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ABG

Metabolic Acidosis
o Low HCO3, Normal pCO2, Low pH
Hyperventilation
Metabolic alkalosis
o High HCO3, Normal pCO2, High pH
Hypoventilation
Respiratory Acidosis
o Normal HCO3, High pCO2, Low pH
Kidneys excrete H+
Respiratory Alkalosis
o Normal HCO3, Low pCO2, High pH
Kidneys excrete HCO3, retain H+

Glucose Methods
2 Enzymatic methods
o Glucose Oxidase
Coupled reactions
Method on urine dipstick
O2 + Chromogenic acceptor = Color
o Hexokinase
Coupled reactions
Final product = NADPH, measured @ 340nm or with colored product

340 nm
AST
ALT
GGT
Amylase (Starch)

Potentiometer
Measures voltage
pH
pCO2
Free calcium
K
Na
pO2
Li
Cl

Amperometric
Measures current
Glucose

Jaffe Reaction
Measures creatinine (color reaction)
Picrate used in reaction

Protein
Albumin
o Dye and colorimetric
o BCG or BCP (Brilliant Cresyl Green or Purple)

Bradford/Coumassie
Colorimetric
Coumassie measures protein in CSF/urine where protein will be in low concentration

Biuret
Copper binds to peptide bonds (Color reaction)

Bilirubin
Jendrassik-Grof
Diazo reagent

Lipoproteins
ApoB-100
o VLDL, LDL
o Liver
ApoB-48
o Chylomicrons
o Intestines

Nephelometry
Igs, Complement

Fluorometric
Hormones (Small MWs) High sensitivity

ALP
Bone

Urobilinogen
Erlichs Test

Lipid Profiles
Chylomicrons
o Exogenous (dietary) triglycerides
VLDL
o Endogenous triglycerides
LDL
o Cholesterol to cells (heart)
HDL
o Cholesterol out of cells (heart)
Triglycerides
o Primary form of lipid storage
o Transported by chylomicrons (exogenous), VLDL (endogenous)
Cholesterol
o Important in cellular physiology

Neurological vs. Cutaneous
Neurological porphyrias
o High ALA, PBG
o Deficiencies early in pathway
Cutaneous porphyrias
o High porphyrins
o Deficiencies later in pathway
o 400 nm absorption causes cellular damage when emission excites oxygen

Transudate vs Exudate
Exudate
o > 0.5
o +++ Protein
Transudate
o < 0.5
Fluid/Serum

Peaks and Troughs
Measure 15 minutes before next dosage for trough

Nephrotoxic Drugs
Gentamycin
Vancomycin
Streptomycin
Tobramycin

Aspirin
Stimulant
Causes respiratory alkalosis, changes to metabolic acidosis

Half Lives
Digoxins has high half life
Normally test at 4 hours, Digoxin is tested at 8 hours


Tylenol
Mucomyst used when overdosed gives glutathione substitute

Cyanide Poisoning
Inhibits mitochondrial cytochrome oxidase, which blocks the electron transport chain
become completely anaerobic. Lactic acidosis because of anaerobic metabolism

Carbon Monoxide Poisoning
Binds to hemoglobin No oxygen transport

MetHgb
Oxidizes Fe2+ to Fe3+ (Ferric to Ferrous)
G-6-PD

Drug Categories
Analgesics
o Opiates
Morphine, Codeine, Hydrocodone, Oxycodone, Demerol
o NSAIDS
Aspirin (salicylate) Reyes Syndrome, Ibuprofen, Naproxin
o Tylenol (Acetaminophen)
Fits/Anti-seizure Drugs
o Phenobarbitol
Barbiturate and Anti-seizure drug
o Phenotoin (Dilantin)
Most common
o Carbamazepine
o Valproic Acid
Psychics
o Lithium
o Tricyclic Anti-Depressants
Cardio
o Digoxin
o Digitoxin

Drugs of Abuse
Acetaminophen
Depressants
o Alcohol
o Barbiturates
o Benzodiazepine

Stimulants
o Cocaine
o Amphetamines
Hallucinogenics
o LSD
o Phencylidine (PCP, Angel Dust)
o Marijuana
Opiates (Narcotics)
o Morphine and others + Opium
Narcotics
o Pinpoint pupils

Creatinine Clearance
U/S x V/T x 1.73/Surface Area

Cardiac Markers
Peaks at 3-4 hours
o Myoglobin
Peaks at 4-8 hours
o CK-MB
Peaks within 4 hours
o Troponin
Peaks at 12-24 hours
o LDH
Duration of Markers
o Myoglobin drops after 24 hours
o CK-MB drops within 2-3 days
o LDH drops after 5 days
o Cardiac troponin drops after 7-10 days

Liver Panels
Viral hepatitis
o ^^ AST = ^^ ALT
o ^ GGT
o ^ ALP
Hint: T = T
Obstructive
o ^ AST = ^ ALT
o ^^ GGT
o ^ ALP
Hint: HALT, Obstruction
Alcoholic
o ^^^GGT
o ^ ALP
o ^ALP
o ^^ AST
Should be 2-3x value for ALT. AST 2-3x > ALT
Hint: Fall on your ASSt as an alcoholic
ALP
o Bone

Endocrinology
Steroids
o Cortisol
Adrenal cortex
o Aldosterone
Adrenal cortex
o Estrogen
Ovaries
o Progesterone
Uterus
o Testosterone
Testes
Peptides
o ADH
Posterior pituitary
o ACTH
Anterior pituitary
o Glucagon (increases plasma glucose)
Pancreas
o PTH
Parathyroid
Protein
o Growth Hormone
Anterior pituitary
o Insulin
Beta cells in pancreas
o Prolactin
Anterior pituitary
o FSH
Anterior pituitary
o HCG
Placenta
o TSH
Anterior pituitary
o LH
Anterior pituitary
Amino Acid Derivatives
o Epinephrine, Norepinephrine
Adrenal medulla
Thyroid
o Hypothyroid (Hasimotos)
Primary = Low T3/T4, Normal TSH (Thyroid)
Secondary = Low T3T4, Low TSH (Pituitary)
o Hyperthyroid (Graves Disease)
Primary = High T3/T4, Normal TSH (Thyroid)
Secondary = High T3/T4, High TSH (Pituitary)
Tertiary = High T3/T4, High TSH, High TRH (Hypothalamus)
o Hypocortisol (Addisons)
Low cortisol and aldosterone
High ACTH, Low sodium
Primary = Low cortisol, Low aldosterone, High ACTH
o Hypercortisol (Cushings)
High cortisol and aldosterone
High ACTH
o Hyperaldosterone (Conns)
High cortisol and aldosterone
Low ACTH