CC WEEK 3 (SWEETNSALTY).pdf

hydates of aldehyde and ketone derivatives main source of energy PROMOTES: CARBOHYDRATES brain consumes most of the carbs...

hydates of aldehyde and ketone derivatives main source of energy PROMOTES: CARBOHYDRATES brain consumes most of the carbs o Glycogenolysis GLUCOSE o Glycolysis Monosaccharides GALACTOSE Simple sugars DECREASES: FRUCTOSE entry of glucose into the cell Disaccharide lactose galactose + glucose PROMOTES: Composed of 2 sucrose fructose + glucose maltose glucose + glucose o Glycogenolysis monosaccharides THYROID HORMONES o Gluconeogenesis Polysaccharide STARCH governs metabolism main stprage of o Intestinal absorption Composed of many GLYCOGEN glucose in man of glucose monosaccharides CELLULOSE Stimulates release of cortisol PANCREAS ADRENOCORTICOTROPIC from the adrenal cortex. Both an endocrine and exocrine organ in the control of HORMONE (ACTH) Promotes glycogenolysis and carbohydrate metabolism. gluconeogenesis. AS AN ENDOCRINE GLAND Produced by the delta ____ cells of o Insulin beta cells (hypoglycemic) the islets of Langerhans of the SOMATOSTATIN pancreas. o Glucagon alpha cells (hyperglycemic) o Somatostatin delta cells Inhibits the action of insulin, growth hormone and glucagon. AS AN EXOCRINE GLAND o Amylase responsible for the breakdown of ingested complex carbohydrates earliest marker for pancreatitis CLINICAL CONDITIONS OF CARBOHYDRATE METABOLISM: HORMONES WHICH REGULATE BLOOD GLUCOSE LEVEL Increase in blood glucose concentration Entry of glucose into the cell Synthesized by the Beta cells of LABORATORY FINDINGS Islets of Langerhans in the Hyperglycemia: INSULIN _________________ pancreas o Increase glucose in I PROMOTES: HYPERGLYCEMIA plasma and urine THE ONLY HYPOGLYCEMIC o Glycogenesis >126 mg/dL FBS LEVEL: ____ o Increase urine specific ↳ glucose to glycogen AGENT o Lipogenesis gravity ↳ carbs to fatty acids renal threshold of normally released when o Glycolysis glucose is 160-180 mg/dl o Ketones in serum and glucose levels are high ↳ glucose to lactate DECREASES: (anaerobic) or pyruvate urine (aerobic) - glycogen o Glycogenolysis to glucose o Decrease blood and Synthesized by the Alpha cells urine pH (acidosis) of Islets of Langerhans in the o Electrolyte imbalance GLUCAGON __________________ THE PRIMARY pancreas HYPOGLYCEMIA Decreased glucose levels in the blood HYPERGLYCEMIC AGENT PROMOTES: Results from an imbalance released during stress and fasting state o Glycogenolysis between glucose utilization 65 mg/dL to 70 mg/dL OTHER HORMONES THAT TEND TO INCREASE GLUCOSE and production. Glucagon and other glycemic CONCENTRATION hormones are released into Diagnosis of hypoglycemia Secreted by the cells of the the circulation should not be made unless a zona fasciculata and zona patient meets the criteria of reticularis of the adrenal 50-55 mg/dL ______ whipple's triad _________________ cortex. Observable symptoms of o Low blood glucose CORTISOL AND non-carb source to hypoglycemia appear concentration PROMOTES: CORTICOSTEROIDS I glucose-6-phosphate o Gluconeogenesis o Typical symptoms {GLUCOCORTICOIDS) converts a-d glucose to b-d glucose diabetes to monitor glycemic control Contains mutarotase enzyme reagent INHIBITORS (high levels): Ascorbic acid, bilirubin, citric For every 1% change in the HbA1c value, acid, creatinine, uric acid, and L-dopa drug 35 mg/dl is added to plasma glucose. the intensity of the end color is directly proportional to the glucose concentration GLUCOSE DEHYDROGENASE METHOD NORMAL: 6.5% (at least 2 occasions) DM: ______ The amount of NADH generated is proportional to the glucose concentration. Also known as glycosylated