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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