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Clinical Chemistry > Trace/toxic Elements > Flashcards

Trace/toxic Elements Flashcards

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1
Q

Essential element

A

If a deficiency impairs a biochemical or functional process and replacement of the element corrects this impairment

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2
Q

Trace elements vs ultratrace elements

A
  • Trace = needed in mg/dl
  • Ultratrace = needed in microgram/dl
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3
Q

Non-essential trace elements

A

Many are toxic and are thus of medical interest

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4
Q

List 5 important factors of elements that are important to the clinical significance of disease states or toxicity

A
  • Absorption
  • Transport
  • Distribution
  • Metabolism
  • Elimination
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5
Q

Which blood collection tube is used for sample collection/processing upon suspicion of trace elements?

A

Royal blue stopper with or without EDTA

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6
Q

List trace element analytical methods

A
  • Atomic emission spectroscopy
  • Atomic absorption spectroscopy
  • Inductively coupled plasma mass spectrometry
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7
Q

Atomic emission spectroscopy

A
  • Quantify element by measuring intensity of emitted radiation from aerosolized sample
  • Setup similar to spectrophotometer (flame or plasma -> light emission -> monochromator -> detector)
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8
Q

Atomic absorption spectroscopy

A
  • Quantify element by measuring absorption of optical radiation by free atoms in gas phase
  • Setup similar to spectrophotometer
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9
Q

Atomic absorption spectroscopy light sources

A
  • Usually hollow cathode lamps (HCLs) and electrodeless discharge lamps (EDLs)
  • Flame and graphite furnaces most common sources
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10
Q

ID the element
Most abundant metal in earth’s crust
Widely used in industrial and household ways
Corrosion-resistant
Lightweight

A

Aluminum

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11
Q

Aluminum mode of absorption

A
  • Ingestion
  • Inhalation
  • Parenteral
  • NOT TRANSDERMAL
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12
Q

What percent of aluminum concentrates in bone and lung?

A

50% bone and 25% lung

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13
Q

Aluminum health effects and toxicity

A
  • Interferes with enzyme activity
  • Encephalopathy, anemia, bone disease, progressive dementia
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14
Q

ID the element
Both metallic and non-metallic properties
In pesticides, pigments, manufacturing processes (wood-preservation)
Odorless/tasteless

A

Arsenic

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15
Q

Arsenic’s largest source of exposure

A

Food
One of the most common poisons in history

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16
Q

Arsenic absorption/transport

A
  • Ingestion and inhalation
  • Hepatic metabolism
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17
Q

Clearance of organic versus inorganic arsenic

A
  • Organic arsenic rapidly cleared
  • Inorganic and methylated forms are toxic
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18
Q

ID the element
Found in rice
Soft, bluish-white metal - can be cut with knife
Used in industry, contaminates soil

A

Cadmium

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19
Q

Cadmium absorption

A
  • Ingestion (5%)
  • Inhalation (10-50%)
  • Higher in females + smokers than males + non-smokers bc iron stores different
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20
Q

Urine accounts for ___% of cadmium excretion and __% in bile

A
  • 95%
  • 2%
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21
Q

Cadmium health effects and toxicity

A
  • No role in human physiology
  • Affects liver, bone, immune system, blood, pulmonary, and nervous systems (everything)
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22
Q

ID the element
Used in making stainless steel
Has essential and toxic forms based on oxidation state

A

Chromium

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23
Q

Chromium absorption/transport

A
  • Ingestion
  • Inhalation
  • Skin
  • Transported bound to albumin and transferrin
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24
Q

Which forms of cadmium are essential or toxic?

A

Cr3+ is essential
Cr6+ is toxic and easier to absorb

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25
Q

Chromium health effects

A
  • Lung irritation and dermatitis more common
  • Liver, kidney, and immune system
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26
Q

ID the element
Relatively soft yet tough metal
Excellent electrical and heat conducting
Important cofactor for reduction of iron in heme synthesis

A

Copper

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27
Q

Copper absorption/transport/excretion

A
  • Ingestion
  • Inhalation
  • Dermal
  • Transported bound to albumin
  • Bile accounts for 98% excretion, <3% in urine/sweat
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28
Q

Copper health effects and toxicity

A
  • Important for many metalloenzymes
  • Hepatic and renal damage
  • Neurologic symptoms
  • Mucous membrane irritant
  • Wilson’s disease copper rings in eyes
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29
Q

Serum and urine copper levels in Wilson’s disease

A

Serum = normal or decreased
Urine = increased

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30
Q

Iron absorption

A

Ingestion (10% ingested is absorbed)
Ferric form must be reduced to Ferrous for absorption

31
Q

Iron transport

A

Bound to proteins (ferritin)

32
Q

Iron excretion

A
  • Primarily by desquamation of epithelia
  • RBC loss in urine/feces
  • Menstruation
33
Q

Iron health effects and toxicity

A
  • Important for Hgb, Mgb, and enzymes
  • Deficiency and overload states possible
  • Stored as ferritin and hemosiderin in BM, spleen, and liver
  • Iron deficiency in 15% world population
34
Q

