*--_._._
`
`Textbook of :“”¢§oi
`LINICAL
`
`CHEMISTRY
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`
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`Editor:
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`NORBERT W. TIETZ, Ph.D.
`
`Professor, Department of Pathology,
`Director of Clinical Chemistry,
`College of Medicine,
`University of Kentucky, Lexington, KY
`
`Editorial Con1m1'!fee:
`
`N. V BHAGAVAN, Ph.D.
`
`WENDELL T CARAWAK Ph.D.
`
`REX B. CONN, M.D.
`
`JOHN E’ K./-ICHMAR, Ph.D.
`
`ELIZABETH L. PHUDEN, Ph.D., M. T (ASCP)
`
`RONALD I. WHITLEY. Ph.D.
`
`1986
`W B. SAUNDERS COMPANY
`
`Philadelphra 0 London I Tbronlo I Mexlco City 0 Rio de Icnleiro II criyduey 0 loicyo 0 Hong Kong
`
`FRESENIUS KABI 1029-0001
`
`

`
`W. B. Saunders Company; West Washington Square
`Philadelphia. PA l9l0S
`
`Library of Congress Cataloging in Publication Data
`Main entry under title‘.
`
`Textbook of clinical chemistry.
`
`1. Chemistry. Clinical. l. Tietz. Norbert W..
`1926-
`[DNLM: 1. Chemistry. Clinical. QY 90 T355]
`RB-$0.T4-II 1986 616.0756
`83-204I0
`ISBN 0-7216-B886-I
`
`Editor: Dudley Kay
`Develop-merrtaf Editor: Dave Kiliner
`Desfgrters Terri Siegel
`Production Manager: Frank Polizzano
`
`Textbook of Clinical Chemistry
`
`ISBN 0-T216-8886-I
`
`© I986 by W. B. Saunders Company. Copyright under the Unilorm Copyright Convention. Siniultnneously
`published in Canada. All rights reserved. This book is protected by copyright. No part of it may be reproduced.
`stored in a retrieval system, or transmitted in any form or by any means. electronic. mechanical. photocopying.
`recording. or otherwise. without written pemtission from the publisher. Made in the United States of America.
`Press of W. B. Saunders Company. Library of Congress catalog card number 83-204-I0
`
`Last digit is the print number:
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`CHAPTER 1
`LRBORATOFIY PRINCIPLES AND INSTRUMENTATION
`CHAPTEFI 1'A. GENERAL. LABORATORY TECHNIQUES AND PROCEDURES
`by Edward W. Hermes. J'r.. Ph.D.. and Donald .5‘. Young. M.B.. PILD.
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`Chemicals and Related Substances .
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`Reagent Grade Water 3; Reagent Grade or Analytical Reagent Grade (AR) Reagents 6;
`Desiccants and Use of Desiocators 8
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`General Laboratory Supplies .
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`Glassware 10; Plasticware 1'}; Synthetic and Rubber-Base Tubing I5
`Volumetric Equipment and Its Calibration . . . .
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`Pipets I5; Burets 21; Volumetric Flasks 22
`Centrifuges 23; Procedures for Concentrating Solutions 27; Separatory Funnels 27; Laboratory
`Mixers and Homogenizers 28; Filtration 28; Balances and Weighing 30; Concept of Solute
`and Solvent 32; Physical and Chemical Units 34; Buffer Solutions and Their Action 35
`Units of Measurement .
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`International System of Units 37; Reporting 42; Conversion of Units 4'4
`Safety.
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`CHAPTER 1.3. ANALYTICAL PROCEDURES AND INSTRUMENTATION ........
`Coordinated by Carl A. Bum’.r.. PhD.
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`Section One. Photometry..... .......
`by Wendell T Caraway. Ph..D.
`Nature of Light 55; Beer's Law 56; Components of Spectrophotometers 6!; Standardization
`of .Spectrophotometers 69
`Flame Photometry 72; Atomic Absorption Spectrophotornetry 75
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`Section Two. Fluorornetry, Nephelometry, and Turbldimetry ..........
`by Thomas O. Itffony. PhD.
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`Fluorescence and Light Scattering Measurements .
