Biochemistry PDF

Biochemistry - Important to assist with developing our treatment plan - Not to be used in isolation need to consider whole clinical picture = guides the treatment and on the particular diet to provide - Don't use this information **[on it own]** to diagnose anyone - Medication an...

Biochemistry - Important to assist with developing our treatment plan - Not to be used in isolation need to consider whole clinical picture = guides the treatment and on the particular diet to provide - Don't use this information **[on it own]** to diagnose anyone - Medication and supplementation needs to be considered - Tests cannot be ordered but only requested via a medical officer - Need to consider cost vs benefit - Sometimes they are expensive   Reference ranges Predifend range that the biochem results need to be in - These values vary depending on: - Facility that u are in - Lab that has completed the test - Age of the individual receiving the test - Gender of the individual receiving the test   **[Albumin ( 34-48g/L)]** - Protein made by the liver - Assist with keeping fluid in blood and transport of vitamin, enzymes and hormones +-----------------------------------+-----------------------------------+ | **[Hypoalbuminaemia = low | **[Hyperalbuminaemia = | | ]** | high]**\ | | | - dehydration\ | | - Inflammation | - high protein diet | | | | | - Infection | | | | | | - Surgery | | | | | | - Liver disease | | | | | | - Renal disease | | | | | | - Diabetes | | | | | | - Malnutrition | | +-----------------------------------+-----------------------------------+ - Treat the underlying condition, may require medication, an infusion will not fix the problem long term - *Consider half life of 21 days = The half-life of albumin, typically around 21 days, reflects the time it takes for the concentration of albumin in the blood to reduce by half due to natural breakdown and elimination from the body.* - *its levels are more reflective of chronic rather than acute changes in nutritional status or protein intake.* - *Not only diet causes decrease there are several other factors that need to be considered hydration, exercise*   **[Bicarbonate (23-31mmol/L)]** - Byproduct of metabolism - Blood passes bicarb to lungs and it is exhaled as CO2 - Excreted and reabsorbed by kidney, regulates pH (acid- base balance) - Altered with liver, respiratory and renal disease +-----------------------------------+-----------------------------------+ | **[Metabolic acidosis = | **[Metabolic acidosis = | | low]**\ | high]** | | - Diarrhoea | | | | \- Vomiting and laxatives = | | - Renal disease | excessive loss of hydrogen ions | | | | | - Liver failure | - Dehydration | | | | |   | - Eating disorder = Anorexia | | | | | Treat = medication | - COPD | | | | |   | This leads to metabolic alkalosis | | | (pH\>7.4) in tissues. | | | | | | Associated with hypokalaemia (low | | | potassium levels in blood) (due | | | to severe vomiting & dehydration) | | | | | | **[Treat underlying | | | cause]** | +-----------------------------------+-----------------------------------+   **[Cholesterol ]**   A blue background with white text Description automatically generated - Important structural component of cell membranes and is important in the production of hormones and bile +-----------------------+-----------------------+-----------------------+ | High levels | **[HDL Cholesterol | **[LDL Cholesterol | | developing heart | (LOW - | (HIGH - | | disease or increasing | concern)] | concern)] | | risk of stroke | **\ | ** | | | Causes:\ | | | | - obesity\ | Causes: | | | - refined | | | | carbohydrates\ | - Poor dietary | | | - low exercise\ | choices | | | - Medications ( beta | | | | blockers/steroids) | - Lack of exercise | | | | | | | | - Genetics | | | | | | | | - Obesity | | | | | | | | - Smoking, age, | | | | | | | | - Diabetes | +-----------------------+-----------------------+-----------------------+     **[Creatinine (45-90mmol/L) ]** - Used to test renal function alongside urine protein - Waste product made by muscles, filtered from blood in kidney and secreted as urine +-----------------------------------+-----------------------------------+ |   | **[High levels ]** | | | | |   | - Renal dysfunction = Acute | | | renal failure or Chronic | | | renal failure | | | | | | - Infection | | | (pyelonephritis/inflammation | | | glomerulonephritis) of the | | | kidney | | | | | | - Diabetes | | | | | | - Hypertension | | | | | | - Heart disease | | | | | | - Issues with urinary tract | | | | | | - Drug toxicity | | | | | | *A higher creatinine level is | | | usually associated with a lower | | | GFR, and indicates kidney | | | dysfunction.