Lab eval of iron status

A
  • Hgb
  • RBC indices
  • Total Fe
  • TIBC
  • % sat
  • Transferrin
  • Ferritin
35
Q

Serum iron

A

Refers to ferric iron bound to transferrin, NOT the free iron circulating in plasma

36
Q

Serum iron collection

A

Early morning collection preferred due to diurnal variation
No visible hemolysis

37
Q

Transferrin

A

Primary plasma iron transport protein, which binds iron

38
Q

Transferrin saturation

A

25-30%

39
Q

Unsaturated iron binding capacity (UIBC)

A

Additional amount of iron that can be bound (empty binding sites left on transferrin)

40
Q

Total iron binding capacity (TIBC)

A

Theoretical amount of iron that could be bound if transferrin and other minor iron-binding proteins present in serum/plasma were saturated

41
Q

TIBC calculation

A

TIBC = transferrin X 1.18

42
Q

Percent saturation

A
  • Transferrin saturation
  • Ratio of serum iron to TIBC
  • % sat = 100 X serum iron/TIBC
43
Q

Ferritin

A

Major iron storage protein

44
Q

Concentration of ferritin is directly proportion to what?

A

Total iron stores in body

45
Q

More sensitive and reliable test for iron deficiency

A

Ferritin

46
Q

Iron deficiency serum iron, transferrin, ferritin, percent sat, and TIBC relative values

A

Serum iron = lower
Transferrin = higher
Ferritin = lower
Percent sat = lower
TIBC = higher

47
Q

Iron overdose serum iron, transferrin, ferritin, percent sat, and TIBC relative values

A

Serum iron = higher
Transferrin = lower
Ferritin = higher
Percent sat = higher
TIBC = lower

48
Q

ID the element
Soft, bluish-white, highly malleable/ductile
Used to be put in gas and paint

A

Lead

49
Q

Lead absorption

A
  • Ingestion and inhalation
  • 99% absorbed by RBC
  • Liver, kidney, and brain with highest in bone (90%)
50
Q

Lead excretion

A
  • 76% urine
  • 16% feces
  • Remainder in sweat, hair, and nails
51
Q

Lead health effects and toxicity

A
  • No physiological role
  • Higher absorption in kids
  • Neurological symptoms and low IQ
  • Anemia
52
Q

ID the element
Used in production of steel

A

Manganese

53
Q

Manganese absorption

A
  • Mainly ingestion
  • Inhalation and dermal limited
  • Found mostly in fat and bone
54
Q

Manganese excretion

A

Bile accounts for majority of excretion

55
Q

Manganese health effects

A

Important for many metalloenzymes and enzyme activation

56
Q

Manganese deficiency effects

A

Clotting issues, dermatitis, elevated serum Ca/phosph/ALP

57
Q

Manganese toxic effects

A

Nausea, vomiting, headache, disorientation, anxiety, compulsive laughing or crying (manganese madness)

58
Q

ID the element
Quicksilver, heavy/silvery metal, liquid at room temp
3 oxidation states

A

Mercury
H^0, Hg1+, Hg2+

59
Q

Mercury absorption

A
  • Inhalation most common
  • Ingestion, cutaneous, injection, and dental
60
Q

Mercury major storage organ

A

Kidney

61
Q

Mercury excretion

A

Fecal and urinary

62
Q

Mercury health effects an toxicity

A
  • No physiologic role
  • CNS and PNS toxicity
  • Can damage most organs/tissues before symptoms occur
63
Q

Molybdenum absorption

A
  • Up to 80% by ingestion
  • Mainly liver, skeleton, kidneys
64
Q

Molybdenum bound to

A

Alpha-macroglobulin and RBC membranes

65
Q

Molybdenum excretion

A

Urinary

66
Q

Molybdenum health effects and toxicity

A
  • Important cofactor for several enzymes
  • Deficiency and toxicity rare
67
Q

ID the element
Used in electronic industry, nutritional supplements, pigments, pesticides, dandruff shampoos, and fungicides

A

Selenium

68
Q

Selenium absorption

A

Ingestion most common (up to 50% of diet)

69
Q

Selenium excretion

A
  • Mainly urine
  • Some in sweat and exhalation
70
Q

Selenium health effects and toxicity

A
  • Important antioxidant
  • Thyroid hormone synthesis
  • Deficient states -> cardiomyopathy
  • Toxic states -> GI, tachycardia, CNS symptoms
71
Q

ID the element
Bluish-white lustrous metal
Stable in dry air
Covered in white coating upon moisture exposure

A

Zinc

72
Q

Zinc absorption

A
  • Ingestion most common
  • Mainly muscle (60%) and bone (30%)
  • RBCs absorb most zinc in blood (80%)
73
Q

Zinc excretion

A

Feces

74
Q

Zinc health effects and toxicity

A
  • Important for enzyme activity, DNA/RNA, membrane structure…etc
  • Deficiency -> growth inhibition, testicular atrophy
  • Toxicity rare
  • Counteracts copper in Wilson’s disease

Clinical Chemistry (21 decks)

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