DOCSLIB.ORG

Endocrinology

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Endocrinology Section 15 Section Editor: Sujit Jha Endocrinology 197. Interpretation of Thyroid Function Tests 202. Evaluation of Non-Diabetic Polyuria Dheeraj Kapoor, Ruchi Kapoor, Abhishek Goyal Indira Maisnam, Soumita Mandal 198. Cognitive Aspects of Hypothyroidism 203. Postgraduate Clinic on Non-Thyroidal Anubha Srivastava, Anurag Varma, Kachnar Varma Illness Syndrome 199. Thyroid Myopathy—An Update Pankaj Kumar Agarwal NS Neki 204. Common Mistakes in Thyroid Disorders 200. Impact of Altered Thyroid Status on Diabetes: Y Bhasker Partners in Metabolic Malfunction 205. Glucocorticoids-induced Osteoporosis Swati Srivastava Saurabh Jain 201. Thyrotoxicosis: Evaluation and Management Manoj Saluja MU-197 (Sec-15).indd 1271 29-01-2021 15:22:54 MU-197 (Sec-15).indd 1272 29-01-2021 15:22:54 CHAPTER Interpretation of Thyroid 197 Function Tests Dheeraj Kapoor, Ruchi Kapoor, Abhishek Goyal Abstract Thyroid disorders have various etiologies and presentations. Pertinent treatment needs a conclusive diagnosis and is influenced by variety of coexisting medical conditions. This chapter delineates how to interpret thyroid hormones, referring to various evidence-based clinical guidelines for the management of thyroid disorders. In depth research of relevant literature and evidence-based approach has been taken to simplify interpretation of thyroid hormone levels. Topics addressed include thyroid hormone assays, thyroid antibodies levels, hyper- and hypothyroidism along with thyroid dysfunction in pregnancy. Introduction available, and hence permitting an accurate diagnosis of thyroid condition to be made in majority of case. Thyroid is a small butterfly shaped endocrine organ However, analytical inference still stands a major hurdle. located anteriorly in the lower part of neck. On an average The interpretation of thyroid function tests is generally it weighs around 25–30 g in an adult. It produces the straight forward; through sometimes the reports may seem thyroid hormones, which are released into the blood fairly clear but are in fact misleading. This article aims to stream and then transported to different tissues in the address the interpretation of thyroid functions test. body. They have an effect on each and every cell and organ of the body. Their main function is to maintain homeostasis in various functions ranging from controlling Thyroid-stimulating Hormone the metabolic rate, the muscle mass, digestive functions, TSH is secreted by anterior pituitary and is central to the development of brain, and bone maintenance. negative feedback mechanism for secretion of thyroid Thyroid gland chiefly synthesizes the hormone hormones. It shows a diurnal variance, presenting a peak thyroxine (T4) and small quantity of triiodothyronine soon after midnight and a nadir by late noon, with peak (T3). T3 being the active form with a short half life is values sometimes even twice the value seen in nadir. converted from T4 with removal of an iodine atom mainly TSH may vary in between measurements to the extent of in liver and in small quantities in heart, gut, muscle, and up to 20% without any change in thyroid state.1,2 nerves. The gland is controlled by a feedback regulation TSH is now considered as the first diagnostic test for from the pituitary, which releases thyroid-stimulating assessment of thyroid condition.3 It presents as a foremost hormone (TSH), which in turn is controlled by the irregularity in case of thyroid disorders when the other thyroid-releasing hormone (TRH) released from the test are normal. When TSH is used to confirm patients hypothalamus. with suspected thyroid diseases in an Endocrine clinic it Progress in technology over time has improved carries