 Signs, Symptoms, Complications
 Selling Sickness
 Carbohydrates
 Pancreas
 Type I vs Type II Diabetes
 Water/Osmolality/Electrolytes
 Acid-Base Disorders
 Lipids
 Heart Disease
 Renal Disease
http://memekid.com/funny-chemistry-cat-memes.htm
http://www.md-reasons.info/2014/07/diabetes-complications-of-diabetes.html
 Ill Defined Diseases
Affect numerous people High Cholesterol and Diabetes
 Drug Companies Profits
Expand boundaries of illness
New customers
 Diabetes
Before 1997 Diabetes diagnosis fasting blood glucose >
140 mg/dL
After 1997 Diabetes diagnosis fasting blood glucose >
126 mg/dL
 Cholesterol
Before 1998 High Cholesterol > 240 mg/dL
After 1998 High Cholesterol > 200 mg/dL
 Increased new customers by 86%
 Lifestyle changes
Diet and Exercise

Types of Energy the body can use
Carbohydrates
Proteins
Lipids
 Carbs are Good
 Carbohydrates
Glycemic index
Insulin Response
 Definitions
Glycolysis
Glycogenesis
Glycogenolysis
Gluconeogenesis – ATP and Pyruvate
http://www.rogerspeakperformers.com/2012/the-glycemic-index/
 Anatomy of a Pancreas
Exocrine – digestive enzymes amylase and lipase
 Increased in pancreatitis (lipase more specific)
Endocrine - Islets of Langerhans
 Beta Cells – Insulin
 Alpha Cells – Glucagon
 Delta Cells – Somatostatin
 Insulin
Allows glucose to enter cells
Only hormone than can decrease glucose
levels
 Glucagon
Primary hormone responsible for elevating
glucose levels
http://www.medicinenet.com/image-collection/pancreas_picture_1/picture.htm
 When the body has an excess of glucose it
will go through the process of:
A) Decreasing cell membrane permeability
B) Gluconeogenesis
C) Glycogenesis
D) Glycogenolysis
 Glucagon acts by:
A) Increasing glycogenolysis
B) Increasing glycogenesis
C) Increasing glycolysis
D) Inhibiting glycogenolysis
PANCREAS
REVIEW
 Type I AKA insulin dependent
diabetes (IDDM)
Mostly young and thin
Little to no insulin produced –
autoimmune destruction
Diabetic ketoacidosis - common
Lab findings
• Blood glucose levels 300-500 mg/dL
• Ketonuria
• Ketonemia
• Decreased Na and Cl
• Increased K
• Slightly increased osmolality
 Type II non insulin dependent
diabetes (NIDDM)
Most common form found in
mostly older and obese adults
Combination of Insulin resistance
and Insulin production issues
Diabetic ketoacidosis – rare
Hyperosmolar coma
Lab findings
 Blood glucose levels >1000 mg/dL
 Greatly increased osmolality
http://www.psychiatrictimes.com/metabolic-disorders/metabolic-monitoring-patients-antipsychotic-medications/page/0/4
 Glucose – serum, plasma, whole blood
Preferred diagnosis test is fasting plasma
glucose (fasting 10 hours prior)
• Reference range 70 -110 mg/dL
 Glycosylated hemoglobin or HbA1C –
average glucose over 3 months
Whole blood EDTA tube
 Ketone levels – serum or urine – acetest
sodium nitroprusside (detects acetoacetic
acid)
 Microalbuminuria – minute concentrations
of albumin in urine (early signs of
nephropathy)
http://blog.diabetesms.com/?cat=3
 Jane Doe is a 55 year-old-female. Her lab
results were:
Fasting glucose 122 mg/dL
Fasting triglycerides 144mg/dL
All other lab tests were normal. The doctor
ordered a 2 hour OGTT. The 2 hour glucose
tolerance test result was 228 mg/dL. These
results indicate:
A) Results are normal
B) Diabetes mellitus
C) Hypoglycemia
D) Ketoacidosis
CARBOHYDRATES
REVIEW
 Monitoring long-term glucose control
in patients with adult onset diabetes
mellitus can best be accomplished by:
A) Urine microalbumin
B) Glucose tolerance testing
C) 2-hour postprandial serum glucose
D) Glycosylated hemoglobin
CARBOHYDRATES
REVIEW
 Average Water Content of the Human Body is 40% to
75% of total body weight.
