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Abstract
Clinical Chemistry considers what happens to the body’s chemistry when affected by disease. Each chapter covers the relevant basic science and effectively applies this to clinical practice. It includes discussion on diagnostic techniques and patient management and makes regular use of case histories to emphasise clinical relevance, summarise chapter key points and to provide a useful starting point for examination revision.
The clear and engaging writing style appreciated by generations of readers has been retained in this new (eighth) edition, while the content has been thoroughly updated throughout. The approach and scope of this trusted text makes it ideal for integrated medical curricula for medical training and for students and practitioners of clinical and biomedical science. The complementary online version of the book, including additional self-assessment material, completes this superb learning package.
- Comes with complete, downloadable eBook on Student Consult
- Additional self-assessment materials – interactive clinical cases and two tier level MCQs (‘standard’ and ‘advanced’)
- New introductory chapter on basic biochemistry - including solutions, solutes, ionisation, pH, buffers, amino acids, peptides and proteins, enzyme activity, including kinetic properties, DNA structure
- ‘Light bulb’ sections give practical advice and clarify difficult concepts or potential pitfalls
- Updated references to core guidelines (UK and international) reflect latest best practice
Table of Contents
| Section Title | Page | Action | Price |
|---|---|---|---|
| Front Cover | cover | ||
| Student PIN code page | IFC2 | ||
| Clinical Chemistry | i | ||
| Copyright Page | iv | ||
| Table Of Contents | v | ||
| Preface | vii | ||
| Further Reading | ix | ||
| 1 An Introduction to Biochemistry and Cell Biology | 1 | ||
| Units and Measurements | 1 | ||
| Analytical Techniques | 1 | ||
| Ions and Molecules of Biological Importance | 3 | ||
| Elements of Cell Biology | 6 | ||
| Transport Mechanisms | 9 | ||
| 2 Biochemical Investigations in Clinical Medicine | 11 | ||
| Introduction | 11 | ||
| Use of Biochemical Investigations | 11 | ||
| Diagnosis | 11 | ||
| Prognosis | 11 | ||
| Monitoring | 11 | ||
| Screening | 11 | ||
| Specimen Collection | 12 | ||
| The test request | 12 | ||
| The patient | 12 | ||
| The specimen | 13 | ||
| Urgent requests | 13 | ||
| Repeat requesting | 14 | ||
| Sample Analysis and Reporting of Results | 14 | ||
| Analysis | 14 | ||
| Reporting results | 15 | ||
| Point-of-care testing | 15 | ||
| Sources of Error | 15 | ||
| Interpretation of Results | 16 | ||
| Is it normal? | 16 | ||
| Is it different? | 17 | ||
| The Clinical Utility of Laboratory Investigations | 18 | ||
| Specificity and sensitivity | 18 | ||
| Efficiency | 20 | ||
| Predictive values | 20 | ||
| Likelihood ratios | 20 | ||
| Evidence-based clinical biochemistry | 21 | ||
| Clinical Audit | 21 | ||
| Screening | 21 | ||
| 3 Water, Sodium and Potassium | 23 | ||
| Introduction | 23 | ||
| Water distribution | 23 | ||
| Sodium distribution | 23 | ||
| Potassium distribution | 24 | ||
| Water and Sodium Homoeostasis | 24 | ||
| Water and extracellular fluid osmolality | 24 | ||
| Sodium and extracellular fluid volume | 25 | ||
| Water and Sodium Depletion | 27 | ||
| Water depletion | 28 | ||
| Sodium depletion | 28 | ||
| Water and Sodium Excess | 32 | ||