high sensitivity of up to 98% and a specificity of up the sensitivity and specificity of thyroid function test to 92%. But in cases of mass screening the sensitivity and MU-197 (Sec-15).indd 1273 29-01-2021 15:22:54 1274 SECTION 15 Endocrinology — Non-thyroidal illness Conditions associated with high risk for thyroid BOX 1 disease in which screening is recommended — Drugs, e.g., glucocorticoids, dopamine Increased TSH levels— z All new borns (neonatal screening) — Primary hypothyroidism z Those with strong family history of thyroid disease — Pituitary adenoma (TSH producing)—secondary z Those having an autoimmune disease, such as type 1 diabetes hyperthyroidism mellitus — z Genetic conditions (e.g., Down’s syndrome, Turner’s syndrome) Pituitary resistance to thyroid hormone (TSH z Past history of neck irradiation unreliable) z Drug therapies such as lithium and amiodarone — Generalized thyroid hormone resistance z Elderly patients — Old age z Women over age 35 — Drugs, e.g., amiodarone z Pregnant women during the first trimester — Recovery phase after severe systemic illness z Women at 6 weeks to 6 months postpartum z Dyslipidemia z Atrial fibrillation Thyroid Hormone Assays z Depression z Reduced bone mineral density Serum Thyroxine T4 levels are elevated in patients of hyperthyroidism. Hence, in the course of treatment their levels are measured positive predictive value is low due to underlying diseases to ascertain the degree of thyroid dysfunction and titration or health of the individual screened, hence making the of doses of anti-thyroid medication, because serum TSH interpretation of test result problematic. As a routine now, values may remain suppressed for a continued duration value of TSH is considered low when less than 0.1 mU/L during the course of therapy.6 and high when more than 6.5 mU/L. Serum T4 values are also important in diagnosis Using TSH as an ace standard does help to categorize of patients suffering from secondary hypothyroidism. patients in over 95% cases. But, TSH alone can be used Because a case of normal TSH and suppressed T4 should only if the pituitary thyroid axis is intact. In case of pituitary direct the clinical toward a possible diagnosis of secondary diseases (hyperthyroidism secondary to TSH producing hypothyroidism, justifying the assessment of pituitary pituitary adenoma), non-thyroidal illness, HAMA hormone levels for further investigations. antibody, drugs (glucocorticoids, tyrosine kinase inhibitor, octreotide, etc.), lab results can be misleading and difficult Serum Triiodothyronine to interpret. Aberrant TSH levels may persist for up to few Evaluation of T3 levels is not suggested routinely because months even after initiation of thyroid treatment. of its short half life and normal levels of it influenced by the The American Thyroid Association recommends endocrine homeostasis. Despite this it is of values in cases routine screening for thyroid disorders in all adults by of T3 toxicosis, in which patients have low TSH, normal measurement of serum TSH starting from the age of 35 T4, and features of hyperthyroidism. This condition is years and then every 5 years, with more frequent screening observed in a small fraction of patients suffering from 4 in high risk or symptomatic person. The American Graves’ disease. A ratio of T3:T4 > 20 ng/mL is indicative Association of Clinical Endocrinologists recommend of Graves’.6 routine measurement of serum TSH in all women of child bearing age before they conceive or during the first Free Thyroxine and Free Triiodothyronine trimester of pregnancy (Box 1).5 Merely a meagre portion of thyroid hormones circulate Conditions associated with abnormal TSH levels: in free form not bound to protein. These free form of Decreased TSH levels— thyroid hormones are