Geriatric/Pediatric Clinical Chemistry Flashcards by Jillian Jarrell

Since 2010, there has been a 34% increase in population 65 and older
Makes up 15.2% of the population

Aging in America

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What is Gerentology

the study of aging

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Define Geriatrics

the subspecialty of clinical medicine that focuses on care of the aged

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True or False

Total body muscle mass decreases with age—rate and extent have strong genetic component

True

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True or False

total creatinine production decreases with age

True

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True or False

Total bone density and mass decrease with age

True and much more dramatic for women post-menopause

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Serum calcitonin and PTH __________ with age

Serum calcitonin increase; PTH increases (affects bone metabolism)

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Atrophic gastritis and low gastric acid production can both increase with age - what are the side effects of this?

Increased malnutrition
Vit B12 deficiency and decreased: calcium, iron absorption, albumin

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Do EPO, ANP, and BNP increase or decrease with age??

Increase

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Does renin, and responsiveness to ANP increase or decrease with age?

Decrease

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Acid/base, water and electrolyte levels normal under optimal conditions but physiologic reserve is _____________ with age

diminished

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Number of functional glomeruli decreases with age and this does what to the kidney size and weight?

Decreases the size and weight of Kidney

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When the GFR declines with age, the ___________________ is reduced

renal blood flow

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True or False

Kidneys concentrating ability increases with age.

False - it declines with age

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The thymus shrinks but their is an ___________ in ANA’s with age.

increase

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Is there an increase or decrease in thymosin, T-cell function, B-cell function and hematopoietic stem cells as someone ages??

Decrease

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Do ACTH and epinephrine levels increase or decrease with age??

Neither - they remain stable

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Do these increase or decrease with age?

TSH

Norepinephrine Secretion

GH, Peak Melatonin and aldosterone

TSH - can have slight increase

Norepinepherin Secretion - increases

GH, Peak Melatonin and Aldosterone - decreases

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What hormones decrease due to menopause (before “geriatric” age)??

decrease in estrogen, progesterone

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What hormone decreases during andropause?

decrease in testosterone

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What happens to glucose metabolism as you age??

Insulin secretion unchanged

Individuals with genetic predisposition to type 2 more likely to manifest illness (Increasing age, BMI, lack of exercise)

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Effects of aging on Muscle Laboratory Testing

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Decrease with age, renal function decreases

Creatinine levels correlate to both so may be the same or slightly increased even when renal function has significantly decreased

Effects of aging on the laboratory testing of bone

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Osteoporosis-lack of sex hormones and hypogonadism
Need adequate calcium and vitamin D to maintain bone density
Inadequate calcium absorption leads to low serum calcium and increased PTH which then increases calcium loss from bones which increases ALP levels

What is this a description of??

Age related changes with the liver analytes
Increased: CRP, GGT, fibrinogen
Decreased: Ferritin, transferrin, albumin, total protein

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Effects of aging on the laboratory tests of the gastrointestinal system

Effects of age on Lab Testing of Urinary System

Enlargement of prostrate--Increase in prostate specific antigen (PSA) , can also cause urinary obstruction

Effects of age on the Lab Testing of immune system

As age increases-so does infection-induced morbidity and mortality

What are these results describing? Increased hormone level: ANP, EPO, PTH, TSH may slightly increase, ADH/AVP Decreased hormone level: DHEA, IGF-1, GH, aldosterone

The effects of aging on the lab testing of the endocrine system

What happens to the sex hormones as a person ages?

All levels decrease: testosterone, estrogen, progesterone

Glucose Metabolism lab testing as a person ages

Insulin sensitivity decreases—increased prevalence of type 2 diabetes

Age-Associated Changes in Drug Metabolism: Absorption

The rate of drug absorption slows with aging

Age-Associated Changes in Drug Metabolism: Distribution

Highly water-soluble drugs tend to be more concentrated. Due to decreased body water

Age-Associated Changes in Drug Metabolism: Metabolism

Hepatic blood flow and hepatic mass decrease with age. The liver is responsible for the majority of drug metabolism

Age-Associated Changes in Drug Metabolism: Elimination

Renal blood flow and renal mass decrease with age. Results in gradual decline in GFR

This can improve quality of life, increase life span, as well as prevent depression, diabetes, heart disease, cancer, and osteoporosis

Exercise: Maintaining physical activity improves physical strength and fitness, as well as balance The successful management of aging requires proper nutrition in addition to regular exercise

At birth, the normal infant rapidly adapts by ___________________________

initiating active respiration

How much does the average baby weigh when delivered at term??

