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Clin Chem Exam 2

Exam 2

3 routes of exposure/absorption Ingestion, Inhalation, and Transdermal absorption
What does TD50 mean? Dose that will have toxic response in ½ the population
What does ED50 mean? Dose that will have beneficial effect in ½ the population
Naloxone (Narcan) opiate antagonist, compete with opiate
N-acetylcysteine acetaminophen poisoning
Activated Charcoal absorbs certain drugs in GI system
Gastric lavage pump the stomach
Chelating agents heavy metal poisoning
Blood alcohol level of 0.40% Unconsciousness, depression, breathing difficulty and slowed heartbeat; sometimes death
How fast is alcohol cleared from the body Alcohol is cleared at an hourly rate of 18 mg/dl in female and 15 mg/dl in males
Methanol Methanol (ADH)--> formaldehyde (ALDH)--> formic acid Formic acid causes severe acidosis/optic neuropathy
Isopropanol Metabolized to acetone—long half-life
Treatment for Alcohol poisoning Administer fomepizole or ethanol to compete for ADH binding sites and inhibit metabolism of ethylene glycol, sodium bicarbonate given to offset the acidosis, hemodialysis/forced diuresis to enhance removal
Analysis of Alcohol Whole blood, serum, urine, saliva, or breath (higher in serum than whole blood) Most labs use enzymatic method (alcohol dehydrogenase) Ethanol + NAD (ADH) --> Acetaldehyde + NADH Production of NADH can be measured or can be coupled with indicator react
Breath alcohol test Principle: Concentration ratio of blood to breath is 2100:1 Screening test: if initial value between 0.02 and 0.04, confirmatory test done (15 minute waiting period) Methods: infrared absorption, photometric, GC, electrochemical oxidation (fuel cell)
Saliva alcohol test Principle- ADH reaction using swab and diaphorase color indicator Potential for use in screening
Urine alcohol test Urine roughly 1.3 X blood concentration (postabsorptive phase). Not approved by DOT Postmortem alcohol can also be analyzed
Reference method used to test Alcohol levels GC (gas chromatography)
Gas Chromatography (alcohol testing) Reference method 1. Dilutes serum/blood with NaCl solution in closed container 2. Volatiles separate into the air space (head space) 3. Head space is sampled to quantitate analytes
Osmometry (alcohol testing) Freezing point depression osmometer may also be used to determine the osmotic strength of a solution Freezing point depression Presence of alcohol will increase the measured osmolarity, increase the osmol gap. Not specific for alcohol
Carbon monoxide background info Colorless, odorless, blood is cherry red Affinity for hemoglobin 200x greater than O2 (shift to the left) Causes hypoxia (decrease of oxygen delivered to tissues)
Treatment for Carbon Monoxide remove CO source, give O2, may use hyperbaric oxygen in extreme cases, can force it off
Types of Alcohols covered (4) Ethanol, Methanol, Ethylene glycol, Isopropanol
5 Heavy metals covered Arsenic, Mercury, Lead, Cadmium, Pesticides
3 Anti-cholingergics covered Trycyclic antidepressants, Pehnothiazines, Antihistamines
Methanol analysis GC and Osometry
Methanol Background Info Solvent, Body breaks down, Formic acid causes acidosis/optic neuropathy
Ethylene glycol Treatment 1) administer fomepizole or ethanol to bind to ADH binding sites and inhibit metabolism of ethylene glycol. 2) Sodium bicarbonate is given to offset acidosis. 3) hemodialysis forces diuresis to enhance removal
Ethanol Testing methods (5) breath alcohol (ratio of blood to breath 2100:1), Saliva alchol (ADH reaction), Urine alcohol (1.3 times blood concentration), GC (reference method), Osmotery (not specific for alcohol)