Intracellular fluid – two-thirds of total body water
Extracellular fluid – one-third of total body water
(Intravascular and extravascular fluid)
 Intravascular fluid plasma (93% water)
Carries proteins, electrolytes, nutrients, hormones, wastes
 What must be kept in a constant concentration in the
body is:
Electrolytes (ions)
pH (acid-base balance)
Water
http://www.apswater.com/article.asp?id=129&title=What+are+the+chemical+properties+of+water?
 Is a physical property of solution that is based on
the concentration of solutes (particles) per
kilogram of solvent
Calculated osmolality (mOsmol / kg H20) =
2 [Na+ ] + [glucose] /20+ [BUN]/3
 Measured Osmolality is done using freezing point
depression
 Reference Range
Serum 275-295 mOsm/kg
 General indicator of water volume
 Plasma osmolality directly effects the hypothalamus
Increase osmolality increases thirst
Increase osmolality increases ADH secretion from the
posterior pituitary
Decreased osmolality decreases ADH secretion
 Deficiency of vasopressin (ADH)
Diabetes Insipidus
Results in large volume of dilute
urine
 Renin-angiotensin-aldosterone
Stimulates sodium reabsorption
and potassium excretion
http://pixgood.com/adh-kidney.html
 Water deficit
Osmolality increases (electrolytes concentrated)
Increased thirst
ADH is secreted
• Increases water reabsorption
Aldosterone is inhibited
• Less sodium reabsorbed = decrease in electrolytes
 Water overload
Osmolality decreases (electrolytes diluted)
Thirst suppressed
Aldosterone secreted
• Sodium is reabsorbed = increase in electrolytes
 Remember two basic types of dehydration
Dying of thirst in the desert – losing more water
relative to electrolytes
• Lab findings – all electrolytes elevated
o Hypernatremia
o Hyperosmolality
Vomiting and Diarrhea – losing more electrolytes
relative to water
• Lab findings – all electrolytes decreased
o Hyponatremia
o Hyposmololality
https://www.cartoonstock.com/directory/t/thirsty.asp
 Anions have a negative charge
 Cations have a positive charge
 Extracellular fluid has a high concentration of Na+, Cl-,
HCO3-
 Intracellular fluid has a high concentration of K+, Ca+,
Mg+, PO4-
Hemolysis is unacceptable for these tests
 Sodium – osmolality = blood volume
Major extracellular cation 135-145 mEq/L
Hyponatremia
• With low serum osmolality – diarrhea, vomiting, diuretics
• With normal serum osmolality – in vitro hemolysis
• With high serum osmolality – hyperglycemia
Hypernatremia
• Dehydration, diabetes insipidus (dilute urine),
hyperaldosteronism
 Potassium – myocardial contraction
Major intracellular cation 3.4 – 5.0 mmol/L (20X greater
inside cell than outside)
• HEMOLYSIS IS UNACCEPTABLE
Both high and low levels will stop the heart
 Hypokalemia
• Vomiting, diarrhea, hyperaldosteronism

Hyperkalemia
• Hyperglycemia, hypoaldosteronism (Addison’s disease)
 Chloride – maintain electrical neutrality (chloride shift)
Major extracellular anion 98-106 mmol/L
Passively follows sodium increased and decreased in the
same conditions
Sweat chloride test for cystic fibrosis –
iontophoresis/pilocarpine
http://www.cdha.nshealth.ca/pathology-laboratory-medicine/clinical-chemistry/hemolysis
 Bicarbonate (HCO3-) – buffering system maintain pH
Second most abundant anion in extracellular fluid
22-29 mmol/L
Measured as total CO2
• 90% of total CO2 is bicarbonate
Acid base imbalance
• Decreased  metabolic acidosis
• Increased  metabolic alkalosis
Exposure to air will decrease CO2
 Electrolytes analysis
 Ion selective electrode – potentiometry using Nernst
equation
 Susceptible to protein build up
 Sodium analysis selective membrane
 Glass ion-exchange
 Potassium analysis selective membrane
 Valinomycin
 Chloride analysis selective membrane
