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Clinical Biochemistry Clinical Biochemistry, Exams of Biochemistry

Massachusetts Institute of Technology (MIT)Biochemistry

Clinical Biochemistry Clinical Biochemistry

Typology: Exams

2023/2024

Available from 04/24/2024

DrShirley
DrShirley 🇺🇸

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Clinical Biochemistry
How is ECF volume tightly regulated? -
- by adjusting water and electrolyte intake and excretion
- goal is to maintain a constant osmolality
Which two electrolytes give information about ECF osmolality? -
Sodium and Chloride
What compound gives information about serum pH? -
bicarbonate
What compounds give information about hormonal disturbances? -
Calcium and Potassium
Sodium -
- principal extracellular cation
- main indicator of ECF oncotic pressure
- low values observed due to water retention with dilutes body fluids (hyponatremia)
- high values commonly caused by dehydration (hypernatremia)
What compound is the main indicator of ECF oncotic pressure? -
Sodium
Potassium -
- major intracellular cation
- important for membrane potential of muscle and nerve cells
- low values (hypokalemia) are commonly caused by potassium loss (GI, Renal)
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Clinical Biochemistry

How is ECF volume tightly regulated? -

  • by adjusting water and electrolyte intake and excretion
  • goal is to maintain a constant osmolality Which two electrolytes give information about ECF osmolality? - Sodium and Chloride What compound gives information about serum pH? - bicarbonate What compounds give information about hormonal disturbances? - Calcium and Potassium Sodium -
  • principal extracellular cation
  • main indicator of ECF oncotic pressure
  • low values observed due to water retention with dilutes body fluids (hyponatremia)
  • high values commonly caused by dehydration (hypernatremia) What compound is the main indicator of ECF oncotic pressure? - Sodium Potassium -
  • major intracellular cation
  • important for membrane potential of muscle and nerve cells
  • low values (hypokalemia) are commonly caused by potassium loss (GI, Renal)
  • high values often result from renal insufficiency (hyperkalemia); affects muscle function and can trigger cardiac arrest with no warning Bicarbonate -
    • indicative of acid/base balance
  • must be monitored in conditions like DKA, along with glucose, pH, and electrolyte concentrations Calcium -
    • affects neuronal and muscular function; it is subject to tight hormonal control
  • low values (hypocalemia) indicates hormonal disturbances
  • high values (hypercalemia) indicates hormonal disturbances, but can also signify degradation of calcium stores in the skeleton through bone disease of cancer Phosphate -
    • stored in bones in the form of calcium phosphate
  • hyperphosphatemia can indicate degenerative bone disease; more commonly it is due to renal failure
  • hypophosphatemia is worrisome because it impairs glucose metabolism; with DKA phosphate levels must be monitored during treatment by glucose infusion Blood gases - CO2 concentration can be measured directly in an arterial blood sample
  • must be rushed to the lab immediately Metabolites in Serum - Glucose, Urea (BUN); Creatinine, Uric acid, direct and indirect bilirubin BUN values - blood urea nitrogen
  • serum increases in urea while urine urea decreases is indicative of kidney disease
  • reflects the balance between AA degradation/urea production and excretion

Serum enzyme markers for MI, and the timing of release - Myoglobin- occurs very quickly after MI; not specific to MI however Creatine Kinase - detectable fairly shortly after MI; peaks at ~2 days AST - released later than CK-MB; peaks ~3 days Troponins - most sensitive markers for MI; if after 12 hours, there are no troponins, there was no MI Cardiac LDH - released several days after MI; peaks ~4 days Alkaline Phosphate -

  • increased levels of alkaline phosphatase are indicative of bone or liver disease
  • obstruction of the gall duct with cause an increase in serum alkaline phosphatase
  • increase in bone remodeling (bone cancer, Paget's disease) will lead to increase in serum AP
  • liver disease will be distinguished with high bilirubin levels AST/ALT -
  • high levels in muscle and liver
  • in heart and other muscles, AST is 10x that of ALT
  • in liver, AST and ALT are approximately equal
  • high AST and low ALT indicate heart and other muscle damage
  • high AST and high ALT indicate liver damage Purpose of Urine Analysis -
  • Glucose: urine glucose signifies hyperglycemia
  • Bilirubin: conjugated bilirubin in urine indicates biliary obstruction
  • Ketones: indicates fatty acid breakdown; occurs in uncontrolled diabetes or starvation
  • Protein: indicates renal disease Basic Metabolic Panel -
  • 8 tests for the analysis of kidney function, blood sugar, acid/base and electrolyte balances
  • glucose, calcium, sodium, potassium, chloride, CO2, BUN, creatinine

Liver Function Tests -

  • bilirubin, AST, ALT, and alkaline phosphatase
  • elevated bilirubin and AP indicate blockage of bile duct
  • elevated AST and ALT indicate hepatocellular damage Kidney Disease -
  • both acute and chronic renal disease disturb the homeostasis of water and electrolytes
  • serum BUN and Creatinine will be elevated in renal failure -urine osmolality will be low in renal failure Diabetes management -
  • glycated hemoglobin HbA1c; indicates long term blood glucose levels
  • proteinuria- protein in the urine can detect the onset of diabetic nephropathy
  • C-peptide: amount of C-peptide in serum is good measure of endogenous production of insulin