Ghb With Synthetic Glycogen For Cancerous Cells

Deoxycorticosterone in aldosterone synthetic pathway, 387f in cortisol synthetic pathway, 380f 11-Deoxycortisol, in cortisol synthetic pathway, 379, 380f, 381 Deoxyhemoglobin, 317-318, 320 Deoxyribonucleic acid. See DNA (deoxyri-

bonucleic acid) Depressant drugs, abuse of, 528 Derived beta-quantification calculation, for low-density lipoprotein, 278-279 Derived lipids, 15-16

Desensitization, of hormone receptors, 375, 376f

Detoxification, in liver, 235 Dexamethasone, for Cushing's syndrome, 381

Dexamethasone suppression test, 386t Diabetes Control and Complications Trial, 154

Diabetes insipidus, 410-412 nephrogenic, 224-228 in oat cell carcinoma, 495-496 Diabetes mellitus, 148-169

biochemical markers for, 15, 26 clinical presentation of, 150 complications of, 154 gestational etiology of, 149, 149t tests for, 151-152, 164-169 hypoglycemia in, 168-169 lipid abnormalities in, 276, 277f, 279-282 lipoprotein abnormalities in, 276-285,

277f, 282t management of, 148 nephropathy in glomerular nephritis, 205 nephrotic syndrome, 209 other specific causes of, 149-150, 149t pathophysiology of, 150 polydipsia in, 411 polyuria in, 411

versus prediabetes, 353-356, 355t symptoms of, 276t tests for for control, 153-154, 154t C-reactive peptide, 153, 153f gestational, 151-152, 164-169 glucose challenge, 150-152, 151t glycated hemoglobin, 161-164 ketones, 155-158 medical decision limits in, 72-73, 73t microalbuminuria, 158-159 monitoring, 153-154, 154t self-monitoring glucose meters, 161 type 1, 155-159 type 2, 159-164 urine glucose, 166 type 1, etiology of, 148-149, 149t type 2, etiology of, 149, 149t types of, 148-150, 149t Diabetes Prevention Program, on metabolic syndrome, 356 Diabetes Research Group study, 26 Diagnostic sensitivity, 73, 469 in medical decision limits, 483-487, 484t-487t, 486f Diagnostic specificity, 73, 469 in medical decision limits, 483-487, 484t-487t, 486f Diarrhea, fluid-electrolyte imbalance in, 367-368

Diazonium salts, in bilirubin measurement, 238

Dietary profile, in nutritional assessment, 335t

Dietitian, 334-336, 356 Diffuse atelectasis, 315 Diffusion, hypoxia and, 310

566 INDEX

Digestive system. See Gastrointestinal tract Digital rectal examination, for cancer, 472 Digoxin measurement of, 512

therapeutic monitoring of, 510-513, 557t toxicity of, 294-295, 510-513 Di-iodotyrosine, in thyroid hormone synthesis, 400 Dilution, 81-96 concentration calculations in, 83-84,

144t-145t flasks for, 87-88, 88f formula for, 81 graduated cylinders for, 88 metric conversions in, 82, 82t pH calculations in, 85-86 pipettes for. See Pipettes pOH calculations in, 85-86 safety in, 81

of samples, 87, 255-256, 258 solution unit conversions in, 84-85 volume conversions in, 82-83, 83t Disaccharidases, 357, 358 Disaccharides, 9-10, 10f-11f, 147 Discrete analysis, 138. See also Automated systems Discrete analyzers, 139, 141 Distribution, of drugs, 506-507 Diuresis, osmotic, in diabetes mellitus, 411 Diuretics, metabolic acidosis due to, 308 Diurnal variations, in hormone levels, 378 DNA (deoxyribonucleic acid) in metabolism, 26 in protein production, 19 replication of, in cell cycle, 488-489, 489f Dopamine, 392, 396 Double-pan balances, 98 Down syndrome, testing for, 448-449, 452 Downregulation, of hormone receptors, 375, 376f

Drug(s). See also specific drugs abuse of. See Drug-of-abuse testing carbon dioxide retention due to, 314 therapeutic monitoring of. See Therapeutic drug monitoring toxicity of, 524 acetaminophen, 516-517, 517f, 519 antibiotics, 508-509, 510t cardioactive, 294-295, 511 drugs of abuse, 527-532 effects of, 505 ethanol, 520-521 hepatitis in, 257-258 methanol, 524-525 salicylates, 518-519 Drug-of-abuse testing, 527-532 automated immunoassays for, 529-530 chromatography for, 530-531 decision-making for, 527, 531-532 drug types and, 528, 556t indications for, 527

instrumentation for, 528-529, 531-532 point-of care devices for, 529 results of, intended use of, 528 specimen collection for, 527 standard method for, 529 Duodenum, function of, 357 Dwarfism, pituitary, 390 Dye-binding method, for urinary protein measurement, 210

Ear, drugs toxic to, 508

EasyStat blood gas analyzer, 327-328

ECG (electrocardiography), in acute myocardial infarction, 269, 270, 276 Eclampsia, fetal lung maturity evaluation in, 459, 460

