chem rotation lec1

what is hyper glycemia

incr glucose prod decr glucose metabolism

what disease is associated with hyperglycemia

diabetes mellitus

what are the three major subtypes of diabetes mellitus

type 1 (insulin dependent) type 2 (insulin nondependent at diagnosis), and gestational diabetes

what is insulin, what does it do, and where is it made

moves glucose into blood, released when glucose levels are high (to regulate it), and from beta cells in the pancreas (islets of langerhans)

describe type 1 diabetes

inulin dependent where beta cells are destroyed and no insulin in produced (bc autoimmune or viral), abrupt onset

what are type 1 diabetics prone to

diabetic ketoacidosis (ketones in blood and urine, decreased sodium and chloride, and increased potassium)

describe type 2 diabetes

insulin resistant (insulin cant get into cells because receptors are inward), due to lifestyle not autoimmunity, usually see high insulin (cant get into cell) levels as well (and severe dehydration because body is afraid to let go of water)

describe gestational diabetes

diabetic during pregnancy associated with high birth weight, increased (mom) BP, (rapid glucose decline after birth can be life threatening to baby)

when is gestational diabetes usually screened for

24 weeks

what is the principle of A1C

Hgb (A1 chain) becomes glycosylated (sugar attaches to A1C component of RBC0 and remains till end of RBCs life

what does A1c measure

avg glucose over 2-3 mo

what are the limitations of hgb A1c

rbcs need to be intact for 3 months (no hemolytic event) and cant have a short RBC life span (hemoglobinopathy) because then there will be no A chain

where are ketones made and what do they do

made in the liver and used when excess fatty acids are metabolized for energy (during low carb avalibility)

what are the three ketones

acetone, acetoacetic acid, 3 beta hydroxybutyric acid

where can ketones be found

in blood and urine (of type 1 or gestational patients)

what protein complex of troponin do we look for and what does it do

Troponin I functions in muscle contraction

what is troponin used to detect and why

APR for MI because levels rise quickly and stay elevated

what is APR

acute phase reactant

what is MI

myocardial infarction (heart attack)

what is TAT

turn around time

a troponin above what value is almost assuredly a MI

above 1000

what is BTNP

brain (beta type) natriuretic peptide; hormone secreted by heart ventricles in response to intravascular volume expansion (edema=retaining fluid)

what can BTNP be a marker for

congestive heart failure (severity and how treatment affects it)

what is the effect of increased BTNP

decr BP and plasma vol.

when can BTNP raise in cases other than CHF

right after a heart attack

what is CHF

congestive heart failure

what is hCG

human chorionic gonadotropin

what fraction/subunit do we look at for hCG

beta subunit (more specific than alpha)

in what cases/states does hCG increase

pregnancy, hydatidiform mole, and testicular/ovarian cancer (prognostic marker)

what doe hCG do in pregnancy, when does it peak and drop

it promotes implantation of the fetus and placenta, it peaks at 8-20 weeks and undetectable 4-6 weeks postpartum

what is a hydatidiform mole

anomaly of the trophoblastic tissue of the placenta

what is fFN and what can it help us detect

fetal fibronectin, component of the extracellular matrix in utero of the amniotic sac, helps us detect preterm delivery

when is fFN elevated and diminished

elevated in the first 24 weeks and beginning in 35 weeks, diminished in between the two

why is it important to not have a preterm delivery

because lungs aren't developed till 35-37 weeks

what can procalcitonin test for

bacterial sepsis

what are the classic indicators of sepsis

elevated WBC, fever, hypotension, increased lactic acid

what is ammonia and why do we test for it

produced during deamination of AA (also why we put it on ice) converts to urea in liver; tested to see liver function

what is teyes syndrom

fatty acid infiltration due to aspirin use with viral infections (children)

what is NPN

non-protein nitrogen which is the end product of catabolism

define azotemia

elevated urea in blood

define uremia

azotemia plus renal failure

why might diabetics have excess BUN

bad blood flow

what are the causes of azotemia

prerenal: reduced flow, incr protein metabolism, GI bleed; renal: kidney failure; postrenal: obstruction of urine flow

what is creatinine and what is it used for

made from the muscles (breakdown) used to asses renal function

when can true kidney failure be diagnosed

when urea and creatinine both increase

what is osmolality

physical property of a solution (conc of solutes and solvent

what two things mainly influence osmolality

sodium and glucose

what hormone responds to changes in osmolality and where is it released from

ADH: from pituitary (hypothalamus)

what do osmolality control

thirst and ADH (water reabsorption by kidney)

what is the number one reason for an incr osmo gap

alcohol

name the other four main causes for a change in osmo gap

alc, sugar, lipid, protein

what is hgb

iron globin and heme

what is bilirubin

breakdown of hemoglobin

what is unconjugated biliruben

indirect; insoluble in water

what destroys biliruben

light

why is bilirubin higher in kids than adults

liver not developed till 6mo

define kernicterus and what can it cause

bilirubin to high in infants brain damage

what is the major cause of prehepatic jaundice and how is it differentiated

hemolytic anemia seen higher levels of unconjugated biliruben

what is the major cause of hepatic jaundice and how is it differentiated

liver cirrhosis or chronic hepatitis, increased conjugated bilirubin

what is the major cause of posthepatic jaundice and how is it differentiated

obstruction (gall or tumors) incr conjugated bilirubin and little to no urobilinogen