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