Ectoderm, adrenal gland development from, 379

Ectopic hormone secretion, 382, 495-496 Ectopic pregnancy, 431-433, 435 Ectopic thyrotoxicosis, 409 Edema, in COPD, 312-313 Education accreditation of, 8 continuing, 8 proficiency testing as, 3 Edwards' syndrome (trisomy 18), tests for,

449, 452 Ehrlich's reagent for porphyrin test, 196-197 for urobilinogen test, 238 Ejaculation, 442

Elastase, in pancreatic fluid, 357 Elderly persons drug toxicity in, 294-295 liver function in, 261 nutritional status of, 352 physiological reference ranges in, 352, 353t

Electrocardiography, in acute myocardial infarction, 269, 270, 276 Electrochemistry, 113-123 amperometry, 114, 116-117, 119 conductivity, 117-118, 119f coulometry, 114, 116-118 description of, 113-114 electrophoresis. See Electrophoresis osmometry, 114, 119-121, 120f polarography, 114, 117-119, 119f potentiometry, 114-116, 115t, 116f voltammetry, 114, 119 Electrodes, 80 ion-selective in potentiometry, 114-116, 116f in spectrophotometry, 103 Electrolytes. See also specific electrolytes anion gap and, 222-223, 223f balance of, 217-218, 381 critical values of, 225 definition of, 202 imbalance of in bulimia nervosa, 368 causes of, 226-227 in diarrhea, 367-368 in vomiting, 366-367 measurement of, 80

electrochemical. See Electrochemistry hemolysis effects on, 219-220 regulation of, 226-227 Electronic balances, 98 Electronic quality control, 52 Electrophoresis definition of, 121 fixing in, 122

for glycated hemoglobin, 163, 198 method for, 123

for multiple myeloma, 472-481, 474f cerebrospinal fluid specimen for,

476-478 high-resolution, 480-481 principles of, 474

serum immunofixation, 477-478, 479f, 480f technique for, 476-477 urine specimen for, 475-478, 479f, 480f principles of, 121-122, 122f scanning in, 122-123 specimen handling for, 49t for total protein, 251, 251f, 251t zone, 109

Electrostatic attraction, in column chro-

matography, 125 Elimination, of drugs, 507 ELISA (enzyme-linked immunosorbent assay), 133, 398 Elution, in column chromatography, 125 Embden-Meyerhof pathway, 12-13, 13f Embryo, 429, 430f

Emission, in fluorometry, 112-113, 113f EMIT. See Enzyme-multiplied immunoassay technique (EMIT) Emphysema, 312-313 Encephalocele, testing for, 448-452, 450t,

451t Encephalopathy hepatic, 260, 260f in lead poisoning, 532 Endocrine hormones, 373 Endocrine system, 34-35, 34f. See also specific glands and hormones feedback control in, 376-378, 377f in homeostasis, 372 Endogenous substances, markers for, 9 Endometrium, in pregnancy, 430 Endoplasmic reticulum, 26 Endpoint colorimetric spectrophotometry, 106, 106t

Endpoint enzymatic spectrophotometry,

106-107, 106t Energy, from carbohydrates, 9 Energy malnutrition, 336 Enteropathy, protein-losing, 337

Environmental factors in nutritional assessment, 335t in reference range determination, 71 Enzymatic spectrophotometry, 106-107, 106t

Enzyme(s), 22-25. See also specific enzymes actions of, 22 activity of, 106

clinical utility of, 244 in kinetic spectrophotometry, 106t, 107-109 as biochemical markers, 22 in carbohydrate metabolism, 12, 13f, 14 classes of, 22-23 definition of, 23 kinetics of, 23-25, 24f in drug metabolism, 507-508 in spectrophotometry, 108-109 in lipid metabolism, 17, 18f liver. See Liver, enzymes of; specific enzymes in metabolism, 26 multiple forms of, 109 as tumor markers, 470t Enzyme immunoassays for catecholamine metabolites, 398 for cortisol, 383 for drugs of abuse, 530 for glycated hemoglobin, 163 for thyroid function, 404-405 Enzyme immunometric assay, for human chorionic gonadotropin, 433 Enzyme-labeled immunoassays, 133, 135-136

Enzyme-linked immunosorbent assay

(ELISA), 133, 398 Enzyme-multiplied immunoassay technique (EMIT), 135 for acetaminophen, 517 for digoxin, 512 for salicylates, 518 for thyroxine, 404-405, 407 Epilepsy, drugs for, therapeutic monitoring of, 513-515, 514t Epinephrine. See Catecholamines (epineph-

rine and norepinephrine) Epitopes, of antigens, 132 Equipment balances for, 97-100, 99t centrifuges, 100-101, 102t flasks as, 87-88, 88f graduated cylinders as, 88 pipettes as. See Pipettes safety, 4-5, 4t Equivalent weight, in normality, 84 Erlenmeyer flasks, 88, 88f Errors analytical, 46

detection of, 57-61, 58f, 58t, 59f method-related, 63-68 patient-related, 42-43 preanalytical. See Preanalytical variables prevention of. See Quality assessment;