physiologically more important. — Primary hyperthyroidism Their quantification is of value in conditions where levels — Pituitary or hypothalamic disease—secondary or of thyroid-binding globulin (TBG) are altered. Levels of tertiary hypothyroidism TBG influence the levels of T3 and T4 in direct proportion MU-197 (Sec-15).indd 1274 29-01-2021 15:22:54 Interpretation of Thyroid Function Tests CHAPTER 197 1275 TABLE 1 Conditions associated with altered TBG6 Thyroid Antibodies Estimation of thyroid antibodies is advisable in altered Increased binding Decreased binding thyroid functions. They help to determine if patient is Oral contraceptives Nephrotic syndrome having an autoimmune thyroid dysfunction. Various Pregnancy Active acromegaly antibodies exist against thyroid antigens. The ones of Neonates Major systemic illness importance include Anti Thyroperoxidase antibody (Anti- Acute intermittent porphyria Genetic factors TPO Ab), antithyroglobulin antibody and TSH receptor Hepatitis, biliary cirrhosis Asparaginase antibody (TSH-RAb). HIV infection Drugs—androgens, large dose glucocorticoids Anti-thyroperoxidase Antibody (Anti-TPO Ab) Drugs—estrogen supplements, tamoxifen Anti-TPO is also known as thyroid microsomal antibodies. They cause hypothyroidism by two distinctive mechanisms. First by blocking the thyroid peroxidase without any change in hormone activity, more TBG falsely thereby hindering the synthesis of T3 and T4 and secondly more T3, T4, and low TBG presenting as falsely low T3 and by antibody dependent cell toxicity and inflammation T4 (Table 1). of thyroid gland.7 Anti-TPO Ab levels facilitate in the diagnosis of subclinical hypothyroidism and helps in Free Thyroxine evaluation of autoimmune thyroiditis. fT4 is performed for optimizing thyroxine therapy in patients of newly diagnosed hyperthyroidism. It is also TSH Receptor Antibody (TSH-RAb) prescribed in diagnosis of secondary hypothyroidism and TSH-RAb may either stimulate of block the TSH receptor. in cases of end organ thyroid hormone resistance. If they stimulate they cause Grave’s disease
Load more

Recommended publications
  • Hyperosmolar Hyperglycemic State (HHS) Erica Kretchman DO October 19 2018 Speaker for Valeritas, Medtronic, Astrazenica, Boehringer Ingelheim
    Hyperosmolar Hyperglycemic State (HHS) Erica Kretchman DO October 19 2018 Speaker for Valeritas, Medtronic, AstraZenica, Boehringer Ingelheim. These do not influence this presentation Objective • Review and understand diagnosis of Hyperosmolar Hyperglycemic State (HHS) and differentiating from Diabetic Ketoacidosis • Treatment of HHS • Complications of HHS Question 1 • Which of the following is NOT a typical finding in HHS? 1. Blood PH <7.30 2. Dehydration 3. Mental Status Changes 4. Osmotic diuresis Question 2 • Hypertonic fluids, such as 3% saline, are the first line of treatment to correct dehydration in HHS 1. True 2. False Question 3 • Which of the following statements is INCORRECT about Hyperosmolar Hyperglycemic State? 1. HHS occurs mainly in type 2 diabetics. 2. This condition presents without ketones in the urine. 3. Metabolic alkalosis presents in severe HHS. 4. Intravenous Regular insulin is used to treat hyperglycemia. Hyperosmolar Hyperglycemic State (HHS) • HHS and DKA are of two of the most serious complications form Diabetes • Hospital admissions for HHS are lower than the rate for DKA and accounts for less than 1 percent of all primary diabetic admissions • Mortality rate for patients with HHS is between 10 and 20 percent, which is approximately 10 times higher than that for DKA • Declined between 1980 and 2009 • Typically from precipitating illness - rare from HHS itself PRECIPITATING FACTORS • The most common events are infection (often pneumonia or urinary tract infection) and discontinuation of or inadequate insulin
