DOCSLIB.ORG

Executive Health Reference Guide

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Executive Health Reference Guide Executive Health Reference Guide 1 CLEVELAND CLINIC EXECUTIVE HEALTH PROGRAM General Health COMPLETE BLOOD COUNT B12 or folic acid, or excessive Calcium – Mineral found primarily smoking or alcohol use. A decreased in bones. May be elevated with bone Your complete blood count will level may be seen in iron deficiency. injury (fractures), cancers that spread provide insight into various aspects of to the bone and certain endocrine your health, with indicators including: Platelet Count – Platelets are blood abnormalities such as overactivity of products critical for normal clotting. the parathyroid glands. Low values Hemoglobin – The protein that carries Abnormal values (either high or low) occur with poor dietary intake, lack of oxygen to all body tissues, carried may be clues to an underlying blood vitamin D or kidney disorders. in red blood cells; low value may disorder. Platelets are also affected by indicate anemias or inherited blood certain medications, alcohol, infection, Phosphorus – Mineral related to disorders. liver disease and, in women, the bone activity and diet. Abnormalities menstrual cycle. can be seen in individuals with Hematocrit – A ratio (expressed as a gastrointestinal, renal, bone or percent) of red cells to whole blood; calcium disorders. reduced in anemias; increased in CHEMISTRY PROFILE chronic lung conditions. Magnesium – Mineral that activates Total Protein – Combination of enzyme systems. Can be abnormal White Blood Cell Count – May be albumin and globulin. Abnormal with alcohol abuse, diabetes, certain elevated in inflammation or infection, values may occur due to kidney, endocrine and kidney disorders, bowel and in smokers. When elevated, a bowel or liver diseases or malnu- disease and diuretic usage. more detailed analysis of specific trition. Proteins characteristic of types of white blood cells may be certain conditions, such as multiple Bilirubin, Total – The level of bile indicated. May be decreased with myeloma (bone marrow cancer), pigment in the blood. Elevated certain medications, viral illness or can be detected. Proteins can levels occur with liver disease or an in nonspecific fluctuations. be further characterized through accelerated breakdown of red blood electrophoresis (a lab test) of the cells (hemolysis). Slight increases MCV (Mean Corpuscular Volume), blood serum and urine. frequently occur in a benign condition, MCH (Mean Corpuscular called Gilbert’s syndrome, and are of Hemoglobin), MCHC (Mean Albumin – Blood protein no clinical significance. Corpuscular Hemoglobin manufactured by the liver, which Concentration – Measures the size makes up two-thirds of total protein. Uric Acid – Final breakdown product and hemoglobin content of red cells; Marked changes may be related to of nucleic acid metabolism. Elevated useful in evaluating subtypes of kidney, bowel or liver diseases or to most commonly with gout. Can be anemia. An increased level of MCV poor nutrition. elevated with malignancies, excessive may indicate deficiencies of vitamin 2 CLEVELAND CLINIC EXECUTIVE HEALTH PROGRAM GENERAL HEALTH, CONTINUED alcohol intake, kidney disorders, Glucose – Blood sugar level frequently and certain endocrine diseases. Mild insulin resistance syndrome, a high elevated in diabetes. Can also be evaluations of no clinical consequence protein diet and certain medications. influenced by diet (inadequate frequently occur with breakdown of fasting) and certain medications. A red blood cells (hemolysis) in the Alkaline Phosphatase – Enzyme in the single elevation, particularly of mild blood drawing process. blood related to liver or bone. Various degree, does not necessarily mean liver diseases in which bile ducts are that diabetes is present. Low levels, Chloride – Mineral important in blocked lead to an increase. Elevated called hypoglycemia, can be due to maintenance of electrolyte balance. levels also can be seen with certain excessive medications, or certain Low levels are seen after prolonged bone disorders. medical conditions (such as endocrine vomiting or excessive use of diuretics. disorders, liver disease or rare tumors) Mild increases are common and may GGT (Gamma-Glutamyltransferase) or a prolonged fasting state. not be due to any clinically significant – A liver enzyme