin made in liveracute phase reactant that binds hmg
Haptoglobin
haptoglobin increased/decreased in these two
increased in acute phases, nephrotic syndrome(Increased α2-macroglobulin is seen in nephrotic syndrome due to increased synthesis and inability to pass through the glomerulus)decreased in transfusion, hemolysis
Alpha2 globulin transports copper, made in liver, acute phase reactant
Ceruloplasmin
Disease with decreased serum ceruloplasmin and increased serum/urine copper. Increased storage of copper in organs/cornea
wilsons
Disease with decreased ceruloplasmin due to decreased absorption, decreased serum copper
Menkes
Ceruplasmin is a …. that transports…increased in these two…decreased in these two conditions…
glycoprotein that transports copperincreased in acute phase/inflammation, pregodecreased in Wilsons disease and Menkes
Type of globulin that is carrier protein for iron and lipidselevated in
Beta globulinincreased LDLIDA
Beta globulins examples
Beta2 microglobulinbeta lipoprotein/LDLtransferrinhemoplexincomplementfibrinogenCRP
Beta globulin that is a heme scavenger
hemopexin
Beta globulin that transports iron
transferrin
examples of glycoproteins
transferrinceruloplasminmucinsAFPimmunoglobulins, antibodiesFSH, LH, HCG, TSHFibrinogen
A non-glycoprotein that are temp sensitive proteins that precipitate from serum/plasma at temps lower than 37C
Cryoglobulin
Striated muscle/cardiac; increased in heart attack, muscle dystrophy, crush
myoglobin
complex of 3 proteins in striated/cardiac; muscle contration, most sensitive for heart attach3 subunits
TroponinTnI, TnT, TnC
Bence Jones in urine migrate to..Prealbumin band seen in…
BJ to gamma regionPrealbumin in CSFUrine/CSF concentration first
globulin increased globulin decreased in viral hepatitis
gamma increasedalbumin decreased
globulins increasedglobulin decreased in maligment tumor
alpha 1/2 increasedalbumin decreased
beta-gamma bridge/broad gamma seen in
active cirrhosis/liver
M spike seen in
Monoclonal gammopathy
increased alpha 2/gamma ratio seen in
nephrotic syndromeliver makes less albumin
Migration of globulins from anode to cathode
albumin, alpha 1, alpha 2, beta, gamma
Polar hydrophillic and nonpoloar hydrophobic fatty acid chains; cell membranes are made of these
phospholipids
Examples of phospholipids
lecithinsphingomyelinPG(phosphatidyl glycerol)
Long chain polyunsaturated fatty acids that activates inflammation Stimultes clotting; also stimulates cervix to dialate and contractions
PGProstaglandins
Transports lipids, classified w/ultracentrifugationProtein part of lipoproteins/structural components
transports lipids: lipoproteinsProtein part: Apoprotein
Order of lipids from heaviest to lighest
HDL, LDL, VLDL, Chylo
Alpha lipoprotein is…Beta lipoprotein is…Prebeta lipoprotein is…Migration of liproteins from origin/cathode to anode
alpha: HDLBeta: LDLPreBeta: VLDLOrigin to Anode:Chylo, LDL, VLDL, HDL
Largest lipoprotein, carrier of exo TrigApoproteins associated with it
ChylomicronApoB-48
Exogenous/dietary lipids and it’s liproprotein/carrier
Triglycerideschylomicrons
most artherogenic lipid causing CHD, mostly composed of cholesterol and transported to the heart
LDL
Endogenous lipid made of mostly triglycerides
VLDL
Lipid transports lipid out to liver, heaviest and smallest
HDL
primary form of lipid storage…transported by these two…
triglyceridesexo/dietary: chylomicronsendo:VLDL
Lipid made monstly in liver, manufacture/repair cell membranes, makes biles salts/vitD, precurosr to steroids….two kinds:transports to cells…transports out of cells…
cholesterolto: LDLout of: HDL
% of Cholesterol made in liver…% of Trig made in liver versus diet…
Cholesterol 85%Trig 10% liver, 90 diet
Apoprotein B-100 are part of these two lipids
LDL, VLDL
Apoprotein A is part of this lipoprotein
HDL
Apoprotein B-48 is part of this lipoprotein
Chylo
LDL % carrries lipids
60-70
HDL % carries lipid
20-35
VLDL % carries lipid
5-12%
Major protein in HDL
Apolipoprotein A
Major protein in LDL/VLDL
Apolipoprotein B
Protein versus lipid density
protein more dense than lipid
Disease with very low HDL
Tangier
Method for cholesterolpurpose of saponification step
cholesterol oxidaseconvert cholesterol esters to free cholesterol
Liebermann Burchard reaction used to determine
cholesterol
2 reagents used for color developemnt in Liebermann Burchard reaction for cholesterol
acetic anhydridesulfuric acid
Lipid w/3 fatty acids/glycerolstorage form90% in diet, 10% liverlipemia from chylomicrons
Trig
Enzyme method for triglycerides…Hydrolyzes to…
Lipase hydrolyzes triglyceride to form glycerol
Fredewald calculation for LDL
TC- (TG/5+ HDL)
Friedwald calculation for VLDL
TG/5
Cannot used Friedwald calculation for LDL/VLDL if…
TG is >400mg/dL
Risk factors for CHDage by gendershistory ofbp, HDLtwo conditions
> 45men, >55 womenfamily history of CHDsmokingbp >120, HDL <40D.mellitus, metabolic syndrome
Lipid goalsTCTrigLDLHDL
TC <200Trig <150LDL<100HDL>35
Condition where blood cholesterol is increased
hypothyroidismThyroid hormones help your liver process blood. When your thyroid hormone levels are low, your liver processes blood more slowly, which can lead to higher levels of cholesterol in your bloodstream
Examples of ….lipid deposits in vascular/legs/armsCAD, AMI, arterieslipid in brain, stroke
atheriosclerosis
Disease with increased TC, LDL and decreased HDLCalculate coronary risk index using these two parametersElevated beta liproprotein is what lipid and leads to which kind of disease
CHDTC, HDLLDL, cardiovascular
4 non protein nitrogen
urea, ammoniauric acidcreatinine