Quality control random, 57, 61 systematic, 57, 59, 61 troubleshooting for, 61 Erythroblastosis fetalis, 455-458, 457f Erythrocyte(s)

abnormal shapes of, 184 rouleaux, in multiple myeloma, 475 Erythrocyte protoporphyrin test, for lead poisoning, 188, 189 Erythropoietic porphyria, 193f, 193t, 194 Erythropoietic protoporphyria, 193f, 194t Erythropoietin, 390t Esophageal varices, 342 Essential amino acids, 19 Essential nutrients, 336 Esters, 15

fatty acid, 276. See also Lipid(s) Estimation method, for carbon monoxide,

322-324 Estradiol, 432

measurement of, 441 in menstrual cycle, 440-441, 441f, 445 in pregnancy, 431 production of, 436, 437f Estriol in pregnancy, 431

reference ranges for, versus gestational age, 451t

Estrogen(s), production of, 436, 437f Estrogen receptors, 556t Estrone in pregnancy, 431 production of, 436, 437f Ethanol, 519-525 abuse of cirrhosis in, 255t vitamin A deficiency in, 342-345, 344f excretion of, 521 hepatitis due to, 257 history of, 520 legal aspects of, 521 measurement of enzymatic method for, 523-524 gas-liquid chromatography in, 129, 522-523

specimen handling for, 49t, 521-522 metabolism of, 507, 521 physiological effects of, 520 toxicity of, 520, 521 Ethosuximide, therapeutic range of, 557t Ethylene glycol, 504, 526-527, 557t Euthyroid state, 402, 410t Ex vivo blood gas analysis, 318 Exclusion criteria, for reference range determination, 70, 71t Excretion of drugs, 507 of waste products, 213

Exocrine glands. See also specific glands and hormones definition of, 363 Exocrine hormones, 373 Exogenous substances, markers for, 9 Exophthalmos, in hyperthyroidism, 408

False-negative results, 72-73, 469 in medical decision limits, 483-487, 484t-487t, 486f False-positive results, 72-74, 470 in medical decision limits, 483-487, 484t-487t, 486f Familial hypertriglyceridemia, 284-285 Fanconi's syndrome hypocalcemia in, 417 renal tubular acidosis in, 218-219 Fasting hypoglycemia after, 168-169 lipemia and, 277 Fat. See Body fat; Lipid(s) Fatty acids biochemistry of, 15-17, 16f clinical importance of, 554t Fecal fat analysis, 358-359 Fecal occult blood test, 470, 472, 473 Feces, handling requirements for, 52t Feedback control, of endocrine system,

376-378, 377f Female infertility causes of, 442-444 endocrine glands involved in, 438 menopause and, 442, 443 physiology of, 438-441, 439f, 441f sex steroids involved in, 436-437, 437f treatment of, 443 FEn (fractional excretion of sodium), 214 Ferritin, 181-182

clinical correlation of, 186t measurement of, 183-184, 189 Ferrochelatase deficiency of, 193f, 194t lead inhibition of, 187, 188f Fertility, problems with. See Infertility Fertilization physiology of, 429, 439-440 in vitro, 443 Fetal testing, 448-464 alpha fetoprotein, 448-452, 450t amniotic fluid collection for, 460, 461t for bilirubin, 456-457, 457f for Down syndrome, 448-449, 452 for galactosemia, 453t for hemolytic disease of the newborn,

455-458, 457f for homocystinuria, 453, 453t for inborn errors of metabolism, 453, 453t for lung maturity, 458-464, 461t for maple syrup urine disease, 453, 453t multiples of the median in, 450-452, 451t for neural tube defects, 448-452

568 INDEX

Fetal testing (Continued)

for phenylketonuria, 453, 453t screening, 449-450, 450t for surfactant function, 461-463 for trisomy 18 (Edwards' syndrome), 449, 452 Fetus(es)

development of, 429, 430f multiple, hormones in, 434, 435 testing of. See Fetal testing Fibrous proteins, 20 Fight or flight response, 393 Filtration, in kidney, 31, 226 Fio2 (fraction of inspired oxygen), 309-310 Fire extinguishers, 4t

First-order kinetics, enzyme, 23-25, 24f, 507 First-pass effect, in drug metabolism, 507 FISH (fluorescent in situ hybridization), for breast cancer, 488, 490 Flasks, 87-88, 88f Flatulence, 358 Fluorescence in fluorometry, 112-113, 113f of porphyrins, 195-197 Fluorescence polarization immunoassay (FPIA), 136 for acetaminophen, 517 for antibiotics, 509 for catecholamine metabolites, 398 for cortisol, 383 for thyroxine, 406 Fluorescent in situ hybridization (FISH), for breast cancer, 488, 490 Fluorescent polarization test, for surfactant, 462-463

Fluorescent-labeled immunoassays, 136 for thyroid-stimulating hormone, 405-406, 407t Fluorometry, 112-113, 113f Foam stability index, for surfactant function,

461-462 Focal atelectasis, 315, 316 Folate, 339t deficiency of, macrocytic anemia in,

348-350 function of, 349 measurement of, 350 reference range for, 338t Folin, otto, 80-81

Follicle(s), ovarian, development of, 431,

438-441, 439f Follicle-stimulating hormone (FSH) action of, 379t, 390t in males, 442, 446 measurement of, 421t, 446 in menstrual cycle, 439-441, 439f, 441f, 446

in perimenopause, 442, 443 source of, 390t synthesis of, 436-437 Follicular phase, of menstrual cycle, 440-441, 441f

