Bio Chemistry, Blood Investigations, Blood Tests
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Bio - Chemistry
Pradeep Chockalingam Snr-2 Physio
www.pdfcoke.com/cpradheep
Aim & Objectives Understand basic Bio-Chemistry
investigations. Understand what information it gives us.
Correlate to day to day practice and
Maximise patient care. www.pdfcoke.com/cpradheep
Contents Electrolytes Renal Liver, Spleen & Pancreas Inflammatory Markers
www.pdfcoke.com/cpradheep
Electrolytes Sodium - Na+ Potassium - K+ Chloride - Cl Phosphorus - P4+ Calcium - Ca++ Magnesium - Mg++ Helps to regulate the fluid balance & electrolyte balance of the body
www.pdfcoke.com/cpradheep
Body Fluid Compartments Intracellular 30L
Extracellular 9L 3L
Interstitial
Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
www.pdfcoke.com/cpradheep
Sodium - Na+ Plays an important role in nerve and muscle
functions. Level of Na+ in the body controlled by aldosterone, it causes the kidneys to retain sodium. Symptoms of an abnormal sodium level include confusion, lack of energy (lethargy), or seizures.
www.pdfcoke.com/cpradheep
Potassium - K+ Needed for proper nerve, muscle and heart
function When sodium levels increase, potassium levels decrease, and vice versa. Levels may alter for people treated with Diuretics and Renal Dialysis. Abnormal potassium levels may cause Muscle Cramps or Weakness, Nausea, Diarrhoea, Frequent Urination, Dehydration, Low B.P, Confusion, Irritability, Paralysis, and Changes in Heart Rhythm. www.pdfcoke.com/cpradheep
Chloride - Cl
-
Keeps the amount of fluid inside and outside
of cells in balance. Maintain proper blood volume, blood pressure, and pH of body fluids. Its levels in blood generally rise and fall along with sodium levels in blood. Low chloride can cause muscle twitching, muscle spasms, or shallow breathing. High chloride can be associated with rapid deep breathing, weakness, confusion, and coma.
www.pdfcoke.com/cpradheep
Phosphorus - P4+ Parathyroid hormone controls level of P4+ &
Ca++. (P4+ Level is inversely proportional to levels of Ca++ & Mg++) High level may indicate renal disease,
parathyroid hormone deficit. Low level may indicate starvation, poor
intestinal absorption, Alcoholic Liver Disease. www.pdfcoke.com/cpradheep
Calcium - Ca++ It is important for Neuromuscular activity,
blood clotting, proper function of the heart. Low level causes 'pins and needles' sensation over the hands and feet, Muscle spasm. High level causes abnormal
heart rhythms,
fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, increased urination. www.pdfcoke.com/cpradheep
Magnesium - Mg++ It is important for Neuromuscular activity,
Defence System & Metabolism. Low level may cause muscle weakness,
twitching, cramping, confusion, cardiac arrhythmias, and seizures.
www.pdfcoke.com/cpradheep
Renal Function
Urea Creatinine
www.pdfcoke.com/cpradheep
Urea Urea is formed when protein is broken down. It is
produced in the liver and eliminated in urine. To monitor renal disease & to determine whether severe dehydration is present. High: Renal injury or disease (DM,↑BP), Blockage of the urinary tract (stone or tumour), Medications (Alloprin, Lasix, Methotrexate, Aspirin), high-protein diet, gastrointestinal bleeding. High level cause neurological disturbances. Low: Malnutrition, or severe liver damage. www.pdfcoke.com/cpradheep
Creatinine It’s a metabolic waste, due to breakdown of
creatine phosphate in muscle. Creatinine levels increase more slowly than
blood urea levels. An increase in creatinine indicates Chronic Renal problem.
www.pdfcoke.com/cpradheep
Liver, Spleen & Pancreas Bilirubin Albumin & Total Protein Alanine Transaminase (ALT) Alkaline Phosphatase (ALP) Gamma Glutamyl Transpeptidase
Amylase
www.pdfcoke.com/cpradheep
Bilirubin Produced when the liver breaks down old red
blood cells, & removed from the body through the stool. Evaluate liver function and monitor the
development of liver disease like hepatitis, cirrhosis & the effects of medications that damage the liver.
www.pdfcoke.com/cpradheep
Albumin & Total Protein To evaluate liver, renal function & to calculate
dietary needs for the chronic ill patient. Maintains fluid balance between the tissues & the circulatory system, Fight infections, Transport hormones. Low: Risk of infection, Peripheral & Pulmonary oedema, Ascites.