    [Show full text]
  • Effect on Ca++. the Clinical Significance of This Observation Re- Suggest That Physiologic Jaundice Results from a Markedly In- Quires Further Evaluation
    ABSTRACTS 413 effect on Ca++. The clinical significance of this observation re- suggest that physiologic jaundice results from a markedly in- quires further evaluation. creased load of bilirubin presented to the liver either from increased bilirubin synthesis or enhanced intestinal reabsorb- Controlled clinical trial of phenobarbital (PB) and light for tion and marked limitation in the capacity to conjugate. management of neonatal hyperbilirubinemia in a predomi- Studies performed at 4 hours of age in a monky born 2 weeks nant Negro population. O. S. VALDES, H. M. MAURER, C. N. post-maturely revealed that hepatic transport and conjugation SHUMWAY, D. DRAPER, and A. HOSSAINI. Med. Coll. of Virginia, of bilirubin was fully mature, indicating that maturation of Richmond, Va. (Intr. by W. E. Laupus). each of these functions may occur in utero. Low birth weight infants, less than 24 hrs of age, were randomly assigned to receive either oral PB, 5 mg/kg/day for 5 A controlled study of intravenous fibrin hydrolysate supple- days, blue light (200-300 footcandles) continuously for 4 days, a ment in prematures <1.3 kg. M. HEATHER BRYAN, PATRICK combination of PB and light, or no treatment. 90% or more of WEI, RICHARD HAMILTON, SANFORD H. JACKSON, INGEBORC C. the infants in each group were Negroes. Infants with a positive RADDE, GRAHAM W. CHANCE, and PAUL R. SWYER. Univ. of Coomb's test were excluded. Toronto and The Research Inst., The Hosp. for Sick Children, Toronto, Ont. Canada. We have compared the effect of early supplemental intra- Total serum bilirubin concentration, mg% (mean ± S.E.) venous 3.5% fibrin hydrolysate plus 10% dextrose to 10% No.
    [Show full text]
  • Severe Hyponatremia with Hypouricemia in a Patient with Medullary Hemorrhage: a Case Report
    SUTIRTHA CHAKRABORTY, TAPAS K BANERJEE SEVERE HYPONATREMIA WITH HYPOURICEMIA IN A PATIENT WITH MEDULLARY HEMORRHAGE: A CASE REPORT The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine SEVERE HYPONATREMIA WITH HYPOURICEMIA IN A PATIENT WITH MEDULLARY HEMORRHAGE: A CASE REPORT Sutirtha Chakraborty1, Tapas K Banerjee2 1Consultant & Chief, Dept. of Biochemistry, Peerless Hospital & B K Roy Research Centre, Kolkata 700094, India 2Sr. Consultant & Head, Dept. of Neurology, National Neurosciences Centre, Peerless Hospital, Kolkata,India Corresponding Author: Dr Sutirtha Chakraborty, MD Consultant & Chief, Dept. of Biochemistry Peerless Hospital & B K Roy Research Centre, Kolkata 700094 , India e‐mail: [email protected] Mobile +91 9874787638 ABSTRACT Hyponatremia is the commonest electrolyte abnormality in hospitalized patients and occurs due to various causes. Here we present a case of SIADH who was diagnosed using commonly available biochemical tests. This case report also discusses the interaction of the laboratory physician with the treating clinician and the approach needed to arrive at a correct diagnosis. It highlights the importance of serum uric acid and fractional excretion of urinary uric acid in the diagnosis of SIADH. It also discusses the approach needed to distinguish SIADH from Cerebral Salt wasting syndrome, where the presenting feature is also hyponatremia. KEY WORDS Hyponatremia, SIADH, Uric Acid. CASE REPORT A 68 year old gentleman was admitted to the Dept. of Neurology with a history of sudden onset uneasiness followed by slurring of speech and giddiness. Examination by the Consultant Neurologist showed that he was conscious and obeying commands with a Glasgow Coma Scale of 14/15.Power was grade 4/5 in all four limbs and DTRs preserved.