Food and Drug Administration, method performance requirements of, 64 Forensic testing for blood alcohol, 521-522, 524 for drugs of abuse, 527-528 FPIA. See Fluorescence polarization immunoassay (FPIA) Fraction of inspired oxygen (Fio2), 309-310 Fraction of oxyhemoglobin, 317-318 Fractional excretion of sodium (FE^), 214 Framingham cardiac risk study, 26 Free cortisol, measurement of, 422t Free thyroxine (T4), 404, 408, 421t Free triiodothyronine (T3), 422t Freezing point methodology for methanol, 524-526 for osmolality, 120 Friedewald calculation, for low-density lipoprotein, 278-279 Fructosamine, measurement of, 555t Fructose clinical importance of, 554t structure of, 10f Fructosuria, 171-172 FSH. See Follicle-stimulating hormone (FSH)

Fumarylacetoacetase deficiency, 453, 453t Fume hoods, 4t

G protein family, as hormone receptors, 374,

374f Galactose clinical importance of, 554t structure of, 10f Galactosemia, 169-171, 453t Galactosyltransferase isoenzyme II, in pancreatic cancer, 498 Gallbladder, function of, 31, 357 Gallstones, obstructive jaundice from, 240 Gametocytes, 438

Gamma globulin(s). See Immunoglobulin(s) Gamma-glutamyltransferase (GGT), 245t, 246-247

Gamma-hydroxybutyrate (GHB), 556t Gammopathies monoclonal. See Monoclonal gam-mopathies; Multiple myeloma oligoclonal, 478 Gas chromatography, 127-129, 128f, 130f for carbon monoxide, 322 for drugs of abuse, 530 mass spectrometry with, 126 Gas-liquid chromatography, 129, 130f, 522-523

Gastrectomy, for gastrinoma, 363 Gastric fluid loss of, fluid-electrolyte imbalance in,

367 pH of, 360 Gastrin, 389t

Gastrin stimulation test, 362 Gastrinoma, 360-363, 498

Gastritis, in alcohol abuse, 342 Gastrointestinal tract. See also specific components anatomy of, 32-34, 33f, 356-357 cancer of, tumor markers for, 471t function of, 32-34, 33f, 356-357 Gaussian distribution in quality control, 54-55, 54f in reference range determination, 71 GEM Premier 3000 blood gas analyzer, 328-329

Gender differences, in myocardial infarction,

291-292 Gene(s), as tumor markers, 470t Genetic factors in apoproteins, 286-289, 288f in metabolism, 26-27 Genome, 26

Gentamicin, therapeutic monitoring of,

508-510, 510t, 557t Germ cell tumors, tumor markers for, 471t Gestational age versus alpha fetoprotein levels, 449-450,

450t, 452 versus estriol levels, 451t versus human chorionic gonadotropin levels, 430-431, 431f versus inhibin levels, 451t Gestational diabetes etiology of, 149, 149t tests for, 151-152, 164-169 GGT (gamma-glutamyltransferase), 245t, 246-247

GH (growth hormone), 379t, 389-390, 390t

GHB (gamma-hydroxybutyrate), 556t Gigantism, 390 Gilbert's syndrome, 239-240 Glassware. See also Pipettes flasks as, 87-88, 88f Globular proteins (globulins), 20

in total serum proteins, 249-250 Glomerular filtration rate, 206

estimation of, creatinine clearance in,

204-205 in kidney failure, 213 Glomerular nephritis, 202, 205-209, 207f Glucagon action of, 150, 389t in carbohydrate metabolism, 14 source of, 389t Glucocorticoids, 381. See also Cortisol diabetes mellitus due to, 150 for fetal lung maturation, 459 Gluconeogenesis, 13f, 14, 148 Glucose abnormal. See Hyperglycemia; Hypo-

glycemia measurement of clinical importance of, 554t in contaminated specimen, 45-47 delayed transport and, 48, 50

hexokinase method in, 106-107, 107t medical decision limits in, 72-73, 73t in metabolic syndrome, 353-356, 355t methodology for, 152 point-of-care, 164, 173-176 in prediabetes, 353-356, 355t quality assessment in, 173-176 self-monitoring meters for, 161 specimen handling for, 49t spectrophotometric reactions in, 110t metabolism of, 12-14, 13f in osmolality, 227 reference ranges for, 151t, 454t storage of, 9 structure of, 10f Glucose challenge test, 150-152, 151t Glucose dehydrogenase method, for glucose, 152

Glucose oxidase method, for glucose, 152 Glucose-6-phosphatase deficiency, 171 Glucose-6-phosphate, in creatine kinase measurement, 273, 274 Glucose-6-phosphate dehydrogenase in amylase measurement, 364-365 measurement of, 555t Glutamate, 553t Glutamate dehydrogenase in ammonia measurement, 260 measurement of, 555t Glutamic acid decarboxylase antibody, 555t Glutamine, 553t

Glycated hemoglobin, 161-164, 198-199 Glycemic control, in diabetes mellitus, 154,