| Water excess | 32 | ||
| Sodium excess | 32 | ||
| Laboratory Assessment of Water and Sodium Status | 33 | ||
| Sodium measurement | 34 | ||
| Measurement of osmolality | 35 | ||
| Measurement of anions (bicarbonate and chloride) | 35 | ||
| Hyponatraemia | 35 | ||
| Causes | 36 | ||
| Sodium depletion | 36 | ||
| Water excess | 36 | ||
| Combined water and sodium excess | 39 | ||
| Other causes of hyponatraemia | 39 | ||
| The ‘sick cell syndrome’ | 39 | ||
| Investigation of hyponatraemia | 40 | ||
| Management of hyponatraemia | 40 | ||
| Hypernatraemia | 40 | ||
| Potassium Homoeostasis | 42 | ||
| Potassium Depletion and Hypokalaemia | 43 | ||
| Clinical features | 44 | ||
| Management | 44 | ||
| Potassium Excess and Hyperkalaemia | 44 | ||
| Clinical features | 46 | ||
| Management | 46 | ||
| 4 Hydrogen Ion Homoeostasis and Blood Gases | 51 | ||
| Introduction | 51 | ||
| Buffering of hydrogen ions | 51 | ||
| Bicarbonate reabsorption and hydrogen ion excretion | 52 | ||
| Transport of carbon dioxide | 53 | ||
| Clinical and Laboratory Assessment of Hydrogen Ion Status | 55 | ||
| Disorders of Hydrogen Ion Homoeostasis | 56 | ||
| Non-respiratory (metabolic) acidosis | 57 | ||
| Increased production of hydrogen ions | 57 | ||
| Decreased excretion of hydrogen ions | 58 | ||
| Loss of bicarbonate | 58 | ||
| Excessive infusion of ‘normal’ (0.9%) saline | 58 | ||
| The anion gap | 59 | ||
| Management | 59 | ||
| Respiratory acidosis | 60 | ||
| Management | 61 | ||
| Non-respiratory (metabolic) alkalosis | 62 | ||
| Management | 63 | ||
| Respiratory alkalosis | 64 | ||
| Management | 64 | ||
| Interpretation of Acid–Base Data | 64 | ||
| Oxygen Transport and Its Disorders | 67 | ||
| Respiratory Failure and Respiratory Support | 69 | ||
| 5 The Kidneys | 73 | ||
| Introduction | 73 | ||
| The Biochemical Investigation of Kidney Function | 74 | ||
| Measurement of glomerular filtration rate | 74 | ||
| Clearance | 74 | ||
| Plasma creatinine | 76 | ||
| Plasma urea | 77 | ||
| Cystatin C | 77 | ||
| Estimated glomerular filtration rate | 77 | ||
| Assessment of glomerular integrity | 78 | ||
| Tests of renal tubular function | 79 | ||
| Imaging and Renal Biopsy | 79 | ||
| Renal Disorders | 80 | ||
| Acute kidney injury | 80 | ||
| Pre-renal acute kidney injury | 81 | ||
| Intrinsic acute kidney injury | 81 | ||
| Causes and pathogenesis. | 81 | ||
| Metabolic consequences. | 81 | ||
| Natural history. | 83 | ||
| Post-renal acute kidney injury | 83 | ||
| Management of acute kidney injury | 83 | ||
| Chronic kidney disease | 85 | ||
| Causes, natural history and screening | 85 | ||
| Metabolic consequences | 85 | ||
| Management of chronic kidney disease | 88 | ||
| Renal replacement therapy | 89 | ||
| Proteinuria and the nephrotic syndrome | 90 | ||
| Investigation of proteinuria | 91 | ||
| The nephrotic syndrome | 91 | ||
| Renal tubular disorders | 93 | ||
| Fanconi syndrome | 93 | ||
| Renal tubular acidosis | 93 | ||
| Defects of urinary concentration | 94 | ||
| Glycosuria and amino aciduria | 94 | ||
| Hypophosphataemic rickets | 94 | ||
| Urinary calculi | 94 | ||
| Pathogenesis | 94 | ||
| Investigation | 95 | ||
| Management | 95 | ||
| 6 The Liver | 99 | ||
| Introduction | 99 | ||
| Bilirubin Metabolism | 99 | ||
| Biochemical Assessment of Liver Function | 101 | ||
| Plasma bilirubin concentration | 101 | ||
| Unconjugated hyperbilirubinaemia | 101 | ||
| Conjugated hyperbilirubinaemia | 102 | ||
