Chemistry Review

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Chemistry Review
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2012-05-30 20:48:21
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Chemistry Review
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  1. 1 through 3 SD values
    • 1-68.2
    • 2-95.5
    • 3-99.7
  2. QC Shift
    6 succesive values falling on either side of the mean
  3. QC Trend
    6 succesive values falling on one side of the mean or the other each successivly farther away from the mean.
  4. Electrolytes
    • Sodium
    • Potassium
    • Chloride
    • Carbon Dioxide
  5. Trace Minerals
    • Calcium (Ca)
    • Phosphorus (PO4-3)
    • Magnesium (Mg)
  6. Increased aldosterone concentration will do what?
    • Increase NA concentration
    • Decrease K concentration
  7. Increased NA cause
    • HYPERADRENALISM
    • CUSHING’S SYNDROME
    • SEVERE DEHYDRATION
    • DIABETIC COMA AFTER INSULIN THERAPY
  8. Decreased NA causes
    • METABOLIC ACIDOSIS
    • HYPOADRENALISM
    • ADDISON’S DISEASE
    • DIARRHEA
    • RENAL TUBULAR DISEASE
  9. Preferred method and specimen type for Na?
    Serum

    • Ion selective electrode
    • Glass ion exchange membrane selective for Na
  10. Increased K causes
    • URINARY OBSTRUCTION
    • RENAL FAILURE DUE TO SHOCK
    • RENAL TUBULAR ACIDOSIS
    • ADDISON’S DISEASE (HYPOADRENALISM)
  11. Decreased K causes
    • INADEQ INTAKE OF K+
    • DIARRHEA,
    • EXCESSIVE USE OF DIURETICS
    • ALKALOSIS
    • CUSHINGS SYNDROME (HYPERADRENALISM)
  12. K preferred fluid and method
    Serum

    ISE method vanomycin membrane selective for K
  13. Increased Chloride causes
    • Dehydration
    • Any condition causing decreased renal blood flow
    • Sever renal tubular disease
  14. Decreased chloride causes
    • Salt losing nephritis
    • Addison's disease (hypoadrenalism)
    • Metabolic Acidosis
    • Prolonged Vomiting
  15. Preffered speciman and method for testing Chloride (Cl-)
    Serum or heparinized plasma

    • ISE
    • Cl sensitive ion exchange membrane that selectively binds Cl

    • Tirtration methods
    • Mercuric nitrate titration with diphenyl carbazone as indicator end point is excess of mercury.

    Coulormetric-Amperometric titration with silver ions to form AgCl; endpoint in excess silver.
  16. Carbon Dioxide dissolves in extracellular fluids to form what?
    Carbonic Acid (H2CO3)
  17. Increased CO2 causes
    • Emphysema
    • Cardiac Disease
    • Hypoventilation caused by drugs
    • General Anesthesia
    • CNS Trauma
    • Compensation for increased HCO3 concentration
  18. Decreased CO2 causes
    • Fever
    • High external temps
    • Hysteria anxiety
    • Hypoxia
    • Salicylate use of mechanical ventilation
    • Alchoholism
    • Compensation for decreased HCO3
  19. Carbon Dioxide speciman collection methods
    • Preffered arteriol whole blood
    • heparin

    • Anaerobic conditions otherwise decreased CO2, increased O2
    • STAT otherwise increased CO2 and Decreeased O2
    • On Ice otherwise increased CO2 and Decreased pH
  20. Carbon Dioxide preffered method
    • Modified pH electrode
    • CO2 diffuses across glass membrane into the chamber with enclosed buffer

    pH change in buffer is measured by internal pH electrode
  21. Arterial Blood gasses
    ROME
    Resperitory Opposites Metabolic Equal
    Resperitory Opposites Metabolic Equal
  22. Metabolic acidosis
    Primary HCO3 deficit caused by?
    • Uncontrolled Diabetes
    • Renal Disease
    • Starvation
    • Diarrhea
    • Aspirin/ Methanol/ Ethylene glycol poisoning
  23. Lab results for Metabolic acidosis
    Decreased pH, CO2, and HCO3
  24. Resporitory alkalosis causes
    CO2 Deficit