that rises with high condition. sensitivity for liver disorders. It can Hemoglobin A1C (Glycosylated rise in response to excessive intake Hemoglobin) – A measure that CO2 (Carbon Dioxide) – A measure of alcohol and/or high cholesterol or reflects average blood sugar over of the bicarbonate buffer system in triglycerides, excess body weight and the preceding three months. Normal the plasma. Increased in conditions insulin resistance syndrome. values are 4.0 to 6.0 percent. Levels of alkalosis from excessive ingestion above 5.5 percent may indicate of antacids or prolonged vomiting. ALT (Alanine Aminotransferase)/ impaired glucose tolerance and Decreased in acidotic conditions such AST (Asparate Aminotranferase) – increased risk for diabetes. Ideal as chronic respiratory failure, diabetes Enzymes found in the liver and values for people already known to or kidney failure. muscle. Damage to these tissues may have diabetes are below 6.5 percent. increase values. Liver disease tends to Anion Gap – A calculation used by increase ALT relatively more than AST. BUN (Blood Urea Nitrogen)/ the physician to determine the likely Elevations of these enzymes need to Creatinine – Kidney function tests cause of excessive acid in body fluids be interpreted in the context of other that measure how well certain waste (acidosis). An increased anion gap liver function test results. AST also is products of metabolism are excreted is seen in acidosis from diabetes, found in muscle cells, including the from the body. BUN is frequently aspirin intoxication and kidney failure. heart, and may be elevated if these elevated with dehydration. Acidosis from diarrhea occurs with a tissues are damaged. normal anion gap. Sodium – Mineral and electrolyte LD or LDH (Lactate Dehydrogenase) that helps maintain fluid balance and Urinary Microalbumin – This test – Enzyme found in the blood cells, volume. Can be abnormal in kidney is a sensitive measure of protein in liver cells and muscle tissue, including disorders, certain endocrine diseases, the urine, which reflects leakage of heart muscle. Breakdown of red blood dehydration or overhydration. a small amount of protein from the cells or damage to liver or muscle kidneys. Presence of protein may be tissue may increase values. Mild Potassium – A mineral and electrolyte an early sign of kidney disease or elevations of no clinical consequences important in nerve impulse conduction damage from diabetes, high blood frequently occur with breakdown of and body fluid balance. Can be low pressure or atherosclerosis. red blood cells (hemolysis) in the with use of diuretic therapy, diarrhea blood drawing process. LD from and certain endocrine diseases. specific tissues (isoenzymes) can Increased with kidney disease, potas- be measured to determine the sium-sparing diuretics, certain other specific source. medications such as ACE inhibitors, CLEVELANDCLINIC.ORG/EXECHEALTH 3 GENERAL HEALTH, CONTINUED Iron/TIBC – Tests used to evaluate stops DNA synthesis and affects Pleural Thickening – Thickening of iron metabolism. In iron deficiency cell growth and repair. Vitamin B12 the lining that covers the lungs. anemia, iron levels are typically low deficiency may lead to memory loss, and TIBC (total iron binding capacity) and problems of the nervous system, Bone Mineral Densitometry – This is high. In iron overload states such anemia or skin changes. Strict test is used to predict your potential as hemochromotosis, iron levels are vegetarians, the elderly and people bone fracture risk. It is only one typically high. with inflammatory bowel disease are of several factors that predict risk, at an increased risk of deficiency. in addition to a history of previous Ferritin – A blood test to measure bone fractures, age, small body serum ferritin levels in your blood. Hepatitis C– A viral hepatitis that may and bone size, tendency to fall, and This blood test can show whether be chronic and produce no symptoms family history of early osteoporosis. there is too much or too little iron in for a long time. There is no vaccine for Although the T-score compares your your body. It can also be elevated by hepatitis C, but it can now be cured bone density to a 21-year-old female underlying inflammatory conditions with antiviral medication. A blood test considered to have peak bone mass at such as arthritis. for antibodies to hepatitis C is the that age, it is only