non protein nitrogen increased in plasma in renal impairment called
azotemia
Best way to evaluate renal impairment and what is most common analyte to monitor it
GFRcreatinine
Creatinine clearance calcbased off the principle that creatinine passes into the ultrafiltrate
U creat/P creat x mL/1440vol in mL, min/24hr
Correction for clerance by body surface area
creat clearx1.73/area
Used with eGFR to stage/monitor CKD
urine albumin
Made from creatine in muscle
Creatinine
Method for creatininereacts withcolor formed
Jaffealkaline picrateyellow-red
Rises more rapidly than serum creatinine in acute renal failure
BUN
BUN increased in these two things
renal impairmenthigh protein
diacetyl monoxime used in determining…by measuring…can be used in untreated urine because…
BUNureamethod isn’t measuring ammonia
Type of method for BUN that measures urea…reagent that reacts with urea…
Colorimetric methodreacts with diacetyl monoxime
Enzymatic method for BUN uses….which hydrolyzes…to…
ureasewhich hydrolyzes urea into ammoniaUnlike the colorimetric method using diacetyl monoxime used for BUN/urea
diacetyl monoxime-urease-
diacetyl monoxime-BUN/ureaurease-BUN/ammonia
BUN mg/dLCreatinine mg/dLBUN/creatinine ratioelevated creatinine will result in elevated BUN of how much
BUN 6-20mg/dLCreatinine around 1mg/dL10:1-20:1BUN will be elevated
GFR marker made by nucleated cells
cystatin c
end product of purine metabolism from nuclei, allantoin
uric acid
The colorimetric method for uric acid is an alkaline oxidation where uric acid reduces…to…
phospho-tungistic acid to tungsten blue
phosphotungistic acid used in
uric acid
Uric acid NV mg/dL
2.6-7.2
Hyperuricemia causes
-gout-leukemia/lymphoma (overproduction of new cells, more breakdown)-Lesch-Nyhan(The HGPRT deficiency causes a build-up of uric acid in all body fluids. The combination of increased synthesis and decreased utilization of purines leads to high levels of uric acid production.)
Disease where there is over production of uric acid that arent recycled; mostly malesThe HGPRT deficiency causes a build-up of uric acid in all body fluids. The combination of increased synthesis and decreased utilization of purines leads to high levels of uric acid production.)
Lesch-Nyhan
Uric acid is measured by… at 290nm before/after treatment with…
UV absorption at 290 before/after treatment with uricaseAlso use isotope dilution/MS
This is from bacterial action on contents of colon and metabolized by liver
ammonia
Analyte that is a prognostic indicator of liver failure
ammonianot eliminated by kidneys
Increased ammonia in these 3 main reasons
liver disease (cirrhosis, viral hep)Reye’s SyndromeReye’s syndrome is a rare condition that happens in children after a viral infection or illness, especially if they took aspirin (salicylate) to treat their symptoms. Reye’s syndrome targets their brain, blood and liver.impaired renal (increased urea,ammonia)
Syndrome that leads to increased ammonia, mostly kids, previous virus, salicylate
Reyes
Bromphenol blue or GLDH used to measure
ammonia
Nessler used to detect
used to detect ammoninapotassium iodide plusmercury iodide/chloride plussodium hydroxide in waterdirty brown precipitate
Disaccharide with 2 glucose
maltose
Disaccharide with 1 glucose, 1 galactose
lactose
disaccharide with 1 glucose, 1 fructose
sucrose
monosaccharide with 6 carbons
hexose
process that uses glucose for energy, changed to lactic acid for energy
glycolysis
process of glucose to glycogen
glycogenesis
process of glycogen to glucose
glycogenolysis
process of glucose from noncarb sources
gluconeogenesis
renal threshold for glucoseCSF glucose % of plasmabest anticoagulant
160-180mg/dLCSF 60-65% of plasmasodium flouride
Diabetes melliutusplasma/OGTTA1C
> 200mg/dL>=6.5%
Hypoglycemia mg/dL
70mg/dl
Hormones that regulate glucosewhich one decreases?all the rest increase
insulin, glucagonepineph/cortisolGH, ACTHT3/T4(Thyroxine)Stomatostainonly one decreases is insulin
hormones made in pancreas:alpha cells/increase or decreasebeta cells/increase or decreasedelta cells/increase or decrease
alpha: glucagon, increasebeta: insulin, decreasedelta: stomatostain, increase
peptide hormone made in beta cells and decreases blood glucose/goes into cells
insulin
steroid hormone that is a glucocorticoid, made in adrenal cortex, and increases blood glucose
cortisol
peptide hormone made in alpha cells, increases blood sugar by making glucose from glycogen
glucagon
hormone made in delta cells, inhibits secretion of insulin making more glucose in blood
stomatostain
hormone that is adrenaline, neurotransmitter and regulates glucose
epinephrine
glycogen storage diseaseincreased or decreased glucose
von Gierkesdecreased
diabetes where glucose is normal
insipidus
condition with tumor that results in increased insulinincreased or decreased glucose
insulinomadecreased glucose
two conditions that increase glucose
hashimotos(Hypothyroidism, which is caused by Hashimoto’s disease, decreases glucose absorption, leading to an accumulation of sugar. In turn, this accumulation of sugar causes more insulin to be produced to utilize excess glucose, eventually leading to insulin resistance.)cushings(increased cortisol)
most employed automated method for glucose uses what two enzymes where there’s oxidation that forms a chromagencontamination can happen with
glucose oxidase, peroxidasecontamination with catalase
Gold standard for glucose testing/higher specificity…Two enzymes used….Amount of… is proportional to glucoseIs read at…nm
Hexokinase methodHexokinase, G6PDNADH formed is proportional to glucose340nm
hexokinase method:what is reduced and measured?measured at what nm?