| Plasma enzymes | 103 | ||
| Plasma proteins | 103 | ||
| Other tests of liver function | 104 | ||
| Non-biochemical investigation of hepatobiliary disease | 104 | ||
| Liver Disease | 105 | ||
| Acute hepatitis | 105 | ||
| Chronic hepatitis | 105 | ||
| Acute liver failure | 106 | ||
| Management | 107 | ||
| Cirrhosis | 107 | ||
| Biochemical investigation | 107 | ||
| Complications | 108 | ||
| Management | 109 | ||
| Ethanol and the liver | 109 | ||
| Non-alcoholic fatty liver disease | 110 | ||
| Tumours and infiltrations | 110 | ||
| Jaundice in adults | 111 | ||
| Inherited abnormalities of bilirubin metabolism | 112 | ||
| Isolated abnormalities of ‘liver enzymes’ | 113 | ||
| Uncommon liver diseases | 114 | ||
| Liver transplantation | 114 | ||
| Gallstones and biliary tract disease | 114 | ||
| Liver disease in children | 115 | ||
| Liver disease in pregnancy | 115 | ||
| Drugs and the liver | 116 | ||
| 7 The Gastrointestinal Tract | 119 | ||
| Introduction | 119 | ||
| The Stomach | 119 | ||
| Gastric disorders and investigation of gastric function | 119 | ||
| Atypical peptic ulceration | 120 | ||
| The Pancreas | 121 | ||
| Pancreatic disorders and their investigation | 121 | ||
| Acute pancreatitis | 121 | ||
| Chronic pancreatitis | 123 | ||
| Tests of pancreatic function | 123 | ||
| Carcinoma of the pancreas | 124 | ||
| The Small Intestine | 125 | ||
| Investigation of intestinal function | 125 | ||
| Tests for gut permeability | 125 | ||
| Tests of carbohydrate absorption | 125 | ||
| Tests of amino acid absorption | 125 | ||
| Tests of fat absorption | 126 | ||
| Tests for bacterial overgrowth | 126 | ||
| Non-biochemical tests of intestinal function | 126 | ||
| Disorders of intestinal function | 127 | ||
| Malabsorption | 127 | ||
| Coeliac disease | 128 | ||
| Intestinal failure | 128 | ||
| Other intestinal disorders | 129 | ||
| Gastrointestinal Hormones | 130 | ||
| 8 Clinical Nutrition | 133 | ||
| Introduction | 133 | ||
| Vitamin Deficiencies | 133 | ||
| Water-Soluble Vitamins | 133 | ||
| Vitamin B1 (thiamin) | 133 | ||
| Nicotinic acid (niacin, vitamin B3) | 134 | ||
| Folic acid | 134 | ||
| Vitamin B12 | 134 | ||
| Vitamin C (ascorbic acid) | 135 | ||
| Fat-Soluble Vitamins | 135 | ||
| Vitamin A | 135 | ||
| Vitamin D | 135 | ||
| Vitamin E | 137 | ||
| Vitamin K | 137 | ||
| Vitamins as Drugs | 137 | ||
| Trace Elements | 137 | ||
| Trace element deficiency | 138 | ||
| Trace element toxicity | 138 | ||
| Laboratory assessment | 138 | ||
| Zinc | 138 | ||
| Copper | 139 | ||
| Selenium | 139 | ||
| Provision of Nutritional Support | 139 | ||
| Nutritional assessment | 139 | ||
| Techniques for generalized nutritional support | 140 | ||
| Parenteral nutrition | 140 | ||
| Laboratory monitoring | 142 | ||
| Eating Disorders | 142 | ||
| Obesity | 143 | ||
| 9 The Hypothalamus and the Pituitary Gland | 147 | ||
| Introduction | 147 | ||
| Anterior Pituitary Hormones | 147 | ||
| Growth hormone | 147 | ||
| Prolactin | 149 | ||
| Thyroid-stimulating hormone | 149 | ||
| Gonadotrophins | 150 | ||
| Adrenocorticotrophic hormone | 151 | ||
| Measurement of Anterior Pituitary Hormones | 152 | ||
| Releasing hormone tests | 152 | ||
| Tests for growth hormone deficiency | 153 | ||
| Tests for adrenocorticotrophic hormone deficiency | 153 | ||
| Insulin hypoglycaemia test | 153 | ||
| Imaging the pituitary | 155 | ||
| Disorders of Anterior Pituitary Function | 155 | ||