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`Approaches to Fluorescence Measurements .
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`Tune Relationships of Fluorescence Emission 80; Fluorescence Polarization 81' ; Limitations
`of Fluormcence Measurements 83; Instrumentation for Measurement of Fluorescence 85;
`Fluororneters for Special Applications 90
`Light Scattering Measurements 91 ; Nephelometric and Turbidimetric Measurements of Scat-
`tered Light 94‘
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`Section Three. EIectropI1oresis...................................... .....
`by Emanuel Epstein, PILD.
`Theory of Electrophoresis 98; Effect of Buffer on Electrophoretic Migration I00; Electro-
`endosmosis or Endosmosis £00
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`A General Method for Electrophoresis . . . .
`Paper Electrophoresis (PE) 104; Agarose Gel Electrophoresis (AGE) 1041'; Cellulose Acetate
`Electrophoresis (CAB) 105: Polyacrylamide Gel Electrophoresis (PAGE) I05; Starch Gel
`Electrophoresis I06; Isoelectric Focusing (IEFJ J06-. Limitation and Errors I08; Problem
`Solving I09
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`39600:! Four. Electrochemistry ............ ................... ....... ........... ....... ..
`by Ole Siggnard-Anderrort. M.D.. Ph.D.
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`FRESENIUS KABI 1029-0003
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`xviii
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`Potentiornetry .
`Ion-Selective Membrane Electrodes N6; Gas Electrodes I2};
`Redox Electrodes II};
`Enzyme Electrodes I22; Liquid-Liquid Junction Potentials 123
`Polarography 124; Amperomctry I25; Coulornetry I27; Conductometry I28
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`Section Five. Osmometry
`by Esther F. Freier, M.S. M. '}’I (ASCP)
`Osmosis I29; Colligative Properties 130
`The Freezing Point Depression Osmometer 131; The Vapor Pressure Osmomctcr 133; The
`Colloid Osmotic Pressure Osmometer 133
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`Section six. Chromatography...........................................................
`by Larry D. Bowers. Ph.D.
`Forms of Chromatography I36; Fundamental Properties of Chromatography I39
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`Separation Mechanisms .
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`Ion-Exchange Chromatography I44; Steric Exclusion Chromatography I45; Adsorption
`Chromatography I46; Partition Chromatography I47; Affinity Chromatography 148
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`Section Seven. Gas Chromatography..................................... ....
`by Sari C. Cfiattoraj. Pi'r.D.
`Basic Principles of Technique I50; The. Gas Chromatograph 15;‘
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`Section Elght. High Performance Liquid Chromatography" ....
`by M. David Uilmrm, Phil. and Carl A. Harris. Ph.D.
`Instrumentation . . .
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`Practical Operation . . .
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`Sample Preparation :70; rut.{,;g',x;s;;.;t3;‘ i-7-I-;-Mo-1)-iiePhase‘i'i7I‘;‘l’t1t‘itps-‘I‘?li;.ln3ectoi'
`I 72; Column 172; Detector I 72; Safety I72
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`Section Nine. Basic Principles of Radioactivity and Its Measurement
`by Edward R. Powsner, M.D.
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`Atomic Structure. Radiation. and Radioactivity.
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`Interaction of Radiation with Matter . .
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`Excitation and Ionization J33; Particulate Radiation I34; Electromagnetic Radiation 184;
`Units of Radiation Exposure and Radiation Dose I86
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`Detection and Measurement of Radioactivity .
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`Autoradiography I86; Gas—Filled Detectors I86; Scintillation Detectors I87; Electronics
`of Scintillation Counting I90; Efficiency of Scintillation Counting I91‘; Counting Statistics
`I93
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`Radiation Safety .
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`SectionTen. Mass Spectrometry.................. ............
`by Brian D. Andresen, Pfi.D.. and Bethany L. Wise, Ph.D., M.T.{ASCP)
`The Instrument I98; Gas Chromatography—M-ass Spectrometry 204; Isotope Dilution Mass
`Spectrometry (IDMS) 206
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`CHAPTER 1C. PRINCIPLES OF IMMUNOCHEMICAL TECHNIQUES. ..... . . ..
`by Gregory J. Buffone, PJLD.