A baby delivered at term weighs about 3.2 kg. A baby whose birth weight is below the 10th percentile for gestational age is considered small for gestational age.

Are most baby's organs fully developed at birth?

No - Glomerular filtration rate (GFR) of the kidney and renal tubular function mature during the first year of life

What issues have prevented the introduction of full-scale automation in pediatrics?

Samples in tubes of many different sizes, varying from standard adult tubes to small pediatric tubes or microtainers Evaporation of sample from open tubes

Primary maintenance of blood gas and pH homeostasis following birth requires what??

Requires that the lungs and kidneys be sufficiently mature to regulate acid and base metabolism.

What are the 2 distinct types of cells that the lungs express at 24 weeks of gestation??

Type 1 pneumocytes—responsible for gas exchange Type 2 pneumocytes—responsible for secretion of surfactant (contains the phospholipids lecithin and sphingomyelin)

What is required for the lungs to expand and the transfer of blood gases following delivery??

Surfactant

What is the failure to excrete CO2 and the levels rise causing respiratory acidosis??

Respiratory Distress Syndrome (RDS)

Why is anaerobic collection a challenge for testing blood gases and pH in neonates and infants??

Because the sample must must be free flowing from a heelstick and sealed quickly. Processed very quickly too.

What are these? The causes of hypernatremia (sodium >145 mmol/L) and hyponatremia (sodium <130 mmol/L) Both must be treated to prevent seizures

Disorders Affecting Electrolytes and Water Balance

Nitrogenous End Products as Markers of Renal Function In contrast to the high neonatal ammonia levels, creatinine and uric acid levels are lower in newborns.

Creatinine concentrations increase with muscle mass Creatinine clearance test not typical—difficult to collect eGFR used—slightly different formula than adults Cystatin C is a potential newer test, not routinely used yet

Normal bone growth, which parallels body growth, requires integration of calcium, phosphate, and magnesium metabolism with endocrine regulation from vitamin D, parathyroid hormone (PTH), and calcitonin.

Lack of Vit D can cause rickets. 98% of total body calcium is in the bone

Define hypocalcemia

Hypocalcemia is defined as total serum calcium below 7.0 mg/dL or ionized calcium below 3.0 mg/dL.

This system is essential for regulating mineral and carbohydrate metabolism

Hypothalamic–Pituitary–Adrenal Cortex System

Hypothalamic–Pituitary–Thyroid System What secretes thyrotropin-releasing hormone (TRH), a 3-amino-acid peptide, into the portal blood system between the hypothalamus and anterior pituitary.

The hypothalamus

The hypothalamus secretes WHAT two regulatory hormones that affect growth??

GH inhibiting factor (somatostatin), GH releasing hormone

Endocrine Control of Sexual Maturation The hypothalamus secretes a 10-amino-acid peptide called gonadotropin-releasing hormone (GnRH) into the portal blood system

But this is suppressed in infants and young children

Describe some components of Neonatal and Infant Antibody Production

The human fetus synthesizes a small amount of IgM and, to a lesser degree, IgA

Transient hypogammaglobulinemia of infancy may occur because of

Prematurity or, in certain infants, may be a result of delayed onset of immunoglobulin production of unknown etiology. (Severe Combined Immune Deficiency—lack both humoral and cellular pathways for killing bacteria and viruses (boy in the bubble))

What is the importance of the list below - what does it symbolize? Phenylketonuria Steroid 21-hydroxylase deficiency Sickle cell disease CF Galactosemia (in some states and countries)

Newborn Screening for Whole Populations Certain inherited diseases are sufficiently common in the population to be considered candidates for whole population screening.

Geriatric/Pediatric Clinical Chemistry Flashcards

(54 cards)