Chemistry Rotation

based on ph/ionic strength

relative solubility

H boning and hydrophobic reaction

based on molecule size

binary separation

Relative retention time

Reaction rate dependent upon substrate concentration

reaction rate independent of substrate concentration

• A= abc
• absorbance= constant*light path*concentration

measures light intensity

measures radiant energy, element specific

• Emission>excition
• Absorbance followed by emission, detect at 90 degrees

measures amount of light scattered by looking at on axis light

Measures increase in off axis scattered light

Looks at the bend in light

Measures potential difference (charge) btwn electrodes

Measure pCO2 w/gas permeable membrane, look at pH change

Measure pO2, amperometry look at change in current

Chloridometer, Ag electrode intereacts w/ Cl and precipitates, concentration of Cl is proportional to charge

look at number of particles

2Na + Gluc/18 +BUN/2.8

Too much Ag leads to underdetermination, all binding sites get used so excess Ab will wash away

Light emitted with reaction, not measured with spectrophotometer

Consistently give an answer close to the true value of the analyte for a given specimen

Consistently give the same answer for a given specimen

compares variance

• KLAMP
• Potassium, LD, AST, Mg, PO4.

AKA lipemia, causes increased light scatter

AKA Icterus, spectral interference

• TP/TP+FN
• Lowered by False Negatives

• TN/FP+TN
• Lowered by False Positives

Specificity vs. sensitivity, looking for maximum efficiency

used to reevaluate results after a large change

AKA ADH, reabsorption of water by the kidney to maintain osmolality

• getting rid of too much water
• central= insufficient AVP
• nephrogenic= poor response to AVP

• Deficit= increase osmolality, prompt AVP secretion
• Excess= decreased osmolality, decrease thirst

• measured-calculated (<13)
• Alcohols etc. interfere, measured via freezing point

• ~140 mmol
• 90% of serm cations, responsible for serum osmolality
• Absorbtion directly linked to water levels

• ~4 mmol
• regulation by kidneys
• follows glucose
• important for muscle strength

• ~100mmol
• passively maintains osmolality/neutrality by following Na

• ~23mmol
• 90% of body's CO2
• Most important buffer in blood

• ~9mmol
• 99% in bone
• 45% free, 45% bound, 10% complexed
• require anaerobic handling or pH will increase

• ~1mmol
• essential cofactor for ~300 enzymes
• regulated by the kidney

• ~3mmol
• regulated by the kidney , age/sex related
• react with ammonium molybdate to get complex @340
• serum or hepranized plasma to avoid interference

• result of anaerobic glycolysis
• marker for sepsis

• pH: 7.35-7.45
• pO2: 90
• HCO3: 45
• pCO2: 23

• Na(+K)- (Cl+HCO3)
• Potassium often negligible

• decreased pH due to loos of HCO3
• Causes: MUDPILES
• Methanol, Urea, Diabetes, Propylene glycol, Isoniazid, Lactate, ethylene glycol, Salicylates
• Also diarrhea or Renal tubular disease, excess loss of HCO3

• decreased pH due to increased CO2
• slowed breathing or impaired gas exchange
• Drug OD or asthma

• increased pH due to increased HCO3
• loss or acid or excess bicarb
• caused by things like vomitting

• increased pH due to increased CO2
• loss of acid via respiration, like hyperventilation, altitude change, etc.

increased pH, decreased pCO2, VitD and temp

decreased pH, increased pCO2, vit D and temp

Heparin

• excretes nitrogenous waste
• maintains homeostasis by reclaiming compounds as needed
• endorcrine functino- renin, erthrypoetin, Vit D

• Glomelular filtration rate
• marker for renal function

• Urea- protein metabolism
• Creatinine- muscle product
• Uric Acid- purine metabolism

acts on BM to stimulate RBC production

• ~13 mmol as BUN
• freely filtered, inverse to urine flow
• Measured by urease kinetic rxn

• completely filtered by glomerluli, best indicator of glomelular function
• measure by Jaffe rxn
• dependent upon muscle mass

• UxV/PxT
• urine creatxUrine vol./plasma creat (1440min)

10:1-20:1

• product of purine metabolism
• can cause renal disease, gout, etc
• forms crystals

enzymes found in hepatocytes for AA metabolism.

Total Protein

Albumin and T/D biirubin

alkaline phosphatase, associated with biliary obstruction and inflammation

marker of hepatobiliary disease, especially elevated in alcoholics

Scavenged from protein metabolism, easily contaminated

Elevated ALT and AST

• RNA virus, vaccine available
• fecal/oral transmission, never chronic

• DNA virus, vaccine available
• sexually transmitted, chronic <5yo
• tested for surface and envelope Ag

• RNA virus, no vaccine
• sexually transmitted, chronic 75%

• defect RNA virus
• requires coinfection of HBV

• RNA virus
• fecal/oral transmission, mostly 3rd world

• Endocrine- insulin and glucagon -> bloodstream
• exocrine- digestive enzymes like amylase an dlipase to the ductal system

• starch digestion, found in pancrease and salivary glands
• obligate Ca cofactor

