Clinical Chemistry Exam 2

3.5-5.4 g/dL

normal range for albumin

•liver dysfunction
•kidney damage
•malnutrition

low albumin clinical significance

•dye-binding methods
•electrophoresis
•immunochemical methods

albumin analytical methods

•dehydration
•high protein diet
•prolonged tourniquet application during blood draw

non-pathologic causes for high albumin levels

•recent large fluid intake
•low protein diet
•pregnancy

non-pathologic causes for low albumin levels

biuret method

reference and routine method for measuring total protein which measures the presence of peptide bonds in a protein sample by reacting them with copper ions in an alkaline solution, producing a color change that can be quantified spectrophotometrically

15-60 mg/dL

normal range for protein in CSF

•Guillain–Barré syndrome
•infection
•brain tumor
•brain bleeding
•nerve inflammation
•brain injury

conditions associated with elevated CSF protein levels

•act as a shock absorber, cushioning the brain and spinal cord from injury
•transport nutrients and remove waste products from the central nervous system

two major functions of CSF

150 mL

normal CSF value for an average adult

500 mL/day

normal CSF production rate for an average adult

1. chemistry
2. microbiology
3. hematology

order of departments to which each aliquot of CSF
collected is delivered to for testing

a lumbar puncture procedure where blood is accidentally drawn
into the cerebrospinal fluid (CSF) due to needle placement, resulting in a high red blood cell
count

traumatic tap

a life-threatening condition where
bleeding occurs in the space surrounding the brain, usually caused by a ruptured
aneurysm, and is indicated by the presence of blood in the CSF along with a characteristic
yellowing called xanthochromia, even if the red blood cell count may be high in the initial samples

subarachnoid hemorrhage (SAH)

xanthochromia present in SAH

main way to tell the difference between a traumatic tap and an SAH

CSF albumin concentration / serum albumin concentration
normal range: <0.007

calculation to determine the blood brain barrier and normal range

•Troponin
•LDL
•creatinine phosphokinase
•LD

cardiac markers most useful in assessing someone’s risk for cardiovascular disease

hypothalamus

produces hormones that signal the pituitary gland to release hormones

pituitary gland

releases hormones that directly affect the body or signals other glands to release
hormones

testes

produce testosterone in males

•estrogen
•progesterone
•hCG (supports implantation)
•relaxin (softens cervix for childbirth)

pregnancy hormones

zona glomerulosa of the adrenal cortex

main site of aldosterone synthesis

zona fasciculata of the adrenal cortex

main site of cortisol synthesis

Leydig cells of the testes

main site of testosterone synthesis

mitochondria

aldosterone, cortisol, and testosterone synthesis all begin when cholesterol is transported to the ____

aldosterone

regulates blood pressure and electrolyte balance by promoting
sodium retention and potassium excretion in the kidneys

cortisol

plays a role in stress response, metabolism, and immune function

corticosterone

same purpose as cortisol, but has a weaker effect
DHEAS (dehydroepiandrosterone sulfate)
precursor to sex hormones, mainly
testosterone and estrogen

androstenedione

precursor to sex hormones

epinephrine (adrenaline)

involved in the “fight or flight” response, increasing heart
rate, blood pressure, and glucose levels

norepinephrine (noradrenaline)

like epinephrine but with a more prolonged
effect

•aldosterone
•cortisol
•corticosterone
•DHEAS
•androstenedione
•epinephrine
•norepinephrine

hormones secreted by the adrenal cortex

•epinephrine
•norepinephrine

hormones secreted by the adrenal medulla

•↑ heart rate
•↑ O2 intake
•↑ blood sugar
•sweating
•pupil dilation

effects of epinephrine

•↑ blood pressure (vasoconstriction)
•↑ blood sugar, heart rate (slightly)
•↑ alertness, focus

effects of norepinephrine

“fight or flight”

stimulates epinephrine/norepinephrine

in front of the trachea

placement of the thyroid in the body

two lateral lobes
connected by a central isthmus

anatomical structure of thyroid

•TSH
•T3
•T4
•thyroid antibody test
•FT4

tests to assess thyroid function

parathyroid hormone (PTH)

hormone secreted by the parathyroid glands, primarily
responsible for regulating calcium levels in the blood by stimulating the release of calcium
from bones, promoting calcium reabsorption in the kidneys, and indirectly increasing
calcium absorption in the intestines through the activation of vitamin D

blood calcium levels (negative feedback loop)

responsible for PTH regulation

Therapeutic Drug Monitoring (TDM)

helps determine the best dosages if you’re taking certain hard-to-dose medicines; detects changes that could affect the medication levels in your blood

•chemistry of the drug (eg, solubility, stability)
•patient age
•patient body composition/sex
•patient pathophysiology/pharmacokinetics

4 main factors when assessing TDM

free drug

drugs that can act on target sites in the tissues and may cause pharmacology

bound drug

drugs that are always pharmacologically inactive because they are not free to
enter the tissue

5-7

approximate number of half-life periods required for a serum drug concentration to reach 97-99% of the steady state

serum cortisol concentrations greater than 15 ug/dL

patients with Cushing’s syndrome exhibit:

vancomycin

an antibiotic used to treat serious bacterial infections

liver

acetaminophen is particularly toxic to what organ

cholesterol→DHEA→androgens

parent substance in the biosynthesis of androgens and estrogen

trough specimen

specimen in therapeutic drug monitoring drawn immediately before next dose

peak specimen

specimen in therapeutic drug monitoring drawn 1

5 ½ half-lives

amount of time it takes to reach a steady state and to clear a drug when medication has stopped

blood draw when steady-state is reached

specimen for therapeutic drug monitoring (TDM)

thyroxine

prominent thyroid hormone in circulation

thyroid stimulating immunoglobulins

autoantibody that binds to TSH receptors

changes in concentrations of TBG

total T4 ↑ in pregnancy and in taking oral contraceptives due to

thyroxine

major fraction of iodine in circulation

ovaries

produce estrogen and progesterone in females

1:5 dilution

dilution when 4mL of water is added to 1mL of serum