154t, 161-164 Glycerol kinase, in triglyceride measurement, 279-280 Glycine, 553t Glycogen, 9, 11f, 554t Glycogen storage disorders, 171 Glycogenesis, 13f, 14, 148 Glycogenolysis, 13f, 14, 148 Glycolipids, biochemistry of, 15, 16f Glycoproteins, as hormones, 373, 437. See also specific hormones Gn-RH (gonadotropin-releasing hormone), 437

action of, 389t in menstrual cycle, 439, 439f, 440, 441f source of, 389t Goiter, 402, 408 toxic multinodular (Plummer's disease), 409

Gold standard method, 67 Gonadotropin-releasing hormone (Gn-RH), 437

action of, 389t in menstrual cycle, 439, 439f, 440, 441f source of, 389t Gonads, 438. See also Ovary; Testis Gout, 229

Granuloma, tubercular, of adrenal cortex, 384

Graves' disease, 403, 408-410, 408t Gravimetric pipette calibration, 95 Growth hormone, action of, 379t Growth hormone (GH) action of, 379t, 390t secretion of, disorders of, 390 source of, 390t synthesis of, 389-390 Growth hormone-releasing hormone

(GHRH), 389t Growth retardation, in growth hormone deficiency, 390 Guanine diphosphate, in hormone-receptor binding, 374, 374f

Half-life (t1/2), of drugs, 506 Hallucinogens, 528 Haptens, 131 Haptoglobin, 21, 253t Hartnup disease, 553t Hashimoto's thyroiditis, 402, 410t hCG. See Human chorionic gonadotropin (hCG)

HDL lipoprotein. See Lipoprotein(s), high-

density (HDL, good) Healing, in Cushing's syndrome, 381 Hearing, drugs toxic to, 508 Heart anatomy of, 27, 28f failure of, 290-291 function of, 27, 28f Heart attack. See Acute myocardial infarction Heavy chain disease, 475 Heavy metals, toxicity of, 532-534, 533t. See also Lead poisoning Heel stick, for neonatal blood specimen collection, 403 Height, body surface area calculation from, 208

Hematopoiesis, 35, 36f Heme degradation of, 237, 239f synthesis of, 180, 181f. See also Iron lead effects on, 187-188 porphyrins and, 181f, 197 Hemochromatosis, 183, 186, 255t Hemoconcentration hyperproteinemia in, 250 in tourniquet use, 43 Hemoglobin, 27-28

dysfunctional forms of, 318 glycated, 161-164, 198-199 oxygen-carrying capacity of, 310-312, 311f synthesis of, 180, 181f. See also Iron abnormal, 184, 197. See also Anemia lead effects on, 186-190, 188f porphyrins and, 181f, 197 total, 317-318 variants of, 197, 320

Hemoglobin A1C (glycated hemoglobin), 161-164 1C

Hemoglobinopathies, 184, 197 Hemolysis hyperbilirubinemia in, 239 in neonates, jaundice in, 241 of specimens, 42-46, 45t causes of, 220 detection of, 219

electrolyte analysis and, 219-220, 227 in LD test, 292 Hemolytic anemia, 183 Hemolytic disease of the newborn, 455-458, 457f

Hemosiderin, 182, 182f Hemosiderosis, 186 Henderson-Hasselbalch equation, 308 Hepatic encephalopathy, 260, 260f Hepatic porphyria, 193f, 194, 194t Hepatitis, 255-258, 257f, 257t, 258f idiopathic neonatal, 241 iron levels in, 183 Hepatitis A, 256-257, 257f Hepatitis B, 256-257, 257t, 258f Hepatitis C, 256-257 Hepatitis delta, 256-257 Hepatitis E, 256 Hepatitis G, 256

Hepatobiliary tissues, enzymes in, 22 Hepatocytes, 236-237, 236f Hepatoerythropoietic porphyria, 193, 194t

HER2 tumor marker, 488, 490, 556t Herbal medicines, interference of, with therapeutic drug monitoring, 513 Hercules III analyzer, 141 Heterogeneous immunoassays, 133, 135f Hexokinase in amylase measurement, 364-365 in creatine kinase measurement, 273, 274

in glucose measurement, 106-107, 107t, 152

Hexose monophosphate pathway, for carbohydrate metabolism, 13-14, 13f High-pressure (high-performance) chromatography, 126-127, 127f for antibiotics, 509

for catecholamine metabolites, 395-398 for salicylates, 518-519 High-pressure thin-layer chromatography, 124

Histidine, diagnostic use of, 553t History, of clinical chemistry, 80-81 Homeostasis, markers for, 9 Homocysteine in cardiovascular disease, 296-297 measurement of, in folate assay, 350 Homocystinuria, fetal testing for, 453, 453t

Homogeneous immunoassays, 133, 281 Homovanillic acid, measurement of, 391,

395, 398, 556t Horizontal-head centrifuges, 100

570 INDEX

Hormone(s), 34-35, 34f. See also specific hormones actions of, 373

classification of, 373-374, 374f control of, 376-378, 377f definition of, 373 diurnal variations in, 378 ectopic secretion of, 495-496 half-lives of, 373

receptors for, 353f-377f, 374-376 tests for, preanalytical variations in,

420-421, 421t, 422t as tumor markers, 470t Hormone response elements, 375 hPL (human placental lactogen), 429, 431 HPLC (high-pressure/high-performance chromatography), 126-127, 127f for antibiotics, 509

for catecholamine metabolites, 395-398 for salicylates, 518-519 Human chorionic gonadotropin (hCG) action of, 390t versus gestational age, 430-431, 431f measurement of qualitative, 432, 435 quantitative, 433, 435 multiple fetuses and, 434 source of, 390t structure of, 429 synthesis of, 429

thyroid hormone interactions with, 409 in trophoblastic neoplasm, 434, 435 as tumor marker, 471t, 556t Human placental lactogen (hPL), 429, 431 HVA (homovanillic acid), measurement of,

