Chemistry week 3 Flashcards
Elec, blood gases, Toxicology, Endocrinology
Ions capable of carrying an electric charge
Electrolyes
Positively charge electrolyte
Cation
negatively charge electrode
Cathode
Negatively charge electrolyte
Anion
Positively charge electrode
Anode
Electrolyte that functions in volume and osmotic regulations
Sodium, Chloride, Potassium
Electrolyte that functions in myocardial rhythm and contractility
Potassium, Calcium, Magnesium
Electrolyte that functions in Regulations of APTase ion pump
Magnesium
Electrolyte that functions in neuromuscular exciteability
Potassium, Calcium, Magnesium
Electrolyte that functions in Production and Use of ATP
Magnesium, phosphate
Electrolyte that functions as an Acid base balance
Potassium, Chloride, Bicarbonate
Electrolyte that functions in Blood coagulation
Calcium, Magnesium
Electrolyte that function as Cofactors in enzyme activation
Calcium, Magnesium, Zinc, Chloride, Potassium
Most abundant cation in the extracellular fluid
Major extracellular cation
Sodium
Promotes sodium retention and potassium secretion
Aldosterone
Promotes sodium excretion
Atrial natriuretic factor
Sodium renal threshold
110 - 130 mmol/L (average of 120mmol/L)
Sodium normal value
135 - 145 mmol/L
Can be caused by loss of water, decreased water
intake, and increased sodium intake or retention
Hypernatremia
Major defense mechanism against hypernatremia
Thirst
▪ Most common electrolyte disorder.
▪ Can be caused by increased sodium loss,
increased water retention, and water imbalance.
Hyponatremia <135 mmol/L
1/3 in the body
ECF
2/3 in the body
ICF
FORMULA FOR OSMOLALITY
- 2 Na + (Glucose mg/dL / 20) + (BUN mg/dL / 3)
OR - 1.86 Na + (Glucose / 18) + (BUN /2.8) + 9
____ of osmolality also increases ADH 4 times more
1-2% increase
____ of osmolality can shut off ADH production
1-2% decrease
Increased sodium level which induce the release of more ADH to direct the reabsorption of water in the kidney
Hypernatremia
Decrease in blood volume
Hypovolemia
Increase in blood volume
Hypervolemia
Mechanism that requires energy to move ions across cellular membranes
Active transport
Passive movement of ions across a membrane depending on the charge of concentrations
Diffusion
Refers to the difference between the sums of the concentration of the principal cations and of the principal anions
Anion gap
Anion gap formula
NA - (Cl + HCO3)
OR
(NA + K) - (Cl + HCO3)
Uremia, Ketoacidosis, Methanol, Aspirin, or ethylene glycol poisoning, Severe dehydration, Lactic acidosis
Increased anion gap
A rare condition wherein sodium chloride gradients cannot form in the loop of Henle causing the retention of chloride ion that is not available for the countercurrent mechanism and sodium loss
Bartter’s syndrome
Below ___ mmol/L for 48 hours or less is considered a medical emergency which can lead to coma or death when not treated immediately
120 mmol/L Na
Panic value for hypernatrimia
160 mmol/L
Method of determination of hypernatremia
ISE - potentiometry where measurement is based on the changes in voltage or potential at a constant current. Measure with GLASS
AAS - uses fire to consume the analyte which is measured at its GROUND STATE
FES/FEP - Uses fire to consume the analyte into atomic particles which is measure at its EXCITED STATE
Colorimetric (Albanese Lein) - Combining sodium with zinc uranyl acetate → sodium uranyl acetate precipitate → addition of water produces YELLOW solution
Direct ISE - uses an ____ sample
Undiluted
Indirect ISE - Uses an ___ sample
Diluted
Major intracellular cation of the ICF
Potassium
Low or High potassium level can cause
Arrhytmia
Catecholamines such as epinephrine promotes entry of Potassium into the cell
Beta-2 stimulator
Impairs the entry of potassium into the cell
Beta-blocker
Overdose of ___ promotes acute entry of Potassium into the skeletal muscles and liver
Insulin
Dehydration, Diabetes Insipidus, Hypoadrenalism, Acidosis, Hemolysis
Hyperkalemia
Muscle weakness, tingling, numbness, or mental confusion
Hyperkalemia
may alter the ECG (K)
6-7 mmol/L
May cause fatal cardiac arrest (K)
> 10 mmol/L
Infusion of insulin, Alkalosis, Vomiting, overhydration, Use of loop diuretics, SIADH, Bartter’s syndrome
Hypokalemia
Reference method for determination of Sodium
AAS
Routinely used - ISE
Potassium method of determination
FES - Violet end color
ISE - uses Valinomycin gel
AAS - Reference method
Colorimetry - Lockhead and Purcell
Chief counterion of sodium
Chloride
Chloride functions
Maintaining osmolality
Blood volume
Electrical neutrality
Chloride shift
Maintains electroneutrality
Bicarbonate diffuses out into the plasma and Chloride diffuses into red cells to maintain electrical balance (BoCi)
Functions in blood coag, enzyme activation, and cardiac and skeletal muscle excitability
Calcium
Ical
Protein bound
complexed with anions
What %?