 Ion exchange
 Carbon dioxide (bicarbonate)
 PCO2 electrode
http://chemwiki.ucdavis.edu/Analytical_Chemistry/Analytical_Chemistry_2.0/11_Electrochemical_Methods/11B%3A_Potentiometric_Methods
 Anion Gap
Difference between unmeasured anions and unmeasured
cations
The anion gap is calculated as follows:
[Na+] – ([Cl- ] + [HCO3- ])
or
([Na+] + [K+ ] ) – ([Cl- ] + [HCO3- ])
 Reference range: 10-20 mmol/L
 Used as a form of QC
 High anion gap common in ketoacidosis
 Hyponatremia with a high osmolality is most
commonly seen in
A) Diarrhea
B) Renal Failure
C) In Vitro Hemolysis
D) Hyperglycemia
 In dehydration which of the following
hormones is responsible for increasing water
reabsorption in the tubules:
A) Antiduretic Hormone
B) Aldosterone
C) Rennin
D) Thyroxin
WATER
ELECTROLYTE
OSMOLALITY
REVIEW
Bicarbonate-carbonic acid buffer system
Normal pH reference range is 7.35-7.45
pCO2 (35-45 mmHg)
HCO3 (22-26 mmol/L)
CO2 ≈ acid
As CO2 increases = pH decreases
As CO2 decreases = pH increases
HCO3- ≈ base
As HCO3- increases = pH increases
As HCO3- decreases = pH decreases
http://groups.csail.mit.edu/medg/people/psz/PatilThesis81/Patil81_ch1.html
 Acidosis or Alkalosis
 Determine what is causing the problem
Respiratory or Metabolic (renal)
 Respiratory problem
 If pH and PCO2 are opposite each other
• pH
PCO2
• pH
PCO2
 Metabolic problem
 If pH and HCO3- go up together or down together
• pH
HCO3-
• pH
HCO3-
 Other normal system can then compensate
(compensatory system)
If Respiratory system
• Hypoventilate
• Hyperventilate
If Metabolic system
• Excrete or reabsorb H+
• Excrete or reabsorb HCO3-
 Look at compensatory system reference range
for either HCO3- or CO2
Uncompensated (value within normal range)
Partially compensated (value outside of normal range)
Compensated (value outside of normal range and pH
within normal range)
 Collection
Heparinized syringe radial artery
No Bubbles or exposure to air
http://www.rtmagazine.com/products/blood-gas-analysis/
 Break it down
 Acidosis or alkalosis?
 Problem organ system?
 Is the other system compensating?
 ABG problem Review
 pH 7.26
 pCO2 16 mmHg
 HCO3- 7.1 mmol/L
 ABG problem Review
pH 7.60
pCO2 25 mmHg
HCO3- 24 mmol/L
 Unsaturated Fat
3
 Saturated Fat
Hydrogenation form of preservation
Trans Fat
Solid at room temperature
https://www.flickr.com/photos/
fotoosvanrobin/11026441715/
http://www.med-health.net/OliveOil-Ear-Wax.html
http://www.indiana.edu/~oso/Fat/trans.html
 Lipids
Organic compounds insoluble in water
Fatty acids
Triglycerides
Cholesterol
 Fatty Acids
Body makes most
Essential fatty acids -not made by the body
• Omega 3 and Omega 6
 Triglycerides
Majority of what we eat
Lots of calories
 Cholesterol
Present in all cell membranes
Building block of bile and steroid hormones
Liver makes most of what we need
 Fat stored as Triglycerides in adipose tissue
Lipolysis – break down of fat for energy
Ketone bodies
 Lipoproteins from largest (least dense) to smallest (most
dense)
 Chylomicrons
• Largest lipoprotein least dense
• Transport dietary lipids from the small intestine to the liver
• Causes turbidity in serum
 VLDL
• Contains mostly triglycerides
• Transports triglycerides from the liver to peripheral tissue
 LDL
• Delivers cholesterol to cells
• Contains mostly cholesterol
• BAD cholesterol associated with Apoliprotein B
• High levels of LDL and Apo B
risk of heart disease
 HDL
• Removes cholesterol out of cells
• GOOD cholesterol associate with Apoliprotein A
• High levels of HDL and Apo A
risk of heart disease
http://dolinabiotechnologiczna.pl/diagnostyka-laboratoryjna-2/ratunku-lipemia/
 Which of the following lipoproteins is the
major carrier of cholesterol to peripheral
tissues?
