8. Carbohydrates
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Which ketone body is not measured using routine urinalysis reagent strips?
Beta-hydroxybutyric acid (BHB)
What is glycolysis
Conversion of glucose to pyruvate/lactate
What reagent is used to detect ketones?
Sodium nitroprusside
What is gluconeogenesis
Production of glucose from non-carbohydrate sources (glycerol, FAs, AAs)
What is acetest
Semi-quantitative test that determines ketones in urine and serum
What happens to lyte levels during diabetic ketoacidosis?
Na+ and K+ are usually decreased due to polyuria and excretion of salts of the acids produced by the utilization of lipids for energy
Why should grey top tubes be cautiously used for other tests?
Enzymes inhibited by additives in it
Equation for calculated osmolality?
2*(Na+) + BUN + glucose
What is glycogenesis
Formation of glycogen from glucose
What does acetest detect? Doesn’t detect?
Detects: acetoacetate, lesser extent acetone Does NOT detect BHB
Clinical significance of elevated HgbA1C?
Indicates poor glucose control over the past 6-12 weeks Values >= 7 mmol/L = poor diabetic control Therapeutic goal is <6.5%
What would cause an elevated anion gap in a ketoacidosis patient?
Increased ketones (unmeasured anion)
Source of cortisol?
Adrenal cortex
What is glycogenolysis
Breakdown of glycogen to G6P to enter glycolysis cycle Production of glucose from glycogen
2 enzymatic methods for glucose determination
• Glucose oxidase - Hexokinase
Equation for osmolar gap?
Osmolar gap = measured osmol - calculated osmol
What are the most common causes of hypoglycemia?
• inappropriate insulin production • insulin injection • ingestion of oral hypoglycemic agents
Source of epinephrine?
Adrenal medulla
4 diagnostic tests to determine enzyme deficiencies in carb malabsorption?
• BC New Born Screening Program • Confirmatory tests • Tolerance testing • Genetic testing
What is microalbuminuria?
Excretion of urinary albumin at a rate of 20-200 ug/min or 20-300 mg/24 hr Highly predictive of diabetic nephropathy in type 1 diabetes
5 hormones that affect [glucose] and their effect on it
• Insulin - lowers • Glucagon - increase • Cortisol - increase • Epinephrine - increase • Growth hormone - increase
2 additives in grey top tubes and their functions
Potassium oxalate - anticoagulant Sodium fluoride - glycolytic inhibitor
How do glucose levels differ in venous and capillary specimens? How do they differ if the patient is fasting?
Fasting: all 3 (arterial, capillary, venous) comparable After meal: venous levels lower than capillary/arterial (common estimate = 10%)
When are ketones present in the blood?
When there is impaired carb metabolism w/ breakdown of FA: • uncontrolled diabetes mellitus • starvation • vomiting • low carb diet