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Clinical Chemistry 1 > Trace Elements and other Electrolytes > Flashcards

Trace Elements and other Electrolytes Flashcards

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1
Q

What are the toxic trace elements?

A

-aluminum
-Arsenic
-Cadmium
-Lead
-Mercury

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2
Q

What are the essential trace elements tested in the lab?

A

-chromium
-copper
-Fluorine
-Iodine
-Manganese
-Molybdenum
-Selenium
-Zinc

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3
Q

increased copper absorption is facilitated by binding to ____________

A

amino acids
-can be used as treatment to increase levels

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4
Q

Copper source dietary (~___% of intake is absorbed)

A

50

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5
Q

Copper is Excreted mainly in ______, with some excretion via urine

around ______ug/day

A

bile, <40

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6
Q

Copper is important for enzymatic activity and is a ___________.

A

cofactors

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7
Q

examples of copper cofactors

A

Ceruloplasmin***, cytochrome oxidase, dopamine β-hydroxylase, tyrosinase, and many
others.

Fe2+ —-> Fe3+

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8
Q

copper carrier that is important for iron

A

Ceruloplasmin***

(ferroxidase?)

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9
Q

Copper:

In plasma, _____% bound to ceruloplasmin (ferroxidase, an enzyme important in
Fe2+ oxidation prior to “transferrin” binding)

A

95

-small amount associated with albumin (not strong binding)

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10
Q

Copper induces ____________ synthesis (complexes with Cd2+, Cu2+, and Zn2+)

A

Metallothionein

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11
Q

What is the function of Cysteine (-SH) rich low MW protein?

A

unclear
Research indicate that protection against metal toxicity
against oxidative stress (similar to how transferrin prevents damage from iron)

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12
Q

Glutathione is reduced from _____ oxidized from GS.

2GSH/GSSG ratio

What does an increased ratio mean? a decreased?

A

GSH

-can handle more oxidative stress
-increased in cells, could have damage by oxidative stress

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13
Q

diet contains about ____ mg/d of copper

A

1.2

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14
Q

During the last 3 months of
pregnancy, liver development
occurs. A premature baby has less ______ storage in the liver.

A

copper

-also abnormal hematological characters and abnormal bone formation

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15
Q

Typically in male infant
@ 2-3 month
X-linked genetic defect

A

Menke’s Kinky Hair Syndrome

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16
Q
  • Impaired Cu2+ intestinal absorption
  • Severe cerebellar & cerebral degeneration, failure to thrive, osteoporosis,
    motor delay, and death within the first decade of life (about 3 year)
A

Menke’s Kinky Hair Syndrome:

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17
Q

how is Menke’s Kinky Hair Syndrome treated?

A

Cu-histidine if caught ealry

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18
Q

causes of copper deficiency?

A

Decreased dietary intake
▪ ↓ Activities of various Enzymes
- Microcytic-hypochromic anemia, neutropenia, heart disease, bone & joint
osteoarthritis, hypothermia, hypercholesterolemia.
- decreased antioxidant protection and metabolic activity

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19
Q

What levels are considered copper deficiency for plasma and ceruloplasmin?

A

< 10μM (70mg/dl) : [Cu++]
plasma
< 220mg/L: ceruloplasmin

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20
Q

Copper excess Can be detected with
* ____ Liver function
* “ [Cu2+] in urine (> _______)

A

decreased, 500μg/L

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21
Q

copper excess is associated with _____________ disease

A

Wilson’s

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22
Q

↑ copper accumulation in
liver, brain, kidney, & cornea of the eye (rings of Cooper-Kayser-Fleisher rings).
* No copper found in serum due to a decrease in “ceruloplasmin”
-with increased non-ceruloplasmin bound Cu2+

A

Wilson’s disease

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23
Q

What is the treatment for Wilson’s disease?

A

chelating agents, .V administration, e.g. Penicillamine

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24
Q

increased copper causes….

________ Vit. C
________ Zinc
_________Vit. A

A

decrased
decreased
increased

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25
Q

◆Factors that increase serum [Cu2+]

A

oral contraceptives, pregnancy, infections.

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26
Q

Increased serum Cu, __________ hepatic synthesis of ceruloplasmin.

A

increased

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27
Q

With Wilson’s disease, is copper increased in tissue or serum?

A

increased in tissues to toxic levels

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28
Q

What is it called when there is a copper ring in the eyes associated with Wilson’s disease

A

Cooper-Kayser-Fleisher rings

29
Q

Copper levels in ________ is not a reliable indicator of copper status.

A

serum

30
Q
  • Measurement of [Cu2+]serum is ______ indicative of copper status
A

NOT

31
Q

What is a more accurate indicator of copper levels?

A

Examination of decreased cytochrome oxidase activity in
leukocytes****

32
Q

Three ways copper can be measured?