NAD coenzyme reduced to NADHmeasured at 340nm
Normal fasting blood glucose
70-110mg/dL
Test to confirm prenatal borderline blood glucose
3 hr GTT
HmgA1C binds to hmg and monitors long term diabetes/largest fraction of HbAhow long of picture of glucose?Normal?Diabetic?
2-3mthNormal 4.0-6.0%Diabetic 6.5%
Juvenille onset, insulin dependent, autoimmune destruction of beta cellsketoacidosis
Type 1
adult onset, non insulin, insulin resistance, no ketoacidosis, obsesity
Type 2
What is a byproduct of insulin and can differentiate between medication/exo insulin and what the body makes/endogenous insulin?
C-peptide
Diabetes caused by placental lactogen inhibiting insulin
GDMgestational diabetes mellitus
Measurement of light intensity, chemical rxn forms color and is absorbed at specific wavelenthvisible light 400-700, frequency inverse to wavelength, uses quartz cuvette for UV rangetungsten or deuterium
spectrophotometry
Filter used for QC of spectrophotometer and what it tests
holmium oxide glass filterwavelength accuracy
Meaasurement of emission of color when element is burned
flame photometry
Measurement of light abosorption of electromagnetic radiation
atomic absorption spectrophotometry
Atomic absorption measures using what light sourcealso uses monochormator, flame sample cell, PM tube
hollow cathod lamp
term that decreases fluorescent intensity of a substanceis a disadvantage of…
quenchingfluorometry
Measurement using electrode, ref electrode, liquid, potential diff between the two equals concentration
ISE
Measurement of light scattered by particles in a solution and measured at an angle, seen in ag-ab rxn…Measurement of reduction in light transmission by particles in suspension ie proteins
scattered: nephelometryreduced transmisson: turbidimetry
In immunoelectrophoresis there must be excess…and a constant…. ……
excess antibodyconstant trough distance
Used to separate volatile or able to volatile and to confirm toxicologyIs a reference for alcoholThis is used to enhance sensitivity and specificity
gas chromatographyMS(mass spectro)
Technique w/sorbent coated and solvent screens for drugs/urineUses Rf valueRf value is…
TLC Thin layer chromatographyRf= drug distance/solvent distance
Osmometry based off measuresm-Osmol/kg
freezing point depressionmeasure osmolality of urine/serum(dissolved particle in sln)Tubular fnc
Hmg-VerdohmgPlasma/store: biliverdin-iron-globinLiver: bilirubin-albuminConjugataed: Bili diglucuronide
…
Ehrlich, p-DMAB reagent measures
Urobilinogen
p-DMAB stands for, used in…for…
p-Di-Methyl-Amino-BenzaldehydeEhrlich method for urobilnogen
Color produced with Erlichs reagent w/porphobilinogen and urobilinogenreagent used to distinguish the two
red/pink colorchloroform,urobilinogen will be soluble porphobilinogen will be insoluble and stay in aqueous phase
Protein that carries unconjugated bilirubin..Where is bilirubin conjugated…Name of conjugated/direct bili…
albumin carries unconjugatedconjugated in liverconjugated is bilirubin diglucuronide
Reaction for and alternate name bilirubin determination
diazo rxn/Jendrassik-Grofuses diazotized sulfanilicturns into purple azobilirubin
Jendrassik-Grof measuresusesturns into
bilirubinuses diazo-tized sulfanilicturns into purple azobilirubin
Bilirubin that is seen is not solube, thus not secreted in urine, cause of hemolytic trans rxn, prehaptic jaundice
indirect bili/unconjugated bili
Bilirubin that is formed/converted in intestine
urobilinogen
bilirubin that is oxidized/green in RE system
biliverdin
oxidized form of urobilinogen excreted in urine…stool…
urobilin: urobilinogen goes to kidney; yellowstercobilin: urobilinogen oxidized, brown stool
Evelyn Malloy method used for…Interference..
