Clinical Chemistry Review

June 8, 2018 | Author: clower112 | Category: Thyroid Stimulating Hormone, Adrenocorticotropic Hormone, Cortisol, Thyroid, Adrenal Gland


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ABG Metabolic Acidosis o Low HCO3, Normal pCO2, Low pH  Hyperventilation  Metabolic alkalosis o High HCO3, Normal pCO2, High pH  Hypoventilation  Respiratory Acidosis o Normal HCO3, High pCO2, Low pH  Kidneys excrete H+  Respiratory Alkalosis o Normal HCO3, Low pCO2, High pH  Kidneys excrete HCO3, retain H+ Glucose Methods  2 Enzymatic methods o Glucose Oxidase  Coupled reactions  Method on urine dipstick  O2 + Chromogenic acceptor = Color o Hexokinase  Coupled reactions  Final product = NADPH, measured @ 340nm or with colored product 340 nm  AST  ALT  GGT  Amylase (Starch) Potentiometer  Measures voltage  pH  pCO2  Free calcium  K  Na  pO2  Li  Cl Amperometric  Measures current  Glucose Jaffe Reaction  Measures creatinine (color reaction)  Picrate used in reaction Protein  Albumin o Dye and colorimetric o BCG or BCP (Brilliant Cresyl Green or Purple) Bradford/Coumassie  Colorimetric  Coumassie – measures protein in CSF/urine where protein will be in low concentration Biuret  Copper binds to peptide bonds (Color reaction) Bilirubin  Jendrassik-Grof  Diazo reagent Lipoproteins  ApoB-100 o VLDL, LDL o Liver  ApoB-48 o Chylomicrons o Intestines Nephelometry  Ig’s, Complement Fluorometric  Hormones (Small MW’s)  High sensitivity ALP  Bone Urobilinogen  Erlich’s Test Lipid Profiles  Chylomicrons o Exogenous (dietary) triglycerides  VLDL o Endogenous triglycerides  LDL o Cholesterol to cells (heart)  HDL o Cholesterol out of cells (heart)  Triglycerides o Primary form of lipid storage o Transported by chylomicrons (exogenous), VLDL (endogenous)  Cholesterol o Important in cellular physiology Neurological vs. Cutaneous  Neurological porphyrias o High ALA, PBG o Deficiencies early in pathway  Cutaneous porphyrias o High porphyrins o Deficiencies later in pathway o 400 nm absorption causes cellular damage when emission “excites oxygen” Transudate vs Exudate  Exudate o > 0.5 o +++ Protein  Transudate o < 0.5  Fluid/Serum Peaks and Troughs  Measure 15 minutes before next dosage for trough Nephrotoxic Drugs  Gentamycin  Vancomycin  Streptomycin  Tobramycin Aspirin  Stimulant  Causes respiratory alkalosis, changes to metabolic acidosis Half Lives  Digoxins has high half life  Normally test at 4 hours, Digoxin is tested at 8 hours Tylenol  Mucomyst used when overdosed – gives glutathione substitute Cyanide Poisoning  Inhibits mitochondrial cytochrome oxidase, which blocks the electron transport chain  become completely anaerobic. Lactic acidosis because of anaerobic metabolism Carbon Monoxide Poisoning  Binds to hemoglobin  No oxygen transport MetHgb  Oxidizes Fe2+ to Fe3+ (Ferric to Ferrous)  G-6-PD Drug Categories  Analgesics o Opiates  Morphine, Codeine, Hydrocodone, Oxycodone, Demerol o NSAIDS  Aspirin (salicylate)  Reye’s Syndrome, Ibuprofen, Naproxin o Tylenol (Acetaminophen)  Fits/Anti-seizure Drugs o Phenobarbitol  Barbiturate and Anti-seizure drug o Phenotoin (Dilantin)  Most common o Carbamazepine o Valproic Acid  Psychics o Lithium o Tricyclic Anti-Depressants  Cardio o Digoxin o Digitoxin Drugs of Abuse  Acetaminophen  Depressants o Alcohol o Barbiturates o Benzodiazepine  Stimulants o Cocaine o Amphetamines  Hallucinogenics o LSD o Phencylidine (PCP, Angel Dust) o Marijuana  Opiates (Narcotics) o Morphine and others + Opium  Narcotics o Pinpoint pupils Creatinine Clearance  U/S x V/T x 1.73/Surface Area Cardiac Markers  Peaks at 3-4 hours o Myoglobin  Peaks at 4-8 hours o CK-MB  Peaks within 4 hours o Troponin  Peaks at 12-24 hours o LDH  Duration of Markers o Myoglobin drops after 24 hours o CK-MB drops within 2-3 days o LDH drops after 5 days o Cardiac troponin drops after 7-10 days Liver Panels  Viral hepatitis o ^^ AST = ^^ ALT o ^ GGT o ^ ALP  Hint: T = T  Obstructive o ^ AST = ^ ALT o ^^ GGT o ^ ALP  Hint: HALT, Obstruction  Alcoholic o ^^^GGT o ^ ALP o ^ALP o ^^ AST  Should be 2-3x value for ALT. AST 2-3x > ALT  Hint: Fall on your ASSt as an alcoholic  ALP o Bone Endocrinology  Steroids o Cortisol  Adrenal cortex o Aldosterone  Adrenal cortex o Estrogen  Ovaries o Progesterone  Uterus o Testosterone  Testes  Peptides o ADH  Posterior pituitary o ACTH  Anterior pituitary o Glucagon (increases plasma glucose)  Pancreas o PTH  Parathyroid  Protein o Growth Hormone  Anterior pituitary o Insulin  Beta cells in pancreas o Prolactin  Anterior pituitary o FSH  Anterior pituitary o HCG  Placenta o TSH  Anterior pituitary o LH  Anterior pituitary  Amino Acid Derivatives o Epinephrine, Norepinephrine  Adrenal medulla  Thyroid o Hypothyroid (Hasimoto’s)  Primary = Low T3/T4, Normal TSH (Thyroid)  Secondary = Low T3T4, Low TSH (Pituitary) o Hyperthyroid (Grave’s Disease)  Primary = High T3/T4, Normal TSH (Thyroid)  Secondary = High T3/T4, High TSH (Pituitary)  Tertiary = High T3/T4, High TSH, High TRH (Hypothalamus) o Hypocortisol (Addison’s)  Low cortisol and aldosterone  High ACTH, Low sodium  Primary = Low cortisol, Low aldosterone, High ACTH o Hypercortisol (Cushing’s)  High cortisol and aldosterone  High ACTH o Hyperaldosterone (Conn’s)  High cortisol and aldosterone  Low ACTH
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