| Hypopituitarism | 155 | ||
| Growth hormone deficiency | 155 | ||
| Pituitary tumours | 157 | ||
| Growth hormone excess: acromegaly and gigantism | 158 | ||
| Hyperprolactinaemia | 160 | ||
| Cushing disease | 161 | ||
| Other conditions related to pituitary tumours | 161 | ||
| Posterior Pituitary Hormones | 161 | ||
| Vasopressin | 161 | ||
| Management of diabetes insipidus | 163 | ||
| 10 The Adrenal Glands | 167 | ||
| Introduction | 167 | ||
| Adrenal Steroid Hormone Biosynthesis | 167 | ||
| Measurement of Adrenal Steroid Hormones | 167 | ||
| Cortisol | 168 | ||
| Aldosterone | 169 | ||
| Androgens | 169 | ||
| Disorders of the Adrenal Cortex | 170 | ||
| Adrenal hypofunction (Addison disease) | 170 | ||
| Adrenal hyperfunction | 173 | ||
| Cushing syndrome | 173 | ||
| Conn syndrome | 176 | ||
| Congenital adrenal hyperplasia | 180 | ||
| Disorders of the Adrenal Medulla | 182 | ||
| 11 The Thyroid Gland | 185 | ||
| Introduction | 185 | ||
| Thyroid Hormones | 185 | ||
| Actions | 185 | ||
| Synthesis | 185 | ||
| Thyroid hormones in blood | 186 | ||
| Tests of Thyroid Function | 187 | ||
| Total thyroxine and triiodothyronine | 187 | ||
| Free thyroxine and triiodothyronine | 188 | ||
| Thyroid-stimulating hormone | 189 | ||
| Thyrotrophin-releasing hormone test | 189 | ||
| Other tests of thyroid function | 190 | ||
| Problems in the interpretation of thyroid function tests | 191 | ||
| Disorders of the Thyroid | 192 | ||
| Hyperthyroidism | 193 | ||
| Hypothyroidism | 195 | ||
| Subclinical hypothyroidism | 196 | ||
| Thyroiditis | 197 | ||
| Thyroid hormone resistance | 197 | ||
| Goitre and thyroid cancer | 197 | ||
| Screening for thyroid disease | 197 | ||
| 12 The Gonads | 201 | ||
| Introduction | 201 | ||
| Androgens and testicular function | 201 | ||
| Oestrogens and ovarian function | 201 | ||
| Progesterone | 202 | ||
| Sex hormone-binding globulin | 202 | ||
| Disorders of Male Gonadal Function | 202 | ||
| Delayed puberty and hypogonadism in males | 202 | ||
| Gynaecomastia | 205 | ||
| Disorders of Female Gonadal Function | 205 | ||
| Delayed puberty and hypogonadism in females | 205 | ||
| Amenorrhoea and oligomenorrhoea | 206 | ||
| The climacteric | 208 | ||
| Hirsutism and virilism | 208 | ||
| Infertility | 209 | ||
| Assisted pregnancy | 210 | ||
| Pregnancy | 210 | ||
| Specific hormonal changes | 210 | ||
| Human chorionic gonadotrophin | 210 | ||
| Oestrogens | 211 | ||
| Secondary metabolic changes | 211 | ||
| Maternal monitoring | 211 | ||
| Fetal monitoring | 212 | ||
| 13 Disorders of Carbohydrate Metabolism | 215 | ||
| Introduction | 215 | ||
| Measurement of Glucose Concentration | 216 | ||
| Diabetes Mellitus | 218 | ||
| Aetiology and pathogenesis | 218 | ||
| Type 1 diabetes mellitus | 219 | ||
| Type 2 diabetes mellitus | 219 | ||
| Pathophysiology and clinical features | 220 | ||
| Diagnosis | 221 | ||
| Management | 223 | ||
| Monitoring treatment | 225 | ||
| Metabolic Complications of Diabetes | 226 | ||
| Ketoacidosis | 226 | ||
| Pathogenesis | 226 | ||
| Management | 228 | ||
| Hyperosmolar hyperglycaemic state | 230 | ||
| Management | 230 | ||
| Lactic acidosis | 232 | ||
| Hypoglycaemia in patients with diabetes | 232 | ||
| Diabetic nephropathy | 232 | ||
| Lipoprotein metabolism in diabetes mellitus | 233 | ||
| Diabetes in Pregnancy | 234 | ||
| Glycosuria | 234 | ||
| Glucose in Cerebrospinal Fluid | 234 | ||
| Hypoglycaemia | 234 | ||
