Name: Chico, Jams Knowell E.

Block: 7

CLINICAL BIOCHEMISTRY and XENOBIOTICS

1. Name at least one xenobiotic that undergoes Phase 2 reactions (name at least one
for each type of reaction)

a. Glucuronidation

Chloramphenicol - an antibiotic used in eye drops to treat bacterial

conjunctivitis
b. Sulfation

Minoxidil – used for the treatment of male-pattern hair loss

c. Conjugation with glutathione

Paracetamol – used for mild to moderate pain relief and fever

d. Acetylation

Isoniazid – used for the treatment of tuberculosis

 e. Methylation

Nicotinamide – used by mouth to prevent and treat pellagra (niacin

deficiency)

2. Expected lab results for the following diseases and explain the rationale of the result

a. Cushing Disease
 Confirmation of Cushing syndrome is done by dexamethasone
suppression test, an adrenal function test
 Secretion of cortisol from the adrenal gland shows diurnal variation.
o Serum cortisol is highest during the early morning hours, the
lowest around midnight.
 The loss of this diurnal variation is one of the earliest signs of adrenal
hyperfunction, which is Cushing syndrome itself.
 Dexamethasone suppression test
o used for the confirmation for the diagnosis of adrenal
hyperfunction
o the demonstration of failure of suppression of the early morning
concentration of cortisol following the administration of 1 mg
dexamethasone (a potent synthetic glucocorticoid)
b. Hashimoto’s Thyroiditis
 Autoimmune thyroiditis (Hashimoto thyroiditis) is associated with the
presence of antibodies against thyroid peroxidase (TPO)
 TPO test detects antibodies against TPO (TPOAb) in the blood
o The presence of TPOAb in the blood reflects a prior attack on
the thyroid tissue by the body's immune system.

o Other autoimmune disorders that may cause a positive TPOAb

test include: Sjogren's syndrome, lupus, rheumatoid arthritis,
pernicious anemia
c. Alcoholic Hepatitis v/s Hepatitis A
 Serum enzyme test, a liver function test, can be performed to
determine which type of hepatitis a patient may have; particularly,
measuring of ALT/AST
o ALT is found in the cytoplasm of cells
 more specific for hepatocytes
o AST is found in the mitochondria
 can also be found in skeletal muscle, cardiac muscle,
and RBCs
o transferases are most commonly used as a measure of cell
death/damage (usually due to inflammation)
o rise in ALT/AST > ALP/GGT suggest hepatocellular disease:
 alcoholic hepatitis/cirrhosis
 drug induced hepatitis (including paracetamol – often
with a marked rise in ALT)
 viral hepatitis (also marked ALT rise)
 autoimmune disease (mild increases in non-hepatitic
disease)
 fatty liver disease (mild increase)
d. Cholelithiases
 Also known as gallstones
 Complete urinalysis can be done to assess the physical and
chemical characteristics of urine
o if there is presence of bile salts and bile bigments in urine, it is
usually associated with obstruction of the biliary tract
o this condition is usually present in people with gallstones or
carcinoma of the head of the pancreas, in which the common
bile duct is obstructed

e. Acute Renal Failure v/s Chronic Renal Failure

 Measurement of creatinine clearance, under kidney function test,
gives an estimate of the glomerular filtration rate
o Can be used to detect the early stages of renal failure

 Many criteria exist, but a useful article in the February 12, 2003 Journal
of the American Medical Association offers the following:

o Acute renal failure occurs when the serum creatinine level

increases by 0.5 mg/dL or more within 2 weeks or less.

o In cases of chronic kidney disease where the baseline

creatinine is greater than 2.5 mg/dL, a 20% increase from
baseline is required.