Your SlideShare is downloading. ×
Clinical chemistry lecture slide show
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

Clinical chemistry lecture slide show

10,499

Published on

Carbohydrates (Glucose) lecture for 3rd yr Med Students of AUF SOM done January 12, 2011.

Carbohydrates (Glucose) lecture for 3rd yr Med Students of AUF SOM done January 12, 2011.

0 Comments
11 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
10,499
On Slideshare
0
From Embeds
0
Number of Embeds
7
Actions
Shares
0
Downloads
0
Comments
0
Likes
11
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Clinical Chemistry by: Noel C. Santos, M.D.
    • Carbohydrates, Proteins and Lipids
    • Renal and Liver Function Tests
    • Electrolytes and Blood Gases
    • Enzymology
    • Endocrinology and Toxicology
  • 2.  
  • 3. Carbohydrates
    • Glucose – most important
    • Sources: endogenous and exogenous
    • Hormones – insulin, glucagon, epinephrine, cortisol, etc.
    • Abnormalities: hypoglycemia and hyperglycemia
    • Must always correlate clinically
  • 4. Glucose
    • Blood Glucose Determination
      • Patient preparation
      • Blood collection: capillary, venous and arterial
      • Chemical Analysis: laboratory or bedside
        • Reduction-Oxidation
        • Condensation
        • Enzymatic
  • 5. Glucose
    • Methods of Glucose Determination
      • Fasting Blood Sugar: 10 to 16 hrs
      • Random Blood Sugar
      • Post-prandial Glucose: screening for compensated diabetes and gestational diabetes: 1 hour = > 8.6 mmol/L (155 mg/dl); 2 hours = > 7.8 mmol/L (140 mg/dl)
      • Glucose Tolerance Test
      • Glycosylated hemoglobin
  • 6. Glucose
    • Oral Glucose Tolerance Test
      • Preceded by 3 days of adequate CHO diet: at least 100 gm., up to 300 gm.
      • Fasting for at least 10 hrs but not more than 16 hrs.
      • Test dose: 75 gm for nonpregnant & 100 gm for pregnant women, children: 1.75 gm/kg body weight (up to 75 gm); consumed w/in 5 mins.
      • Specimens: fasting, 30 min for 2 hrs
  • 7. Glucose Interpretation
    • Hypoglycemia: 2.8 mmol/L (<50 mg/dL)
    • Hyperglycemia: 7 mmol/L (>125 mg/dL)
    • OGTT: Normal, Diabetes, Gestational Diabetes
  • 8. According to National Diabetes Data Group
      • Normal: fasting = 6.4 mmol/L (115 mg/dl), at intermediate times 11.1 mol/L (200 mg/dl) and at 2 hours = 7.8 mmol/L (140 mg/dl)
      • Fasting: 7 mmol/L on two or more occasions
      • Diabetes:more than 11 mmol/L in any determination
  • 9. Glucose Interpretation (cont.)
  • 10. Causes of Hyperglycemia
    • Primary: IDDM and NIDDM
    • Secondary:
      • Pancreatic diseases
      • Hormonal abnormalities
      • Drugs
      • Chronic diseases
  • 11. Causes of Hypoglycemia
    • No anatomic lesion
      • Reactive: functional, alimentary, DM and IGT
      • Ethanol and drug
      • Factitious
    • Anatomic lesion present
      • Insulinoma
      • Extrapancreatic neoplasms
      • Adrenocortical insufficiency
      • Hypopituitarism
      • Massive liver disease
  • 12. Protein
    • Over 100 proteins identified
    • Functions:
      • Transport : Thyroxine binding globulin, apolipoproteins, transferrin
      • Humoral immunity : Ig’s
      • Maintenance of OP : all proteins
      • Enzymes : renin, clotting factors, complements
      • Protease inhibitors : alpha 1-antitrypsin
      • Buffering : all proteins
  • 13. Proteins
    • Changes in concentrations of individual proteins: hypo- or hyper-
    • Factors:
      • Rate of synthesis
      • Rate of removal
      • Volume of distribution
    • Measurement of Plasma Proteins
      • Total plasma protein
        • Albumin
        • Globulin
  • 14. Proteins
    • Increased
      • Hypergammaglobulinemia and paraproteinemia
      • Artefactual: hemoconcentration
      • Dehydration
    • Decreased
      • Malnutrition and Malabsorption
      • Liver disease and Humoral immunodeficiency
      • Over-hydration and Increased capillary permeability
      • Protein-losing states and Catabolic states
  • 15. Proteins
    • Electrophoresis
      • Semi-quantitative assessment
      • Detection of paraproteins
      • Serum specimens
      • Separates into distinct bands: pre-albumin, albumin, globulins: alpha 1 & 2, beta and gamma
  • 16. Proteins
    • Alpha 1-globulin: Alpha 1-antitrypsin
    • Alpha 2-globulin: haptoglobins, alpha 2-macroglobulin, ceruloplasmin
    • Beta globulin: transferrin, LDL, complement components (C3)
    • Gamma globulin: Ig’s
  • 17.  
  • 18.  
  • 19. Proteins
    • Specific protein determination
      • Protein of interest
      • More precise diagnostic information
      • When electrophoresis is not helpful or may be misleading

×