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Summary Clinical Biochemistry notes

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Clinical biochemistry notes detailing electrolyte disorders, lipid disorders, metabolic bone disease and poisonings. Notes made from multiple resources such as oxford handbook, question banks, university lectures and UK guidelines. Look at specialty section and content list for the summary conte...

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  • September 5, 2022
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  • 2022/2023
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Clinical Biochemistry

Seán Keenan

2022

, Disease Patterns


Abnormal Kidney Function
Reduced eGFR Dehydration
- AKI: Early acute oliguric renal failure - U&E: ↑↑ Urea; ↑ Creatinine
- CKD: ↓ eGFR ↓ Hb + ↑ PTH - FBC: ↑ Haematocrit (PCV)
Tubular dysfunction - Other: ↓ Urinary Output; ↓ Skin Turgor
- Test: Water deprivation test (see DI notes) Thiazides and Loop Diuretics
- Urine: Polyuria; Glucosuria; Proteinuria - U&E: ↓ Na+;↓ K+; ↑HCO3-; ↑ Urea
- Cx: AKI; ↑Ca2+; ↑Urea; ↑K+; Heavy metal poisoning - Calcium: Thiazides ↑ Ca2+; Furosemide ↓ Ca2+
Biochemical Profile in Abnormal Kidney Function
Electrolyte Low eGFR Tubular Dysfunction
Urea ↑ ↔
Creatinine ↑ ↔
Urate ↑ ↓
Potassium ↑ ↓
Hydrogen Ions ↑ ↑
Bicarbonate ↓ ↓
Phosphate ↑ ↓
Calcium ↓ ↔
Bone Disease
Serum Biomarkers of Bone Disease
Disease Ca2+ PO43- ALP
Osteoporosis ↔ ↔ ↔
Osteomalacia ↓ ↓ ↑
Paget's ↔ ↔ ↑↑
Myeloma ↑ ↑/↔ ↔
Bone Metastases ↑ ↑/↔ ↑
Primary Hyperparathyroidism ↑ ↓/↔ ↔/ ↑
Hypoparathyroidism ↓ ↑ ↔
Renal Failure (Low eGFR) ↓ ↑ ↔/ ↑

Hepatic Function Cardiac Function Myocardial Infarction
Hepatocellular Disease Myocardial Infarction
- Enzymes: ↑ Bilirubin; ↑↑ AST; ↑ ALP (slight) - Troponin: ↑ TnT + ↑ TnI are cardiac markers
- Synthetic: ↓ Albumin; ↑ Clotting times - NB: TnC is a skeletal marker (not relevant in MI)
Cholestasis - Other: ↑ CK; ↑ AST; ↑ LDH
- LFTs: ↑ Bilirubin; ↑↑ γGT; ↑↑ ALP; ↑ AST Heart Failure
- Synthetic: ↔ Albumin; ↔ Clotting times - BNP: >100 mg/mL
Alcohol Excess - ProBNP: >125 pg/mL <74 YO; >450 pg/mL >75 YO
- Early: ↑ γGT; ↑ MCV; ↑ Ethanol
- Late: AST:ALT >2; AST:ALT >3 suggests hepatitis

Endocrinological Diseases
Addison’s Disease Diabetes Insipidus
- U&E: ↑ K+; ↑ Urea; ↓ Na+ - U&E: ↑ HCO3-; ↑ / ↔ Na+; ↓ K+
- Hormones: ↓ Cortisol (Short Synacthen) - Test: Water Deprivation (see ADH pathologies)
Conn’s Syndrome Sudden Inappropriate ADH Secretion
- U&E: ↑ HCO3-; ↑ / ↔ Na+ ;↓ K+ - U&E: ↓ / ↔ Urea + Creatinine
- Hormones: ↑ Aldosterone; ↓ Renin - Sodium: ↑ Urinary Na+ + ↓ Plasma Na+

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