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`Antigen-Antibody Binding—-Theory of Interaction .
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`Qualitative Methods for Detecting Proteins .
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`Passive Gel Diffusion 2I5; Immunoelectrophoresis 2}?
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`Quantitative Methods for Measuring Proteins .
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`Radial Immunodiffusion (R113) and Electroimmunoassay (EIA) 222; Turbidimetric and
`Nephelometric Assays 223; Techniques for Detecting Primary Association Between Antigen
`and Antibody 224; Irnmunocytochemistry 229; Agglutination Assays 230
`Monoclonal Antibodies . . .
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`CHAPTER 1D. AUTOMATION IN THE CLINICAL LABORATORY . . . . . . . . . . . . . . . . . . . .
`by Ernest Macffn, RE, and Dormfd S. Yormg. M.B.. PILD.
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`CONTENTS
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`Instrurnenialconcepts .
`Definitions 237; Specimen Identification 238; Specimen Preparation 240: Specimen Han-
`dling, Presentation. and Transport 24!; Removal of Protein and Other Interferents 243;
`Sample Transport and Delivery 244; Reagent Handling 246; Reagent Delivery 249
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`Chemical Reaction Phase . .
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`Mixing and Incubation in Centrifugal Analyzers 25!; Reaction Vessels and Cuvets in
`Discrete Systems 252
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`Measurement Approaches. .
`Systems Using Absorbancci"Transmittance Photometry 255; Other Forms of Photometry
`25 7; Systems Using Electrochemical Measurements 258; Signal Processing. Data Handling.
`and Microprocessors 259
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`Examples of Automated Clinical Chemistry Systems . . . . .
`ASTRA 261'; COB/AS-BIO 263; DEMAND 265; Bktachem 700 267; Parallel 269;
`SMAC H 272
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`Selection of Instruments 274; Trends in Instrumentation 276
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`CHAPTER 2
`ACQUISITION, MANAGEMENT, AND APPLICATION OF LABORATORY DATA .
`CHAPTER 2A. STATISTICAL
`by Robert 0. Kringle, M.S.. and George E Johnson, PILD.
`Sources of Variation in Analytical Data 287; The Role of Statistics in Analytical Work 288
`Fundamental Statistical Concepts . .
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`Basic Concepts 289; The Gaussian Probability Distribution 293; Student‘s t Probability
`Distribution 296
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`Sampling Distributions . . .
`Independence and Random Sampling 298; Sampling Distributions 298; Estimation of Pop-
`ulation Parametcrs 300; Significance Testing 300
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`Inference About Population Means .
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`The Randomized Comparison 305; The Randomized Paired Comparison 307
`Designing Experiments in Analytical Work . . .
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`Confidence Intervals for Population Means 310; The Poisson Distribution 31-=1
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`Inferences About a Single Population Variance 316; Inference About the Ratio o-f,la'i; of
`Two Population Variances 339
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`The Study of Variation in Analytical Work . .
`The Expected Value and Variance of a Linear Combination of Random Variables 32!;
`Transmission of I-Error 323; Estimating Variance Components by Nested ANOVA 324;
`interferences Concerning Variances Estimated in One-Stage and Two-Stage Nested ANOVA
`328
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`Regression Analysis 332; The Total Analytical Error of an Analyzer System 343; Statistical
`Quality Control 350; Outliers 352; Simulation of Random Events 354
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`CHAPTER 2B. ESTABLISHMENT AND USE OF REFERENCE VALUES.............
`by Helge Erik Sofberg. M.D.. Pk.D.
`The Concept of Reference Values 356; Selection of Reference Individuals 359; Specimen
`Collection 364
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`Importance of Analytical Procedures and Quality Control. .
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`Statistical Procedures Used in Establishing Reference Values . . . . .
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`Determination of Reference Limits: General Considerations 37!; Presentation of an Observed
`Value in Relation to Reference Values 379; Multivariate. Population-Based Reference Re-
`gions 380; Subject-Based Reference Values 382; Transferabilily of Reference Values 383
`Dynamic vs. Static Interpretation of Clinical Chemistry Data . .