Carbon Monoxide Lab monitoring, and Specimen types Carboxyhemoglobin and oxyhemoglobin levels Whole blood, EDTA sample, Heparinized whole blood
CO Testing (3 types) 1) Spot (Qualitative) 2) Spectrohotometric (most common, different wavelengths measure different fractions of hemoglobin) 3) GC (reference method, accurate/precise, CO + potassium ferricyanide, presence of CO measured by change in thermal conductivity
Cyanide Info Almond ordor,Headache, di zziness, respiratory depression. Binds heme iron, depletes cell ATP, O2 not utilized, increased pO2 levels and hypoxia Exposure: inhalation, transdermal absorption, used in industrial processes, insecticides, rodent poison
Cyanide Tests (2) ISE (ion specific electrode), and Photometric
Cyanide 1) lab monitor 2) Specimen 3) Treatment 1) urine 2) Cyanide converted to thiocyanate (enzymatically) and excreted renally 3) Administer sodium nitrite, causes formation of methemoglobin which binds to and clears cyanide
Arsenic Info Garlic breath, vomiting, GI distress. Chronic: Anemia, Renal failure. Usually accidental exposure. Rat Poisoning
Arsenic 1) Specimen 2) Test 3) Treatment 1) urine (recent exposure), hair and nails (long term) 2) Atomic absorption 3) Gastric lavage
Mercury 1) Info 2) Toxic effects 1) inhalation or ingestion, usually from contaminated foods. Neurological symptoms: Tremors, behavioral changes, mumbling, loss of balance. 2) Inhibition of enzymes, GI, tremors, renal dysfunction
Mercury 1) Specimen 2) Tests 3) Treatment 1) Blood or urine 2) Measure whole blood or 24 hour urine 3) Chelaters, EDTA and BAL
Lead 1) Info 2) Toxic symptoms 1) Paint, old plumbing, children more susceptible. Inhibits enzymes, synthesis of heme, accumulates over time. Heaviest in bones. 2) GI irritation, decreased IQ, kidney damage, CNS damage
Lead 1) specimen 2) tests 3) treatment 4) lab monitor 1) whole blood 2) Atomic absorption and spectrophotometry 3) chelators, EDTA and BAL 4) BUN and creatinine, also basophilic stippling on blood smear
Cadmium Info Industrial, Inhalation, Renal tubular dysfunction (proteinuria, etc.)
Cadmium Toxic Symptoms Protein binding inhibits enzymes. Accumulates and affects kidneys
Cadmium 1) Specimen 2) Test 1) Whole blood or urine 2) Atomic absorption and Spectrophometry
Pesticide Info Death from respiratory failure. Tightness in chest, Increase bronchial secretions, Increase sweating and salivation, GI disruptions, Involuntary urination and defication
Pesticides 1) Tests 2) Lab monitoring 1) Immunoassay 2) Measure pseudocholinesterase activity
Tricyclic antidepressant Info Treats depression, Headaches, ADD. Narrow therapeutic range, fatal toxicity
Tricyclic antidepressant toxic symptoms Tachycardia, dialed pupils, dry skin/mouth, decrease GI motility, Resp Depression
Tricyclic Treatment Gastic lavage, Activated charcoal, IV fluids, NaHCO3 for dysrhythmias
Phenothiazines Info Treatment for psychiatric illness
Pehnothiazines Toxic symptoms CNS, cardiovasuclar, sedation, coma, resp depression, seizures, hypotension
Phenothiazines Testing TLC
Phenothiazines Treatment IV fluids, gastric lavage, activated charcoal
Antihistamines info Treats allergy and colds
Antihistamines Toxic symptoms CNS depression, sedation, ataxia, coma, excitement, dilated pupils,urinary retention
Antihistamines Determination not commonly done, some urine drug screenings will detect
Antihistamines Treatment Gastric lavage, activated charcoal
Amphetamine info Stimulant, Meth high potential for abuse
Amphetamine Toxic symptoms OD rare, hypertension, convulsions, cardiac
Amphetamine Determination Immunoassay