bilirubinhemolysis
Jaundice with increasd unconjugated and increased urine urinobilinogen
Prehepatic jaundice
Disease where all bili is increased, bili/uro in urine
hepatic
condition where unconjugated is normal, decreased uro, but increased conjugated in urine
Posthepatic obstruction
Have diff/mobility rates due to different aminos/structureElectrophoretic property is different for each isoenzymeBut have same rxn/react to same chemicals
Isoenzyme
Metals ions in enzymatic reactions act as
activators
This contant determines rate of conversion of substrate to product by differing substrate concentrations and rate of dissociation of complex
Michaelis-Menten
Order rxn where large excess substrate allows for amt of enzyme activity to be limiting factor when all enzyme is bound to substratesubstrate: A reactant in a chemical reaction is called a substrate when acted upon by an enzyme.
zero order
LD catalyzes lactate +NAD to… And…
pyruvate + NADH
LD isoenzyme that migrates the fastest to anode and highest in heart/rbc
LD1 HHHH
LD isoenzyme in healthy, HHHM
LD2
LD isoezyme that migrates the slowest
LD5
Increased in LD1,2,3
PApernicious anemia
Enzyme greatly affected by hemolysis because its in all cells
LD
CK increased in these 3: stress to muscles
heart attackmuscular dystrophyexercise
3 CK isoenzymes are dimersFastest to slowestBrain faster than muscle
CKBB, CKMB, CKMM
CK isoenzyme slowest, in skeletal muscle
CKMM
CKMB sensitive for AMIrises w/in…down in…
2-4hrs2-4 days
Most sensitive for AMI and two most usedrise/fall
TroponinTnT,TnI4-8hrs, 10 days
LD rises, days last
rises 8-12hrs, 10-14 days
Myoglobin rises, normal
30min, 24hrs
condition can’t pump, fluids in lungs, cause CAD, BNP to diagnose
CHF
Condition were lack of oxygen, ischemia, leads to CHF/angina/heart attackNarrowing of the small blood vessels that supply blood and oxygen to the heart.
CHDCoronary heart disease (CHD) is also called coronary artery disease
3 conditions elevated AST1 not elevated
acute heartliver diseasemuscularnot elevated in acute pancreatitis
Liver enzyme not affected by hemolysis
ALT
Increased ALP in 3 things in liver
obstruction of biliary tract/jaundiceacute viral hepbiliary cirosis
ALP increased in these 3 bone disordersincreased in 1 random
Pagets: overgrowthosteomalacia: soft bones, decreased D/CaRickets: Vit d defprego
High ALP but no other liver increased
bone
pH for ACPincreased in
5.0acidprostatic disease
Enzyme in alcoholics, heptobiliary, obstructive jaundice, cirrhosis
GGT
Enzyme in mumps and acute pancreatititsenzyme most specific for pancreatittis
mumps: amylasepancreatitis: lipase
Cherry Crandall used to determine…substrate…
lipaseolive oil
Disease with highest level of aldolase
muscular dystrophyAldolase is necessary for glycolysis in muscle as a “rapid response” pathway for production of adenosine triphosphate, independent of tissue oxygen.
Zollinger-Ellison is a… increased…
gastrinomagastrin HCl
diacetyl monoxime used to determine
BUN
phospho-tungistic acid to tungsten blue used to determine
Uric acid
most uric acid in plasma is what form…increased in…
monosodium urategout
Kayser-Fleischer
Cooper deposits in cornea
To evaluate ionized calcium you need to know these two things and why
pH and proteinionized calcium is pH dependent; ph will increase if CO2 is lostCa will increase with increased protein
3 things that regulate calcium/increase/decrease
VitD/PTH: increase Ca-VitD increases GI absorption of Ca-low Ca will stimulate PTH productionCalcitonin: decrease Ca-inhibits bone reabsorption
Hypocalcemia causes
Tetany (decreased Ca,Mg)VitD def, hypoPTHhypo mag, albuminNormally, the parathyroid glands release a hormone that increases blood calcium levels when they are low. Magnesium is required for the production and release of parathyroid hormone, so when magnesium is too low, insufficient parathyroid hormone is produced and blood calcium levels are also reduced (hypocalcemia).