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`CHAPTER 20. ANALYTICAL GOALS AND CLINICAL RELEVANCE OF
`LABORATORY PROCEDURES.................................... .... ..
`5}‘ Robert S. Galen, M.D.. M.P.H.. and Theodore Peters, Jr.. P.fl'.D.
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`Analytical Goals 338; Analytical Performance Compared with Analytical Goals 393
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`XX
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`CONTENTS
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`Clinical Relevance of Laboratory Procedures 394; The Predictive Value of Laboratory Tests
`395; Appropriate Use of the Laboratory 402
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`Goals and Objectives . . .
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`CHAPTER 2n. EVALUATION OF
`by Theodore Peters‘. Jr-.. Ph.D.. and James 0. Westguro’. PILD.
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`Characteristics of Analytical Methods 41'0; Setting Quality Goals for Analytical Performance
`413; Recommendations for Quality Goals 414; Judging Performance Based on Quality
`Goals 4l5
`Selecting an Analytical Method 416; Evaluating an Analytical Method 4??
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`CHAPTER 2E. QUALITY
`by James 0. Westgard. P!i.D., and George G. Klee. M.D., Phi).
`Establishing Quality Goals. . .
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`Control of Pre—Analytical Variables 426; Systems Analysis of the Process 426; Procedures
`for Monitoring Pro-Analytical Variables 42 7; Control of Analytical Variables 429; Control
`of Analytical Quality Using Stable Control Materials 432
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`Levey-Jennings Control Chart 438; Westgard Multi-Rule Chart 440; Cumulative Sum
`(Cusum) Control Chart 442; Shewhart Mean and Range (or Standard Deviation) Control
`Charts 447
`Control of Analytical Quality Using Patient Data 449; Role of External Quality Assurance
`(CIA) Procedures 453; Identifying the Sources of Analytical Errors 455
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`CHAPTER 2F. MICROPFIOCESSOFIS AND COMPUTERS IN THE CLINICAL
`LABORATORY........................... .....
`by Franklin R. Elevfreh. JI-if.D.. and G. Phr'llip flicks. Ph.D.
`The Computer System 460; Computer Hardware 461; Peripheral Devices 461; Central Pro-
`cessing Unit (CPU) 466
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`Software Programming Languages 466; Database 467
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`Background 468; Planning a Laboratory Information System 469; Data T-ransactionsiin
`the Laboratory 469; The Laboratory Database 470
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`CHAPTER 3.. SPECIMEN COLLECTION AND PROCESSING; SOUFICES OF
`BIOLOGICAL VARIATION.............................. ........
`by Donald S Young, M.B., Ph.D., and Edward W. Bemies. J'r.. PILD.
`Collection of Blood 478; Urine Collection 488; Collection of Feces 492; Collection of Spinal
`Fluid 492; Collection of Other Fluids and Tissues for Analysis 493
`Handling of Specimens for Testing . . . .
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`CHAPTER 4. AMINO ACIDS AND PROTEINS...........................................
`by Lawrence M. Silvermarr. P:':.D., Robert H. Chrrstensorr, Ph.D., and Gregor H. Grant. B.M.,
`KR.C. Path.
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`Basic Chemistry of Amino Acids and Proteins .
`Disorders of Amino Acid Metabolism 529; The Aminoacidurias 531
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`Screening Tests 537; Thin Layer Chromatography 537; Colorimetric Screening Tests for
`Urine 544; Quantitative Tests for the Separation of Amino Acids 545
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`Selected Disorders of Amino Acid Metabolism . . ,
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`Hyperphcnylalaninemias 546; Tyrosinemia and Related Disorders 550; Alkaptonuria 554;
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`FRESENIUS KABI 1029-0006
`
`

`
`CONTENTS
`
`Melainuiia 554; Disorders of Sulfur-Containing Amino Acids 555; Cystinuria 556; [listi-
`dinemia 556; Organic Acidurias 55 7; Maple Syrup Urine Disease 557; Disorders of Pro-
`pionate and Methylrnalonate Metabolism 55 7; Nonketotic Hyperglycinemia 558; Defects
`of Urea Cycle Enzymes 553
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`Proteins of Body Fluids . . . . .