an estimate of your best screening method. The screening possible bone fracture risk. A T-score OTHER LAB TESTS/SCREENINGS blood test is recommended for all less than -1.0 suggests possible people born between 1945 and 1965 thinning of the bone, often called TSH (Thyroid Stimulating Hormone) because their rate of hepatitis C is osteopenia, while a score of -2.5 or – Hormone secreted by the pituitary much higher than other age groups. If less suggests an even lower degree gland that regulates the production of the antibody test is positive, additional of bone density in the osteoporosis thyroid hormones. When increased, testing is advised to detect whether range, which is associated with a it may indicate under-function of the the virus itself is present in the blood. possibly higher risk of bone fractures. thyroid gland (hypothyroidism) or The bone mineral densitometry failing
Load more

Recommended publications
  • Quantitation of Relative Mobilities of Serum Transferrin in Quarter Horses and Thoroughbreds Using Crossed Immunoelectrophoresis
    QUANTITATION OF RELATIVE MOBILITIES OF SERUM TRANSFERRIN IN QUARTER HORSES AND THOROUGHBREDS USING CROSSED IMMUNOELECTROPHORESIS BY RUTH GREER KAGEN II Bachelor of Science in Biology East Central Oklahoma State University Ada. Oklahoma 1982 Submitted to the Faculty of the Graduate College of the Oklahoma State University in partial fulfillment of requirements for the degree of MASTERS OF SCIENCE December. 1985 4 ' ;_ '" SERUM TRANSFERRIN IN QUARTER HORSES AND THOROUGHBREDS USING CROSSED IMMUNOELECTROPHORESIS Thesis Approved ii 1236431 ~ ACKNOWLEDGEMENTS The author wishes to express sincere gratitude to Dr. T. E. Staley for serving as the principle advisor and for providing the facilities and financial support necessary to carry out this work. I am most in­ debted to Dr. Staley for his continued faith in my work. his constant support and patient advice. and for his attentive and meticulous instruc­ tion as well as superb organization--all without which this study would not have been possible. I also wish to thank the members of the committee: Dr. C. L. Ownby and Dr. L. G. Stratton. I wish to extend my sincere thanks to Dr. C. L. Ownby for her continued interest in my career and her invaluable advice. both which greatly assisted me in the endeavors to carry out this work. I am very grateful for all the time which Dr. Ownby has afforded me and for her objective and sincere counsel. I am most appreciative of Dr. L. G. Stratton's interest in this project. Through his generous support and concern. we were provided with Pxcellent facilities in which to carry out this work and we were also provided with access to the animals needed for this project.
    [Show full text]
  • Wilson Disease
    Wilson Disease What is Wilson disease? Wilson disease is a hereditary disease in which excessive amounts of copper accumulate in the body, mainly in the liver. The disease affects approximately one in every 30,000 Canadians. Small amounts of copper are essential to good health. One of the liver’s jobs is to maintain the balance of copper in the body. The liver is also the main organ to store copper. In Wilson disease, when its storage capacity is full, copper is released into the blood stream. It then accumulates in various organs such as the brain and the cornea of the eye. This copper overload damages these organs. Left untreated, Wilson disease can be fatal. What causes the disease? Wilson disease is inherited. In order to have the disease, a person must get two defective genes, one from each parent. The liver begins to retain copper at birth and it may take years before symptoms manifest themselves. Having only one defective gene does not lead to Wilson disease. What are the symptoms of Wilson disease? Wilson disease is sometimes difficult to diagnose. Affected individuals may have no symptoms for years. When symptoms develop, they can be subtle. Sometimes symptoms of Wilson disease resemble hepatitis. Alternatively, some individuals have an enlarged liver and spleen and liver test abnormalities. Copper accumulation in the brain can present itself in two ways: (1) as physical symptoms such as slurred speech, failing voice, drooling, tremors or difficulty in swallowing or (2) as psychiatric disorders such as depression, manic behaviour or suicidal impulses. Very rarely, Wilson disease may cause the liver to fail.
