Geriatric and Pediatric Chemistry Flashcards
T/F in 2010 there was a dec in population 65 and older
false there was a 34% increase
What year did life expectancy go down? Why? Approx ages?
2021 went down 1 year
covid
females: 80
Males: 75
T/F there is notable growth in populations 65+ and shrinking in 14yrs
true because less people are having kids
Gerontology
study of aging
Geriatrics
clinical medicine focusing on care of aged pts
General changes in aging
Muscle
Total body muscle mass decreases with age, strong genetic component
Decreased creatinine production
General changes in aging
Bone
total bone density decreased, much more dramatic in women post menopause
serum calcitonin increased
PTH increased
GI system general changes in aging
ag…
what is low production?
increased?
decreased? v/c/a
atrophic gastritis, low stomach acid production
increased malnutrition
decreased VIT B12, Calcium/Albumin
General changes in aging
Urinary
causes
what is decreased in size?
increased?
decreased?
golmerulous diseases, decreased kidney size, Dec GFR
increases EPO, ANP, BNP
Decreased renin, response to ANP
Gen changes in aging
Immune system
what shrinks?
increased?
decreased?
thymus shrinks
increased ANAs
decreased T/B cells, HSC, thymosin
Gen changes aging
endocrine system
what is normal?
slightly inc?
increased?
decreased:g/p/a
ACTH norm, epinephrine norm, TSH slight inc
increased noepinephrine
decreased GH, Peak melatonin, aldosterone
Gen changes in aging
Sex hormones
menopause (before geriatric age) decreased estrogen/progrestrogen
andropause - decreased testosterone
Gen changes in aging
Glucose metabolism
what is unchanged?
what is likely to manifest illness with???
insulin secretion unchanged
genetic type 2 likely to manifest illness with increased age, bmi lack of excersise
Lab testing w age
Muscle
muscle decreases with age, creatinine slight increase w decreased renal function
Lab testing with age
Bone
o
lack of?
hypo?
needs?
low…
increased
osteoporosis, lack of sex hormones, hypogonadism
needs calcium/VitD
low serum calcium and increased PTH/calcium loss increases ALP
Lab testing w age
GI
increased: c/g/f
decreased:f/t/a/t
increased CRP
GGT
Fibrinogen
decreased ferritin, transferrin, ALB, TP
Lab testing w age
Urinary
enlarged?
increased?
obstruct?
enlarged prostate
increased PSA, urinary obstruction
Lab testing w age
Immune
induced?
infection induced morbitity/mortality
Lab testing w age
Endocrine
increased: a/e/p/t/a
decreased: D/I/G/A
increased ANP/EPO/PTH/TSH AHD/AVP
decreased DHEA, IGF-1, GH, aldosterone
Lab testing w age
Glucose metabolism
insulin sensitivity decreases
prevelence in type 2 diabetes
Refrence ranges with geriatrics
most common?
death due to?
gender specific and age specific, little data for approporiate age specific ref ranges for older adults (most are not considered normal)
Most common hypertension/cholesterol
death due to covid/heart disease
Age associated changes in drug absorption
Absorption
Distribution
absorption: rate of abs slows w age
distribution: highly water sol drugs tend to be more conc because decreased body water
Age associated changes in drug absorption
Metabolism
Elimination
Metab: hepatic blood flow/mass decrease w age/liver response
Elim: renal flow/mass dec gradual dec in GFR
Atypical presentations of common disease
multiple coexisiting/interacting problems
excersice increases lifespan and improves quality of life in old people
Neonates/baby clinical chem
respiration
infant at birth initiates active respiration
Neonates/baby clinical chem
Growth
at birth baby is 3.2 kg, below 10th percentile is small
Neonates/baby clinical chem
Organ development
what matures during the first yr of life
GFR and renal tube function mature during first year of life
Neonates/baby clinical chem
Premature/immature
intra….
pre programed for
intrauterine development pre programmed for 38-40 wks of gestation
Neonates/baby clinical chem
Phlebotomy
blood collection from infants is complicated by?
blood collection from infants is complicated by pt size and ability to communicate
Preanalytical concerns infants
choice of?
samples in tubes of many sizes, evaporation of sample
choice of analyzer: onyl a few preform multiple procedures on sample volumes
POCT in peds
factors:
t
eval
device
analytical
expanding in pediatrics
factors:
turn aroundtimes
eval of POCT devices
device limitations for ped use
analytical preformance not as good
Reg of blood gas and pH in neonates
requires lung/kidney to be sufficiently mature to reg acid/base metabolism
at 24 wks gestational lung expresses two types
Type 1 and Type 2
gestational lung cells types
Type 1
Type 2
Type 1 pneumocytes: gas exhange
Type 2 pneumocytes: secretion of sufactant (lecthin/sphignomyelin)
Surfactant
required for lungs to expand and transfer blood gases following delivery
RDS
failure to excrete CO2 and the levels rise casusing Respiratory Acidosis
Blood gas/acid base measurement
what can be measured ? how?
some analyzers can take….
many can measure
oxygen can be measured using non invasive transcuaneous (same with CO2)
some analyzers can take small capillaru samples, many can measure lactate, urea, bilirubin/creatininine
Disorders affecting electrolytes and water balance
cause of?
must be treated to prevent?
cause of hypernatremia/hyponatremia both must be treated to prevent seizures
Physiologic jaundice
what is processed slowly?
failure to adequately?
pharmocologic agents processed slower in neonates failure to adequately metabolise bilirubin
Diabetes
what homeostasis
hepatic met of?
type 1 is…
type 2 significance?
blood glucose homeostatsis, hepatic met. of glucose, Type 1 juvenile
type 2 grown quickly in last 30yrs
Nitrogen Metabolism
what has central role
metabolic intraconversions of….
synth of:
met breakdown of products of …..:….
liver central role
metabolic intraconversions of AA/synth of non essential AA
synth of proteins: ALb/transferrin
Met of breakdwon products of nitrogen turn over: ammonia
Blood amonia in children vs newborns
Higher in newborns than older children
Nitrogenous end products as markers of renal function
high … in neonates, but low…..
what increases w muscle mass
what is typically not done?
what is used?
possible?
high ammonia in neonates but low creatninine/uric acid
Creatinine incr w muscle mass
creat clearance not typically done
eGFR used
Cystatin C possible
Calium and bone growth
norm growth requires integration
endocrine?
lack of vit D?
total calcium ?
normal growth requires integration of calcium/phosph/magnese and endocrine reg from VITD, PTH calcitonin
Lack VITD ricketts
98% total calcium is bone
HPTS
what is secreted from where…to?
between?
hypothal secretes TRH, 3AA, INTO PORTAL blood system between hypothal and anterior pituitary
HPACS
regulates…
regulates minerals/carb metabolism
Growth factors
GH inhibiting factor (somatostatin) GH releasing hormone
Sexual maturation
what is supressed in young children/infants?
GnRH supressed in infants/young children
Basic components of immune system
innate and adaptive immune system
Components of the immune system
skin, phagocytes, B/T cells, APR abs
Neonate Ab production
what immunoglobulin classes does a fetus synth?
fetus synth small amounts of IgM and tiny amounts of IgA
Immune disorders
Hypogammaglob
SCID
transient hypogammaglobulina - prematurity delayed onset of Ig production/unknown cause
SCID: Lack of humoral/cellular immunity (boy in bubble)
CF
caucasions, CFTR gene mutation
Newborn screen for populations
p
2
s
c
g
phenylketoniria, 21-H deficiency, sicke cell, CF, galacosemia