`Analysis of Proteins 563; lmmunoglobulins 566; Methods for the Analysis of Immuno-
`globulins 572; Immunofixation Electrophoresis 573; Complement Proteins 575; Methods
`for the Determination of Proteins in Serum and Plasma 5 79
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`Prealbumin and Retinol-Binding Protein 586; Albumin 587: oi,-Antilrypsin .590; E1;-Acid
`Glycoprotein 591; C11-FetI.‘J[JI’0lBlI1 592; Haptoglobin 592; ct;-Macroglobulin 594; Cerule-
`plasmin 595; Transferrin 596; B2-Microglobulin 597; C—Reactive Protein 598; Arnyloid
`599; Other Plasma Proteins 60!
`Proteins in Urine 602; Laboratory Studies of Proteinuria 604
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`Proteins in Cerebrospinal Fluid .
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`Total Protein in CSF 610; Methods for Specific Proteins in CSF 612; Silver Staining of
`Protein" Fractions After Electrophoresis 61}
`Proteins in Other Body Fluids . .
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`cuaeren 5.
`by Donald W. Moss, Pli.D., D.Sc.. A. Ralph Henderson. 11413.. Cl1.B., Ph.D., and John E
`Kochmor. P}i.D.
`Enzyme Nomenclature 619; Enzymes as Proteins 621; Enzymes as Catalysts 623; Progress
`of Enzymatic Reactions and the Measurement of Reaction Rates 644; Measurement of
`Enzymes in Terms of Mass 651; Enzymes as Analytical Reagents 652
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`lsoenzymes and Other Multiple Forms of Enzymes . . .
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`Aspartate Aminotransferase 669; Alanine Aminotransferase 669; Creatine Kinase 678;
`Aldolase 689; Lactate Dehydrogenase 691; Enzyme Tests in the Determination of Myo-
`cardial Infarction 698
`lsocitrate Dehydrogenase 700; Glutamate Dehydrogenase 703; Alkaline Phosphatase 70-9'
`Bi1iary'l'ract Enzymes...... . .
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`S‘-Nucleotidase 718; Gamma-Glutamyltransferase 721
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`Amylase 725; Amylase lsoenzymcs 734; Lipase 735; Trypsin 741; Chymotrypsin 744‘
`Cholinesterases 746; Acid Phosphatase 752; Terminal Deoxynucleotidyl Transferase 757
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`LYSOSOMAL ENZYMES
`by John F. O'Brien, P1i.D.
`Method'for the Determination of B-N-Acetylglucosarninidase Isoenzymes (Hexosaminidase
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`CHAPTER 6. CARBOHYDRATES........................................................
`by Wendell ll". Caraway, Ph.D., and Nelson 13. Watts, MZD.
`Chemistry of Carbohydrates 775; Metabolism of Carbohydrates 779
`Determination of Glucose in Body Fluids .
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`Diabetes Mellitus 796; Glycohemoglobins 802; Ketone Bodies 807
`H:moslyceniia.... ..................................... ... ............................. ..
`Other Tolerance Tests .
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`CHAPTER 7. LIPIDS, LIPOPROTEINS, AND RPOLIPOPFIOTEINS . . . . . . . . . . . . . . . . . . .
`5}’ Evan A. Stein. M.D.. Plr.D.
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`Ch‘-‘-‘mi5f|‘Y and Physiology of Lipids .
`Ailollpoproteins 345; Lipoproteins 849
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`B19
`822
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`B29
`
`829
`
`FRESENIUS KABI 1029-0007
`
`

`
`xxii
`
`CONTENTS
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`Clinical Interrelationships of Lipids. Lipoproteins. and Anolipoproteins .
`Diagnostic Tests for Lipoprotein Disorders . . .
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`HDL-Cholesterol 379; Cholesterol 832; Triglyceride 886
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`CHAPTER 8
`NUTRITION, VITAMINS, AND TRACE ELEMENTS. ....
`CHAPTEHBA. NUTFIlTION...................... ......
`by Doriee M’. Czojko—Nort‘ns, Pt.-.D.