    • Fever and High external temps
    • Hysteria, anxiety
    • Hypoxia
    • Excessive use of mechanical ventilation
  25. Respiratory alkalosis lab results
    • increased pH
    • Decreased CO2
    • Decreased HCO3
  26. Calcium controlled by?
    • PTH
    • Vit D
    • Calcitonin
  27. Calcium Ions do what?
    • DECREASE MUSCULAR EXCITABILITY
    • DECREASE CELL MEMBRANE PERMEABILITY
    • TRANSMIT NERVE IMPULSES
    • BLOOD COAGULATION
    • ENZYME ACTIVATOR
  28. Increased Ca causes?
    • PRIMARY HYPERPARATHYROIDISM
    • HYPERVITAMINOSIS (VIT D)
    • MULTIPLE MYELOMA
    • NEOPLASTIC BONE DISEASE
  29. Decreased Ca causes?
    • HYPOPARATHYROIDISM
    • STEATORRHEA
    • NEPHROSIS; NEPHRITIS
    • PANCREATITIS
  30. Ca collection anticoagulant?
    • Serum or heparinized plasma preffered
    • Most anticoagulants not sutable due to the chelation of calcium to prevent clotting
  31. Ca method
    ISE and O-Cresolphthalein complexone

    • O-CRESOLPHTHALEIN FORMS A COLORED COMPLEX WITH Ca+2 AT pH of 10 – 12; MEASURED SPECTROPHOTOMETRICALLY
    • 8-HYDROXYQUINOLONE IS ADDED TO REMOVE INTERFERING SUBSTANCES LIKE PO4 & Mg
  32. When is phosphorus monitered?
    • After infusion of dextrose solutions
    • Nutritional recovery syndrome
    • Alchoholic withdrawal
    • to evaluate kidney function
  33. Methods for Mg measurment.
    • Colorimetric
    • Titan Yellow
    • Methyl Thymol Blue
    • Calmagite

    ISE
  34. Dietary Fe+3 converted to Fe+2 by ______ then absorbed by________?
    • HCL
    • Small Intestines
  35. 70% of Fe+2 used in what?
    Hgb formation
  36. Ferrous Iron is what?
    Fe +2
  37. Ferric Iron is what?
    Fe +3
  38. Normal serum iron range
    • 50-150 ug/dl in adults
    • lower in adults over 50
  39. TIBC normal range
    300-360 ug/dl
  40. Normal iron % saturation
    20-45 in adults
  41. Serum Iron Ferritin normal ranges
    • 90 ug/L in males
    • 20-250 ug/L in females
  42. How to calculate percent saturation?
    Serum Fe / TIBC x 100 = % Saturation
  43. UIBC is?
    • Unsaturated Iron Binding Capacity (UIBC)
    • Unoccupied binding sites for the Fe on the transferrin molecule.
  44. Blood urea nitrogen is?
    • Waste product of protein metabolism
    • Made from ammonia (N3) in the liver.
    • BUN is filtered by the glomerulus 40% reabsorption by the renal tubules.
  45. BUN decreased causes?
    Seen only in instage liver disease.
  46. BUN Increased causes?
    Prerenal: Cardiac compensation, dehydration, increased protein catabolism.

    Renal: Acute Glomerulonephritis, Chronic Nephritis, Polycystic Kidney, Nephrosclerosis, Tubular Necrosis.

    Postrenal: Obstruction of urinary tract. Stones, tumors, prostate disease.
  47. MEASUREMENT OF BUN
    • FEARON REACTION REACTION
    • HEATED TO 100 C FOR 10 MINS
    • DIRECT REACTION OF UREA WITH DIACETYL MONOXIME TO FORM COLORED DIAZINE DERIVATIVE

    ENZYMATIC USING UREASE
  48. Creatinine reabsorption?
    • 100% filtered by kidneys
    • 0% reabsorbed
  49. Creatinine formation
    • Formed by dehydration of creatine phosphate (made in the liver stored in muscle)
    • muscle energy source
  50. Increased Creatinine
    Renal Disease specifically affecting glomerular function.

