CHEMISTRY QUICK NOTES(ASCP)

Glucose, fasting

- 70-99

- Increased: diabetes, acute stress, pancreatitis

- Decreased: insulinoma

- Glucose oxidase and Hexokinase(more accurate)

Cholesterol, total

- < 200

- Used in conjunction with HDL, LDL, Trig to assess risk of CAD

- Enzymatic methods

-

HDL

- >/= 60

- Inversely related to CAD

LDL

- < 100

- Risk factor for CAD

- Total cholesterol - (HDL + VLDL)

Triglycerides

- < 150

- Risk factor for CAD

VLDL

- < 30

- Triglycerides/5

Total protein

- 6.4-8.3

- < 4.5: peripheral edema

- Increased: dehydration, chronic inflammation, MM

- Decreased: nephrotic syndrome, malabsorption

- Biuret method

Albumin

- 3.5-5

- Increased: dehydration

- Decreased: malnutrition, liver disease, nephrotic syndrome

- Regulates osmotic pressure

- Bromocresol green and purple

Microalbumin

- 50-200

- Increased: diabetics at risk of nephropathy

Glucose Hormones

- Insulin: Decreases glucose, increases glycogenesis

- Glucagon: Increases glucose, inhibits glycolysis

- Cortisol: Insulin antagonist, increases gluconeogenesis

- Epinephrine: Promotes glycogenolysis and gluconeogenesis

- Thyroxine: Increases glucose absorption in GI, stimulates glycogenolysis

Tests for Diabetes

- Random plasma glucose: >/= 200

- Fasting plasma glucose: >/= 126, two times

- 2hr plasma glucose: >/= 200, two times

- Hemoglobin A1c: >/= 6.5%

Lab findings in Uncontrolled Diabetes

- Decreased: Bicarbonate and Blood pH

- Increased: Everything else

Order of Migration ( Fastest to Slowest)

- Albumin - Alpha 1 - Alpha 2- Beta - Gamma

Acute inflammation pattern

- Increased: Alpha 1 and Alpha 2

Chronic infection pattern

- Increased: Alpha 1, Alpha 2, and Gamma

Cirrhosis pattern

- Polyclonal increase in Gamma

Nephrotic syndrome pattern

- Decreased Albumin

- Increased Alpha 2

BUN

- 8-26

- Increased: Kidney disease

- Decreased: Overhydration or liver disease

Creatinine

- 0.7-1.5

- Increased: Kidney disease

Uric Acid

- Males: 3.5-7.2

- Females: 2.6-6

- Increased: Gout, renal failure, leukemia

- Decreased: Renal tubular defects

Ammonia

- 19-60

- Increased: Renal failure, Reye's syndrome, liver disease

Sodium

- 136-145

- Increased: Sweating, burns, IV intake, diabetes

- Decreased: Vomiting, diarrhea, increased extracellular fluid volume

Potassium

- 3.5-5.1

- Increased: Crush injuries, metabolic acidosis

- Decreased: Increased GI + urinary loss, metabolic alkalosis

Chloride

- 98-107

- Increased: IV intake, diabetes, burns

- Decreased: Prolonged vomiting, diabetic ketoacidosis, aldosterone deficiency

CO2, total

- 23-29

- Increased: Metabolic alkalosis, compensated by respiratory acidosis

- Decreased: Metabolic acidosis, compensated by respiratory alkalosis

Magnesium

- 1.6-2.6

- Increased: Renal failure, dehydration, bone cancer

- Decreased: Severe illness, GI disorders

Calcium

- Total: 8.6-10

- Ionized: 4.6-5.08

- Increased: Primary Hyperparathyroidism, cancer, MM

- Decreased: Primary Hypoparathyroidism, malabsorption, vit D deficiency

Acid Phosphatase (ACP)

- Increased in Prostate cancer

Alkaline Phosphatase (ALP)

- Increased in liver and bone disease

- Higher in biliary tract obstruction than hepatocellular disorders(cirrhosis)

Aspartate aminotransferase (AST)

- Increased in liver disease with markedly increased Viral Hepatitis

- Increased with MI and muscular dystrophy

Alanine aminotransferase (ALT)

- Increased with liver disease

Gamma-glutamyl transferase (GGT)

- Increased in all hepatobiliary disorders and chronic alcoholism

Lactate dehydrogenase (LDH)

- Increased with MI, liver disease, pernicious anemia

Creatine Kinase (CK)

- Increased with MI and muscular dystrophy

Amylase (AMS)

- Increased in acute pancreatitis and mumps

Lipase (LPS)

- Increased in acute pancreatitis

Total Bilirubin

- 0.2-1

- > 20 in infants: Kernicterus

- Increased: Liver disease, hemolysis, HDFN

Conjugated(direct) Bilirubin

- < 0.2

- Increased: Liver disease and obstructive jaundice

Unconjugated(indirect) Bilirubin

- < 0.8

- Increased: Pre and Post hepatic jaundice and some hepatic jaundice

Prehepatic jaundice

- Increased: Total bili and urine urobilinogen

Hepatic jaundice

- Increased: Total bili

- Decreased: urine urobilinogen

Posthepatic jaundice

- Increased: Total bili and Direct bilirubin

- Decreased: urine urobilinogen

Primary Hypothyroidism

- Increased: TSH

- Decreased: Free T4 and Free T3

Secondary Hypothyroidism

- Decreased: TSH, Free T4, and Free T3

Hyperthyroidism

- Increased: Free T3 and Free T4

- Decreased: TSH

Analgesics

- Salicylates and acetaminophen

Antiepileptics

- Phenobarbital and Phenytoin

Antineoplastics

- Methotrexate

Antibiotics

- Aminoglycosides and Vancomycin

Cardioactives

- Digoxin and Quinidine

Psychoactives

- Lithium

Immunosuppresents

- Cyclosporine and Tacrolimus

Respiratory acidosis

- Increased: PCO2

- Decreased: pH

Metabolic acidosis

- Decreased: pH and HCO3

Respiratory alkalosis

- Increased: pH

- Decreased: PCO2

Metabolic alkalosis

- Increased: pH and HCO3