Also diarrhea or Renal tubular disease, excess loss of HCO3
Respiratory Acidosis
decreased pH due to increased CO2
slowed breathing or impaired gas exchange
Drug OD or asthma
Metabolic Alkalosis
increased pH due to increased HCO3
loss or acid or excess bicarb
caused by things like vomitting
Respiration alkalosis
increased pH due to increased CO2
loss of acid via respiration, like hyperventilation, altitude change, etc.
Increased HgB O@ affinity
increased pH, decreased pCO2, VitD and temp
Decreased HgB O2 affinity
decreased pH, increased pCO2, vit D and temp
Blood gas anticoagulant
Heparin
Kidney function
excretes nitrogenous waste
maintains homeostasis by reclaiming compounds as needed
endorcrine functino- renin, erthrypoetin, Vit D
GFR
Glomelular filtration rate
marker for renal function
3 main nitrogenous waste products
Urea- protein metabolism
Creatinine- muscle product
Uric Acid- purine metabolism
Erythropoetin
acts on BM to stimulate RBC production
Urea
~13 mmol as BUN
freely filtered, inverse to urine flow
Measured by urease kinetic rxn
Creatinine
completely filtered by glomerluli, best indicator of glomelular function
measure by Jaffe rxn
dependent upon muscle mass
Creatinine Clearance
UxV/PxT
urine creatxUrine vol./plasma creat (1440min)
BUN creat ration
10:1-20:1
Uric acid
product of purine metabolism
can cause renal disease, gout, etc
forms crystals
What are aminotransferases?
enzymes found in hepatocytes for AA metabolism.
What is the biuret rxn for?
Total Protein
What tests are the true markers of hepatic function?
Albumin and T/D biirubin
What is ALP
alkaline phosphatase, associated with biliary obstruction and inflammation
What is GGT?
marker of hepatobiliary disease, especially elevated in alcoholics
Ammonia
Scavenged from protein metabolism, easily contaminated
What are the laboratory findings associated with hepatitis?
Elevated ALT and AST
Hepatitis A
RNA virus, vaccine available
fecal/oral transmission, never chronic
Hepatitis B
DNA virus, vaccine available
sexually transmitted, chronic <5yo
tested for surface and envelope Ag
Hepatitis C
RNA virus, no vaccine
sexually transmitted, chronic 75%
Hepatitis D
defect RNA virus
requires coinfection of HBV
Heptatits E
RNA virus
fecal/oral transmission, mostly 3rd world
What are the main functions of the pancreas?
Endocrine- insulin and glucagon -> bloodstream
exocrine- digestive enzymes like amylase an dlipase to the ductal system
Amylase
starch digestion, found in pancrease and salivary glands
obligate Ca cofactor
Lipase
triglyceride digestion
most specific to the pancreas (9000x other organs)
What is fecal fat testing for?
measuring pancreas exocrine function, look for improperly processed lipids
Instrinsic Factor
producted by parietal cells in the stomach, required for b12 absorption
What does a xylose absorption test look at?
evaluates malabsorption
Triglycerides
primary storage form of energy
Cholesterol
structural element of cell membranes
precursor of steroid hormones
lipoproteins
allow for lipid transport
Cylomicron
transport of exogenous trig and some chol
apo B-48
will float
VLDL
trig rich, apo-100
LDL
chol rich, the "bad"
HDL
the "good", gets rid of deposited chol
APO A-1
Calculations of LDL
LDL= total chol- trig/5
invalid if trig>400 (no fast required)
What is the desired total chol
<200, LDL <100
risk modification if HDL>60
CRP
response to inflammation
prognostic value for coronary artery disease
Myoglobin
most rapidly rising marker of myocardial injury
CK-MB
measures muscle damage, small amounts in skeletal muscle
being replaced by troponin
Troponin
slow to peak cardiac marker, lasts longer before returning to normal
(+) always indicates myocardial injury
What is the universal definition of an MI
rise and/or fall of cardiac biomarkers with at least one value >99th percentile
BNP
marker of CHF, not a stand alone diagnosis
Insulin
produced by pancreatic B cells, facilitates uptake of glucose and conversion to glycogen
only hormone to lower Gluc
What is C-peptide
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)
What is the reference method for glucose measurement?
G6PDH hexokinase
Type 1 DM
insulin deficiency due to autoimmunity to beta cells
Requires replacement
Type 2 DM
body becomes resistant to insulin, metabolic syndrome causing B cell dysfunction
makes up ~90% of cases
Diagnostic results for DM
Hgb A1C >6.5%
fasting glucose >126
2 hr glucose >200
Diagnostic values for GDM
1 hr nonfasting GTT if >140 then perform 3hr GTT
Urinary microalbumin
measures excretion of albumin in urine, indicates leaking proteins. Can be early sign of diabetes
Iron Storage
Ferritin
Normal amount of free iron
0, free iron is toxic
Iron transport
Transferrin
Stages of Iron depletion
depletion: decreased ferritin, normal serum and TIBC
iron deficient erythropoiesis: decreased ferritin serum and Trf sat. Increased TIBC