    Muscle disease
  51. Decreased creatinine
    • Due to low normal range (0.5-1.4)
    • Low creatinine is not significant.
  52. Creatinine Method
    • JAFFE METHOD
    • REAGENT: Alkaline picrate solution

    ENZYMATIC REACTION
  53. Uric acid formation?
    Breakdown product of nucleic acid metabolism
  54. Uric acid significance
    Indicates renal disease but rises only after Bun and Creatinine are already elevated.

    Diagnosis of gout
  55. Measurement of Uric Acid
    PHOSPHOTUNGSTIC ACID

    URIC ACID + PTA + Na2CO3 ------> CO2 + ALLANTOIN + TUNGSTEN BLUE
  56. Urea Clearance tells what?
    • Measure of overall kidney function
    • 100% filtered with 60% reabsorbed.
  57. Creatinine clearance tells what?
    • Measure of glomerular function
    • 100% filtered
    • 0% reabsorbed
  58. Hormones that increease blood glucose
    • Epinephrin
    • Growth Hormone
    • ACTH
    • Cortisol
  59. Diabetes Mellitus Type 1
    • AKA Juvenile Diabetes
    • 10% of known diabetics
    • Prone to ketosis
    • Abrupt Onset
    • Genetic Inheritance
    • Will die without insulin.
    • Inslet antibodies present in most
  60. DIABETES MELLITUS: TYPE II
    • Adult Onset
    • 80% of all Diabetics
    • 12% of entire population
    • Not prone to Ketosis
    • Insulin may or may not be necessary.
  61. HYPOGLYCEMIA
    • INSULIN INDUCED IN KNOWN DIABETICS
    • HYPERINSULINISM
    • HEPATIC DISEASE
    • IDIOPATHIC HYPOGLYCEMIA IN INFANTS

    ENDOCRINE DISORDERS: PANHYPOPITUITARISM, HYPOTHYROIDISM, HYPOADRENALISM
  62. GLUCOSE OXIDASE METHOD
    • Glucose oxidase
    • Glucose + O2 + H2O ----> Glucuronic acid & H2O2

    • Peroxidase
    • H2O2 + O-dianisidine -----> oxidized O-dianisidine + water
  63. GLUCOSE METHODS HEXOKINASE
    Glucose + ATP ----------> Glucose-6-phosphate & ADP

    Glucose-6-phosphate +NAD -----> 6-phosphogluconate + NADH
  64. O2 consumption Glucose method
    O2 depleted after the first step of the glucose oxidase reaction is proportional to glucose concentration.
  65. HA1C determines what?
    Average glucose conc. that cells have been exposed to over past 2 months
  66. Increased HA1C means what?
    Can detect uncontrolled diabetics who are compliant with treatment only immediatly prior to Dr. visit.
  67. Available HA1C methods
    • Cation-exchange chromatography
    • Electrophoresis
    • Iso-electric focusing
    • Immunoassay
  68. Total protein Functions
    • Enzymatic
    • Transport
    • Protective
    • Structural
    • pH Buffers
    • Maintain Osmotic pressure
    • Storage
    • Contractile
    • Hormones
    • Synthesis of body tissues
  69. Increased total protein means
    • Dehydration
    • Prolonged Stasis during venipuncture
    • Chronic disease state e.g.
    • SARCOIDOSIS, CIRRHOSIS, COLLAGEN DISEASES, CHRONIC INFLAMMATORY CONDITIONS
  70. Decreased total protein means?
    • Overhydration
    • Nephrotic Syndrome
    • Extensive Burns
    • Protein Losing Lesions in GI tract
    • Dietary protein deficiency
    • Malabsorption syndromes
    • Liver disease
  71. Total Protein Methods
    • Refractometry
    • Biuret
  72. Biuret Reaction
    Measurement of total protein