or glycated FRUCTOSAMINE albumin/plasma protein ketoamine mutarotase _____________ is also added to shorten the time necessary to reach equilibrium for patients with hemolytic dse. For short term glucose control (3-6 weeks) 1-2 weeks POLALOGRAPHIC GLUCOSE OXIDASE (modified glucose oxidase) i measures the rate of oxygen consumption which is proportional to glucose concentration DIAGNOSTIC CRITERIA FOR DM glucose oxidase in the reagent catalyzes the oxydation of glucose by oxygen, forming H2O2 H2O2 is prevented from re-forming oxygen by adding molybdate, iodide, catalase/ethanol FBS >126 mg/dl Catalase inhibits reversible movement of H2O2 2-HOUR OGTT >200 mg/dl RBS HbA1c >6.5% 3 |L E C T U R E N O T E S B Y : M S. S O P H I A J. P A N G I L I N A N , R M T  7 most common very pretty Cori Aquino met her tita fanconi NOTE: CSF GLUCOSE 60% of the blood plasma glucose level ____ Formed during the conversion of pro- insulin to insulin The amount of circulating C-peptide C-PEPTIDE provides reliable indicators for pancreatic and insulin secretions ( B-cell function). Post-operative and post-transplantation marker Recommended when plasma glucose reached 300 mg/dL Normal ratio of B-hydroxybutyrate and acetoacetic acid is 1:1 (0.5-1.0 mmol/L KETONE TEST each) The ratio of B3-hydroxybutyrate to acetoacetate is greatly increased in diabetic ketoacidosis ____________________ Maturity-onset Diabetes of the Youth (MODY) It is a form of monogenic diabetes. It is believed to be caused by damage to the pancreatic beta cells. It is usually asymptomatic, non-ketotic, and hyperglycemia predominantly appears between 20 years to 30 year of age in otherwise normal weight young adults. Distinct feature: Absence of specific islet cell autoantibodies; with residual C-peptide Related gene mutations: GCK, HNF1A, HNF4A, and HNF1B Neonatal Diabetes Mellitus (NDM) It is also known as the infantile diabetes or congenital diabetes. It is form of monogenic diabetes that curs in infant less than 6 months of age. Pathognomonic feature: Persistent hyperglycemia (PFG > 250 mg/dL) Possible etiologies: Increased parenteral glucose administration, sepsis, stress, and medications such as steroids Most common cause of permanent NDM: Genetic mutations in KCNJ11 and ABCC8 Most common cause of transient NDM: Overexpression of genes at chromosome 6q24 Laboratory test: Fasting plasma glucose (FPG), C-peptide, serum insulin, urine ketones, and pancreatic ultrasound 4 |L E C T U R E N O T E S B Y : M S. S O P H I A J. P A N G I L I N A N , R M T  Lipids and lipoproteins LIPIDS ↑ plasma conc. -> atherosclerosis and CAD DIFFERENT TYPES OF LIPIDS FATTY ACIDS ________________: building blocks o Primary sources of fuel functions o o [ Provide stability to cell membrane Allow for transmembrane transport o o PHOSPHOLIPID (Conjugated Lipid) Most abundant lipid Independent risk factor for atherosclerosis o INSOLUBLE in blood and water o SOLUBLE in organic solvents (chloroform and ether) o Phospholipids alter fluid surface tension (surfactant) o >2 L/S ratio: _____ Fetal lung maturity MAJOR LIPIDS most to least abundant o 65 mmol/L of sweat electrolytes - usually recognized in infancy or early childhood inherited disorder of the exocrine gland 7 produced abnormally thick secretions of mucus RAAS renin angiotensin aldosterone system na ↓ BP to activate RAAS REFERENCES: ü Bishop’s Clinical Chemistry 7th ed (Chapters 14-16) ü Rodriguez’s Review Handbook in Clinical Chemistry 7th Ed. (Chapters 10,11,16) ü Linne and Ringsrud’s Clinical Laboratory Science Concept 7th Ed. (Chapter 10) 11 | L E C T U R E N O T E S B Y : M S. S O P H I A J. P A N G I L I N A N , R M T