www.pdfcoke.com/cpradheep
Body Fluid Compartments Intracellular 30L
Extracellular 9L 3L
Interstitial
Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
www.pdfcoke.com/cpradheep
A.L.T., A.L.P. & Gamma G.T. These are enzymes found in the liver. Helps to
evaluate where or what the problem in the liver. If ALT is six times higher than its normal level and ALP is only two times higher then diagnosis favours liver disease. If ALP is six times higher than its normal level and ALT is only two times higher then diagnosis favours biliary obstruction. GGT is elevated in hepatobiliary disease only, but A.L.T., A.P. may also elevate due to other reasons. www.pdfcoke.com/cpradheep
Amylase Enzyme found in the pancreas & the salivary
glands. High levels indicates Pancreatitis, Pancreatic
diseases, Diabetic ketoacidosis & Blockage or damage to the bowel.
www.pdfcoke.com/cpradheep
Inflammatory Markers C-Reactive Protein Lactate Troponin-T D-dimer www.pdfcoke.com/cpradheep
C-Reactive Protein It is produced by the liver during an
inflammatory reaction or due to bacterial infection. CRP levels rise within 2 to 6 hours of surgery
and then decrease by day 3. If CRP levels remains elevated after 3 days, an infection may be present.
www.pdfcoke.com/cpradheep
Lactate Waste product of anaerobic respiration
(Normal: Carbohydrate breaks into H2O + CO2). May increase due to Severe Exercise,
Infection, Pulmonary embolism, Hypoxia, Dehydration.
www.pdfcoke.com/cpradheep
Troponin - T Cardiac enzyme enters into blood circulation
if there is any injury to the cardiac tissues. Usually detected on blood after 6 to 12 hrs.
after cardiac tissue injury. May also elevate due to surgery, renal failure,
some drugs like Statins (Anti-Cholesterol). www.pdfcoke.com/cpradheep
D-dimer (Fibrin degradation fragment) This is a protein released into the blood
stream when a thrombosis degraded by the process called as fibrinolysis Normal range between 0-300ng/ml
High in DVT, PE & pregnant women
www.pdfcoke.com/cpradheep
Further Readings http://www.webmd.com/ http://medlineplus.gov/ http://www.labtestsonline.org/index.html http://www.wikipedia.org
http://health.allrefer.com/health/test.html http://www.gpnotebook.co.uk/homepage.cfm www.pdfcoke.com/cpradheep
Pradeep Chockalingam Snr-2 Physio
www.pdfcoke.com/cpradheep
Aim & Objectives Understand basic Bio-Chemistry
investigations. Understand what information it gives us.
Correlate to day to day practice and
Maximise patient care. www.pdfcoke.com/cpradheep
Contents Electrolytes Renal Liver, Spleen & Pancreas Inflammatory Markers
www.pdfcoke.com/cpradheep
Electrolytes Sodium - Na+ Potassium - K+ Chloride - Cl Phosphorus - P4+ Calcium - Ca++ Magnesium - Mg++ Helps to regulate the fluid balance & electrolyte balance of the body
www.pdfcoke.com/cpradheep
Body Fluid Compartments Intracellular 30L
Extracellular 9L 3L
Interstitial
Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
www.pdfcoke.com/cpradheep
Sodium - Na+ Plays an important role in nerve and muscle
functions. Level of Na+ in the body controlled by aldosterone, it causes the kidneys to retain sodium. Symptoms of an abnormal sodium level include confusion, lack of energy (lethargy), or seizures.
www.pdfcoke.com/cpradheep
Potassium - K+ Needed for proper nerve, muscle and heart
function When sodium levels increase, potassium levels decrease, and vice versa. Levels may alter for people treated with Diuretics and Renal Dialysis. Abnormal potassium levels may cause Muscle Cramps or Weakness, Nausea, Diarrhoea, Frequent Urination, Dehydration, Low B.P, Confusion, Irritability, Paralysis, and Changes in Heart Rhythm. www.pdfcoke.com/cpradheep
Chloride - Cl
-
Keeps the amount of fluid inside and outside
of cells in balance. Maintain proper blood volume, blood pressure, and pH of body fluids. Its levels in blood generally rise and fall along with sodium levels in blood. Low chloride can cause muscle twitching, muscle spasms, or shallow breathing. High chloride can be associated with rapid deep breathing, weakness, confusion, and coma.