`Dietary Requirements 903; Factors Altering Nutritional Requirements 905; Development of
`a Nutritional Problem 907; Nutritional Assessment 907; Nutritional Adequacy in North
`America 915
`Nutritional Support in Patient Management 9H5; Nutritional Support
`Situations 920
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`in Special Clinical
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`....
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`CHAPTEFISB.
`by Donald B. McCormick. Ph.D.
`Definition of Vitamins 92?; Classification of Vitamins 923
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`Vitamins Essential for Humans .
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`Vitamin A 928; Vitamin D 934; Vitamin E 936; Vitamin
`946; Vitamin 13.; 950; Niacin and Niaeinarnide 953; Folic Acid and Vitamin B” 955; Biotin
`955; Pantothenic Acid 95 7; Ascorbic Acid. 959
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`853872
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`CHAPTERBC. TRACE 965
`by Robert A. Jacob. PhD.
`965
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`Essential Trace Elements
`Characteristics of Tract: Element Functions 967
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`laboratory Assessment of Trace Metal Status .
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`Magnesium 971; Iron 975; Zinc 975; Copper 98}; Manganese 985; Molybdenum 986;
`Chromium 987; Cobalt 989; Nickel. Vanadium. Silicon. and Arsenic 990; Selenium 99;‘;
`Fluoride 993
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`968
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`CHAPTEFIQ.
`by Sort‘ C. C/rottoroj, Pt‘t.D.. and Nelson B. Watts. MD.
`Actions of Hormones 998; Control of Hormone Secretion 999; Hormone-Receptor Interactions
`I004; Receptor Regulation 1005; Mechanism of Action of Hormones 1006
`Protein Hormones . . . .
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`Insulin 1011; Proinsulin I011; C-Peptide f012
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`Anterior Pituitary Hormones
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`'ns 10} 9; Prolactin I026; Corticotropin (ACTH) and
`Growth I-[ormone and Sornatornedi
`Related Peptides (,3-LPH. Endorphins, and Enkephalins)
`I029; Pituitary Glycoprotein
`Honnones (LH. FSH. TS]-I) I030
`Posterior Pituitary Hormones . . .. . .
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`Adrenocortical Steroids
`Methods for the Determination of: Cortisol I073 ; Aldosterone 1075 ; ll-Deoxycortisol 1076:
`17-Hydroxyprogesterone I076; Dehydroepiandrosterone Sulfate (DHEAS
`steroids 1078
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`997
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`1 1 16
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`Renin and Angiotensins . . . .
`Androgens I085; Testosterone I089; Progesterone I094; Pregnanediol I098; Estrogcns 1099;
`Estrogen and Progesterone Receptors U08
`Reproductive Endocrinology .
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`Thyroid Function . . .
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`Methods for the Determination
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`FRESENIUS KABI 1029-0003
`
`

`
`CONTENTS
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`Hormone Binding H29; Free Thyroxine H29; T; Uptalte H31; Free Thyroxine Index 1132;
`TBG H33; Thyrotropin iTSH} H34; Thyroglobulin H35; Antithyroglobulin and Anti-
`mierosomal Antibodies H36
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`Catecholamines and Metabolites . . .
`Serotonin and 5-Hydroxyindoleacctie Acid (5-HIAA) .
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`Ectopic Hormone and Paraneoplastic Syndromes .
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`CHAPTEFI 10. ELECTFIOLYTES, BLOOD GASES, AND ACID-BASE BALANCE
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`Section One. Electrolytes.................................................. ............ ..
`by Norbert W. Tierz, _Ph.D.. Elizabeth L Pruden. Ph.D.. and
`Ole Stggoard-Andersen, M.D.. Ph.D.
`Sodium H73; Potassium H75; Chloride U83; Bicarbonate (Total Carbon Dioxide} 1188
`Quality Control of Concurrent Electrolyte Measurements .
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`.........
`Section Two. Biood Gases and
`by Eiizoberfr L. Prudert. Ph.D., Oie Sfggaord-Andersen, M.D., Ph.D.. and
`Norbert‘ FF’. Tfetz. P!:.D.
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`xxiii
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`1136
`1155
`1160
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`1172
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`1172
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`1 190
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`1191
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`Respiration H91; Physical Principles I196
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`The Interrelationship Between ctC01, cHC03‘ . cdCO2, and pH . .