391, 395, 398, 556t Hyaline membrane disease (respiratory distress syndrome), 316-319, 459 Hybridomas, 132 Hydatidiform mole, 434 Hydration status, electrolyte concentrations and, 227-228 Hydrochloric acid, solutions of, molarity of, 84

Hydrocortisone. See Cortisol Hydrogen, production of, in lactose breath test, 360

Hydrogen ion concentration, of acids, 85-86 Hydrophobic environment, for cholesterol transport, 286 Hydrops fetalis, 456 P-Hydroxybutyrate dehydrogenase/diaphorase method, for ketones, 156 17-Hydroxycorticosteroids, in cortisol synthetic pathway, 379, 380f, 381 Hydroxyl ions, concentration of, 86 Hyperaldosteronism, 388-389, 388t Hyperamylasemia, 364 Hyperbetalipoproteinemia, 288-289

Hyperbilirubinemia, 234, 237-243 in bile duct obstruction, 240 causes of, 237, 239-240 enzyme correlations with, 244, 247 in hemolytic disease of the newborn,

455-458, 457f hepatic, 239-240

neonatal, 241-243, 455-458, 457f posthepatic, 240 prehepatic, 239 tests for bilirubin, 238 neonatal, 242 prenatal, 456-457 urobilinogen, 238 Hypercalcemia, 415-416, 420 of malignancy, 416, 472 in multiple myeloma, 478 Hypercalciuria, 415

Hypercortisolism. See Cushing's syndrome Hyperglycemia, in diabetes mellitus, 148-150 control testing in, 153-154, 154t glycated hemoglobin test for, 161-164,

198-199 ketone test for, 155-158 pathologic changes in, 154 urine glucose test for, 166 Hyperkalemia, 225-226 in adrenal insufficiency, 386 erroneous reporting of, 219, 220 Hyperlipemia, in electrolyte measurement interference, 220, 224 Hyperlipoproteinemia, 284-285 Hypernatremia, 225, 412 Hypernatriuria, 411 Hyperparathyroidism, 415-416 Hyperphosphatemia, 418 Hyperplasia, definition of, 388 Hyperproteinemia, 250 in multiple myeloma, 475 thyroid hormones in, 410t Hypertension in diabetes mellitus, 158-159 in pheochromocytoma, 391 in pregnancy, 167 Hyperthermia, in hyperthyroidism, 408 Hyperthyroidism, 403, 408-410, 408t Hypertonicity, of plasma, polydipsia in, 411 Hypertriglyceridemia, 284-285 Hyperuricemia, 229 Hyperviscosity, of plasma, in multiple myeloma, 475 Hypoalbuminemia, 253 Hypoaldosteronism, 388-389, 388t Hypoalphalipoproteinemia, 287-288 Hypocalcemia, 74, 75, 416 Hypochromic anemia, 184 Hypocortisolism, 382-386, 386t Hypoglycemia, 168-169

Hypokalemia, 226, 367 Hypomagnesemia, 420 Hyponatremia, 225

in adrenal insufficiency, 386 erroneous reporting of, 220, 224 in oat cell carcinoma, 495-496 Hypoperfusion, metabolic acidosis due to, 308

Hypophosphatemia, 418 Hypophysectomy, adrenal insufficiency after, 385

Hypophysis. See Pituitary gland Hypoproteinemia, 250-251 Hypothalamus disorders of adrenal insufficiency in, 385 diabetes insipidus due to, 411-412 in hormone control, 378, 399-400, 399f, 438

hormones of, 389t, 438 Hypothyroidism, in neonates, 398-399, 402, 403

Hypovolemia, lactate in, 172 Hypoxia arterial blood gas analysis in, 310 in carbon monoxide poisoning, 321 in COPD, 312-313 Hypoxic drive, in chronic bronchitis, 313

Icterus, 44, 234 Identification, patient in neonatal department, 453 for specimen collection, 303 Idiopathic diseases, definition of, 205, 384 IDL (intermediate-density lipoprotein) biochemistry of, 15, 17 elevated, 289 IEP (immunoelectrophoresis), for multiple myeloma, 473, 474f IFE (immunofixation electrophoresis), for multiple myeloma, 473, 474f, 477-478, 479f, 480f Immune globulin, Rh0D, 458 Immunoassays, 80, 130-137 for antibiotics, 509 for catecholamine metabolites, 398 chemiluminescent-labeled, 112-113, 136,

