Beruflich Dokumente
Kultur Dokumente
Enzyme concentration
Substrate
concentration
Saturation kinetics
Cofactors
Coenzymes
Activators
Metalloenzymes
Inhibitors
Competitive inhibitor
Noncompetitive
inhibitor
Uncompetitive inhibitor
Isoenzymes
Temperature
40-50C
60-65C
Temperature coefficient
(Q10)
pH
Storage
Hemolysis
Lactescence or milky
specimen
Enzyme nomenclature
Enzyme classification
Oxidoreductases
Serum
Enzyme concentration = reaction rate
Reagent
If enzyme > substrate, substrate = reaction rate
When substrate concentration reaches a maximal value, higher
concentration of substrate no longer results in increased rate of
reaction
Nonprotein entities
Organic compound
Ex. NADP
Coenzyme = Velocity
Inorganic ions
Alters spatial configuration of the enzyme for proper substrate
binding
Ex. Ca2+ (#1 activator), Zn2+ (LDH), Cl- (AMS), Mg2+ (CK, ALP)
Inorganic ion attached to a molecule
Ex. Catalase, cytochrome oxidase
Interferes with the enzymatic reactions
Binds to the active site of an enzyme
Reversible (Substrate > Inhibitor)
Binds to the allosteric site (cofactor site)
Irreversible
Binds to the enzyme-substrate complex
Substrate = ES = Inhibition
Same catalytic reactions but slightly different molecular structures
Fractionation of isoenzymes
37C = optimum temperature for enzyme activity
Temperature = Reaction rate (movement of molecules)
Denaturation of enzymes
Inactivation of enzymes
For every 10OC increase in temperature, there will be a two-fold
increase in enzyme activity
Most physiologic reactions occur in the pH range of 7-8
Enzymes: -20C = for longer period of time
Substrate and Coenzymes: 2-8C
LDH (LD4 & 5): Room temperature
Mostly increases enzyme concentration
Decreases enzyme concentration
1st digit: classification
2nd and 3rd digits: subclass
4th digit(s): serial number
OTHLIL
Oxidoreductases
Transferases
Hydrolases
Lyases
Isomerases
Ligases
Redox reaction
Dehydrogenases:
lec.mt 04 |Page | 1
Transferases
Hydrolases
Lyases
Isomerases
Ligases
Active site
Allosteric site
Prosthetic group
Holoenzyme
Zymogen/proenzyme
Emil Fishers/Lock and
Key theory
Kochlands/Induced fit
theory
Enzyme kinetics
Absolute specificity
Group specificity
-Cytochrome oxidase
-LDH
-MDH
-Isocitrate dehydrogenase
-G-6-PD
Transfer of a chemical group other than hydrogen from 1 substrate
to another
Kinases, Transaminases, Aminotransferases:
-CK
-GGT
-AST
-ALT
-OCT
Hydrolysis/splitting by addition of water
Esterases:
-ACP
-ALP
-CHS
-LPS
Peptidases:
-Trypsin
-Pepsin
-LAP
Glycosidases:
-AMS
-Galactosidases
Removal of groups w/o hydrolysis (product contains double bonds)
Aldolase
Decarboxylases:
-Glutamate decarboxylase
-Pyruvate decarboxylase
-Tryptophan decarboxylase
Intramolecular arrangements
Glucose phosphate isomerase
Ribose phosphate isomerase
Joining of 2 substrate molecules
Synthases
Water-free cavity
Where the substrate interacts
Cavity other than the active site
May bind regulatory molecules
Coenzyme that is bound tightly to the enzyme
Apoenzyme + Prosthetic group
Inactive form of enzyme
Shape of the key (substrate) must fit into the lock (enzyme)
Based on the substrate binding to the active site of the enzyme
Acceptable theory
Enzymes catalyze reactions by lowering the activation energy level
that the substrate must reach for the reaction to occur
Enzyme combines w/ only 1 substrate and catalyzes only 1
reaction
Enzymes combine w/ all the substrates in a chemical group
lec.mt 04 |Page | 2
Bond specificity
Zero-order reaction
First-order reaction
Measurement of
enzyme activity
International Unit
Katal Unit
Nonkinetic assay
Alkaline Phosphatase
Phenylalanine
L-leucine
Levamisole
3M urea
Methods (ALP)
Increased ALP
Acid Phosphatase
Prostatic ACP
RBC ACP
Methods (ACP)
Aspartate
Aminotransferase
(AST/SGOT)
Alanine
Aminotransferase
(ALT/SGPT)
Methods (AST and ALT)
Increased
Transaminases
Amylase
Methods (AMS)
Saccharogenic
Amyloclastic
Chromogenic
Coupled-enzyme
Lipase
Methods (LPS)
Lactate dehydrogenase
Methods (LDH)
Duchennes muscular
pH 7.5
340nm
Major Source: Liver
1. Karmen method = Kinetic
2. Reitman and Frankel = Endpoint
-Color developer: DNPH
-Color intensifier: 0.4N NaOH
DeRitis ratio (ALT:AST) >1.0 = Acute hepatitis (Highest)
20x = viral or toxic hepatitis
Moderate elevation = chronic hepatitis, hepatic cancer, IM
Slight elevation = Hepatic cirrhosis, alcoholic hepatitis, obstructive
jaundice
Smallest enzyme (appears in urine)
Earliest pancreatic marker
P3: most predominant pancreatic AMS isoenzyme in AP
Isoenzymes:
S-type (ptyalin): anodal
P-type (amylopsin): cathodal
Samples w/ high activity of AMS should be diluted w/ NaCl to prev.