hypercalcemia
Vit excess, hyperPTHMalignancy
In the complexometric titration for Ca, the pH is adjusted to prevent
interference from Mg8-hydroxy-quinoline removes Mg
Method for Ca where its precipitated as Ca oxalate and converted to oxalic acid w/sulfuric acid and measured by titration against K permanganate
Clark-Collip
Clark-Collip measures…it will be precipitated as…
Calciumoxalate
In determining calcium, lanthanum is used to
bind phosphate
Most phosphorus is in… at pH
bone 7.4
Phosphorus is controlled by this and how does it affect it, opposite of Ca
PTH:decreases Phoincreases Ca
Affect on PhosPTHCalcitonin, Vit D
PTH decreased PhoCalcitonin, Vit D increases phosphate
Reagent used for phosphate
molybdatemolybdeum blue
Hyperparathyroidism= increased PTH,Phosphorus is
decreased
Hypoparathyroidism= decreased PTHPhosphorus…
increased
Magnesium is controlled by kidney thru tubular reabsorption, what is renal threshold
1.5-2.1mg/dL
Treatment for preeclampsia/contractions will result in what lab result to be increased
magnesiumhypermagnesemia
Condition decreased iron/ferritin/% sat, increased transferrin/TIBC
IDA
Reagent for magnesium
titan yellow
2 Conditions with increased iron/ferritin/%sat and decreased transferrin/TIBC
sideroblastic and hemocromatosis
trace metal involved in melanin, inorganic cofactor, bound to albumin, transported by ceruloplasmin
copper
Fat soluble vitamins
A,D,E,K
Water soluble vitamins
All B, C
Fat soluble Retinol, cause of night blindness
A
Fat soluble calciferol, hormone precursor, Rickets
D
Fat soluble Tocopherol, antioxidant/immunityHemolytic anemia
E
Fat soluble phylloquinine, for clotshemmorage
K
Water soluble B1condition
thiaminBeriberi
water soluble riboflavin
B2
water soluble B3, condition
niacinpellegra
water soluble pyridoxal
B6
water soluble B7
Biotin
water soluble B9, condition
folatemegaloblastic
water soluble cobalamin, condition
B12PA/IF
cause of Scurvy
C
Major extracellular cation, NV
Sodium 135-145
Hormone that increases Na reabsorption and acts on distal convoluted tubeReleased by adrenals
Aldosterone
Hypoaldosterone NaHyperaldosterone Na
Hypo: decreased NaHyper: increased Na
Normal valuesNa ClK
Na 135-145Major extracellular cationCl 98-106Major extracellular anion K 3.5-5.0Major intracellular cation
BUNCreatinine
BUN 6-20Creatinine 0.7-1.5
CO2/Bicarb
23-29
Na 165Cl 125K 3.5
Saline contamination
Diabetes mellitus FastingGlucose
126, 200
Increased K causesPhleb issuesTubeCondition
Hemolysis, tourniquet, squeezingEDTADiabetic ketoacidosis(Insulin promotes potassium entry into cells. When circulating insulin is lacking, as in diabetic ketoacidosis, potassium moves out of cells, thus raising plasma potassium levels even in the presence of total body potassium deficiency )
Used to enhance sensitivity of ISE electrode for K
Valinomycin
Hypokalemia is less thanHyperkalcemia greater than
Potassium<3.5>5
Chloride shift
Cl is inverse HCO3, when one leaves the other goes inHigh Cl, low HCO3=metabolic acidosis
Causes of increased Cl
IVDehydrationMetabolic/diabetic acidosis(lose HCO3, chloride shift)
Low Cl 4 things
Diarrhea, vomitingRenal failuremetabolic alkalosis
Chloride measured with titration methods such asC.A. and S.S.C.A. is…S.S. is…
Coulometric amperometricSchales-Schales
Coulometric amperometric method uses…What is measured…How is it measured…
TitrationChlorideTime needed to get to end pt
Schales-Schales is what kind of method…For…Violet color formed from reaction with…
Mercurimetric titrationChlorideExcess Hg++
C-A and S-S are both these kind of reactions…for…
TitrationChloride
Most CO2 in blood is
Bicarb
Specimen Least ordered, not used for CO2
Urine
Anion Gap, NV
Na+K-(Cl+HCO3)10-20
Increased anion Gap
Diabetic ketoacidosisLactic acidosisSalicylateMethanolEthanolPoly glycolUnmeasured
Decreased anion Gap used as, due to
Analytical QCAnalyzer error
Glass, Ag/AgCl, measures H for measurement of
pH
pH electrode with membrane measures
pCO2PC, MD-NADH
Platinum+Ag/AgCl, amperometric measures
pO2
Henderson Hasselbalch
pH= pKa + log [salt]|[acid][A base]|[HA acid]pH=log HCO3/pCO2pH=log kidney/lungspH=log metabolic/respiratory
Bicarb: carbonic acid ratio in plasma
20:1
AcidosisNormalAlkalosis
<7.387.35-7.45, around 7.4>7.42
Metabolic acidosis: pH, HCO3 levels compensation
Decreased pH, HCO3Lung: Hyperventilating releases CO2
Metabolic alkalosis 2 parameters influenced, compensation
Increased pH, HCO3Lung: Hypoventilation increases CO2
Respiratory acidosis 2 parameters, compensation
Decreased pH, Increased CO2Kidneys: increase bicarb
Respiratory alkalosis 2 parameters, compensation
Increased pH, decreased pCO2Kidneys compensate
Beer-Lambert law
The Beer-Lambert law relates the concentration of a sample to the amount of light the sample absorbs as it passes through the sample.
Synovial: joints, hyaluronic acid makes viscous, obtain by arthrocentesis2 Synovial crystals/conditions
Uric acid: goutPyro-phosphate: pseudogout
Amniotic fluid: access neural tube defects/AFP4 Fetal lung tests…
L/S: >2PGFLM 2Lamellar
Sweat:AnalyteCondition, death cause
ClCystic fibrosis, pneumonia
Sperm:mL, live%, motility %, #/mL
2-5mL>75% alive>50% motility# 20-250 million/mL
Decreased CSF glucose seen inIncreased CSF glucose seen in
Decreased CSF glucose: Bacterial meningitis Increased CSF glucose:Diabetes
CSF tube order/department
1 chem 2 micro3 heme
CSF protein mg/dL
15-45
CSF glucose
60-70% plasma
CSF diff
70% lymph30% mono
4 causes of increased CSF Protein
MeningitisIntracranial hemorrhageTraumatic tapMS
Decreased CSF TP seen in
Leak, tear
Increased CSF IgG index and oligoclonal banding seen in
MS Multiple scelerosis
Urine ph normal…If left at rt becomes..