407t, 487-488 competitive, 133, 134f for cortisol, 383-384 for drugs of abuse, 529-530 enzyme-labeled, 133, 135-136 for estradiol, 441 fluorescent-labeled, 136 for follicle-stimulating hormone, 446 heterogeneous, 133, 135f homogeneous, 133 for human chorionic gonadotropin qualitative, 432, 435 quantitative, 433, 435

noncompetitive, 132-133 particle, 137

principles of, 131-132, 131f, 132f for prostatic acid phosphatase, 494 for thyroid function, 404-407, 406t-407t for troponin I, 271 for troponin T, 270, 271 two-site, 133 types of, 132-133 Immunochemistry, 109 Immunocompetence, in nutritional assessment, 337

Immunoelectrophoresis (IEP), for multiple myeloma, 473, 474f Immunofixation electrophoresis (IFE), for multiple myeloma, 473, 474f, 477-478, 479f, 480f Immunogens, 131 Immunoglobulin(s), 21

measurement of, in multiple myeloma,

473, 474f, 475-478, 479f, 480, 480f in monoclonal gammopathy of undetermined significance, 481 Immunoglobulin A, 254t Immunoglobulin G, 254t Immunoglobulin M, 254t monoclonal, in Waldenstrom's macroglob-ulinemia, 481 Immunometric assays, for luteinizing hormone, 445 Immunoradiometric assay (IRMA), for prostate specific antigen, 492, 493 Immunosuppressive drugs, therapeutic monitoring of, 516 Inborn errors of metabolism, tests for,

170-171, 453, 453t Indices, for specimen acceptability, 44 Inert solvents, 82

Infarction. See also Acute myocardial infarction definition of, 270 Inference studies, 67 Infertility causes of, 442-444 endocrine glands involved in, 438 physiology and, 438-442, 439f, 441f sex steroids involved in, 436-437, 437f tests for estradiol, 441

follicle-stimulating hormone, 446 luteinizing hormone, 445 quality assessment in, 445-447 treatment of, 443 Infiltration, of beta cells, in diabetes mellitus,

148 Inhibins, 437 versus gestational age, 451t in menstrual cycle, 440-441, 441f perimenopause, 442 Inhibitors, of enzyme activity, 23

In utero fetal testing, 449 In vitro fertilization, 443 In vitro stability, of specimens, 48 Instrumentation, 102. See also specific instruments automated. See Automated systems for drug-of-abuse testing, 528-529,

531-532 future, 143-144

for point-of-care testing. See Point-of-care testing

Insulin action of, 148, 150, 389t in carbohydrate metabolism, 14 deficiency of, in diabetes mellitus, 148 for diabetes mellitus, 148 measurement of, 153 receptor for, 374-375, 375f resistance to, 149 source of, 389t structure of, 153f Insulin-like growth factor, in nutritional assessment, 337t Insulin-like growth factor-1, as tumor marker, 494

Insulin-like growth factor binding protein-3, as tumor marker, 494 Insulinoma, 498

Intelligent quality management, 329 Intermediate-density lipoprotein biochemistry of, 15, 17 elevated, 289 International System of Units (SI), 84 International unit (U) of activity, for enzymes, 23 Intrinsic factor, 348, 351 Iodine-125 uptake, for thyroid function, 407 Iodotyrosines, in thyroid hormone synthesis, 400

Ion-exchange chromatography, 109, 125, 162-163

Ionophores, in potentiometry, 115 Ion-selective electrodes for calcium, 417 for electrolytes, 221-224 in potentiometry, 114-116, 116f in spectrophotometry, 103 Iontophoresis, in sweat chloride test, 365 IRMA (immunoradiometric assay), for prostate specific antigen, 492, 493

Iron absorption of, 181, 182f measurement of, 182-186

clinical correlation of, 183, 186, 186t indirect, 182-183 in iron deficiency, 183-185 methodology for, 184-185 storage of, 181-182, 182f toxicity of, 533t transport of, 182, 182f

Iron-binding capacity total (TIBC), measurement of, 182-185, 186t unsaturated (UIBC), measurement of, 182-183, 185 Iron-deficiency anemia, 183-185 Ischemia, myocardial, 269 ISE (ion-selective electrode) technology for electrolytes, 221-224 in potentiometry, 114-116, 116f in spectrophotometry, 103 Islet cells, antibodies to, 153, 555t Isoelectric focusing, for glycated hemoglobin, 163

Isoelectric point, of proteins, 20 Isoenzymes, 109, 244-245 alkaline phosphatase, 247, 248t creatine kinase, 272-274, 272f lactate dehydrogenase, 273-274, 275f,

292-293 liver, 247, 248t Isoleucine, diagnostic use of, 553t Isopropanol, 504, 526

Jaffe reaction, in spectrophotometry, 106,

107t, 203 Jaundice definition of, 234 liver enzyme measurement in, 247 neonatal, 241-243 obstructive, 234, 234t, 240 physiological, 242-243 JCAHO. See Joint Commission on Accreditation of Healthcare Organizations Jendrassik-Grof reaction, in bilirubin measurement, 238 Joint Commission on Accreditation of Healthcare Organizations critical value policy of, 74-75 point-of-care testing requirements of, 325-326 Juxtacrine hormones, 373

Kernicterus, 241, 456 Ketamine, abuse of, 556t Ketoacidosis, in diabetes mellitus, 150,

155-157 Ketones formation of, in lipid metabolism, 16 measurement of, 156 Kidney anatomy of, 31, 32f, 205-206, 207f calculi of, 228-230, 416 Kidney function, 31-32, 201-232, 205-206, 207f in acid-base balance maintenance,