    [Show full text]
  • Leukocyte Esterase Activity in Vaginal Fluid of Pregnant and Non-Pregnant Women with Vaginitis/Vaginosis and in Controls
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by PubMed Central Infect Dis Obstet Gynecol 2003;11:19–26 Leukocyte esterase activity in vaginal fluid of pregnant and non-pregnant women with vaginitis/vaginosis and in controls Per-Anders Mårdh 1, Natalia Novikova 1, Ola Niklasson 1, Zoltan Bekassy 1 and Lennart Skude 2 1Department of Obstetrics and Gynecology, University Hospital, Lund and 2Department of Clinical Chemistry, County Hospital, Halmstad, Sweden Objectives: Todeterminethe leukocyteesterase (LE) activity invaginal lavage fluid ofwomen with acuteand recurrentvulvovaginal candidosis (VVC and RVVC respectively), bacterial vaginosis(BV), and in pregnant and non-pregnantwomen without evidenceof the threeconditions. Also tocompare the resultof LEtestsin women consultingat differentweeks inthe cycle andtrimesters of pregnancy.The LEactivity was correlatedto vaginal pH, numberof inflammatory cells instained vaginal smears,type of predominatingvaginal bacteria andpresence of yeast morphotypes. Methods: Onehundred and thirteen women with ahistoryof RVVC,i.e. with at least fourattacks of the conditionduring the previousyear and who had consultedwith anassumed new attack ofthe condition,were studied.Furthermore, we studied16 women with VVC,15 women with BV,and 27 women attendingfor control of cytological abnormalities, who all presentedwithout evidenceof either vaginitisor vaginosis. Finally, 73 pregnantwomen wereinvestigated. The LEactivity invaginal fluid duringdifferent weeks inthe cycle of 53 of the women was measured. Results: Inthe non-pregnantwomen, anincreased LE activity was foundin 96, 88, 73 and56% of those with RVVC,VVC and BV andin the non-VVC/BVcases,respectively. In 73% of pregnantwomen inthe second trimester,and 76% of thosein the third,the LEtestwas positive.In all groupsof non-pregnantwomen tested, the LEactivity correlatedwith the numberof leukocytesin vaginal smears,but it didnot in those who were pregnant.There was nocorrelation between LE activity andweek incycle.
    [Show full text]
  • Arterial Blood Gases: Acid-Base Balance
    EDUCATIONAL COMMENTARY – ARTERIAL BLOOD GASES: ACID-BASE BALANCE Educational commentary is provided through our affiliation with the American Society for Clinical Pathology (ASCP). To obtain FREE CME/CMLE credits click on Earn CE Credits under Continuing Education on the left side of the screen. **Florida licensees, please note: This exercise will appear in CE Broker under the specialty of Blood Gas Analysis. LEARNING OUTCOMES On completion of this exercise, the participant should be able to • identify the important buffering systems in the human body. • explain the Henderson-Hasselbalch equation and its relationship to the bicarbonate/carbonic acid buffer system. • explain the different acid-base disorders, causes associated with them, and compensatory measures. • evaluate acid-base status using patient pH and pCO2 and bicarbonate levels. Introduction Arterial blood gas values are an important tool for assessing oxygenation and ventilation, evaluating acid- base status, and monitoring the effectiveness of therapy. The human body produces a daily net excess of acid through normal metabolic processes: cellular metabolism produces carbonic, sulfuric, and phosphoric acids. Under normal conditions, the body buffers accumulated hydrogen ions (H+) through a variety of buffering systems, the respiratory center, and kidneys to maintain a plasma pH of between 7.35 and 7.45. This tight maintenance of blood pH is essential: even slight changes in pH can alter the functioning of enzymes, the cellular uptake and use of metabolites, and the uptake and release of oxygen. Although diagnoses are made by physicians, laboratory professionals must be able to interpret arterial blood gas values to judge the validity of the laboratory results they report.