Amphetamine Therapeutic uses Narcolepsy, ADD, OTC cold medicines
MDMA (ecstasy) Info Adverse effects: (headache, nausea, anxiety, violent behavior, hypertension, resp depression, renal failure)
MDMA (ecstasy) Detection GCMS (not immunoassay)
Weed Info lipophilic sequesters in fat. 1/2 life 1 day (single use) or 3-5 days. Impairment of short-term memory. dependence
Weed Specimen Urine
Weed Lab monitor TCH-COOH
Weed Determination Immunoassay (screening) GCMS (confirmation)
Cocaine info Short 1/3 life. Local anesthetic, CNS stimulant, euphoric feeling. Toxic effect: hypertension, seizure, MI
Cocaine Specimen, Lab monitor, and Tests Urine, Benzyoylegonine in urine 3 days (single) 20 days (chronic), Immunoassy, GCMS
Phencylidine (PCP) info Stimulant, depressant, anesthetic, hallucinogen. Long 1/2 life (lipophilic), Agitation, hostility, paranoia
Phencylidine (PCP) Lab monitor Detect parent drug (PCP)
Phencylidine (PCP) Testing Immunoassay and GCMS
Narcotics/Opiates/Opioids Natural form Opium, Morphine, Codeine
Narcotics/Opiates/Opioids Chemically modified Heroin, Oxycodone
Narcotics/Opiates/Opioids Synthetic form Demerol, Methadone
Narcotics/Opiates/Opioids Info High potential for abuse, Depress CNS relieve pain
Narcotics/Opiates/Opioids Toxic symptoms Overdose: classic triad (coma, resp depression, miosis (pinpoint pupils)), resp acidosis
Narcotics/Opiates/Opioids Determination and Treatment Immunoassay and CGMS Naloxone (Narcan) antidote that quickly reverses CNS depression
Barbiturates (Names) Secobarbital, Pentobarbital, Phenobarbital
Benzos (Names) Valium, Ativan
Sedatives Info CNS depressant. Overdose: lethargy, slurred speech, coma, death
Sedatives Toxic CNS and Resp depression, cardiac insufficiency, hypotension
Sedatives Determination and Treatment Immunassay, GC or LC. Supportive, ABC's (airway, breathing, ciruclation), Flumazenil can be given
Steroids Info Treat male hypogonadism, abuse: muscle mass
Steroid Toxic Effects quality and purity questionable. hepatitis, enlarged heart, stroke, MI, Aggression, Testicular atrophy, sterility
Steroid Determination Screen with testosterone/epitesterone ratio (high can mean exogenous source)
GHB Toxic effects Nausea, vomiting, hypotension, resp depression. "date rape drug" muscle relaxant. Outside US treats Alcohol, opioid withdrawl
GHB Determination GCMS (GHB rapidly eliminated)
LSD (Lysergic acid diethylamide) info Binds serotonin receptors in CNS, perceptual distortions, rapidly changing emotions, OD rare. most clinical effects are benign, no medical intervention needed
LSD (Lysergic acid diethylamide) Determination Rapid excretion, Immunoassay within 12-24 hours. GCMS (confirmatory)
Salicylates Info Aspirin, Analgesic < 60mg. Inhibits cyclooxygenase which decreases thromboxane and prostaglandin. Adverse effects: inhibit platelet aggregation, GI function, Reye's syndrome (fatal disease when children OD)
Salicylates Excessive ingestion Respiratory alkalosis, Inhibits Krebs cycle, Increase lactate, Metabolic acidosis, Excess ketones produced. Initial alkalosis --> GI irritation, metabolic acidosis. Acid-base imbalance, usually net acidosis
Salicylates Determination and Testing Trinder reaction (most common), GC or LC (most sensitive/specific). Neutralize the acid, regulate electrolytes (IV), diuresis, NaHCO3
Acetaminophen (Tylenol) Overdose Nausea, vomiting, malaise, pallor, anorexia, buildup of MFO due to glutathione depletion. MFO causes cell damage/necrosis of liver
Acetaminophen (Tylenol) Determination and Treatment Immunoassay and Competitive enzyme/FPIA Treatment: N-acetylcysteine conjugate the toxin and excretion
Created by: tdmickalowski