* | | | | | | Treat underlying condition, may | | | require dialysis | +-----------------------------------+-----------------------------------+ - Endogenous creatinine comes from skeletal muscles, people with larger muscles tend to produce more. - Reflective of glomerular filtration rate (GFR)   **[eGFR ]**   Measure of how well the kidneys filter blood = Level of kidney function - Kidney filter blood = remove waste + extra water = urine. - eGFR test that measure the level of kidney function and determines the stage of kidney disease by measuring the filtration rate - Impacted by - Age, gender, race, height and weight - Medications ( anti-inflammatories/diuretics/antibodies) - Dehydration - Kidney disease   **[Haemoglobin ( 115-155g/L)]** - Protein found in RBC carries oxygen to body to give energy and blood its colour - Lymphoma - Leukaemia - Anaemia ( sickle cell) - Multiple myeloma - Chronic kidney disease - Chemotherapy - Bleeding - Splenomegaly +-----------------------------------+-----------------------------------+ | **[Low ]** | **[High ]** | | | | | - Due to anaemia or conditions | - Dehydration | | causing body to produce fewer | | | RBCs ( cancer, renal disease, | - Certain patients who | | cirrhosis) | experience chronic hypoxia ( | | | heart/lung disease) | | - Blood loss (trauma, surgical | | | procedure) |   | | | | | | *Sometimes can be elevated | | | following bone marrow producing | | | increase RBCs (polycythemia) = | | | due to depletion od plasma | | | volume* | +-----------------------------------+-----------------------------------+   - Increase Hb? - Blood transfusion = in hospital - Increase iron intake through the diet and iron supplementation at home   **[Iron]** A blue background with white text Description automatically generated - Involved in the transport of oxygen in blood, storage of oxygen in muscle, immune fucntion and component of enzymes used for energy production - Serum iron = iron in liquid part of blood - Ferritin protein that stores iron ( in liver and bone marrow = can measure stored iron in the body) - Transferrin the main transport protein of iron ( made relative to bodies need, when iron is low transferrin is high) - Transferrin saturation how much the transferrin can hold +-----------------------------------+-----------------------------------+ | Low iron | High iron\ | | | - haemochromatosis\ | | - Inadequate dietary intake | - chelation, blood removal | | | | | - Actue or chronic infections | | | | | | - Poor absorption | | | | | | - Coeliac disease | | | | | | - IBD | | | | | | - Surgery | | | | | | - Blood loss | | | | | | - Menorrhagia | | | | | | - GI bleeding bowel cancer | | | | | | - Ulcer | | | | | | - Medications | | | | | | - Dietary manipulation, | | | medication, transfusion, | | | treat underlying cause | | +-----------------------------------+-----------------------------------+  - Epo medication usually given for anaemia of chronic disease, cannot be treated with diet, they might be given iron transfusion and , if haemoglobin low then blood transfusion given   Varies = enlarged... Malaena = blood in the stool   **[Liver function tests (LFT)]** A blue background with white text Description automatically generated - Diagnostic tool to determine how the liver is functioning - Measure the levels of particular enzymes and proteins in the blood +-------------+-------------+-------------+-------------+-------------+ | Alanine | Aspartate | Alkaline | Gamma-Gluta | - Bilirub | | transaminas | transaminas | phosphatase | myltransfer | in | | e | e | (ALP) | ase | = | | (ALT) = | (AST) | enzyme | (GGT) | produce | | enzyme | enzyme that | found in | enzyme in | d | | found in | helps | the liver | the blood. | during | | the liver, | metabolise | and bone, | Increase | RBC | | helps | amino | important | levels | destruc | | convert | acids, | protein | indicate | tion. | | protein | increase | degradation | liver or | It | | into | indicates |. | bile duct | passes | | energy, | liver | Increased | damage | through | | liver | damage, | levels may | | the | | damage | disease or | indicate |   | liver | | releases | muscle | liver | | and | | ALT into | damage | damage | **[High = | excrete | | the blood | | | ]{.underlin | d | | stream |   |   | e}** | in | | | | | | stool. | |   |   | **[High = | - cholest | Increas | | | | ]{.underlin | atic | ed | | **[High | **[High | e}** | liver | levels | | =]{.underli | =]{.underli | | disease | jaundic | | ne}** | ne}** | - Cholest | | e | | rapid and | rapid and | asis | - High | = | | excessive | excessive | (blocke | alcohol | indicat | | increase | increase | d | consump | e | | indicative | indicative | bile | tion | liver | | of liver | of liver | duct) | | damage | | disease. | disease. | due to | - Elevate | or some | | | | underly | d | types | | - Can |   | ing | by some | of | | remain | | infecti | drugs | anaemia | | elevate | Can remain | on/inflamma | (antico | | | d | elevated | tion | nvulsants |   | | for | for months | of | *( used | | | months | | biliary | for | **[Hyperbil | | |   | tract = | treatme | irubinemia | | - Can | | long | nt | ( HIGH) | | indicat | In chronic | term | of | ]{.underlin | | e | liver | can be | epilept | e}** | | excessi | disease AST | nil per | ic | | | ve | levels van | gut | seizure | - Cholest | | parente | be normal | (parent | s)* | asis | | ral | or slighlty | al | | due to | | nutriti | high | nutriti |   | underly | | on | | on | | ing | | |   | used) | | infecti | | | | | | on | | | In | - Followi | | | | | Alcoholic | ng | | - long | | | liver | bone or | | term | | | disease AST | intesti | | nil by | | | more | nal | | gut | | | elevated | trauma | | (PN) | | | then ALT | | | | | | | - Presenc | | - Excessi | | | | e | | ve | | | | of | | PN | | | | hyperpa | | | | | | rathyroidis | | - Impaire | | | | m | | d | | | | | | liver | | | | LOW = | | functio | | | | following | | n | | | | blood | | seconda | | | | transfusion | | ry | | | | , | | to | | | | Zn | | alcohol | | | | deficiency | | ic | | | | or in | | liver | | | | severe | | disease | | | | cases of | | or | | | | PEM ( | | viruses | | | |  malaise | | leading | | | | (extreme | | to a | | | | fatigue and | | build-u | | | | flu- like | | p | | | | symptoms) | | of | | | | when | | unconju | | | | minimal | | gated | | | | physical or | | bilirub | | | | mental | | in | | | | activity is | | | | | | done | | | +-------------+-------------+-------------+-------------+-------------+   - Liver not functioning = increases ALT in blood - Elevated LFT\'s - Viral hepatitis - Alcohol - Medications - Liver cancer - Liver disease - Heart failure - Obesity - Sepsis     **[Magnesium (0.75-1.1mmol/L)]** - Most common seen in refeeding - Involved in 300 biochemical reactions - Maintains nerve and muscle function, regular heart beat, supports immune function and helps with bone health +-----------------------------------+-----------------------------------+ | Hypomagnesemia = low | Hypermagnesemia = High\ | | | It is uncommon but can occur in | | - increased intracellular | someone with renal impairment and | | movement | they have consumed excess | | | supplement magnesium orally (diet | | - Increased renal losses | or medication sources) or IV | | | | | - Can lead to respiratory | | | dysfunction | | | | | | dietary inadequacy | | | | | | - alcoholism | | | | | | - Diarrhoea | | | | | | - Medications ( | | | diuretics/proton pump | | | inhibitors, antibiotics) | | | | | | - Acute pancreatitis | | | | | | - Gastric by pass | | | | | | - Refeeding | | | | | | - Treatment = supplementation | | | oral/IV, improve diet | | +-----------------------------------+-----------------------------------+     **[Neutrophils ]**  - Important part of immune response, produced in bone marrow, defend body against infection and inflammation - Neutrophils type of WBC +-----------------------------------+-----------------------------------+ | **[Neutropenia = | **[Leukocytosis = | | low]** | high]**\ | | | - medications | | - Cancer | | | | - Stress | | - Severe infection | | | | - Burns | | - Medications (chemotherapy, | | | radiotherapy) | - Pregnancy | | | | | - Autoimmune disorders | - Splenectomy | | | | | - Aplastic anaemia | - Smoking | | | | |   | - Obesity | | | | | - Granulocyte | - Cancers (leukemia) | | colony-stimulating factor | | | (G-CSF), antibodies, stem |   | | cell | | +-----------------------------------+-----------------------------------+   **[Phosphate ( 0.75 -1.5mmol/L)]** - Electrolyte assist body with energy production and nerve function - building strong bones and teeth +-----------------------------------+-----------------------------------+ | **[Hypophosphatemia = low | **[Hyperphosphatemia = high | | levels]** | levels]**\ | | | - renal disease\ | | - Malnutrition | - hypocalcaemia\ | | | - uncontrolled diabetes | | - Alcoholism | | | | - Dietary restriction or | | - Severe burns | phosphate binders | | | | | - Diarrhoea | | | | | | - Diabetic ketoacidosis | | | | | | - Medications | | | (diuretics/antacids/corticost | | | eroids) | | | | | | - Refeeding (increased | | | intracellular movement from | | | ECF | | | | | | - Chronic depletion can lead to | | | osteomalacia | | | | | | - Severe drops can cause | | | neuromuscular disturbances | | | such as progressive | | | encephalopathy, respiratory | | | depression, seizures, coma | | | | | |   | | | | | | - Supplementation oral/IV | | +-----------------------------------+-----------------------------------+   **[Platelets ]** - Thrombocytes are colourless blood cells that are found in the blood and spleen, form blood clots to slow or stop bleeding = assist with wound healing +-----------------------------------+-----------------------------------+ | **[Thrombocytopenia = low | **[Thrombocytosis = | | ]** | High]**\ | | | \ | | - Leukaemia and other cancers | - secondary to blood loss trauma, | | | surgery, malignancy, viral | | - Some types of anaemia | infections | | | | | - Viral infections, such as |   | | hepatitis C or HIV | | | | *This means that the high | | - Chemotherapy drugs and | phosphate level in the blood is | | radiation therapy | caused by blood loss. Blood loss | | | can lead to a decrease in blood | | - Heavy alcohol consumption | volume, which can cause the body | | | to retain phosphate.