    [Show full text]
  • K392-100 Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric)
    FOR RESEARCH USE ONLY! Total Iron-Binding Capacity (TIBC) and Serum Iron Assay Kit (Colorimetric) rev 08/19 (Catalog # K392-100; 100 assays; Store at -20°C) I. Introduction: BioVision’s TIBC and Serum Iron Assay Kit measures both Total iron-binding capacity (TIBC) and Serum iron. Those values indicate the requisite iron for transferrin saturation and Serum Iron respectively. In humans, Transferrin is a blood protein that binds and transports iron throughout the body. Iron bound to transferrin and not bound are reflected in the following: 1) Total Iron Binding Capacity, 2) Unbound Iron, 3) Transferrin Saturation Bound Iron, and 4) Free Iron. Those measurements can be used for to detect and monito transferrin saturation and also iron-deficiency anemia and chronic inflammatory diseases. Part A: TIBC Part B: Serum Iron 1 1 2 2 3 3 4 II. Application: Determination of TIBC, Unbound Iron, Transferrin Saturation, Serum Iron III. Sample Type: Serum or plasma. Serum-off-the clot is preferable to normal serum. IV. Kit Contents: Components K392-100 Cap Code Part Number TIBC Assay Buffer 25 ml WM K392-100-1 Iron Solution 100 µl Blue K392-100-2 TIBC Detector 2 x 1.5 ml Brown K392-100-3 TIBC Developer 5 ml NM K392-100-4 Iron Standard (100 mM) 100 µl Yellow K392-100-5 V. User Supplied Reagents and Equipment: • 96-well plate clear plate with flat bottom • Microplate reader capable of absorbance reading VI. Storage Conditions and Reagent Preparation: Store kit at -20°C, protected from light. Briefly centrifuge small vials prior to opening.
    [Show full text]
  • Ileal Neobladder: an Important Cause of Non-Anion Gap Metabolic Acidosis
    The Journal of Emergency Medicine, Vol. 52, No. 5, pp. e179–e182, 2017 Ó 2017 Elsevier Inc. All rights reserved. 0736-4679/$ - see front matter http://dx.doi.org/10.1016/j.jemermed.2016.12.036 Clinical Communications: Adult ILEAL NEOBLADDER: AN IMPORTANT CAUSE OF NON-ANION GAP METABOLIC ACIDOSIS Jesse W. St. Clair, MD and Matthew L. Wong, MD, MPH Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts and Department of Emergency Medicine, Harvard Medical School, Boston, Massachusetts Reprint Address: Matthew L. Wong, MD, MPH, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Rosenberg Building, 2nd Floor, 1 Deaconess Road, Boston, MA 02446 , Abstract—Background: The differential diagnosis for a disease, or medications such as acetazolamide. non-anion gap metabolic acidosis is probably less well Commonly used mnemonics to remember the differential known than the differential diagnosis for an anion gap for the non-anion gap metabolic acidosis include metabolic acidosis. One etiology of a non-anion gap acidosis ‘‘ABCD’’ for ‘‘Addison’s, Bicarbonate loss, Chloride is the consequence of ileal neobladder urinary diversion (administration), and Drugs,’’ as well as ‘‘HARDUP’’ for the treatment of bladder cancer. Case Report: We pre- for ‘‘Hyperchloremia, Acetazolamide and Addison’s, sent a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a Renal Tubular Acidosis, Diarrhea, Ureteroenterostomies, urinary tract infection and ureteroenterostomy. Why and Pancreaticoenterostomies’’ (Table 1) (1). Should an Emergency Physician Be Aware of This?: Part Ureteroenterostomies are when the ureter has an of the ileal neobladder surgery includes ureteroenteros- abnormal connection with a segment of intestine.
