Bio Chemistry, Blood Investigations, Blood Tests

Bio - Chemistry
Pradeep Chockalingam
Snr-2 Physio
www.scribd.com/cpradheep
Aim & Objectives
 Understand basic Bio-Chemistry

investigations.
 Understand what information it gives us.
 Correlate to day to day practice and

Maximise patient care.
Contents
 Electrolytes
 Renal
 Liver, Spleen & Pancreas
 Inflammatory Markers
Electrolytes
 Sodium - Na+
 Potassium - K+
-
 Chloride - Cl
 Phosphorus - P4+
 Calcium - Ca++
 Magnesium - Mg++
Helps to regulate the fluid balance & electrolyte balance

of the body
Body Fluid Compartments
Intracellular Extracellular
30L 9L 3L
Interstitial Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
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.
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.
-
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.
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.
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.
Magnesium - Mg++
 It is important for Neuromuscular activity,

Defence System & Metabolism.
 Low level may cause muscle weakness,

twitching, cramping, confusion, cardiac
arrhythmias, and seizures.
Renal Function
 Urea
 Creatinine
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.
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.
Liver, Spleen & Pancreas
 Bilirubin
 Albumin & Total Protein
 Alanine Transaminase (ALT)
 Alkaline Phosphatase (ALP)
 Gamma Glutamyl Transpeptidase
 Amylase
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.
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.
Body Fluid Compartments
Intracellular Extracellular
30L 9L 3L
Interstitial Intravascular
http://renux.dmed.ed.ac.uk/EdREN/Teachingbits/fluids/Compartments.swf
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.
Amylase
 Enzyme found in the pancreas & the salivary

glands.
 High levels indicates Pancreatitis, Pancreatic

diseases, Diabetic ketoacidosis & Blockage
or damage to the bowel.
Inflammatory Markers
 C-Reactive Protein
 Lactate
 Troponin-T
 D-dimer
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.
Lactate
 Waste product of anaerobic respiration

(Normal: Carbohydrate breaks into H2O +
CO2).
 May increase due to Severe Exercise,

Infection, Pulmonary embolism, Hypoxia,
Dehydration.
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).
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
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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Bio - Chemistry

 Understand basic Bio-Chemistry

 Understand what information it gives us.

 Correlate to day to day practice and

 Liver, Spleen & Pancreas

Helps to regulate the fluid balance & electrolyte balance

 High level may indicate renal disease,

 Low level may indicate starvation, poor

 It is important for Neuromuscular activity,

 Low level may cause muscle weakness,

 It’s a metabolic waste, due to breakdown of

 Creatinine levels increase more slowly than

 Produced when the liver breaks down old red

 Evaluate liver function and monitor the

 To evaluate liver, renal function & to calculate

 Enzyme found in the pancreas & the salivary

 High levels indicates Pancreatitis, Pancreatic

 It is produced by the liver during an

 CRP levels rise within 2 to 6 hours of surgery

 Waste product of anaerobic respiration

 May increase due to Severe Exercise,

 Cardiac enzyme enters into blood circulation

 Usually detected on blood after 6 to 12 hrs.

 May also elevate due to surgery, renal failure,

 This is a protein released into the blood

 Normal range between 0-300ng/ml

 High in DVT, PE & pregnant women

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