inactivation
Salivary AMS = inhibited by wheat germ lectin
Substrate: Starch
Reducing sugars produced
Classic reference method (SU)
Degradation of starch
Increase in color intensity
Continuous-monitoring technique
Late marker (AP)
Most specific pancreatic marker
Substrate: Olive oil/Triolein
1. Cherry Crandal (Reference method)
2. Tietz and Fiereck
3. Peroxidase coupling (most commonly used method)
Lacks specificity
RBC: 150x LDH than in serum
Sources:
LD1 (-HBD) and LD2 = Heart, RBC, Kidneys
LD3 = pancreas, lungs, spleen
LD4 an LD5 = liver and muscle
LD6 = alcohol dehydrogenase
1. Wacker method (forward/direct) = pH 8.8, 340 nm, most
commonly used
2. Wrobleuski LaDue (reverse/indirect) = pH 7.2, 2x faster
3. Wrobleuski Cabaud
4. Berger Broida
Hepatic carcinoma and toxic hepatitis
Viral hepatitis and cirrhosis
Isoenzymes:
CK-BB = most anodal, brain
CK-MB = myocardium (20%)
CK-MM = least anodal, skeletal and smooth muscles (Major, 94100%)
Total CK: 50x URL (highest)
lec.mt 04 |Page | 4
dystrophy
CK-MB
Methods (CK)
Adenylate kinase
N-acetylcysteine
Liver cells and RBC
Clelands reagent and
glutathione
Electrophoresis
CK relative index (CKI)
Aldolase
5 Nucleotidase
GGT
Methods (GGT)
Cholinesterase/
Pseudocholinesterase
Angiotensin-Converting
Enzyme
Ceruloplasmin
Ornithine carbamoyl
transferase
G-6-PD
Normal Values
(Enzymes)
Aldosterone
Atrial natriuretic factor
Hypernatremia
Hyponatremia
Thirst
Pseudohyponatremia
(artifactual)
Methods (Na+)
Potassium
Specimen
Considerations (K+)
Hyperkalemia
Hypokalemia
pH and K+
Methods (K+)
Chloride
Specimen
Considerations (Cl-)
Methods (Cl-)
Hyperchloremia
Hypochloremia
Calcium
3 Forms of Calcium
Vitamin D3
PTH
Calcitonin
Practical considerations
(Ca2+)
Hypercalcemia
Hypocalcemia
Primary hypocalcemia
Secondary
hypocalcemia
Methods (Ca2+)
Inorganic Phosphorus
3 Forms of Inorganic
Phosphorus
PTH
Calcitonin
Growth hormone
Practical considerations
Hyperphosphatemia
Hypophosphatemia
Methods (iPO4)
Magnesium
3 Forms of Magnesium
PTH
Aldosterone (&
Thyroxine)
Hypermagnesemia
Hypomagnesemia
Methods (Mg2+)
-(+)Chloranilic acid
3. Colorimetric = Ortho-Cresolphthalein complexone dyes
-Dye: Arzeno III
-8-hydroxyquinoline = chelates (inhibits) Mg2+
4. EDTA titration method (Bachra, Dawer and Sobel)
5. AAS = Reference method
6. ISE = Liquid membrane
7. FEP
85% Bones
15% ECF (iPO4)
Maximally absorbed in the jejunum (Ca2+: duodenum)
Trancellular shift: Once absorbed inside cells, it no longer comes
out used for energy production
Dirunal variation: late morning, evening
Organic phosphate = principal anion within cells
Inorganic phosphate = part of the blood buffer (Measured in the
clin.lab.)