    [Show full text]
  • Understanding Your Blood Test Lab Results
    Understanding Your Blood Test Lab Results A comprehensive "Health Panel" has been designed specifically to screen for general abnormalities in the blood. This panel includes: General Chemistry Screen or (SMAC), Complete Blood Count or (CBC), and Lipid examination. A 12 hour fast from all food and drink (water is allowed) is required to facilitate accurate results for some of the tests in this panel. Below, is a breakdown of all the components and a brief explanation of each test. Abnormal results do not necessarily indicate the presence of disease. However, it is very important that these results are interpreted by your doctor so that he/she can accurately interpret the findings in conjunction with your medical history and order any follow-up testing if needed. The Bernards Township Health Department and the testing laboratory cannot interpret these results for you. You must speak to your doctor! 262 South Finley Avenue Basking Ridge, NJ 07920 www.bernardshealth.org Phone: 908-204-2520 Fax: 908-204-3075 1 Chemistry Screen Components Albumin: A major protein of the blood, albumin plays an important role in maintaining the osmotic pressure spleen or water in the blood vessels. It is made in the liver and is an indicator of liver disease and nutritional status. A/G Ratio: A calculated ratio of the levels of Albumin and Globulin, 2 serum proteins. Low A/G ratios can be associated with certain liver diseases, kidney disease, myeloma and other disorders. ALT: Also know as SGPT, ALT is an enzyme produced by the liver and is useful in detecting liver disorders.
    [Show full text]
  • Lab Dept: Urine/Stool Test Name: MICROALBUMIN, URINE
    Lab Dept: Urine/Stool Test Name: MICROALBUMIN, URINE General Information Lab Order Codes: UMAR Synonyms: Albumin/Creatinine Ratio CPT Codes: 82043 – Albumin: urine, microalbumin, quantitative 82570 – Creatinine; other source Test Includes: Urine Microalbumin in mg/L, Urine Creatinine in mg/dL and Albumin/creatinine ratio in mg albumin/g creatinine Logistics Test Indications: Increased excretion of albumin (microalbuminuria) is a predictor of future development of clinical renal disease in patients with hypertension or diabetes mellitus. Lab Testing Sections: Chemistry Phone Numbers: MIN Lab: 612-813-6280 STP Lab: 651-220-6550 Test Availability: Daily, 24 hours Turnaround Time: 1 day Special Instructions: N/A Specimen Specimen Type: Urine, random collection Container: Plastic leakproof container (No preservatives) Draw Volume: 1 - 3 mL from a random urine collection Processed Volume: Minimum: 1 mL urine Collection: A random urine sample may be obtained by voiding into a urine cup and is often performed at the laboratory. Bring the refrigerated container to the lab. Make sure all specimens submitted to the laboratory are properly labeled with the patient’s name, medical record number and date of birth. Special Processing: Lab Staff: Centrifuge specimen before analysis. Patient Preparation: Sample should not be collected after exertion, in the presence of a urinary tract infection, during acute illness, immediately after surgery, or after acute fluid load. Sample Rejection: Mislabled or unlabeled specimens; samples contaminated with blood Interpretive Reference Range: Albumin/creatinine ratio (A/C <30 mg/g Normal ratio) 30 - 299 mg/g Microalbuminuria >300 mg/g Clinical albuminuria Urine Creatinine: No reference ranges established Critical Values: N/A Limitations: Due to variability in urinary albumin excretion, at least two of three test results measured within a 6-month period should show elevated levels before a patient is designated as having microalbuminuria.
