Clinical Chemistry 3

formed and function intracellulary thus we should see decreased levels in the blood. Exist in specific cells/tissues/organs thus increased levels in the blood indicates a problem with that specific cell/tissue/organ

• 1. Leap out of damaged or dying cells
• 2. Increased production (i.e. growth)
• 3. Blockage of excretory route

IU - international units

• Hemolysis
• Lipemia

• Protein synthesis (albumin, clotting proteins)
• Metabolism of carbs, proteins, lipids, and drugs
• Cholesterol synthesis
• Bile synthesis
• Detoxification of blood (converts ammonia to urea)

• ALT
• AST
• Alk Phos
• GGT
• Bilirubin

• Alanine aminotransferase. Routine test
• Dogs, cats, primates --> major source is hepatocytes. Liver specific enzyme
• Horses, ruminants, pigs --> NOT liver specific

• Liver disease
• Hepatic trauma
• Neoplasia
• Long term use of certain drugs (steroids, NSAIDs)

Cirrhosis (Liver failure)

• Asparate aminotransferase
• NOT liver specific (in hepatocytes, RBCs, cardiac muscle, skeletal muscle, kidneys, and pancreas)

• Liver disease
• Hepatic trauma
• Neoplasia
• Long term use of drugs
• Strenuous exercise
• IM injection
• Cardiac disease

• Alkaline Phosphatase (ALKP, Alk Phos, ALK)
• Made by hepatobiliary cells and osteoblasts/chondroblasts
• Not reliable in sheep and cattle because it fluctuates

• HBO
• Drugs
• Bone injury
• Bone tumors
• Young patient - bone growth

• Gamma glutamyltranspeptidase
• Not used much in dogs or cats
• Good large animal indicator of liver function. Primary source in large animals is hepatocytes

Liver disease - usually obstructive

• T. Bili
• Light sensitive
• On most routine panels

Hemolysis

liver disease

• Cholesterol
• On most routine panels.
• Synthesized by liver. Also comes with food. Synthesized by many cells

• HBO (Chol component of bile)
• Hypothyroidism (thyroid hormones play role in breakdown of Chol)
• Steroids
• DM, pancreatitis, obstructive liver disease

• Liver failure (can't synthesize)
• Prolonged anorexia/starvation

• Total Protein
• Includes TP, albumin, and globulin
• On most routine panels
• SERUM protein is lower then PLASMA because it's missing clotting proteins

• Albumen
• Synthesized by liver

• Globulins
• Alpha and Beta are synthesized by liver. Gamma is synthesized by lymph and are the most abundant in the body

• Liver disease
• Protein losing enteropathy (like parvo)
• Protein losing nephropothy (abnormal filtration in glomerulus)
• Prolonged anorexia/starvation (decreased intake)

Immune response

• Liver disease/failure (no production)
• Immunosuppression (decreased gamma)

• Regulate H2O balance
• regulate electrolytes
• regulate blood pH
• excrete non-protein nitrogenous wastes (BUN, creatinine)
• Synthesize renin
• Synthesize EPO
• Conserve nutrients like glucose and protein

Blood, Uria, Nitrogen

• liver disease/failure (unable to convert ammonia to urea)
• young animals (anabolic and high H2O intake)

• Creatinine
• Non-protein nitrogenous waste product from muscle cells

• Pre-renal azotemia
• Primary renal azotemia
• Post renal azotemia

Diuresis

Azotemia

Exocrine and Endocrine functions

• Digestive enzmes:
• Amylase
• Trypsine
• Lipase

• Hormones
• Insulin ( decreases bood glucose, drives it into cells)
• Glucagon (increases blood glucose. Glycogen = stored glucose in liver --> glucose)

• Glucose. On most routine panels
• Measures endocrine function of the pancreas. Separate serum or plasma ASAP becauseglucose decreases by 10% every hour

• DM (lacks insulin)
• Post-prandial
• Stress, fear, excitement, restraint
• Pancreatitis
• Hyperadrenocorticism

• Liver failure (decreased glycogen storage)
• Prolonged anorexia/starvation
• Jeuvenile hypoglycemia
• Insulinoma (overproduction of insulin)
• Insulin overdose

• run together. Amylase is difficult to interpret results because of large range of valuse and short half life.
• Pancreatitis --> increased in both
• Normal lipase = NOT pancreatitis

• DM
• duct obstruction
• steroid treatment

• acute pancreatitis
• obstructed duct
• renal failure
• dcreased excrection by the kidney

Creatine Kinase. Produced by striated muscle (skeletal and cardiac)

• CK leaks into blood when muscle is damaged:
• IM inject.
• Sx
• Lacerations
• Bruising of muscle
• Paralysis
• Electric shock
• Vigorous exervise
• Saddle thrombus (cats)
• Mylopathies

Sodium

• regulated by aldosterone
• released by renal tubules
• sodium in, potassium out
• Regulates H2O balance, H2O follows Na

• Decreased Sodium
• Decreased intake (salt deficiency in herbivores)
• Dilution (overhydration, edema)
• Increased loss (V/D, Addison's disease, diuresis, chronic renal failure)