55% = Free
35% = Complexed with ions
10% = Protein-bound
PO4 = Ca2+
PO4 = Ca2+
PO4 (renal reabsorption)
Fasting is required (Nonfasting: PO4)
Hypoparathyroidism
Renal failure
Hypervitaminosis D
Alcohol abuse = most common cause
Primary hyperparathyroidism
Avitaminosis D (Rickets, Osteomalacia)
Most accurate: unreduced phosphomolybdate formation (340nm)
1. Fiske Subbarow Method (Ammonium molybdate method)
-Reducing agents: Pictol, Elon, Senidine, Ascorbic acid
-(+) Phosphomolybdenum blue
53% Bones
46% Muscles and soft tissues
1% Serum and RBC
Vasodilator
55% = Free/Ionized/Physiologically active
30% = Protein-bound
10% = Complexed with ions
Mg2+ = Ca2+ = PO4
Mg2+ = K+ = Na+
Addisons disease
Chronic renal failure
Acute renal failure
Chronic alcoholism
1. Calmagite
-(+) Reddish-violet complex
2. Formazen dye method
-(+) Colored complex
3. Magnesium Thymol blue method
lec.mt 04 |Page | 9
Bicarbonate
Chloride shift
Anion Gap
Increased AG
Decreased AG
Cystic Fibrosis
(Mucoviscidosis)
Pilocarpine
Gibson & Cooke
pilocarpine
iontophoresis
Iron
Methods (Iron)
Increased iron
Decreased iron
TIBC
UIBC
% Transferrin
Saturation
Transferrin
Note
Normal Values
(Electrolytes)
Regulation of Acid-Base
balance
20:1
4:1
Expanded HendersonHasselbalch equation
Chloride-isohydric shift
pCO2
pO2
Metabolic Acidosis
Metabolic Alkalosis
Respiratory Acidosis
Respiratory Alkalosis
Full compensation
Partial compensation
Buffer base
Methods for Blood
Gases and pH
Factors affecting Blood
gases & pH
measurements
Methods
(Blood gases & pH)
-Bicarbonate deficiency
-DKA (normochloremic acidosis)
-Renal failure
-Diarrhea (HCO3-)
Compensation: Hyperventilation
Compensated: HCO3- + pCO2 + pH <7.4
Causes:
-Bicarbonate excess
-Vomiting (Cl-)
-Hypochloremia
-Hypokalemia
Compensation: Hypoventilation
Compensated: HCO3- + pCO2 + pH >7.4
Causes:
-CO2 excess (Hypoventilation)
-COPD
-Drug overdose (morphine, barbiturates, opiates)
Compensation: Bicarbonate retention
Compensated: HCO3- + pCO2 + pH <7.4
Causes
-CO2 loss (Hyperventilation)
Compensation: Bicarbonate excretion
Compensated: HCO3- + pCO2 + pH >7.4
pH normal range
pH near normal
All forms of base that will titrate hydrogen ions
Specimen: Arterial blood
Blood gas analyzers: meas. pH, pCO2, pO2
For every 1OC above 37OC:
pH by 0.015
pO2 by 7%
pCO2 by 3%
Bacterial contamination: consume O2 (pO2)
Excess heparin (acid MPS) = pH
Air exposure (bubbles):
pO2 = 4 mmHg/2mins
pCO2 = 4 mmHg/2mins
1. Gasometer
a. Van Slyke
b. Natelson
-Mercury: produce vacuum
-Caprylic alcohol: anti-foam reagent
-Lactic acid
-NaOH
-NaHSO3
2. Electrodes
a. pH = potentiometry
-Silver-silver chloride electrode (Reference electrode)
-Calomel electrode [Hg2Cl2] (Reference electrode)
b. pCO2 = Severinghaus electrode (potentiometry)
c. pO2 = Clark electrode (polarography-amperometry)
Dissolved CO2 + H2CO3 + HCO3lec.mt 04 |Page | 12
Transcutaneous
electrodes
Blood gas QC
Normal Values
(Blood gases and pH)
lec.mt 04 |Page | 13