215-216, 216t, 217f, 309 in azotemia, 211-212, 212t in diabetes insipidus, 224-228 in diabetes mellitus, 209-211

572 INDEX

Kidney function (Continued) in drug metabolism, 507-508 in elderly persons, drug toxicity and, 294-295

electrolyte balance and, 217-218,

226-227, 417 failure of, 213-214, 416-417 drug-induced, 505 in multiple myeloma, 475, 478 in glomerular nephritis, 202, 205-209, 207f in nephrotic syndrome, 209-211 in oat cell carcinoma, 495-496 reabsorption, 206 in renal tubular acidosis, 214-215,

218-219 tests for anion gap, 222-223, 223f BUN-to-creatinine ratio, 212, 212t creatinine clearance, 203-205 electrolyte analysis, 220-224, 223f fractional excretion of sodium, 214 hemolysis effects on, 219-220 osmolality, 228 urea, 211-212, 212t uric acid, 229-230 urinary albumin, 210-211 urinary protein, 210 Kinetic spectrophotometry, 106t, 107-109 Kinetics, of enzymes, 23-25, 24f in drug metabolism, 507-508 in spectrophotometry, 23-25, 24f Km (Michaelis constant), 24, 24f

Labeling, of chemicals, 5-6, 5f Lactate, measurement of, 172-173 Lactate dehydrogenase (LD) in creatine kinase measurement, 273 isoenzymes of, 273-274, 275f, 292-293 measurement of in myocardial infarction, 271-274, 275f, 292-293

spectrophotometric reactions in, 110t origins of, 244, 245t in triglyceride measurement, 280 Lactose clinical importance of, 554t malabsorption of, 360 structure of, 10f Lactose breath test, 360 Lamellar body count, for fetal lung maturity,

463-464 Large intestine. See Colon Lasers, in nephelometry, 111 Law of mass action, in immunoassays, 131 LCAT (lecithin:cholesterol acyltransferase), 286-287

LD. See Lactate dehydrogenase (LD) LDL lipoprotein. See Lipoprotein(s), low-

density (LDL, bad) Lead, reference range for, 454t Lead poisoning, 186-190, 188f, 532, 533t causes of, 189, 557t heme synthesis pathway in, 187-188 lead measurement in, 187-189 Lecithin (phosphatidylcholine) in fetal lung maturation, 316-317 in surfactant, 459 Lecithin:cholesterol acyltransferase (LCAT), 286-287

Lecithin-to-sphingomyelin (L/S) ratio, 459,

463-464 Leucine, diagnostic use of, 553t Levey-Jennings chart, 56, 56f, 58, 59f Levothyroxine, for hypothyroidism, 402 Leydig cells, 442

LH. See Luteinizing hormone (LH) Libido, maintenance of, 442 Licensure, 6-8, 7t

Lidocaine, therapeutic monitoring of, 511, 557t

Light scatter, measurement of, 110-111, 111f, 283

Liley chart, for bilirubin in amniotic fluid, 456, 457f

Linearity, of calibration curve, 109, 109f Lineweaver-Burk linear transformation, 24, 24f

Linoleic acid, clinical importance of, 554t Linolenic acid, clinical importance of, 554t Lipase measurement of, 365 in pancreatic cancer, 497-499 quality control in, 60, 62-63 in triglyceride measurement, 279-280 Lipemia, 44

in electrolyte measurement interference,

220, 222, 224 fasting status and, 277 Lipid(s). See also specific lipids as biochemical markers, 17-18 biochemistry of, 15-18, 16f, 18f definition of, 15 fecal, 358-359

malabsorption of, 358-359, 417 metabolism of, 17, 18f, 25-26, 25f structures of, 15, 16f types of, 15-17 Lipid panel, 18, 280, 282, 282t Lipogenesis, insulin in, 148 Lipolysis, 15 Lipoprotein(s)

apoproteins associated with, 286-289, 286t, 288f biochemistry of, 15-17, 18f definition of, 275 elevated, causes of, 284 high-density (HDL, good), 277

apoproteins associated with, 286-287, 286t, 288f biochemistry of, 15, 17-18 composition of, 277f guidelines for, 282

in hypoalphalipoproteinemia, 287-288

measurement of, 49t, 280-281 menopause and, 291-292 physiological changes in, 280 role of, 277 intermediate-density biochemistry of, 15, 17 elevated, 289 lipoprotein (a), 296 low-density (LDL, bad)

apoproteins associated with, 286-287, 286t, 288f biochemistry of, 15, 17 composition of, 277f in diabetes mellitus, 281 guidelines for, 282, 282t measurement of, 278-279 physiological changes in, 280 metabolism of, 286-287, 288f types of, 276, 277f very low-density (VLDL)

apoproteins associated with, 286-287, 286t, 288f biochemistry of, 15, 17 composition of, 277f Lipoprotein (a), 296 Lipoprotein lipase deficiency, 284-285 Liquid chromatography, high-pressure (high-performance), 126-127, 127f, 395-398

Lithium, therapeutic monitoring of, 515,

557t Liver anatomy of, 31, 235-237, 236f drug metabolism in, first-pass effect in,

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