    [Show full text]
  • Diagnostic Accuracy of Calculated Serum Osmolarity to Predict Dehydration in Older People: Adding Value to Pathology Laboratory Reports
    Open Access Research BMJ Open: first published as 10.1136/bmjopen-2015-008846 on 21 October 2015. Downloaded from Diagnostic accuracy of calculated serum osmolarity to predict dehydration in older people: adding value to pathology laboratory reports Lee Hooper,1 Asmaa Abdelhamid,1 Adam Ali,1 Diane K Bunn,1 Amy Jennings,1 W Garry John,2 Susan Kerry,2 Gregor Lindner,3 Carmen A Pfortmueller,4 Fredrik Sjöstrand,5 Neil P Walsh,6 Susan J Fairweather-Tait,1 John F Potter,1,2 Paul R Hunter,1,2 Lee Shepstone1 To cite: Hooper L, ABSTRACT et al Strengths and limitations of this study Abdelhamid A, Ali A, . Objectives: To assess which osmolarity equation best Diagnostic accuracy of predicts directly measured serum/plasma osmolality ▪ – calculated serum osmolarity Dehydration has become a generic term we and whether its use could add value to routine blood to predict dehydration in have clearly described dehydration type (water- older people: adding value to test results through screening for dehydration in older loss dehydration) and used serum osmolality, pathology laboratory reports. people. the correct reference standard. BMJ Open 2015;5:e008846. Design: Diagnostic accuracy study. ▪ Assessment of equations in five different groups doi:10.1136/bmjopen-2015- Participants: Older people (≥65 years) in 5 cohorts: of older people including healthy free-living older 008846 Dietary Strategies for Healthy Ageing in Europe people, frailer people living in residential care, (NU-AGE, living in the community), Dehydration and older people visiting emergency care or ▸ Prepublication history and Recognition In our Elders (DRIE, living in residential staying in hospital, living in several European additional material is care), Fortes (admitted to acute medical care), countries, and including men and women, available.
    [Show full text]
  • Using Osmolality to Diagnose and Treat Hyponatremia in Covid-19 Patients
    SCIENTIFIC RESOURCE USING OSMOLALITY TO DIAGNOSE AND TREAT HYPONATREMIA IN COVID-19 PATIENTS ARTICLE SUMMARY Recent publications have shown that COVID-19 (coronavirus disease 2019), an infectious disease caused by a novel coronavirus known as severe acute respiratory syndrome coronavirus (SARS-CoV-2), is associated with electrolyte disorders including hyponatremia.1,2,3 Early diagnosis and etiologic determination are critical in any hyponatremic patient to ensure proper treatment and to avoid potential harm to the patient.4,5 Osmolality testing is quick, inexpensive and effective to help with early detection and diagnosis of hyponatremia.6 Osmolality testing can help ensure that appropriate treatment strategies are implemented early for hyponatremic patients which may be even more significant in patients hospitalized with COVID-19.5,7,8 As clinicians and researchers continue to expand their understanding of COVID-19, additional laboratory testing is important to consider to help better understand and diagnose a COVID-19 patient’s underlying conditions. OSMOLALITY TESTING CAN HELP WITH EARLY DIAGNOSIS AND ETIOLOGICAL DETERMINATION OF HYPONATREMIA, WHICH IS CRITICAL FOR THIS PATIENT POPULATION As association between COVID-19 of hyponatremia. The use of urine and respiratory failure. and hyponatremia has been shown in osmolality to establish a correct Understanding the the literature.1,2,3 Hyponatremia is an underlying diagnosis of hyponatremia is underlying causes electrolyte disorder that occurs when critical to avoid inappropriate treatment
    [Show full text]
  • Effects of Hyperglycemia and Rapid Lowering of Plasma Glucose in Normal Rabbits