A
  1. Flame Atomic Absorption spectrophotometry (serum plasma or urine)
  2. Colorimetric spectrophotometry using chromagen;
    1) cuppizone or 2) bathocupoine
  3. Immunoassay: Ceruloplasmin
    TRACE ELEMENTS: COPPER METHODOLOGY
    [Cu2+]serum is not reliable indicator of Cu2+ status
    * In the case of Cu2+ depletion: “ free ceruloplasmi
33
Q

In the case of Cu2+ depletion: ________ free ceruloplasmin

A

increased

34
Q

What are the two chromagens that can be used with Colorimetric spectrophotometry?

A

1) cuppizone or 2) bathocupoine

35
Q

_______ is 2nd most abundant trace element in body (~2g in adult)
(first is iron)

A

Zinc

36
Q

Zinc: ______% found in muscle, _____% in bone, _____% in blood.

A

50-60,
28,
0.5 (RBCs are 75-88%)

37
Q

Zinc:
In serum, ________% bound to albumin, ________% to α2-macroglobulin & transferrin

A

60-70, 30-40

*small fraction in free from

38
Q

Zinc is an essential __________ for many enzymes. examples?

A

Cofactor

carbonic anhydrase, alcohol dehydrogenase, RNA/DNA polymerase

39
Q

Zinc is necessary for cell _________________ and organ ________________.

A

Reproduction, development

40
Q

copper binds to protein more firmly than ____ does.

➢ Unabsorbable (zinc?) complex in GI tract —-> Decrease Cu++ absorption

A

zinc

41
Q

zinc fingers are formed from…

A

cysteine and histadine

42
Q

about ___ mg/d of zinc in diet

A

10

43
Q
  • Required for the activity of enzyme that are critical for nucleic acid replication &
    protein synthesis
    -Necessary component for cell replication
A

zinc

44
Q

most common cause of zinc deficiency

A

Malabsorption & dietary deficiency

(causes increased susceptibility to disease)

45
Q

effects of zinc deficiency

A

infections, trauma, sickle cell anemia, renal disease,
and alcohol abuse
* skin lesions (extremities and orifices), diarrhea, hair loss,
growth retardation, and decreased immune system function.

46
Q

CLINICAL CASES OF Zn DEFICIENCY:

A

-IV feeding after surgery
-delayed wound healing, dermatitis,
mental depression, diarrhea

47
Q

Experimental evidences for Zinc deficiency
- Fetal abnormalities…

A

Impaired embryogenesis
* Impaired brain development
* Impaired vision

48
Q

symptoms of zinc toxicity

A

Abdominal pain
* Diarrhea
* Nausea
* Vomiting

49
Q

What is the major source of circulating ammonia?

A

action of Bacterial 1) proteases, 2) Urease, 3) Amine oxidase acting on GI tract content

50
Q

NH3 is absorbed into ________ circulation

A

portal

51
Q

ammonia is removed by the _______, urea synthesis, and eliminated in ________

A

liver, urine

52
Q

cirrhosis or severe hepatitis, or decreased liver function = _________

A

increased ammonia due to inability to convert to urea

53
Q

________ function determines the NH3

A

liver

54
Q

small amounts of ammonia are produced by _____________.

A

exercise

55
Q

Renal tubules produce their own NH3 from…

A

deamination of glutamine

-NH3 diffuses from renal cells into tubule

56
Q

Does the kidney contribute to blood NH4?

A

NO**

57
Q

NH3 in urine binds to H+ to form…

A

NH4

58
Q

False elevation [NH3]: correction of sources of preanalytical error include…

A

1) Contamination
2) Collection process: prolonged tourniquet use
3) Delayed analysis

59
Q

causes of increased ammonia?

A

-infants (liver is still developing)
-liver disease (acute viral hepatitis and “Reyes syndrome”
-Chronic cirrhosis

60
Q

is a form of hepatic destruction following recovery from viral infection

A

REYES SYNDROME

61
Q

what can increased ammonia cause?

A

Causes neurological abnormalities because NH3 can cross BBB (coma, seizures)

62
Q

In pH of 9-9.6, Lactate dehydrogenase ______ —> _______ by NAD+ to NADH + H+

A

L-Lactate —–> Pyruvate

63
Q

In pH of 7.5, Lactate dehydrogenase ______—> _______ by NADH + H to NAD+

A

Pyruvate —–> L-lactate

64
Q

_______ in blood, is a sensitive indicator of oxygen deprivation.

Who should be monitored for this?

A

lactate

critically ill patients

65
Q

Increased lactate may be caused by…

A

Decrease in 1) tissue blood perfusion which could decrease tissue oxygenation (coronary
ischemia)
* Defective carbohydrate metabolism
* Respiratory disease

66
Q

what are the therapeutic levels of lithium?
toxic levels?

A

-1-1.2 mEq/L
->1.5 mEq/L)

67
Q

How does lithium affect the CNS?

A

inhibiting effects of norepinephrine (NE) and serotonin release and increasing reuptake of NE.

68
Q

Toxicity of Lithium is associated with…

A

vomiting, ataxia, muscular rigidity, and EEG changes.

Clinical Chemistry 1 (9 decks)

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