    3 CONH + ALK CuSO4 --> Chelated Cu complex

    *Chelated Cu complex has violet blue color
  73. Albumin Info
    • Made almost exclusivly by the liver
    • Supports osmotic pressure
    • Helps control water distribution in the body
    • Transports small molecules
    • Binds substances: Bilirubin, calcium, free fatty acids, aspirin
  74. Increased Albumin means what?
    Seen only when there is a loss of plasma water (dehydration) or excessive IV albumin therepy
  75. Decreased Albumin means?
    • Low protein intake
    • liver failure
    • Increased protein loss
    • reduced synthesis of proteins
    • increased protein catabolism
    • inadequate digestion or absorption of injested protein
  76. Dye binding assays for the measurement of Albumin
    • Binding of albumin to dye causes color change
    • (Nonionic-->Ionic)

    • Methyl Orange
    • 2,4-Hydroxy, Azobenzene-Benzoic Acid (HABA)
    • Bromcresol Green
    • Bromcresol Purple
  77. Dye binding reaction color changes for Albumin
    ALBUMIN + INDICATOR DYE -----> ALBUMIN-DYE COMPLEX

    • BCG Yellow--->Green
    • BCP Yellow---->Purple
  78. Globulin formula from total protein
    TP Value - Albumin Value= Globulin
  79. A/G Ratio
    Albumin globuin ration

    Albumin / Globulin
  80. Protein Electrophoresis migration order
    (+) Albumin, Alpha 1, Alpha 2, Beta, Gamma (-)
  81. Hemolysis (DIC)
  82. Monocolonal Gammopathy
  83. Normal SPEP
  84. Bilirubin is formed how?
    • Hemoglobin Metabolism
    • Hemoglobin Breakdown

    Billirubin forms from broken down heme then excreted through the liver.
  85. What happens to the iron from broken down HGB
    Recycled into new HGB
  86. What happnes to protein leftover from the breakdown of HGB
    Recycled into the amino acid pool
  87. Progression of Hemoglobin breakdown.
    • Biliverdin--->
    • Free protein bound Bilirubin--->
    • Conjugated Bilirubin (Liver-->bile duct)--->
    • Urobilinogen by bacterial intestinal flora--->
    • Feces and kidney/urine
  88. Direct Bilirubin
    • Conjugated
    • processed through liver and conjugated with glucuronic acid
    • can be excreted through kidneys; non toxic
  89. Indirect Bilirubin
    • Unconjugated
    • Most likely cause of Jaundice
    • Water Insoluble
    • Bound to albumin for transport
  90. Increased Total Bilirubin
    Prehepatic Conditions- Hemolysis

    Hepatic Conditions-anything that causes damage to the liver

    Post hepatic conditions- Gallstones, neoplasms, bile duct obstructions.
  91. Decreased total bilirubin means
    Not a damn thing
  92. Total Bilirubin methods
    • Based Van Den Bergh Reactions
    • Jendrassik-Grof Method
    • Evelyn- Malloy Method
  93. Based Van Den Bergh Reaction
    Measurement of bilirubin

    BILIRUBIN + SULFANILIC ACID + HCl + NaNO2---> AZOBILIRUBIN
  94. Jendrassik - Grof Method
    For measurement of Bilirubin

    USES CAFFEINE BENZOATE TO MAKE DIRECT & INDIRECT BILI WATER SOLUBLE; ALKALINE TARTRATE SHIFTS pH TO ALKALINE (BLUE COLORED COMPLEX)
  95. EVELYN-MALLOY method
    USES METHYL ALCOHOL TO MAKE ALL TYPES OF BILI WATER SOLUBLE; END PRODUCT READ AT ACID pH
  96. TOTAL BILI REACTION
    TBILI + DIAZO RGT + ALCOHOL OR CAFFEINE ----> AZOBILIRUBIN

    • IF pH ACIDIC AZOBILIRUBIN IS RED
    • IF pH ALKALINE AZOBILIRUBIN IS BLUE
  97. DIRECT BILI REACTION
    TBILI + DIAZO RGT ----> AZOBILIRUBIN

    • IF pH ACIDIC AZOBILIRUBIN IS RED
    • IF pH ALKALINE AZOBILIRUBIN IS BLUE
  98. Formation of ammonia
    Formed in the liver from removal of NH2 amino acids.