• Increased sodium
• Water loss (dehyrdration)
• Increased intake (salt poisoning)

Potassium

• Regulated by aldosterone
• Released by renal tubules
• Na in K out
• Muscle function
• Increased K --> bradycardia --> death

• Decreased Potassium
• Decreased intake
• Increased loss (V/D, diuresis, chronic renal failure)

• Increased potassium
• Decreased loss (Acute renal failure, urinary tract obstruction/rupture, Cushing's disease)
• Cellular redistribution (Acidosis, decreased insulin levels - DM)
• Artifacts (Hemolysis - K is component of RBC membrane)

Chloride

• Closely associated with Na+
• Tends to follow Na+
• Component of many secretions (tears, sweat, saliva, HCl in stomach)

• Decreased chloride
• Decreases with hyponatremia
• Vomiting (HCl loss)
• Diuresis

• Increased chloride
• Increases with hypernatremia
• Relative increase varies inversely with HCO3
• Diarrhea (HCO3 loss, Cl left behind)

Magnesium

• 50% bone, 50% blood
• function of enzymes
• plays role in break down of acetylcholine

• Dietary deficiency
• Grass Tetany

Calcium

• parathyroids --> parathormone (PTH) --> acts on renal tubules
• Keep Ca, ditch Phos
• 99% in bone, 1 % in blood
• Blood coagulation, maintains neuromuscular exibility and tone

• Decrease calcium
• Hormonal imbalance (hypoparathyroidism,parathyroidectomy)
• Increased utilization (exlampsia, ethylene glycol intoxication)

• Increased calcium
• Hormonal imbalance (hyperparathyroidism, lymphosarcoma)
• Bony lessions (multiple myeloma, osteosarcoma)

Phosphorous

• 80% in bone, 20% in blood
• plays a role in energy storage, release, and transfer
• ATP
• CHO metabolism
• Part of nucleic acids (DNA, RNA)
• Component of phospho-lipids

• Increased Phos
• Decreased excretion (renal failure - decreased filatration, urinary obstruction)
• Decreased loss (Hormonal balances that affect calcium)
• Artifact (Hemolysis - phospholipid bilayer)

• Decreased Phos
• Decreased intake
• Increased loss (Hormone imbalances that affect calcium - hyperparathyroidism)

Total CO2

• Metabolic Acidosis
• Renal Disease
• Ketosis/Diabetic Ketoacidosis
• Lactic Acidosis -
• -Heart failure
• -shock
• -colic
• -pneumonia
• -extreme exercise
• Poisoning
• Diarrhea

• Metabolic Alkalosis
• Vomiting

Used to diagnose Acid base imbalance and hypoxia

• venous
• pCO2

• Partial pressure of CO2 (Dissolved CO2 in plasma)
• Helps measure alveolar ventilation (how well O3 and CO2 are being exchanges across alveoli)

• Hypercapnia (hypercarbia)
• Respiratory Acidosis
• Decreased alveolar ventilation (CO2 is building up in blood, not leaving blood stream across alveoli)
• Causes can be anesthesia

• Hypocapnia (hypocarbia)
• Respiratory alkalosis
• Increased alceolar ventilation (too much CO2 is leaving blood stream)
• Causes are panting and hyperventilation

• Partial pressure of O2 (dissolved O2 in plasma)
• Does NOT measure total O2 in blood (O2 hooked to hemoglobin)
• Destermines O2 saturation of HgB

• 100 mmHg breathing room air. Dissolved O2 in plasma (not hooked to anything)
• O2 sat: 95-97% of Hgb has O2 hooked onto it

• Increased O2 sat: 98-100%
• Causes are breathing gases with increased O2 concentration
• Anesthesia
• 100% O2, O2 cage, mask

• Decrease O2 sat.
• Hypoxis (decrease O3 in blood, decreased O2 getting to tissue)

Arterial

• Decreased pO2
• Decrease O2 sat
• Increased reduced Hgb
• Cyanosis

• Hypoxia
• acid/base imbalances

3 cc syring with a 22 or 25 gauge needle, coated with heparin

0.5-1.5 ml

• Femoral artery
• Dorsal metatarsal artery
• Lingual artery

metabolic state at tissue level

• 15-30 min
• 2 hours

• Decreased pH
• Decreased HCO3
• Diabetic ketoacidosis
• Lactic acidosis
• Diarrhea
• Renal insufficiency
• hypoadrenocorticism
• Oral intake of ammonium chloride, ethylene glycol, methanol, salicylate

• Decreased pH
• Increased pCO2
• Decreased alveolar ventilation
• primary lung disease
• airway obstruction
• chest wall disease
• pleural space disease
• medistinal disease
• diaphragmatic hernia
• neuromuscular disease
• cardiopulmonary arrest

• Increased pH
• Increased HCO3
• Vomiting
• hyperadrenocorticism
• exogenous steroid therapy
• potassium deplteting diuretic therapy
• bicarbonate therapy

• Increased pH
• Decreased pCO2
• hypoxemia
• sepsis
• fever
• pain