LIPID REVIEW
A) VLDL
B) LDL
C) HDL
D) Chylomicrons
 True or False:
Increased levels of apolipoprotein A-I are
associated with increased risk of coronary
artery disease.
http://investorplace.com/2014/03/bacon-smell-oscar-mayer-aapl-stock-krft-stock/#.VT01CWN8MXk
 Lipid panel includes (fasting 10-12 hours)
Total cholesterol - measured
LDL – calculated using Friedewald calculation
• LDL = total cholesterol – (HDL + VLDL)
• Invalid Trig > 400 mg/dL
HDL - measured
Triglycerides – measured
• High levels increase risk of pancreatitis
 Arteriosclerosis – hardening of the arteries
If it affects the heart called Coronary Artery Disease
http://healthinformatics.wikispaces.com/Balloon+Angioplasty
 Initial Cardiac Panel includes:
 Troponin - Most specific cardiac marker
• Troponin I (TnI) increases 4 hours normal after 6 days
• Troponin T (TnT) increases 4 hours normal after 7 days
 Total CK – nonspecific marker
• Found in all muscle increased in rhabdo, MD
 CK-MB (isoenzyme)– second most specific cardiac marker
• Peaks in 1 day returns to normal in 2 days
 Myoglobin – least specific marker
• Sensitive rises within 1 hour returns to normal in 1 day
• Early indicator
• Not included on subsequent cardiac panels only initial
http://dietchoices.com/diet-plans/heart-attack-grill-diet/
 Which of the following tests monitors
inflammation levels that may contribute
to acute coronary syndromes?
A) hs-CRP
B) Troponin I
C) BNP
D) Total CK
HEART
DISEASE
REVIEW
 hsCRP – high sensitivity C-reactive protein
Measures inflammation related to stress (cortisol)
• Increased hsCRP = increased plaque formation
 BNP – B natriuretic peptide
Increased in CHF
 Elimination of waste
 Urea
•
Protein degradation = ammonia =urea
 Creatinine
Waste product of creatine
• Jaffe reaction
o Ketones positive interference
 Falsely elevate creatinine levels
•
 Uric Acid
Final product of purine metabolism
• Monosodium urate crystals synovial fluid = gout
o Polarized microscope
•
 Glomerular Filtration Rate
 24 hour urine Creatinine Clearance
Creatinine Clearance = U
S
x
V
24V
x
1.73
SA
 Normal Kidneys
Serum
• Normal levels of BUN and Creatinine
Urine
• Concentrated
• High in BUN and Creatinine
• Little to no protein
 Abnormal Kidneys - Renal Failure
Serum
• High levels of BUN and Creatinine
Urine
• Dilute low specific gravity
• Low in BUN and Creatinine
• High in protein
o Microalbuminuria – early indicator diabetic nephropathy
o Renal failure will result if diabetes is not well managed
http://www.rayur.com/acute-renal-failure.html
Bishop, M.L., Fody, E.P., & Schoeff, L. E. (Edward P Fody MD). Clinical
Chemistry: Principles, Tehcniques, and Correlations. Philadelphia:
Lippincott Williams & Wilkins.
Moynihan, R., & Cassels, A. (2006). Selling Sickness: How the World’s Biggest
Pharmaceutical Companies Are Turning Us All Into Patients. New
York: Nation Books.