| Causes | 234 | ||
| Clinical features | 234 | ||
| Diagnosis | 235 | ||
| Reactive hypoglycaemia | 236 | ||
| Drug-induced hypoglycaemia | 236 | ||
| Postprandial hypoglycaemia | 237 | ||
| Alcohol and reactive hypoglycaemia | 238 | ||
| Other causes of reactive hypoglycaemia | 238 | ||
| Fasting hypoglycaemia | 238 | ||
| Insulinoma | 238 | ||
| Non-pancreatic neoplasms | 239 | ||
| Liver and kidney disease | 240 | ||
| Endocrine disease | 240 | ||
| Alcohol-induced fasting hypoglycaemia | 240 | ||
| Sepsis | 240 | ||
| Inherited metabolic disease | 240 | ||
| Other causes of hypoglycaemia | 240 | ||
| Hypoglycaemia in Childhood | 240 | ||
| Neonatal hypoglycaemia | 240 | ||
| Hypoglycaemia in infancy | 240 | ||
| 14 Calcium, Phosphate and Magnesium | 245 | ||
| Introduction | 245 | ||
| Bone | 245 | ||
| Plasma Calcium | 245 | ||
| Calcium-Regulating Hormones | 246 | ||
| Parathyroid hormone | 247 | ||
| Calcitriol | 248 | ||
| Calcitonin | 249 | ||
| Fibroblast growth factor 23 | 249 | ||
| Calcium and Phosphate Homoeostasis | 250 | ||
| Disorders of Calcium, Phosphate and Magnesium Metabolism | 250 | ||
| Hypercalcaemia | 250 | ||
| Malignant disease | 252 | ||
| Primary hyperparathyroidism | 252 | ||
| Secondary and tertiary hyperparathyroidism | 253 | ||
| Other causes of hypercalcaemia | 253 | ||
| Investigation | 254 | ||
| Management | 255 | ||
| Hypocalcaemia | 255 | ||
| Vitamin D deficiency | 256 | ||
| Impaired vitamin D metabolism | 256 | ||
| Kidney disease | 256 | ||
| Hypoparathyroidism | 256 | ||
| Other causes of hypocalcaemia | 256 | ||
| 15 Bones and Joints | 263 | ||
| Introduction | 263 | ||
| Metabolic Bone Diseases | 263 | ||
| Rickets and osteomalacia | 263 | ||
| Osteoporosis | 264 | ||
| Paget disease of bone | 267 | ||
| Chronic kidney disease–mineral and bone disorder | 267 | ||
| Hyperparathyroid bone disease | 268 | ||
| Other metabolic bone diseases | 268 | ||
| Articular Disease | 268 | ||
| Gout and hyperuricaemia | 268 | ||
| Introduction | 268 | ||
| Uric acid metabolism | 269 | ||
| Hyperuricaemia | 270 | ||
| Gout | 270 | ||
| Diagnosis. | 272 | ||
| Management. | 272 | ||
| Natural history. | 273 | ||
| Rare causes of hyperuricaemia | 273 | ||
| Hypouricaemia | 274 | ||
| Other crystalline arthropathies | 274 | ||
| 16 Plasma Proteins and Enzymes | 275 | ||
| Introduction | 275 | ||
| Measurement of Plasma Proteins | 275 | ||
| Total plasma protein | 275 | ||
| Protein electrophoresis | 275 | ||
| Specific Plasma Proteins | 276 | ||
| Albumin | 276 | ||
| α1-Antitrypsin | 278 | ||
| Haptoglobin | 278 | ||
| α2-Macroglobulin | 279 | ||
| Caeruloplasmin | 279 | ||
| Transferrin and ferritin | 279 | ||
| Acute phase proteins and the acute phase response | 279 | ||
| Other plasma proteins | 280 | ||
| Immunoglobulins | 280 | ||
| Hypogammaglobulinaemia | 281 | ||
| Physiological causes | 281 | ||
| 17 Lipids, Lipoproteins and Cardiovascular Disease | 293 | ||
| Introduction | 293 | ||
| Triglycerides, Cholesterol and Phospholipids | 293 | ||
| Classification of Lipoproteins | 293 | ||
| Lipoprotein Metabolism | 295 | ||
| Chylomicrons | 295 | ||
| Very low-density and intermediate-density lipoproteins | 296 | ||
| Low-density lipoprotein | 297 | ||
| High-density lipoprotein | 298 | ||
| Summary | 298 | ||
| Lipid Investigations | 298 | ||
| Reference ranges and clinical goals | 298 | ||
| Laboratory measurement of lipids and lipoproteins | 300 | ||