* | | - Medications (heparin, | | | quinine, anticonvulsants) | *This is not a common condition, | | | and it is usually seen in people | |   | with severe blood loss, such as | | | those who have undergone major | | THE LOWER THE VALUE THE INCREASED | surgery or trauma.* | | RISK OF SPONTANEOUS BLEEDING | | | | | |   | | | | | | Treat = transfusion or | | | medications | | +-----------------------------------+-----------------------------------+     **[Potassium (3.5-5.2mmol/L)]** - Usually seen in the malnourished - Electrolyte that assists with nerve function and muscle contraction - Regulates heart beat and movement of nutrients in and waste products out of cells +-----------------------------------+-----------------------------------+ | **[Hypokalaemia = low levels | **[Hyperkalaemia = high | | ]** | levels]** | | | | | - Causes | - Causes | | | | | - Vomiting/diarrhoea | - Impaired Renal function | | | (acute or chronic kidney | | - Excessive sweating | disease) | | | | | - Antibiotic therapy | - Dehydration | | | | | - Hypomagnesemia | - Medications ( ACE | | | inhibitors/diuretics/beta | | - Poor dietary intake | blockers) | | | | | - Refeeding | - Type 1 diabetes | | | | | - Treated = supplementation of | - Destruction of RBC due to | | potassium oral or IVT | tissue injury | | | | | *Hypokalaemia or recurrent | - Medical conditions | | requirement for repletion can be | (Addision\'s disease) | | linked to underlying MG | | | deficiency* | - Check for haemolysed samples | | | = This is when the red blood | | | cells burst or break down | | | | | | - Treated = potassium | | | restriction or may require | | | medication\ | | |   | +-----------------------------------+-----------------------------------+ - Constipation can causes increase in potassium       **[Sodium ( 133-145mmol/L)]** - Electrolyte - Maintaining fluid balance in your cells - Plays a key role in normal nerve and muscle function +-----------------------------------+-----------------------------------+ | **[Hyponatraemia = low levels of | **[Hypernatremia = high levels of | | sodium]** | sodium ]** | | | | | Overhydration or solution | - Causes | | dilution | | | | - Dehydration | | - Causes | | | | - Vomiting | | - Diarrhoea/vomiting | | | | - Renal disease | | - Excessive hydration | | | | - Poorly controlled | | - Medical conditions | diabetes | | (hypothyroidism) | | | | - Diabetes insipidus | | - Medications (diuretics) | | | | - Treated with IVT | | - SIADH (syndrome of | | | inappropriate secretion | | | of antidiuretic hormone) | | | | | | - Recreational drugs | | | | | | - Treated by fluid restriction | | | or IV therapy | | | | | |   | | +-----------------------------------+-----------------------------------+       **[Triglycerides ( 0.3-2mmol/L)]** - type of fat found in blood - Stored in fat cells and released for energy following hormonal response - **[Causes of high ]** - Meds ( diuretics/steroids/beta-blockers/immunosuppressants) - Parental nutrition - Obesity - Poorly managed diabetes - Excessive alcohol intake - Genetic - Liver disease - Renal disease ** ** **[Urea (2.7-8mmol/L)]** - By product of ammonia breakdown, occurs in liver where it is filtered and excretes in urine +-----------------------------------+-----------------------------------+ | **[Low]** | **[Uraemia = high ]** | | | | |   |  | | | | | - Severe liver disease |   | | | | | - Severe lanutrition | - Breakdown of lean tissues | | | | | | - Excessive administration of | | | protein ( overfeeding) | | | | | | - Dehydration | | | | | | - Impaired kidney function can | | | be exacerbated in individuals | | | with chronic heart failure | | | due to poor blood perfusion | | | of kidneys | +-----------------------------------+-----------------------------------+ - May require dialysis = only when u have renal failure   White blood cell   +-----------------------------------+-----------------------------------+ | **[Low]** | **[High]**\ | | |   | | - Low failing immunocompetence, | | | secondary to chemo, | - Upregulated immunocompetence | | radiotherapy | ( secondary to infection and | | | or inflammation) | | | | | | - Leukaemia, trauma or stress | +-----------------------------------+-----------------------------------+