    MILESTONES IN NEPHROLOGY J Am Soc Nephrol 11: 1776–1788, 2000 Mark A. Knepper, Feature Editor Studies on Mechanisms of Cerebral Edema in Diabetic Comas EFFECTS OF HYPERGLYCEMIA AND RAPID LOWERING OF PLASMA GLUCOSE IN NORMAL RABBITS ALLEN I. ARIEFF AND CHARLES R. KLEEMAN WITH THE TECHNICAL ASSISTANCE OF ALICE KEUSHKERIAN AND HELEN BAGDOYAN From the Departments of Medicine, Wadsworth Veterans Administration Center and Cedars-Sinai Medical Center, and the Cedars-Sinai Medical Research Institute, and University of California Los Angeles Medical Center, Los Angeles, California 90048 with comments by ALLEN I. ARIEFF AND RICHARD STERNS Reprinted from J. Clin. Invest. 52:571–583, 1973 A BSTRACT To investigate the pathophysiology of cerebral edema occurring during treatment of diabetic coma, the effects of hyperglycemia and rapid lowering of plasma glucose were AUTHOR COMMENTARY evaluated in normal rabbits. During 2 h of hyperglycemia (plasma glucose = 61 mM), both brain (cerebral cortex) and Allen I. Arieff muscle initially lost about 10% of water content. After 4 h of hyperglycemia, skeletal muscle water content remained low University of California, but that of brain was normal. Brain osmolality (Osm) (343 San Francisco mosmol/kg H2O) was similar to that of cerebrospinal fluid Sausalito, California (CSF) (340 mosmol/kg), but increases in the concentration of Na+, K+, Cl–, glucose, sorbitol, lactate, urea, myoinositol, and amino acids accounted for only about half of this increase. n 1936, Dillon, Riggs, and Dyer described a syndrome The unidentified solute was designated “idiogenic osmoles”. Iwhereby individuals who were being treated for diabetic When plasma glucose was rapidly lowered to normal with coma and apparently recovering suddenly deteriorated, with insulin, there was gross brain edema, increases in brain content worsening of coma, respiratory insufficiency, hypotension, of water, Na+, K+, Cl– and idiogenic osmoles, and a signifi­ tachycardia, high fever, and death (1).
    [Show full text]
  • Water Deprivation Test and Desmopressin Test in Adults
    BLOOD SCIENCES DEPARTMENT OF CLINICAL BIOCHEMISTRY Title of Document: Water Deprivation Test in Adults Q Pulse Reference No: BS/CB/DCB/EN/16 Version NO: 5 Authoriser: Sadie Redding Page 1 of 4 WATER DEPRIVATION TEST Introduction Diabetes insipidus (DI) involves deficient production or lack of effective action of antidiuretic hormone (ADH or arginine vasopressin). ADH stimulates the kidney to conserve fluid. Deficient production of ADH or lack of effective action of ADH causes a high urine output, thirst, dehydration, and low blood pressure in advanced cases. Disease of the hypothalamus/pituitary gland leading to a deficiency in ADH production is called cranial or central DI. Disease of the kidney leading to lack of response of the kidney to fluid conserving action of ADH is called nephrogenic DI. The principle of the water deprivation test is to assess the ability of the patient to concentrate urine when fluids are withheld. Water deprivation should normally cause increased secretion of ADH, resulting in the production of small volumes of concentrated urine. Initial tests Polyuria should be confirmed by 24hour urine volume. Rule out diabetes, UTI, hypercalcaemia, hypokalaemia, renal failure and thyrotoxicosis. Morning urine osmolality >600mOsm/kg rules out DI and therefore a water deprivation test is not necessary. Preparation Please contact the Duty Biochemist at least 24 hours before the test (ext.48437) Normal dinner and fluids are allowed the night before the test. No alcohol or caffeine. 7am light breakfast but NO fluids, tea, coffee or smoking. Supervision is required throughout to assess compliance and safety. Contraindications Hypovolaemia or hypernatraemia Procedure Print out a worksheet and record results in the table (appendix 1).