50% Ical
40% protein bound (albumin)
10% complexed with anions
Hormones that control calcium level
Parathyroid hormone - Parathyroid gland
Vitamin D - Skin, Kidney
Calcitonin - Thyroid Gland
Hypercalcemic hormone
Parathyroid hormone and Vit D
Hypocalcemic hormone
Calcitonin
Cancer, Hyperthyroidism, Iatrogenic causes, Multiple myeloma, hyperParathyroidism, Sarcoidosis
Hypercalcemia (CHIMPS)
Calcitonin, Hypoparathyroidism, Alkalosis, Renal failure (Ca Bi So), Vitamin D deficiency
Hypocalcemia (CHARD)
Flame test
Lithium
Potassium
Rubidium
Magnesium
Calcium
Sodium
Lithium - red
Potassium - violet
Rubidium - Red
Magnesium - blue
Calcium - orange
Sodium - yellow
4 electrolytes for anion gap
Sodium, Potassium, Chloride, and Bicarbonate
Methanol poisoning, Uremia, Diabetic ketoacidosis, Paraldehyde ingestion, Hypernatremia, Instrument error, Iron, Inhalants, Isoniazid, Ibuprofen, Lactic acidosis, Ethylene glycol/Ethanol acidosis, Salicylates, Starvation
Increased anion gap (MUDPHILES)
Decreased Anion gap
Increased in unmeasured cation
Decrease in unmeasured anion
(ADIC)
eg. Hypoalbuminemia
Hypercalcemia
Major electrolyte concentration that provides the largest contribution to the osmolality value of serum (92%)
Sodium, Chloride, Bicarbonate
Osmolality method of determination
Direct method - Osmometer (colligative property)
Indirect method - computation
* 2 Na + (Glucose mg/dL / 20) + (BUN mg/dL / 3)
OR
* 1.86 Na + (Glucose / 18) + (BUN /2.8) + 9
____ particle concentration = _____ freezing point, vapor pressure and ____ boiling point, osmotic pressure
Increase, decrease, increase
Essential for the function of cellular enzymes and energy metabolism
Magnesium
Important role in membrane stabilization, nerve conduction, and ion transport and calcium channel activity
Magnesium
Distribution of magnesium
46% in tissues
53% in bones
1% in serum
1/3 are bound to albumin
2/3 are free or ionized form or bound to citrate
Regulation of magnesium
Henle’s loop is the major renal regulatory site (50-60% is reabsorbed in the ascending limb)
Hypermagnesemia in the ff (rare)
Iatrogenic
Elderly and patients with bowel disorder and renal insufficiency
Important in constituent in nucleic acid, phospholipid, and phospoproteins
Phosphorus
Regulation of phosphorus
Vitamin D - Increases phosphate levels by absorption in the intestine and reabsorption in the tubules
Growth hormone - increases phosphate level by decreasing renal excretion of phosphate
Parathyroid hormone - facilitates excretion of phosphate for reabsorption of calcium
Acidosis, over medication with vitamin D, infant’s drinking cow’s milk or adult drinking laxatives, lymphoblastic leukemia, Dec. PTH
Hyperphosphatemia
Alcohol abuse, vitamin D deficiency, steatorrhea, Ketoacidosis, COPD, Asthma, and malignancy
Hypophosphatemia
Specimen of choice for phophate
Serum sample
Plasma - lithium heparin as anticoagulant
By product of an emergency mechanism that produces a small amount of ATP when oxygen is severely diminished
Lactate
Can be an early indicator of hypoxia
Lactate
Specimen of choice for lactate
Anticoagulant iodacetate and fluoride or heparin can be used. Must be placed in ice and quickly separated