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`Oxygen Saturation I203; Hemoglobin-Oxygen Dissociation I20-ti; p0;(0.S) or Pm 1205
`Determination of pCO3, p01. and pH 1207; Tonometry 1212; Quality Control HM
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`1200
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`1221
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`Section Three. Acid-Base Balance and Acid-Base Disorders
`by Norbert W. Tietz, Ph.D.. 0.-'e Siggaard-Andersen, M.D.. Ph.D.. and
`Elizabeth L. Prttdert. PFLD.
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`Electrolyte Composition of Body Fluids .
`Acid-Base Parameters——Definitions and Abbreviations .
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`1223
`1228
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`Buffer Systems and Their Role in Regulating the pH of Body Fluids 1230; The Isohydric
`and Chloride Shift I233
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`The Respiratory Mechanism in the Regulation of Acid-Base Balance . . .
`Renal Excretion of Acid, Ammonia Formation, and Reabsorption of Bicarbonate—Tl1e
`Renal Compensatory Mechanism . . .
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`Conditions Associated with Abnormal Acid-Base Status and Abnormal Anion-Cation
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`Composition of the Blood . . .
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`Metabolic Acidosis I239; Metabolic Alkalosis I242; Respiratory Acidosis. 1245; Respiratory
`Alkalosis 124 7
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`Estimates Derived from Electrolyte Measurements I24 9; Anion Gap I249; Osmolal Gap I251‘
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`CHAPTER 11. NITROGEN METABOLITES AND RENAL FUNCTION .. . . . . . . .... . . . .
`by Robert C Rock, M11. W. Gordon Walker. M.D., and C Darrch’Jet1nin_gs, Mi).
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`Functions of the Kidney .
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`Renal Clearance and Gloruerular Filtration Rate 1262; Nonprotein Nitrogen -—Containing
`Compounds I266; Urea I266; Creatinine and Creatine I271; Estimation of Creatinine
`Clearance from Plasma Creatinine Level I274; Determination of Creatininc I276; Endoge-
`nous Creatinine Clearance 1280; Creatine in Biological Fiuids I281; Uric Acid 128}
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`Renal Tubular Acidosis (RTA) .
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`Water Homeostasis I292; Determination of Specific Gravity I299: Usmolality of Serum and
`Urine I300
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`Renal Disease and the Role of the Laboratory .
`End-Stage Renal Disease and the Pathophysiology of the Uremic Syndrome 1303; Acute
`Renal Failure I30-it‘; Glomerular Diseases I306; Tubular Diseases I308; Urinary Tract
`Obstruction 1309; Use of the Laboratory for the Patient with Renal Disease 1309
`Renal Caleuli I31}; Laboratory Analysis of Kidney Stones HI3
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`1235
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`1235
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`1238
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`1254
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`1257
`1262
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`1283
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`1302
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`FRESENIUS KABI 1029-0009
`
`

`
`xxiv
`
`CONTENTS
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`CHAPTER 12. CALCIUM AND PHOSPHATE METABOLISM
`by Donald Fraser. M.D., Ph.D., Glcnvfllc Jones. Ph.D.. Song llfilioy Kooh, M.D., Ph.D..
`F.R.C.P.(C). and Ingeborg C. Rodde. M'.D., Plt.D., F..R.C.P.(C‘)
`Calcium I317; Phosphate 1318
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`Hormones that Regulate Calcium and Inorganic Phosphate Transport .
`Parathyroid Hormone 1319; Calcitonin 1321; Vitamin D and Metabolites 1322; Plasma
`Ca and P, Regulation I324
`Significance of Plasma Levels oiCa1-. Ca.. Pl. PTH. CT. and Vitamin D Metabolites
`Diseases Associated with Hypercalcernic States I325; Hypocalcernic States 1329; Hyper-
`phosphatemia 1333; Hypophosphatemia I335; Norrnocalcemic States I335
`Clinical Significance "of Plasma PTH Determinations 1336; Elevated Levels of Calcitonin in
`Plasma 1339; Changes in Vitamin D Metabolites in Plasma 1339
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`Analytical Methods .
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