Bio - Chemistry
Pradeep Chockalingam
Snr-2 Physio
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Aim & Objectives
Understand basic Bio-Chemistry
investigations.
Understand what information it gives us.
Correlate to day to day practice and
Maximise patient care.
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Contents
Electrolytes
Renal
Liver, Spleen & Pancreas
Inflammatory Markers
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Electrolytes
Sodium - Na+
Potassium - K+
Chloride - Cl-
Phosphorus - P4+
Calcium - Ca++
Magnesium - Mg++
Helps to regulate the fluid balance & electrolyte balance of the body
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Body Fluid Compartments
Intracellular Extracellular
30L 9L 3L
Interstitial Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
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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.
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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.scribd.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.
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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.
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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.
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Magnesium - Mg++
It is important for Neuromuscular activity,
Defence System & Metabolism.
Low level may cause muscle weakness,
twitching, cramping, confusion, cardiac
arrhythmias, and seizures.
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Renal Function
Urea
Creatinine
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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.
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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.
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Liver, Spleen & Pancreas
Bilirubin
Albumin & Total Protein
Alanine Transaminase (ALT)
Alkaline Phosphatase (ALP)
Gamma Glutamyl Transpeptidase
Amylase
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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.
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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.
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Body Fluid Compartments
Intracellular Extracellular
30L 9L 3L
Interstitial Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
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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.
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Amylase
Enzyme found in the pancreas & the salivary
glands.
High levels indicates Pancreatitis, Pancreatic
diseases, Diabetic ketoacidosis & Blockage
or damage to the bowel.
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Inflammatory Markers
C-Reactive Protein
Lactate
Troponin-T
D-dimer
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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.
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Lactate
Waste product of anaerobic respiration
(Normal: Carbohydrate breaks into H2O +
CO2).
May increase due to Severe Exercise,
Infection, Pulmonary embolism, Hypoxia,
Dehydration.
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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).
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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
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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
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