    [Show full text]
  • Hypertonic Saline Test for the Investigation of Posterior Pituitary
    Arch Dis Child 1998;79:431–434 431 Hypertonic saline test for the investigation of Arch Dis Child: first published as 10.1136/adc.79.5.431 on 1 November 1998. Downloaded from posterior pituitary function Angelika Mohn, Carlo L Acerini, Timothy D Cheetham, StaVord L Lightman, David B Dunger Abstract (ADH) concentrations. The test is well estab- The hypertonic saline test is a useful tech- lished in adults56 yet there is little reported nique for distinguishing partial diabetes experience of its use in children. insipidus from psychogenic polydipsia, We describe five cases in which the hyper- and for the diagnosis of complex disorders tonic saline test provided a clear diagnosis of of osmoreceptor and posterior pituitary various disorders of water balance where function. However, there is little infor- standard diagnostic procedures had failed or mation concerning its use in childhood. were deemed unreliable. The experience of using this test in five children (11 months to 18 years) who pre- Methods and materials sented diagnostic problems is reported. In All the tests were performed at the John two patients, in whom water deprivation RadcliVe Hospital, Oxford and informed con- tests were equivocal or impractical, an sent was obtained from the patients and/or inappropriately low antidiuretic hormone their parents. Before testing, each patient was (ADH) concentration (< 1 pmol/l) was assessed to exclude the presence of any demonstrated in the presence of an ad- confounding factor such as hypercalcaemia, equate osmotic stimulus (plasma osmola- hypokalaemia, glycosuria or any other cause of lity > 295 mosmol/kg). In two children— a solute diuresis.
    [Show full text]
  • Review of Serum Chemistry Interpretation in Neonatal Foals
    APPLIED MEDICINE: CLINICAL PATHOLOGY AND DERMATOLOGY Review of Serum Chemistry Interpretation in Neonatal Foals Bryan M. Waldridge, DVM, MS, Dipomate ABVP (Equine Practice), Diplomate ACVIM Interpretation of serum chemistry results in foals can be very confusing because reference ranges are usually based on adult samples, and many values are increased in foals compared with adults. Un- derstanding the expected differences in serum chemistry results between foals and adult horses improves the recognition of abnormalities and facilitates making an accurate diagnosis. Author’s address: PO Box 1843, Georgetown, KY 40324; e-mail: [email protected]. © 2013 AAEP. 1. Introduction Serum alkaline phosphatase (ALP) activity is 2,3,6,7 Reference ranges for many serum chemistry values highest during the first 2 to 8 weeks of life and 7 6 in adult horses cannot reliably diagnose disease in remains elevated for 8 weeks to at least 90 days. foals.1–4 Placental abnormalities may influence There is a wide individual variation and large stan- dard deviation of ALP activity in foals, which limits clinicopathologic results in neonates during the first 2 1 its effectiveness to diagnose hepatobiliary disease. few days of life. Most hepatic indices in foals are 8 significantly different from adult horses, especially Hank et al measured activity of specific ALP during the neonatal period. Ideally, age-specific isoenzymes and determined that 80% to 92% of total ALP activity is from bone. However, Dumas and reference ranges should be used in foals, but it is 9 difficult to sample a large enough population of clin- Spano reported that increased ALP activity in foals ically normal foals and few laboratories are able to is mainly of hepatic origin.
    [Show full text]
  • The Measurement of Serum Osmolality and Its Application to Clinical
    Jornal Brasileiro de Patologia e Medicina Laboratorial ISSN: 1676-2444 [email protected] Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial Brasil Faria, Daniel K.; Mendes, Maria Elizabete; Sumita, Nairo M. The measurement of serum osmolality and its application to clinical practice and laboratory: literature review Jornal Brasileiro de Patologia e Medicina Laboratorial, vol. 53, núm. 1, febrero, 2017, pp. 38-45 Sociedade Brasileira de Patologia Clínica/Medicina Laboratorial Rio de Janeiro, Brasil Available in: http://www.redalyc.org/articulo.oa?id=393549993007 How to cite Complete issue Scientific Information System More information about this article Network of Scientific Journals from Latin America, the Caribbean, Spain and Portugal Journal's homepage in redalyc.org Non-profit academic project, developed under the open access initiative REVIEW ARTICLE J Bras Patol Med Lab, v. 53, n. 1, p. 38-45, February 2017 The measurement of serum osmolality and its application to clinical practice and laboratory: literature review 10.5935/1676-2444.20170008 A medida da osmolalidade sérica e sua aplicação na prática clínica e laboratorial: revisão da literatura Daniel K. Faria; Maria Elizabete Mendes; Nairo M. Sumita Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, Brazil. ABSTRACT Introduction: Serum osmolality is an essential laboratory parameter to understand several clinical disorders such as electrolyte disturbances, exogenous intoxication and hydration status. Objective: This study aims to update knowledge about the osmolality examination through research papers published to date. Materials and methods: The survey was conducted on PubMed database. It highlights main concepts, both historical and physiological aspects, and the clinical applications of the serum osmolality test.