www.pdfcoke.com/cpradheep
Phosphorus - P4+ Parathyroid hormone controls level of P4+ &
Ca++. (P4+ Level is inversely proportional to levels of Ca++ & Mg++) High level may indicate renal disease,
parathyroid hormone deficit. Low level may indicate starvation, poor
intestinal absorption, Alcoholic Liver Disease. www.pdfcoke.com/cpradheep
Calcium - Ca++ It is important for Neuromuscular activity,
blood clotting, proper function of the heart. Low level causes 'pins and needles' sensation over the hands and feet, Muscle spasm. High level causes abnormal
heart rhythms,
fatigue, depression, confusion, anorexia, nausea, vomiting, constipation, increased urination. www.pdfcoke.com/cpradheep
Magnesium - Mg++ It is important for Neuromuscular activity,
Defence System & Metabolism. Low level may cause muscle weakness,
twitching, cramping, confusion, cardiac arrhythmias, and seizures.
www.pdfcoke.com/cpradheep
Renal Function
Urea Creatinine
www.pdfcoke.com/cpradheep
Urea Urea is formed when protein is broken down. It is
produced in the liver and eliminated in urine. To monitor renal disease & to determine whether severe dehydration is present. High: Renal injury or disease (DM,↑BP), Blockage of the urinary tract (stone or tumour), Medications (Alloprin, Lasix, Methotrexate, Aspirin), high-protein diet, gastrointestinal bleeding. High level cause neurological disturbances. Low: Malnutrition, or severe liver damage. www.pdfcoke.com/cpradheep
Creatinine It’s a metabolic waste, due to breakdown of
creatine phosphate in muscle. Creatinine levels increase more slowly than
blood urea levels. An increase in creatinine indicates Chronic Renal problem.
www.pdfcoke.com/cpradheep
Liver, Spleen & Pancreas Bilirubin Albumin & Total Protein Alanine Transaminase (ALT) Alkaline Phosphatase (ALP) Gamma Glutamyl Transpeptidase
Amylase
www.pdfcoke.com/cpradheep
Bilirubin Produced when the liver breaks down old red
blood cells, & removed from the body through the stool. Evaluate liver function and monitor the
development of liver disease like hepatitis, cirrhosis & the effects of medications that damage the liver.
www.pdfcoke.com/cpradheep
Albumin & Total Protein To evaluate liver, renal function & to calculate
dietary needs for the chronic ill patient. Maintains fluid balance between the tissues & the circulatory system, Fight infections, Transport hormones. Low: Risk of infection, Peripheral & Pulmonary oedema, Ascites.
www.pdfcoke.com/cpradheep
Body Fluid Compartments Intracellular 30L
Extracellular 9L 3L
Interstitial
Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
www.pdfcoke.com/cpradheep
A.L.T., A.L.P. & Gamma G.T. These are enzymes found in the liver. Helps to
evaluate where or what the problem in the liver. If ALT is six times higher than its normal level and ALP is only two times higher then diagnosis favours liver disease. If ALP is six times higher than its normal level and ALT is only two times higher then diagnosis favours biliary obstruction. GGT is elevated in hepatobiliary disease only, but A.L.T., A.P. may also elevate due to other reasons. www.pdfcoke.com/cpradheep
Amylase Enzyme found in the pancreas & the salivary
glands. High levels indicates Pancreatitis, Pancreatic
diseases, Diabetic ketoacidosis & Blockage or damage to the bowel.
www.pdfcoke.com/cpradheep
Inflammatory Markers C-Reactive Protein Lactate Troponin-T D-dimer www.pdfcoke.com/cpradheep
C-Reactive Protein It is produced by the liver during an
inflammatory reaction or due to bacterial infection. CRP levels rise within 2 to 6 hours of surgery
and then decrease by day 3. If CRP levels remains elevated after 3 days, an infection may be present.
www.pdfcoke.com/cpradheep
Lactate Waste product of anaerobic respiration
(Normal: Carbohydrate breaks into H2O + CO2). May increase due to Severe Exercise,
Infection, Pulmonary embolism, Hypoxia, Dehydration.
www.pdfcoke.com/cpradheep
Troponin - T Cardiac enzyme enters into blood circulation
if there is any injury to the cardiac tissues. Usually detected on blood after 6 to 12 hrs.
after cardiac tissue injury. May also elevate due to surgery, renal failure,
some drugs like Statins (Anti-Cholesterol). www.pdfcoke.com/cpradheep
D-dimer (Fibrin degradation fragment) This is a protein released into the blood
stream when a thrombosis degraded by the process called as fibrinolysis Normal range between 0-300ng/ml
High in DVT, PE & pregnant women
www.pdfcoke.com/cpradheep
Further Readings http://www.webmd.com/ http://medlineplus.gov/ http://www.labtestsonline.org/index.html http://www.wikipedia.org
http://health.allrefer.com/health/test.html http://www.gpnotebook.co.uk/homepage.cfm www.pdfcoke.com/cpradheep
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