    [Show full text]
  • Ocular Copper Deposition Associated with Monoclonal Gammopathy of Undetermined Significance: Case Report
    RELATOS DE CASOS Ocular copper deposition associated with monoclonal gammopathy of undetermined significance: case report Depósito ocular de cobre associado a gamopatia monoclonal de significância indeterminada: relato de caso Patrick F. Tzelikis1 ABSTRACT Peter R. Laibson2 Marco P. Ribeiro3 To report a case of ocular copper deposition in both eyes at the level of 4 Christopher J. Rapuano Descemet’s membrane associated with a monoclonal gammopathy of 5 Kristin M. Hammersmith undetermined significance (MGUS). A 49-year-old white woman had Elisabeth J. Cohen6 golden-brown metallic dust-like deposits on Descemet’s membrane of both eyes. A systemic examination revealed an elevated serum copper, normal serum ceruloplasmin and a normal level of total protein. Serum protein electrophoresis demonstrated a single peak (M-spike) in the gamma region (M-protein in serum = 11 g/l). Flow cytometric analysis of the marrow aspirate identified a monoclonal plasma cell population that represents approximately 2% of the total marrow cells consistent with the diagnosis of monoclonal gammopathy of undetermined significance. Copper deposits at the level of Descemet’s membrane may be a finding in a patient with monoclonal gammopathy of undetermined significance. Keywords: Copper/analysis; Blood protein electrophoresis; Descemet’s membrane; Gama-globulins/diagnosis; Paraproteinemias/diagnosis INTRODUCTION Bilateral deposition of copper on Descemet’s membrane occurs in a variety of conditions associated with hypercupremia, including multiple (1-3) (4) From the Cornea Service, Wills Eye Hospital, Jefferson myeloma , pulmonary carcinoma , and also benign monoclonal gamma- Medical College of Thomas Jefferson University, nopathies(5-6). We describe the third case in the literature of deposition of Philadelphia, Pennsylvania, U.S.A.
    [Show full text]
  • TITLE: Acid-Base Disorders PRESENTER: Brenda Suh-Lailam
    TITLE: Acid-Base Disorders PRESENTER: Brenda Suh-Lailam Slide 1: Hello, my name is Brenda Suh-Lailam. I am an Assistant Director of Clinical Chemistry and Mass Spectrometry at Ann & Robert H. Lurie Children’s Hospital of Chicago, and an Assistant Professor of Pathology at Northwestern Feinberg School of Medicine. Welcome to this Pearl of Laboratory Medicine on “Acid-Base Disorders.” Slide 2: During metabolism, the body produces hydrogen ions which affect metabolic processes if concentration is not regulated. To maintain pH within physiologic limits, there are several buffer systems that help regulate hydrogen ion concentration. For example, bicarbonate, plasma proteins, and hemoglobin buffer systems. The bicarbonate buffer system is the major buffer system in the blood. Slide 3: In the bicarbonate buffer system, bicarbonate, which is the metabolic component, is controlled by the kidneys. Carbon dioxide is the respiratory component and is controlled by the lungs. Changes in the respiratory and metabolic components, as depicted here, can lead to a decrease in pH termed acidosis, or an increase in pH termed alkalosis. Slide 4: Because the bicarbonate buffer system is the major buffer system of blood, estimation of pH using the Henderson-Hasselbalch equation is usually performed, expressed as a ratio of bicarbonate and carbon dioxide. Where pKa is the pH at which the concentration of protonated and unprotonated species are equal, and 0.0307 is the solubility coefficient of carbon dioxide. Four variables are present in this equation; knowing three variables allows for calculation of the fourth. Since pKa is a constant, and pH and carbon dioxide are measured during blood gas analysis, bicarbonate can, therefore, be determined using this equation.