    [Show full text]
  • Hyponatraemia- Principles, Investigation and Management
    Hyponatraemia- Principles, Investigation and Management Sirazum Choudhury Biochemistry Contents • Background • Investigation • Classification • Normal Osmolality • General management and SIADH • Cases Background • Relatively common: - Estimated 15-30% prevalence in all acute admissions - Prevalence 2.48% in community with 0.97% incidence in 1985 • Associated with gait disturbance, cognitive disturbance, osteoporosis and mortality - (Not causative) Background • Hyponatraemia: Serum sodium of less than 135mmol/L - Mild: 130-135 - Moderate:125-129 - Severe: <125 • Acute is <48 hours, Chronic is >48 hours. • Reflects serum osmolality • Hyponatraemia causes cell overhydration Background adaptation Pseudo Background hyponatraemia Lipid Pseudo True hyponatraemia hyponatraemia Normal 1L /1Kg Na 1L Na 1Kg Na 1L /1Kg Na 135 125 135 125 Osm/Kg-280 Osm/Kg-280 Osm/Kg-265 Background Background - Symptoms • Mild: - Asymptomatic - Headache, anorexia, nausea, lethargy • Moderate: - Confusion, muscle cramps, weakness, confusion, ataxia • Severe: - Drowsiness, coma, vomiting, brainstem herniation, seizures • Rapid correction: - Cerebral pontine demyelinolysis Assessment Examination Investigations • Capillary refill • U+Es • Tissue turgor • LFTs • Radial pulse- ?tachycardia • Osmolality (paired serum and urine) • Mucous membranes • Urine Sodium and Potassium • JVP • Thyroid function Tests • Heart sound- ?flow murmurs • 9am Cortisol ?S3 • CXR • Breath sounds- ?crepitations • CT Head (?SIADH) • Ascites • Peripheral oedema If required: • Lipid profile • Protein
    [Show full text]
  • Diabetic Ketoacidosis (DKA) Author: Leigh Vaughn
    Diabetic Ketoacidosis (DKA) Author: Leigh Vaughn DKA definition: Elevated glucose, presence of ketones, metabolic acidosis (triad) + dehydration, with absolute or relative insulin deficiency increase counter regulator hormones breakdown of fat and muscle. Not a hyperosmolar state like Hyperglycemic Hyperosmolar State (HHS). Epidemiology: • Most common at onset Type 1 DM, recurrent episodes common • Can occur in Type 2 DM. More often affects young • Death can be related to cerebral edema or the precipitating trigger/illness for the DKA. • Mortality < 1%, significantly lower than mortality of HHS Triggers (The “I’s”): • Initial (new onset) disease • Insulin omission (adherence, access, absorption) • Infection • Ischemia (ACS, stroke) • Intra-abdominal (pancreatitis, cholecystitis, ischemic bowel, pregnancy) • Ingestions (ETOH, substance abuse, meds-steroids, antipsychotics, thiazides, pentamidine), Pathophysiology: • 3 causes of increased glucose: Gluconeogenesis, Glycogenolysis, Impaired glucose utilization • Increase glucose + deficiency of insulin + stress (trigger) increases the secretion of glucagon, catecholamines, cortisol, and growth hormone (counter-regulatory hormones) promotion of lipolysis increases FFA delivery to the liver FFA converted by free fatty acyl CoA into ketones Clinical presentation: • Develops over hours to days; not days to weeks, like HHS. • Polyuria, Polydipsia, Polyphagia, Fatigue, Muscle cramps (from Acidosis), Flushed facial appearance, Kussmaul’s respirations and dyspnea (from acidosis) Nausea and
    [Show full text]