normal 6.0 (4.5-8)alkaline at RT
Normal urine volume:poly> olig
1200-1500poly >2500olig<400noc: more at nightanuria: none
left at RT, what decreases…increases
decreases:glucose/ketonesbili/urocells/castsincreases:nitrites/bacteriaturbiditypH
3 things kidneys make2 hormones that influence kidney
renin, erythropoeitin, PGaldosterone, ADH
Urine is made of 7 things
95% waterurea, uric acid, creatinineCl/Na/K
Urine RBCs color
smoky, red/brown urine
Urine bili/pyridum color
dark yellow/amber/orange
Met/Hmg and homogentistic acid urine color
brown black upon standing
Reabsorbs H2O onlyRebabsorbs solutes only
H2O only Descening Loopsolutes only ascending loop
Specific gravity NV…increased in these 3decreased in this
1.003-1.030increased in: isotheniuria/renal damage 1.010diabetes mellitusxraydecreased in diabetes insipidus
3 methods to determine sg
refractometerreagent stripharmonic oscillation: densitometry; current helps measure sg
Urine strip protein method name…ph…what protein it binds to…color…confirm with…
protein error of indicators3.0albuminsulf.acid precipitation
How many neprons per kidney….filtration ml/min
1 million20mL/min
Protein of indicators on dipstick description…has nothing to do with…not affected by…What will cause false pos…
Most of the indicator is non-ionized and the protein will combine with the non-ionized form and will change the ratio of ionized and nonionizedHas nothing to do with pH and not affected by bence jonesFalse pos due to alkaline/buffered urine
Renal threshold for glucosedipstick measures only glucosetwo enzymes in rxn
160-180mg/dLglucose oxidase, perioxidase
Clinitest/Benedicts is a…is for…Can screen for…but reacts with…False neg with these two…
copper reduction method for glucosescreen for galctosemiareacts with all reducing substancesfalse neg with Vit C and pass thru
Occult blood on urine dipstick depends on
perioxidase activity of rbc/hmg
Nitrite:bacteria type…2 names for rxn:
GNR (E.coli)Diazo, Griess rxn
RBC dipstick:false neg with one vitamin and mistaken with 3 things…false pos…
false neg: vitC, yeast, oil, calcium oxalate crystalsfalse pos: oxidizing like bleach
UTI, renal calculi, acute glomerulonephritis you’ll see these cells
RBCs
reagent for LE, color
diazo reagent, purple
Cell related to glitter cell, UTI/pyelonephritistype seen in UTI
whiteneutrophils
Seen in diabetes mellitus, breakdown of lipids…reagent…color…confirm with…
ketonessodium nitroprusside purpleAcetest (diacetic acid, acetone)
Sodium nitroprusside used in determination of…on dipstick
ketones
Acetest is used to confirm…detects these two..
confirm ketonesdiacetic acid, acetone
Ictotest, Diazo rxn used for
Bilirubin
Erlich, p-DMAB used in
Urobili
Leukocyte in dilute hypotonic urine where granules appear to move/Brownian Mvt
glitter cell
Large epithelial seen in catherterization, renal pelvis, ureter, bladder
transitional
Cell seen in tubular necrosis, renal tubles, oval fat bodies are made from
renal tubular
glycoprotein made from TRE that makes up casts (two names)
Tamm horsfall mucoproteinUromodulin
Cast are formed in what part of tubules
distal convoluted tubule
Casts seen in chronic renal disease, urinary stasis
waxy
cast seen in stress/exercise, normal
hyaline
cast seen in nephron/acute glomerulonephritis
RBC
Cast from dialated collecting ducts
broad
cast seen in acute glomerulonephritis and is decomposition of cellular
granular
cast from break down of epi casts/oval fat bodies, nephrotic syndrome
fatty
cell in pyleonephritis
wbc
4 urine parasites
T.vagE.vermiculares (bread loaf ova)strongyS.haematobium
5 abnormal crystals
Cysteine: 6 sidesLeucine: concentric circlesTyrosine: needlesBili: yellow/brown needlesCholesterol: notched plates
3 normal crystals in acidic urine
Uric acid: rhomboid/pleomorphicamorphouse urates: pink sedimentCalcium oxalate: envelope/oval/dumbell, antifreeze
4 normal crystals in alkaline urine
amorphous phosphatestriople phosphate: coffin lidcalcium carbonate: dumbellamm. biurate: thorny apple
NV for… 50-200 mg/24hr
microalbumin
AAT globulin
Alpha-1-antitrypsinAlpha1 globulininhibits the neutrophil elastase activity in the lung and hence can protect it from proteolytic damage.
Tangier low in
HDL
Colorimetric method for BUN measures, uses Enzymatic method for BUN measures, uses Which one can be used for untreated urine, why
Colorimetric measures urea and uses diacetyl monoxime, can be used with untreated urine since it’s not measuring ammonia Enzymatic measures ammonia and uses urease
The NAD coenzyme is reduced to NADH and measured at 340nm in this method…for which analyte?