Specimen handling for lactate
Avoid using tourniquet, if used blood should be collected immediately w/ no hand clenching
Normal value of pH
7.35 - 7.45
Normal value of pCO2
35-45 mmHg
Normal value of HCO3
22-29 mEq/L
pCO2 <35 mmHg
Respiratory alkalosis
pCO2 >45 mmHG
Respiratory acidosis
HCO3 <22 mEq/L
Metabolic acidosis
HCO3 >29 mEq/L
Metabolic alkalosis
Electrode for pH and it’s principle
Glass electrode
Electrode for pCO2 and it’s principle
Clarke electrode Amperometry/polagraphy
Electrode for HCO3 and it’s principle
Severinghaus electrode / Potentiometry
Hormones produced:
Thyrotrophin-releasing hormone
Corticotrophin-releasing factor
Other releasing or inhibiting horomens
Hypothalamus
Hormones produced:
TSH
ACTH
LH
Prolactin
GH
Anterior pituitary gland
Hormones produced: (store and secrete)
Vasopressin
Oxytocin
Posterior pituitary gland
Hormones produced:
Epinephrine (Adrenaline)
Norepinephrine (Noradrenaline)
(Catecholamines)
Adrenal Medulla
Hormones produced:
Cortisol
Aldosterone
11-deoxycortisol
Adrenal cortex
Hormones produced:
T3
T4
Calcitonin
Thyroid gland
Hormones produced:
PTH
Parathyroid gland
Hormones produced:
Insulin
Glucagon
Pancreas
Hormones produced:
Gastrin
Gastrointestinal tract
Hormones produced:
Estrogen
Progesterone
Ovaries
Hormones produced:
Progesterone
hCG
Human placental lactogen
Placenta
Hormones produced:
Testosterones
Other androgens
Testes
Hormones produced:
EPO
1,25-dihydroxy Vitamin D
Prostaglandin
Kidneys
What type of hormones?
Cortisol
Aldosterone
Progesterone
Estrogens
Testoterones
Steroid hormones
What type of hormones?
Insulin
PTH
LH
FSH
TSH
Thyrotropin-releasing hormone
ACTH
Prolactin
GH
Calcitonin
Glucagon
Peptide or protein hormones
What type of hormones?
Epinephrine
Norepinephrine
T4
T3
Amines or amino acid derivatives
What type of hormones?
Prostaglandins
Fatty acids
Stimulates the release of TSH and PROLACTIN
TRH
Stimulates the release of LH and FSH
Gonadotropin-releasing hormone (GnRH)
Stimulates ACTH release
Corticotrophin-releasing hormone (CRH)
Stimulates GH release
Growth hormone releasing hormone (GHRH)
Inhibits GH and TSH
Somatostatin
Inhibits prolactin release
Dopamine
Also known as the master gland
Anterior Pituitary gland
Most abundant of all pituitary hormone
GH
Decreased GH or GHD
Dwarfism
Confirmatory test for dwarfism
Insulin tolerance test
Due to overproduction of GH in adulthood
Acromegaly
Screening and confirmatory test for adulthood
Screening = IGH-1 / Serum somatomedin C
Confirmatory - OGTT
Hypersecretion of GH during childhood
Gigantism
Turns off secretion of ACTH and CRH
Increased cortisol
Stimulates secretion of ACTH
Decreased cortisol
ACTH is highest at what time of the day
Morning
ACTH function
Stimulates the synthesis of cortisol (adrenal cortex)
Gondaotropins
FSH and LH
what does FSH do in male
Aids in spermatogenesis
What does FSH do in female
aids in ovulation and final follicular growth
What does LH do in male
Helps leydig cells produce testosterone
What does LH do in female
Helps corpus luteum produce estrogen
Also known as thyrotropin
TSH
Also known as pituitary lactogen hormone
Prolactin
Does not have the capacity to produce hormones, only releases hormones.