• triglyceride digestion
• most specific to the pancreas (9000x other organs)

measuring pancreas exocrine function, look for improperly processed lipids

producted by parietal cells in the stomach, required for b12 absorption

evaluates malabsorption

primary storage form of energy

• structural element of cell membranes
• precursor of steroid hormones

allow for lipid transport

• transport of exogenous trig and some chol
• apo B-48
• will float

trig rich, apo-100

chol rich, the "bad"

• the "good", gets rid of deposited chol
• APO A-1

• LDL= total chol- trig/5
• invalid if trig>400 (no fast required)

• <200, LDL <100
• risk modification if HDL>60

• response to inflammation
• prognostic value for coronary artery disease

most rapidly rising marker of myocardial injury

• measures muscle damage, small amounts in skeletal muscle
• being replaced by troponin

• slow to peak cardiac marker, lasts longer before returning to normal
• (+) always indicates myocardial injury

rise and/or fall of cardiac biomarkers with at least one value >99th percentile

marker of CHF, not a stand alone diagnosis

• produced by pancreatic B cells, facilitates uptake of glucose and conversion to glycogen
• only hormone to lower Gluc

produced alongside endogenous insulin.  Can serve as a marker to see if insulin issues are an overproduction (elevated C peptide) or overdose (normal C peptide)

G6PDH hexokinase

• insulin deficiency due to autoimmunity to beta cells
• Requires replacement

• body becomes resistant to insulin, metabolic syndrome causing B cell dysfunction
• makes up ~90% of cases

• Hgb A1C >6.5%
• fasting glucose >126
• 2 hr glucose >200

1 hr nonfasting GTT if >140 then perform 3hr GTT

measures excretion of albumin in urine, indicates leaking proteins.  Can be early sign of diabetes

Ferritin

0, free iron is toxic

Transferrin

• depletion: decreased ferritin, normal serum and TIBC
• iron deficient erythropoiesis: decreased ferritin serum and Trf sat.  Increased TIBC
• Iron deficient anemia: additionally decreased Hbg, MCV, MCH, MCHC.  (microcytic, hypochromic)

• normal amounts of iron, not used well
• hepcidin prevenets iron release
• Differentiate from IDA with normal ferritin and TIBC

metabolic disorder from partial enzyme deficiency

increased copper deposition throughout the body

methylmalonic acid

Agarose gel or polyacrylamide for IEF

True. All other fractions measure more than one types of protein

Nutritional marker, esp. for nitrogen

AAT, acid glycoprotein, fetoprotein (AFP, hepatic tumor marker)

macroglobulin, ceruloplasm (copper transport, wilsons disease), haptoglobin (intravascular hemolysis)

Transferrin (iron transport), complement (immune response)

decreased alb and gamma, increased alpha 2

decreased gamma region

decreased alb, increased gamma, bridged Beta/gamma (increased IgA)

decreased alb

predicting and monitoring treatment

AFP

CEA

CA 15-3, CA 27-29

CA 125

CA 19-9

• Hypothalamus--> pituitary --> endocrine gland --> hormone
• Works on a negative feedback loop most of the time

secretes direct effector hormones (GH, Prl) and trophic hormones (ACTH, FSH, LH, TSH)

Secretes AVP and oxytocin

• Growth Hormone
• stimulated by GHRH, pulsatile secretion makes it hard to measure
• Anabolic: protein synthesis, growth
• catabolic: tissue breakdown

• Negative feedback from glucose
• GHRH-->GH-->IGF

• Insulin-like Growth Factor
• Good marker for GH
• very age dependent

excess GH after growth is complete

test for hypersecretion with an oral GTT, negative feedback should lead to reduced levels of GH

• Prolactin
• Synthesized in hypothalamus, stored in posterior pituitary, no releasing hormone
• Under constant inhibition by dopamine
• No target tissue, often influences lactation
• Suppresses GnRH to maintain pregnancy

primary function to secrete calcitonin, which has a mysterious role

T4

T3

• Hyperthyroidism, autoimmune against TSH receptors
• overproduction of T4 and T3

• hypothyroidism
• antibodies against TPO or Tg
• Look for a-TPO antibodies in diagnosis

• TSH is primary test, 2x change in T4= 100x change in TSH
• Will measure T4 over T3, much higher levels of T4 than T3

• Thyroglobulin, tumor marker for thyroid tissue
• no Tg= no functioning thyroid tissue

False, cortisol is on a diurnal variation with highest levels in the morning

• primary hypoadrenalism, decreased levels of glucocorticoids
• No negative feedback to ACTH

• Hyperadrenalism
• excess cortisol, high levels of glucose
• Cushings disease= ACTH producing tumor

• Draw baseline cortisol levels, then inject cosyntropin (ACTH mimic)
• Check for expected increase in cortisol

secreted by adrenal medulla, stress homeostasis

plasma levels aren't recommended, look for plasma metanephrines

Secerted in pulsatile fashion from hypothalamus, promotes FHS/LH

• Follicular maturation and estrogen
• spermatogenesis

• follicular rupture and progesterone
• libido hormone (testosterone)

decreased estrogen, increased FHS/LH

• Parathyroid Hormone
• stimulates osteoclasts to break down bone to release Ca and Phos