    Detoxified by conversion to urea.
  99. Normal Ammonia range

    Critical range and meaning
    10-70 ug/dl

    • >400 ug/dl
    • reyes's syndrome & impending coma
  100. UV KINETIC (DECREASE ABS) method
    Measurement of Ammonia (NH3)

    • NH3 + ALPHA KG + NADH -----> NAD + H2O + GLUTAMATE
    • Glutamate Dehydrogenase= GDH
  101. AST is what?
    Aspartate Aminotransferase

    • AST catalyzes transfer of an amino group
    • Found primarily in liver, heart & skeletal, and kidney
  102. Markedly increased AST mean what?
  103. AMI (24-36 hours after onset of pain)
    • Viral Hepatitis
    • Toxic liver necrosis
  104. Moderatly elevated AST means what?
    • Cirrhosis
    • Skeletal Muscle Disease
    • After Trauma or Surgery
    • Severe Hemolytic Anemia
  105. Decreased AST
    Not commonly seen

    Uremia and Vit B12 deficiencies may cause low values
  106. AST measurement methods
    Coupled enzymatic reaction

    L-aspartate + alpha-oxoglutarate -- Oxaloacetate + L-glutamate

    Oxaloacetate + NADH + H+ -- Malate + NAD
  107. ALP is what?
    • Alkaline Phosphotase
    • Plays role in membrane transport of molecules
    • Group of several enzymes that catalyzes transfer of PO4 (phosphate) group in an alkaline medium.
    • Primarily related to liver and bone disease.
  108. 10 X increase in ALP means what?
    Obstructive Hepatobiliary tract disorders
  109. moderate 1-3 x increase in ALP means what?
    Hepatic disease
  110. Increase in ALP values not caused by Hepatobiliary tract disorders
    • Osteoblastic cells of bones:
    • Paget's Disease, Ricketts
    • Hyperthyroidism
    • In children, adolescents, healing bone fractures
  111. Decreased ALP (Alkaline Phosphotase)
    • Hypothyrodism
    • Scurvy
    • Hypophosphatemia
    • Severe anemia
  112. ALP does what at room temp?
    Increases 5-10%
  113. ALP methods
    Based on Bessey, Lowery, Brock method

    P-Nitrophenylphosphate changes to p-nitrophenol a yellow color deveopes and is measured at 405 um
  114. ALT is what and does what?
    • Alanine Transferase
    • ALT catalyzes transfer of amino group
  115. What is the ALT co-enzyme?
    • pyridoxal-5,-phosphate
    • needed for full enzyme activity
  116. What liver enzyme is more specific than AST?
    ALT (Alanine Transferase)
  117. ALT (alanine transferase) methods
    Coupled enzymatic reaction

    Alanine, pyruvate, L glutamate, lactate,

    measured at 340 nm
  118. What is CK?
    • Creatine Kinase
    • CK is a cytoplasmic & mitochondrial enzyme that catalyzes phosphorylation
    • Mg required for full enzyme activity
  119. CK is elevated when?
    • Predominatly in diseases of skeletal and cardiac muscle.
    • Used to diagnose AMI
  120. CK levels after AMI?
    • Begin to rise 4-12 hours
    • Peak levels at 24 hours
    • Returns to normal after 3 days
  121. CK-MB
    • Not specific for MI but rises with other cardiac conditions
    • Typical pattern
    • 4-8 hours
    • peak 15-24
    • normal 48-72
  122. CK method
    • Coupled Enzymatic reaction
    • End product Phosphogluconate