HexokinaseGlucose
diazo rxn/Jendrassik-Grof
Bilirubin
Jendrassik-Grof andEvelyn Malloymeasure
Bilirubin
Jendrassik-Grof=Bilirubin+Diazo (caffeine)=azobili
Jendrassik-Grof=Bilirubin+Diazo (caffeine)=azobili
Evelyn Malloy method uses…as an accelerator Jendrassik-Grof uses…as an accelerator Measures…
Evelyn Malloy method uses methanol as an accelerator Jendrassik-Grof uses caffeine benzoate acetate as an accelerator bilirubin
LD1 HHHH Fastest, marker for these two
heart/rbc
sideroblastic and hemocromatosisIron,ferritin,%sat, transferrin/tibc high or low
increased iron/ferritin/%sat and decreased transferrin/TIBC
Pyrophosphate seen in
pseudogout
Porter-Silber reaction uses phenylhydrazine to detect…Zimmerman reaction detects…
PS=phenylhydrazine=corticosteroidsZimm=17-ketosteroids
Phenlyhydrazine used to detect corticosteroids in what reaction
PS=Porter-Silber
17-ketosteroids/17-KS is detected in what reaction…
ZimmermanZimmerman is a man that takes 17-KS/steroids
Porter and Zimmermand take steroids
…
Hypothalmus makes releasing/inhibiting hormones that act on the pituitaryPituitary then makes hormones that have their effects on organs that make the end product/action
…
Primary caussed by…secondary caused by…tertiary caused by…
Primary…end organSecondary:pituitaryTertiary: Hypothalamus
Increased GH causes these two thingskids versus adultsDecreased GH causes
kids: giantismadults: acromegalydwarfism
Hormone that solely initiates and maintains lactation
prolactin
Hypogonadism and prolactinoma (pituitary tumor) due to…
increased prolactin
menstral disorder and inadequate lactation due to
decreased prolactin
Vasopression is also called
antidiuretic hormone
ADH acts on…to increase…decreased in…
acts on renal tubles to increase water reabsorptiondiabetes insipidus
Hormone that stimulates urterine contraction/myoepithelial cells in breast thus ejecting milk
oxytocin
Hormone that forms male sex characteristics, spermatogensis, facial hair, deep voice, sex drive
testosterone
Testosterone is made from…
cholesterol (as is a lot of steriods)
hormones that stimulate sex organ development, linear growth, epiphyseal fusion
androgens
infertility men/women, adrenal hyperplasia, polycystic ovarian due to
hypertestosteronemia
hypogonadism due to
hypotestosteronemia
TRH, GRH, CRH GHRHPIF, GHIH released by
hypothalamus
GH, PRL, TSH, LH, FSH, ACTH released by the
anterior pituitary
ADH, oxytocin released by
posterior pituitary
Hormone that induces ovulation, ovary secretes estrogens/progesterone for possible pregnancy and stimulates testes androgens in males
Luteinizing hormone
GnRH stimulates this organ to produce… which affects these organs
GnRH stimulates pituitary to make LH and FSH to affect ovaries or testes
GHIH/GHRH gets the pituitary to make… which acts on these two organs
soft tissue/bone
FSH stimulates, secretesfemales:males:
females: egg development, estrogenmales: sperm, testosterone
hypothalmus makes CRH that act on pituitary to make ACTH, this stimulates the adrenal cortex to make steroid hormones made from cholesterol3 steroids made adrenal cortex…
mineralcoritcoids(aldosterone)glucocorticoids(cortisol)sex hormones (androgens, estrogens)
What converts angiotensinogen to angiotensin I which converts to II and stimulates cortex to make aldosterone
Renin
hormone that induces secretion of glucorticoids(cortisol) of adrenal cortex
ACTHadreno-cortiotropic hormone
CRH stimulates the…to make… which causes this organ to release cortisol, aldoseterone, estrogens and testosterone
CRH stimulates the pituitary to make ACTH causing the adrenal cortex to make cortisol, aldosterone, estrogens/testosterone
Mineralocorticoids, glucorticoids, and androgens released by
adrenal cortex
aldosterone is an example of a…maintains…excretes…retains…
mineralocorticoidmaintains H2O/electrolytesexcrete K/retain Na
Cortisol is a type of
glucocorticoid
Hyperadolsoterone, increased Na, decreased K, hypertension
Conns Disease
Hypoaldosterone, decreased Na/Cl, decreased cortisoleverything down
Addisons Disease
Increased cortisol, increased glucose, increased Nabuffalo hump
Cushingseverything up
Testosterone is a type of
androgenmale sex hormone
metabolite of androgen…reaction used to detect…
17-ketosteroid, 17-KSZimmerman reaction
3 types of catecholaminespurpose
epinephnorepidopaminemobilize energy stores
Two GI hormones
Gastrinserotonin
Hormone increased in Zollinger Ellison syndrome
gastrin
Hormone made in GI, vascoconstricter of PLTs/brain/tissue
serotonin
5HIAA is a urinary metabolite of…increased in chromaffin cell tumors of GI, drugs, bananas, pineapples etc
serotonin
Catecholamines produced in…by…
adrenal medullaby chromaffin cells
Metabolites of epineph
metanephrine, VMA
Metabolites of norepineph