Posterior pituitary gland
Vasopressin and Oxytocin are produced in?
Hypothalamus
Main stimulus for the creation of thyroid hormone
Iodine
Lobes of thyroid glands are connected by
Isthmus
Produced by follicular cells
T3 and T4
Produced by parafollicular cells
Calcitonin
Two major cells of thyroid gland
Follicular cells and Parafollicular cells
Most active thyroid hormonal activity
T3
Better indicator of recovery from hyperthyroidism as the recognition of recurrence of hyperthyroidism
T3
Most abundant thyroid hormone
T4
T3 - INC
T4 - INC
TSH - DEC
Primary hyperthyroidism
T3 - INC
T4 - INC
TSH - INC
Secondary Hyperthyroidism
T3 - N
T4 - N
TSH - DEC
Subclinical Hyperthyroidism
T3 - Dec
T4 - Dec
TSH - INC
Primary hypothyroidism
T3 - Dec
T4 - Dec
TSH - Dec
Secondary hypothyroidism
T3 - N
T4 - N
TSH - INC
Subclinical Hypothyroidism
Primary hormone that responds to stress
Catecholamines
Outer region of adrenal gland
Adrenal cortex
Major site of steroid hormone
Adrenal cortex
Principal source of meralocorticoid (aldosterone)
Zona glomerulosa
Site of glucocorticoid synthesis (cortisol)
Zona Fasciculata
Produces androstenedione and dehydroepiandrosterone
Zona reticularis
Principal glucocorticoid
Cortisol
Cushing’s syndrome
Excessive production of cortisol
Screening test for cushing’s syndrome
24 hour urinary free cortisol
Overnight dexamethasone
Midnight salivary cortisol
Confirmatory test for cushing’s syndrome
Low-dose dexamethasone suppression
Midnight plasma control
Corticotrophin-releasing hormone stimulation test
Cortisol: INC
ACTH: INC
Cushing’s disease (Primary)
Cortisol: INC
ACTH: DEC
Cushing’s syndrome (secondary)
Addison’s disease
Decrease cortisol production
Screening test and confirmatory test for addison’s disease
Screening: ACTH stimulation test
Confirmatory test: Insulin tolerance test
Most potent mineralocorticoid
Aldosterone
Conn’s disease
Primary Hyperaldosteronism
Function is for sodium retention
Aldosterone
Screening and confirmatory test for conn’s disease
Screening - Plasma aldo concentration/ Plasma renin activity ration
Confirmatory test - Saline suppression test
Oral sodium loading test
Fludrocortisone suppresion
Captopril challenge
Testosterone - DEC
LH and FSH - DEC
Pre-testicular (secondary hypogonadism)
Testosterone - DEC
LH and FSH - INC
Testicular (Primary hypogonadism)
Testosterone - N
LH and FSH - N
Post-testicular
Rise in FSH stimulates estrogen production
Follicular phase
After the LH surge, subsequent luteinization of the graafian follicle to form the corpus luteum
Luteal phase
Most abundant estrogen in post-menopausal women
Estrone (E1)
Most potent estrogen secreted by the ovary and the most abundant estrogen in premenopausal women
Estradiol (E2)
Estrogen found in maternal urine
Major estrogen secreted by the placenta during pregnancy
Estriol (E3)
Used to assess fetoplacental viability and as a marker for Down syndrome
Estriol (E3)
Natural steroid produced by the human fetal liver
May be used as an oral contraceptive
Estetrol (E4)
FSH and LH - HIGH
E2 - LOW
Menopause (primary hypogonadism)
FSH and LH - LOW
E2 - LOW
Sheehan’s syndrome (Secondary hypogonadism)
Diagnostic marker for Zollinger Ellison syndrome
Gastrin
Produced by trophoblast cells of the placenta
hCG
A dimeric molecule consisting of one alpha and one beta subunit that confers antigenic individuality