    G6PD
  123. Troponin is what?
    • Regulates muscle contractions
    • Specific for cardiac necrosis and is helpful when CK-MB has already returned to normal.
  124. Prognosis of elevated Troponin
    Poor
  125. Elevated Troponin levels in time
    • 4 hours within onset of pain
    • remains elevated for 10-24 days
  126. Myglobin useful for what?
    • Highly sensitive marker for AMI
    • Rises 2-5 hours after Infarc
    • peaks at 12 hours
    • Cleared by kidneys
    • Not specific for cardiac muscle
  127. Amylase main function?
    • Aids in digestion of carbohydrates
    • First salivary amylase
    • then pancreatic
  128. Amylase meaning and activity time frame
    Used for the diagnosis of acute pancreatitis

    • Rises 2-12 hours after onset of pain
    • PEaks at 24 hours
  129. Lipase useful for what?
    • Diagnosis of acute pancreatitis when amylase levels have returned to normal
    • Remains elevated for up to 14 days
  130. GGT is what and indicates what?
    • Gamma-glutamyl Transferase
    • Serves as an early indicator of liver disease.
    • especially due to alcohol damage
    • Also obsturctive liver disease in children or during pregnancy
  131. Increased Lactic dehydrogenase (LD) can mean
    • Hemolyzed sample
    • Hematological disorders
    • AMI
    • Hapatitis/ Liver Disease
    • Acute Renal disease
    • Malignancies
  132. Cardiac Enzyme Profile Tests
    • CK
    • CK-MB
    • AST
    • Troponin
    • Myglobin
  133. Liver Enzyme Profile Tests
    • ALT
    • AST
    • ALP
    • GGT
  134. Pancreatic enzyme profile
    • Amylase
    • Lipase
    • GGT
  135. Muscle enzyme profile
    • CK
    • CK-MM
    • AST
  136. Bone Enzyme profile
    • ALP
    • ACP
  137. Malignancy Enzymes
    • ACP
    • LD
  138. good cholesterol
    • HDL
    • packaged for removal by the liver
  139. Cholesterol Methods
    • Leiberman-Burchardt (Fat Burchardt)
    • Uses
    • Sulfuric Acidd
    • Acetic acid
    • Green end product
  140. What are triglycerides?
    Fatty acids are stored in cells as tryglycerides
  141. Lipid Electrophoresis order
    • Anode to cathode
    • HDL, VLDL, LDL, Chylomicrons
  142. Iron is stored as what?
    • Ferritin
    • Hemosiderin
  143. Iron method
    • Spectrophotomic
    • Acidification release to change Fe+3 to Fe+2
    • Complexes with color reagent
  144. UIBC is what?
    • Unsaturated Iron Binding Capacity
    • Part of anemia work-up
    • Asses iron binding sites not already bound with iron
  145. UIBC calculated how?
    Difference between Serum Iron concentration and TIBC
  146. Thyroid Hormones regulate what?
    • Carbohydrate, Lypid and protein metabolism
    • CNS development
    • Bone & Tissue Growth development
    • GI function
    • Sexual Maturation
  147. What are the thyroid hormones and what are they used for?
    • T3= triiodothyronine
    • T4= Thyroxin

    • Used to determine the extent of hyperthyroidism or hypo...
    • t4 found in higher concentration than T3
  148. Increased T3 & 4 means what?
    • Graves disease
    • toxic multinodular goiter
    • Pituitary tumors
    • Thyroiditis
  149. Decreased T3 and 4 means
    • Hypershyroidism
    • Hashimoto's thyroiditis
    • Pituitary or Hypothalmic disease
    • Spontaneus hypothyroidism
  150. First and best test for thyroid abnormalities?
    • s-TSH
    • uses 3 seperate monocolonal antibodies to give test high specificity
  151. Excess of cortisol?
    Cushings Syndrome
  152. Addison's disease lab results
    • Lack of cortisol
    • LAck of aldosterone
    • Decreased NA
    • Increased K
    • Increased BUN
    • Decreased Glucose

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