normetaneph,VMA
Metabolites of dopamine
HVA
Pheochromocytoma is a tumor with increased
VMA
Neuroblastoma is a tumor with increased
HVA
Most of the releasing and inhibiting hormones (except for ACTH) are producted by the…
hypothalamus
Thyroid hormones: stimulate metabolic processesIn tissues…is coverted to….99.97% of…is bound to mosntly TBG, some TB-PA, albumin99.5% of….is also bound
In tissues T4 is converted to T399.97% of T4 is bound to TBG99.5% of T3 is bound
TSH stimulates the … to make these two
thyroid, T3/T4
3 things hormones made by thyroid
thyroxine/T4, triiodothyronine/T3calcitonin
Thyroxine/T4 increases…Triiodothyronine/T3 increases…Calcitonin increases…
Thyroxine, Triiodothyronine: metabolismCalcitonin: Ca reabsorbtion
3 calcitropic hormones
PTH, VitD, calcitonin
Parathyroid mades these two…PTH stimulates renal production of this…
Calcium, PhosphorusVitD
Low PTH lowers/increases serum…
Lowers serum Ca, DIncreases Phos
Hypothalamus releases…which acts on anteroir pituitary
TRH
TRH stimulates pituitary to release… which acts on…
TSH, acts on thyroid
TSH stimulates thyroid to make…
T3,T4
Free… stimulate negative feedback loop and inhibit secretion of…
Free T3/4 inhibit TSH
primary Hyperparathyroidism also called…symptoms
Gravesweight loss, heat, hair loss, anxious
Graves is hyper or hypo…T3/T4 levels…TSH levels…
hyper: T3/T4decreased TSH to stop production of T3/T4Primary means thyroid overproduces T3/T4 due to TSH antibodies
Primary Hypothyroidism is called…symptoms
Hashimotosweight gain, tired, cold
Hashimotos is hyper or hypo…T3/T4 levels…TSH levels…
hypo: T3/T4increased TSH to increased T3/T4 levelsThyroid autoab
Major binding protein for thyroxineHow is it measured
TBGthyroid binding globulinBy measuring T3 uptake (amount of TBG bound to thyroid hormones)
3 good indicators for hypothyroidism1 not good indicator
FT4, TT4, s-TSH (singles best)not good T3 uptake (indirect, not used)
Ovaries productes these two hormones
estrogen, estadiol
hormone female sex charac, hyper=amenorrhea, hypo=menopause
Estrogen
hormone that’s active form of estrogen, evaluates fetoplacental function
estadiol
Progesterone made by the
corpus luteum
prepares uterus for pregoj, maintains endometrium lining, inhibits uterine contractions, prepares breasts for lactation
progesterone
progesterone levelsperimenopausepostmenopause
peri: increased progesteronepost:decreased progesterone
What hormone maintains progesterone in early pregnancy
HCG
HCG increased/decreased…
increased: prego, mutiple pregos, tumorsdecreased: spontaneous abortion
HCG subunits are…
alpah, beta subunitsnoncovalently bound subunits
subunit that cross reacts with LH,FSH,TSh
alpha
subunit that has analytical specificity
beta
Trimester with highest level of HCG…When does it show up, how long does it last…
firstseen in days, peaks 2-3mths
Toxicology, best specimen for screening/qualitative, best for quantitative
Urine-QLBlood-QNT
Creatitinine, pH, or oxidizing activity, dilute/substituted/adultered as a measure of
validity
Major disadvantage of immunoassay drug detection…best 2 ways to confirm for drugs that have positive screens…
Immunoassays can’t simultaneously assay multiple drugs in one specimengas chromatography/MS
Aminoglycosides and Glycoprotein are two kinds of
antibiotics
Kind of Glycoprotein/antibiotic
Vancomycininhibit cell wall synthesis, treat gp
gentami/tobramy/amika/kana-cin are allinhibit protein synthesis, treat gn
aminoglycosides
Monitor toxic range of antibiotics to prevent damage to…and…
hearing/ototoxickidneys/nephrotoxic
Phenobarbital, phenytoin/dilantinValproic acid, Carbamazepineethosuximide are all
anti-epileptic/anti-convulsants
Bronchodialatorasthma, IV/oral, 10-20ug/mL, toxic >20ug
Theophyllineactive metabolite in neotates is caffeine, also caffeine given as a brochodilator
Cyclosporine, Tacrolimus, Sirolimus,MPA all are
immunosuppressives
Methotrexate are all
antineoplastics/antitumor
Cyanide, arsenic, mercury all are
heavy metals
Substances/acute poisoning
acetaminophen-liver damagesalicylatesalcohols-ethanol,isopro,glycolcyanidecarbon monoxidecarboxyhmg (200x infinity)organophosphates/pesticide:-CNS, decrease cholinesterase
Must wait until…to TDMhow many half lives to reach…how many half lives to clear…metabolized by liver, excreted in urine
steady state5.5
Specimen drawn imme before next dose is called…Peaks drawn…hrs
Trough1-2hrs after oral dose
Amtriphtyline, Imipramine, DoxepinLithium are all
pyschotropics
Amtriphtyline, Imipramine, Doxepin are all
tricyclics
Digoxin, Quinidine, Procainamide,Disopyramide, Lidocaine all are
Antiarrythmics/cardiactive
What body does to drug…What drug does to body…
Body does to drug: pharmacokineticsDrug does to body: pharmacodynamics