| Clinical indications for lipid testing | 301 | ||
| Disorders of Lipid Metabolism | 302 | ||
| Classification | 302 | ||
| Secondary hyperlipidaemias | 302 | ||
| Primary hyperlipidaemias | 303 | ||
| Familial hypercholesterolaemia | 303 | ||
| Polygenic hypercholesterolaemia | 304 | ||
| Remnant hyperlipoproteinaemia | 304 | ||
| Familial chylomicronaemia | 305 | ||
| Familial hypertriglyceridaemia | 306 | ||
| Familial combined hyperlipidaemia | 306 | ||
| Familial hyperalphalipoproteinaemia | 306 | ||
| Cardiovascular Risk Management | 306 | ||
| Risk factors and risk assessment | 306 | ||
| Rationale for treatment of hyperlipidaemia | 307 | ||
| Hypercholesterolaemia | 308 | ||
| Hypertriglyceridaemia | 308 | ||
| Lipoprotein Deficiency | 308 | ||
| Abetalipoproteinaemia | 308 | ||
| Hypobetalipoproteinaemia | 308 | ||
| Tangier disease | 308 | ||
| Myocardial Infarction | 308 | ||
| Heart Failure | 310 | ||
| Hypertension | 310 | ||
| 18 Muscles, Nerves and Psychiatric Disorders | 315 | ||
| Introduction | 315 | ||
| Muscle Diseases | 315 | ||
| Markers of muscle damage | 315 | ||
| Muscular dystrophies | 316 | ||
| Metabolic myopathies | 316 | ||
| Other myopathies | 316 | ||
| Nervous System Disease | 317 | ||
| Coma | 317 | ||
| Dementia | 318 | ||
| Seizures | 318 | ||
| Movement disorders | 318 | ||
| Ataxia | 318 | ||
| Peripheral neuropathies | 319 | ||
| Stroke | 319 | ||
| Other neurological disorders | 319 | ||
| Examination of the cerebrospinal fluid | 320 | ||
| Psychiatric Disease | 321 | ||
| Acute confusional state | 321 | ||
| Other psychiatric manifestations of systemic illness | 321 | ||
| Endocrine and metabolic manifestations of psychiatric disorders | 322 | ||
| Metabolic side effects of psychotropic drugs | 322 | ||
| 19 Inherited Metabolic Diseases | 325 | ||
| Introduction | 325 | ||
| Effects of enzyme defects | 326 | ||
| Decreased formation of the product | 326 | ||
| Accumulation of the substrate | 327 | ||
| Increased formation of other metabolites | 327 | ||
| Inherited Metabolic Disorders | 327 | ||
| Glucose 6-phosphatase deficiency | 327 | ||
| Galactosaemia | 328 | ||
| Phenylketonuria | 329 | ||
| Variants and related conditions | 330 | ||
| Steroid 21-hydroxylase deficiency | 330 | ||
| Cystic fibrosis | 330 | ||
| Other inherited metabolic diseases | 331 | ||
| Diagnosis | 331 | ||
| Newborn Screening | 332 | ||
| Prenatal Diagnosis | 333 | ||
| Maternal and fetal screening | 333 | ||
| Down syndrome | 333 | ||
| Cystic fibrosis | 334 | ||
| DNA Analysis | 334 | ||
| Treatment | 334 | ||
| Restriction of substrate intake | 334 | ||
| Supply of missing product | 335 | ||
| Addition of vitamin cofactors | 335 | ||
| Complex formation and removal of toxic substances | 335 | ||
| Replacement of missing enzyme or other protein | 335 | ||
| Replacement of the defective gene | 336 | ||
| 20 Disorders of Haemoproteins, Porphyrins and Iron | 339 | ||
| Introduction | 339 | ||
| Haemoproteins | 339 | ||
| Haemoglobin and haemoglobinopathies | 339 | ||
| Amino acid substitutions | 339 | ||
| Thalassaemias | 339 | ||
| Abnormal derivatives of haemoglobin | 339 | ||
| Methaemoglobin | 339 | ||
| Haematin | 340 | ||
| Carboxyhaemoglobin | 340 | ||
| Detection | 340 | ||
| Porphyrins | 340 | ||
| The porphyrias | 341 | ||
| Acute porphyrias | 342 | ||
| Clinical features | 344 | ||
| Diagnosis | 344 | ||
| Management | 344 | ||
| Non-acute porphyrias | 344 | ||
| Diagnosis | 345 | ||
| Management | 345 | ||
