Glossary of Clinical Lab: Carbs, Proteins, Lipids
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- Carbohydrates are...
- -complex sugars
-metablized into basic sugars
- Blood glucose may change d/t...
- -inc or dec metabolism of carbs into sugar
-inc or dec rate of consumption of glucose by cells
-hormones help to regulate glucose movement into and out of the cell
- What decreased blood sugar?
- What increased blood sugar?
- -produced in pancreas in islets of langerhans (beta cells)
-controls cells ability to take glucose from the blood stream (increases cells uptake of glucose)
- What factor is most important in regulating insulin secretion?
- circulating concentration of blood glucose
- Diabetes Mellitus
- -disruption of insulin relgulation
-deficient beta cell insulin production or release (pancreatic factor)
-insulin receptor dysfcn (extra-pancreatic factor)
- Testing/Monitoring Diabetes
- -measuring insulin is ideal but difficult and costly
-C-peptide predicts insulin levels
- What is c-peptide?
- -insulin precursor
-protein connecting alpha chain of pro-insulin
-released into bloodstream when insulin is produced
-CORRELATES WITH INSULIN LEVELS (generally)
- Can use c-peptide instead of insulin for..
- -diabetics with anti-insulin antibodies
-pt who secretly admin insulin to themselves
-diabetic taking insulin
-pts with insulinoma (excess insulin)
- What is more accurate than whole blood glucose for monitoring glucose?
- serum glucose
- Tube of choice for glucose monitoring
- serum separator tube (completely separates cells and serum)
- If whole blood glucose is your only option for monitoring glucose, what tube should you use?
- -Grey top tube (NaFl) because it blocks glucose metabolsim
-normally whole blood glucose drops 10 mg/dl for each hour it sits
- What do most labs used for monitoring glucose?
- automated glucose oxidase methodology
- CLIA approved procedures for monitoring glucose include...
- -glucose oxidase
- What may interfere with glucose reading?
- -increased HCT can increase glucose
-ascorbic acid or lipemia
- Fasting Glucose:
Non gestational Diabetes
- Adult: 70-115 mg/dl
Neonate: 30-40 mg/dl
Gestational Diabetes: >105 mg/dl
Non-gestational Diabetes: >140 mg/dl
- Glucose Tolerance Tests:
- -3 hr procedure used to rule out DM in border line cases
-prep includes 150 gm carb diet for 3 days, followed by 12 hour fast
- Glucose Tolerance Test: Expecected reactions
- Fasting: 70-100 mg/dl
Peak (30 min -1 hour): 120-170 mg/dl
1 Hour: 120-170 mg/dl
2 Hours: 70-120
3 hours: 70-120
**ALL VALUES MUST BE IN RANGE TO BE CONSIDERED NORMAL
*If you extend it for 5 hours, it can detect hypoglcemia (values will drop below 70 and stay down for a long time)
- how do test results differ with diabetics?
- -after the peak, there is a slow decrease
- Under normal circumstances, glucose attached to ....
- Beta chain of hemoglobin A
- glucose + hemoglobin A produces...
- hemoglobin A1C
- What is the link between glycosylation of hemoglobin and blood glucose levels?
- Glucosylation will increase with sustained levels of blood glucose
(increase in blood glucose levels leads to increases glycosylation)
- Hb A1C values indicate glucose levels over what amount of time?
- over the past 3 months
Because of RBCs lifespan (110-120 days)
- High glycosylated hemoglobin levels indicates...
- poor control in a diabetic
- What is the Normal non-diabetic glycosylated Hb level?
- How is glycosylated Hb test used?
- -to monitor diabetic therapy
-differentiate short term hyperglycemia from a diabetic condition
-eliminate ficticous report by pt
- Causes of hyperglycemia:
-states of stress (MI, CVA, trauma, general anesthesia)
-drugs (corticosteroids, some dieretics, beta blockers)
-IV fluids with dextrose
- Causes of hypoglycemia:
- -excess inslun
-sulfonylurea (drugs that cause pancreas to produce insulin)
-insulinoma (excess insulin)
- Plasma lipoproteins carries most of the ..... and ...... in the blood
- carries most of the cholesterol and esterified lipids in the blood
- 4 major lipoprotein classes:
-very low density lipoproteins (VLDL)
-low density lipoproteins (LDL)
-high density lipoproteins (HDL)
- Major fucntion of the lipoproteins is...