hCG
Diagnostic marker for carcinoid tumor
5-HIAA
Secreted in one location and release into blood circulation, binds to specific receptor to elicit physiological response
Endocrine
Secreted in endocrine cells and released into interstitial space; binds to specific receptor in adjacent cells and affects its function
Paracrine
Secreted in endocrine cells and sometimes released into interstitial space; binds to specific receptor on cell of ORIGIN resulting SELF-regulation of its function
Autocrine
Secreted in endocrine cells and remains in relation to plasma membrane; acts on immediately adjacent cell by direct cell-cell contact
Juxtacrine
Secreted in endocrine cells and released into lumen of gut
Exocrine
Secreted in neurons and release into extracellular space; binds to receptor nearby cells and affects its function
Neurocrine
Secreted in neurons and released from nerve endings; interacts with receptors of cells at distant site
Neuroendocrine
Secreted in the cells and REMAINED as well as function inside the synthesis of origin
Intracrine
The hypothalamus is above the pituitary gland and is connected to the ____
Infundibulum
Responsible for secreting compounds towards the pituitary gland in order for the hypothalamus to be able to regulate the compounds released by the pituitary gland
Neurons
Carry the trophic hormones directly to the anterior pituitary
Portal vessel
Release their hormones into the second set of capillaries for distribution to the rest of the body
Endocrine cells of the pituitary gland
Inhibitory neutrotansmitter
Gamma-aminobutyric acid (GABA)
Affected by serotonin, endorphins, acetylcholine
ACTH release
Stress, inflammation, hypoglycemia
Physiologic stimulus
Looks like a pinecone
Conarium/Epiphysis cerebri (pineal gland)
Inappropriate production of breast milk
Galactorrhea - Hypersecretion of PRL
Inhibits the release of ADH
Ethanol
Cortisol is bound to a glycoprotein which is known as
Transcortin
Most potet meralcorticoid
Aldosterone
Resembles primary aldosteronism clinically, but aldosterone level is
low and absence of hypertension
Liddle’s syndrome
Aldosterone: Inc
Renin : dec
BP: High
K: Low
Primary hyperaldosteronism
Aldosterone: Inc
Renin: Inc
BP: high except in edematous disorder
K: Low / normal
Secondary hyperaldosteronism
Aldosterone: Dec
Renin: Inc
BP: Low
K: High
Primary hypoaldosteronism
Hyperthyroidism with peculiar edema behind the eyes called exolphthalmos
Grave’s disease
The thyroid turns into a woody or stone-hard mass
Riedel’s
Most common cause of primary hypothyroidism
Hashimoto’s disease
Aluminum is measured using
ICP-MS or GFAAS
Blackfoot disease
Arsenic exposure
Normal amount of copper in the body
50-120mg
Menke’s disease
extreme copper deficiency
Interferes with absorption of iron and zinc
Copper
Wilson’s disease
Copper toxicity
- Iron deficiency
- Late pregnancy
- Oral contraceptives
- Viral Hepatitis
Increase in TIBC
- Chronic infections
- Malignancy
- Iron poisoning
- Nephrosis
- Kwashiorkor
- Thalassemia
Decrease in TIBC
Typical threshold for acute lead toxicity
45ug/dL
Upper threshold for lead toxicity, shows signs and symptoms
60ug/dL
Acute manganese aerosol intoxication
Locura manganica (manganese madness)
Keshan’s disease and Kashin-beck disease
Selenium deficiency