| Other causes of porphyrinuria | 345 | ||
| Iron | 345 | ||
| Iron absorption and transport | 345 | ||
| Diagnostic tests for iron status | 346 | ||
| Plasma iron | 346 | ||
| Total iron-binding capacity | 346 | ||
| Plasma ferritin | 346 | ||
| Transferrin receptor | 347 | ||
| Iron deficiency | 347 | ||
| Iron overload | 347 | ||
| Hereditary (primary) haemochromatosis | 347 | ||
| Management and prognosis | 348 | ||
| 21 Metabolic Aspects of Malignant Disease | 351 | ||
| Introduction | 351 | ||
| Paraneoplastic Endocrine Syndromes | 351 | ||
| Origins and classification | 351 | ||
| Neuroendocrine tumours | 351 | ||
| Cushing syndrome | 352 | ||
| Ectopic vasopressin secretion | 352 | ||
| Hypercalcaemia of malignancy | 352 | ||
| Tumour-associated hypoglycaemia | 354 | ||
| Other paraneoplastic endocrine syndromes | 354 | ||
| Other Metabolic Complications of Malignant Disease | 354 | ||
| Cancer Cachexia | 354 | ||
| Carcinoid Tumours | 355 | ||
| Management | 356 | ||
| Multiple Endocrine Neoplasia | 356 | ||
| Tumour Markers | 357 | ||
| α-Fetoprotein | 358 | ||
| Carcinoembryonic antigen | 358 | ||
| Carbohydrate antigen markers | 360 | ||
| Paraproteins | 360 | ||
| Human chorionic gonadotrophin | 360 | ||
| Other hormones as tumour markers | 361 | ||
| Prostate-specific antigen | 361 | ||
| Enzymes as tumour markers | 361 | ||
| Other tumour markers | 362 | ||
| Conclusion | 362 | ||
| 22 Therapeutic Drug Monitoring and Chemical Aspects of Toxicology | 365 | ||
| Introduction | 365 | ||
| Therapeutic Drug Monitoring | 365 | ||
| Measuring plasma concentration | 366 | ||
| Monitoring of Specific Drugs | 367 | ||
| Phenytoin | 367 | ||
| Other anticonvulsants | 367 | ||
| Digoxin | 369 | ||
| Other antidysrhythmics | 370 | ||
| Lithium | 370 | ||
| Antipsychotic drugs | 370 | ||
| Antidepressants | 370 | ||
| Theophylline | 370 | ||
| Immunosuppressive drugs | 370 | ||
| Aminoglycoside antibiotics | 371 | ||
| Methotrexate | 371 | ||
| Toxicology | 371 | ||
| Management | 371 | ||
| Poisoning with Specific Agents | 372 | ||
| Paracetamol (acetaminophen) | 372 | ||
| Clinical features | 372 | ||
| Management | 373 | ||
| Salicylates | 374 | ||
| Management | 375 | ||
| Iron | 375 | ||
| Lead | 376 | ||
| Clinical features and management | 376 | ||
| Other metals | 376 | ||
| Ethanol | 376 | ||
| Clinical features and effects | 376 | ||
| Other poisons | 377 | ||
| Screening for Drugs | 377 | ||
| Drug and substance abuse | 378 | ||
| Pharmacogenomics | 378 | ||
| 23 Clinical Chemistry at the Extremes of Age | 381 | ||
| Old Age | 381 | ||
| Reference ranges | 381 | ||
| Screening | 383 | ||
| Childhood | 384 | ||
| Reference ranges | 384 | ||
| Screening | 384 | ||
| Childhood disorders | 385 | ||
| Neonatal hypoglycaemia | 385 | ||
| Neonatal hypocalcaemia and hypomagnesaemia | 385 | ||
| Jaundice | 385 | ||
| Inherited metabolic disorders | 386 | ||
| Failure to thrive | 387 | ||
| Disorders of sex development and abnormal puberty | 388 | ||
| Appendix Adult Reference Ranges | 391 | ||
| Index | 393 | ||
| A | 393 | ||
| B | 395 | ||
| C | 396 | ||
| D | 398 | ||
| E | 399 | ||
| F | 400 | ||
| G | 400 | ||
| H | 401 | ||
| I | 404 | ||
| J | 404 | ||
| K | 405 | ||
| L | 405 | ||
| M | 406 | ||
| N | 406 | ||
| O | 407 | ||
| P | 408 | ||
| R | 410 | ||
| S | 410 | ||
| T | 411 | ||
| U | 412 | ||
| V | 413 | ||
| W | 413 | ||
| X | 413 | ||
| Z | 413 | ||
| Clinical Key advert | IBC1 |