    [Show full text]
  • Approach to Acute Kidney Injury: Differentiation of Prerenal, Postrenal and Intrinsic Renal Disease, Acute Tubular Necrosis and Renal Vascular Disease
    Acute Kidney Injury, Renal Vascular Disease Renal Genital Urianry System 2019 APPROACH TO ACUTE KIDNEY INJURY: DIFFERENTIATION OF PRERENAL, POSTRENAL AND INTRINSIC RENAL DISEASE, ACUTE TUBULAR NECROSIS AND RENAL VASCULAR DISEASE Biff F. Palmer, MD, Office: H5.112; Phone 87848 Email: [email protected] LEARNING OBJECTIVES • Given laboratory tests results and radiographic imaging, be able to diagnose a patients with an increased serum creatinine concentration as having post-renal renal disease and list the common clinical etiologies of urinary obstruction • Given laboratory tests results and radiographic imaging, be able to diagnose a patients with an increased serum creatinine concentration as having pre-renal kidney injury • Given pertinent aspects of the history, physical examination, serum and urine electrolytes, and urinalysis in any patient, be able to distinguish pre-renal renal failure from intrinsic renal disease • Given urine and plasma concentrations of sodium and creatinine in any patient, be able to calculate the fractional excretion of sodium (FENa) and interpret the results • List the renal syndromes associated with use of NSAID’s • List the characteristics of thromboembolic disease of the kidney, multiple choesterol emboli syndrome, renal vein thrombosis, and renal artery stenosis After determining chronicity and assessing the level of renal function, one should attempt to classify the patient with renal disease into one of several syndromes based on the renal structures most affected: pre-renal, post-renal or intrinsic renal disease. This classification is based on the information obtained in the history, physical examination, laboratory tests and selected imaging studies. It is particularly important to identify prerenal and postrenal disorders because theses disorders are often readily reversible.
    [Show full text]
  • Prevalence of Microalbuminuria and Associated Risk Factors Among Adult Korean Hypertensive Patients in a Primary Care Setting
    Hypertension Research (2013) 36, 807–823 & 2013 The Japanese Society of Hypertension All rights reserved 0916-9636/13 www.nature.com/hr ORIGINAL ARTICLE Prevalence of microalbuminuria and associated risk factors among adult Korean hypertensive patients in a primary care setting Yon Su Kim 1, Han Soo Kim2, Ha Young Oh3, Moon-Kyu Lee4, Cheol Ho Kim5, Yong Soo Kim6,DavidWu6, Amy O Johnson-Levonas6 and Byung-Hee Oh7 Microalbuminuria is an early sign of nephropathy and an independent predictor of end-stage renal disease. The purpose of this study was to assess microalbuminuria prevalence and its contributing factors in Korean hypertensive patients. This cross-sectional study enrolled male and female patients of X35 years old with an essential hypertension diagnosis as made by 841 physicians in primary care clinics and 17 in general hospitals in the Republic of Korea between November 2008 and July 2009. To assess microalbuminuria prevalence, urine albumin/creatinine ratio (UACR) was measured in patients with a positive dipstick test. Of the 40 473 enrolled patients, 5713 (14.1%) had a positive dipstick test. Of 5393 patients with a positive dipstick test and valid UACR values, 2657 (6.6%) had significantly elevated UACR (X30 lgmgÀ1), 2158 (5.4%) had microalbuminuria (30 lgmgÀ1pUACR o300 lgmgÀ1) and 499 (1.2%) had macroalbuminuria (UACR X300 lgmgÀ1). Based on multivariate analysis, independent factors associated with elevated UACR included low adherence to antihypertensive medication (23% higher; P ¼ 0.042), poorly controlled blood pressure (BP; 38% higher for systolic BP/diastolic BP X130 mm Hg/X80 mm Hg; Po0.001), obesity (47% higher for body mass index (BMI) X25.0 kg m À2; Po0.001), age (17% lower and 58% higher for age categories 35–44 years (P ¼ 0.043) and 475 years (Po0.001), respectively) and a prior history of diabetes (151% higher; Po0.001) and kidney-related disease (71% higher; Po0.001).
    [Show full text]