- transport of trigylceride and cholesterol from sites of origin (intestine and liver) to sites of energy storage and utilization
- Normal Triglycerides
- Male: 40-160
- Normal Total Cholesteral
- <200 mg/dl
- Normal HDL
- >40 mg/dl
- Normal LDL
- <100 mg/dl
- Normal Chol:HDL ratio
10 = double the risk
20 = triple the risk
- Which lipid values change with fasting state? Which do not?
- Triglycerides change with a fasting state
Total cholesterol does not
- Cholesterol is the main lipid associated with....?
- arteriosclerotic vascular disease
- Is cholesteral a good indicator of CAD?
- by, itself, cholesterol is NOT an accurate predictor of CAD (it fluctuates daily)
- What is a better measure of CAD?
- Total cholesteral:HDL ratio
- What is cholesterol used for?
- required for production of sex hormones, steroids, etc.
- What percentages of cholesteral are bound to LDL and HDL?
- 75% to LDL
25% to HDL
- Causes of increased cholesterol?
- Causes of decreased cholesterol?
- -severe liver disease
-MI (levels falls 24-48 hours, reach low point at 7-10 days at ~30-40% lower than normal)
- Where are tricglycerides produced,transported, etc.?
- -Produced in the liver and tranported by LDL
-Incorporated into the chylomicrons (protein shell)
-gives blood a milky appearance if too high
- Triglycerides are hydrolyzed by .... into ....
- hydrolyzed by pancreatic lipase into FFA and monoglycerides
- Triglycerides can be measured as an assessment of...
- Coronary risk
- Causes of increased triglycerides:
- -glycogen storage disease
-chornic renal disease
- Causes of decreased triglcyerides:
- Where and how is LDL produced?
- Produced in the liver by combingin Tg and cholestereol with apoproteins
- LDL consists of...
- 35% protein
- What does LDL do?
- -carries Tg to peripheral tissue to be used by cells
-contributes to deposition of cholesterol in the artery walls
- LDL values:
- <100 desirable (<70 if hx of MI)
>160 high risk
- HDL consists of..
- 50% protein
- What does HDL do?
- -transports cholesterol from tissue back to liver
-offers some protection from atherosclerosis
- HDL values:
- Male 35-65 mg/dl (<35 is CAD risk)
Female 35-80 mg/dl (<40 is CAD risk)
- What are apolipoproteins?
- -polyproteins that make up the protein component of lipoproteins
-involved in the binding of lipoproteins to receptors on the cell surface (facilitates lipid uptake by cells)
- What is the major polypeptide component of HDL? of LDL?
- HDL: Apolipoprotein A
LDL: Apolipoprotein B
- Indication for apolipoproteins labs?
- evaluate the risk of atherogenic heart disease or peripheral vascular disease
- Factors affecting lipid panel results:
- -pt not on usual diet for past 2 weeks
-medications (OCPs, estrogens, BP meds)
-thyroid, hepatic, or kidney dz
-prolonged use of touniquet during blood draw (inc level)
-pregnancy (inc level)
- Two main types of proteins:
-Globulin (lipoprotein, glycoprotein, immunoglobulins)
- What can be used to separate albumin and globulin?
- -protein electrophoresis can be used to separate albumin and globulin and establishes levels of various components that are specific for certain disease states
- Electrophoresis is used to ..
- -detect gammopathies
-assess severe liver dz
-assess nutritional status
- -most common protein (2/3 of total)
-smaller and light than globulins
-produced in liver
- What does Albumin do?
- -maintains serum osmotic pressure
-transports various substances (carrier protein) such as calcium, magnesium, bilirubin, coumadin, etc.
-source of endogenous amino acids
- Albumin assays
- -assayed by chemical method that react with nitrogen atoms or with a dye that binds to albumin and produces a color change
-ultra-centrifugation has been used to study some groups of globulins
- Total serum protein =
- albumin + globulins
- Normal Total Serum Protein
- Adults: 6-8 g/dl
- Causes of hyperproteinemia:
-collage disorders (SLE,RA)
- Causes of hypoproteinemia:
- -increased protein loss (nephrotic syndrome, burns, etc)
-increased catabolism (inflammation, malignancy)
-decreased synthesis (liver dz, decreased AA intake)
- -proteins that act as antibodies in the immune system
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