DIAGNOSTIC IN CLINICAL

CHEMISTRY I
MKEB 2404

ADITIONAL DIAGNOSTIC PROCEDURE

 Two hour postprandial plasma glucose
 Hemoglobin AIC:
Valine amino terminal of hemoglobin β – chain (one or both) may be
glycosylated
 Although many other protein such as albumin are glycosylated,
measurement of glycosylated Hb are performed routinely to monitor
glucose control
 Chromatography (using cation – exchange resin) of human red cells
hemolysates – 3 peaks are eluted, before hemoglobin A peak:
AIa, AIb, AIC, A
 The glycosylation of hemoglobin A depends on the glucose concentration
during the 120-day life span of the cell
 Hb AIC is 3 to 6% of total Hb in healthy individual. It can be double or
triple in hyperglycemia. With good control of diabetes the level is back to
the reference level

AGE protein:
 The diagnosis of diabetes mellitus can be made by measurement of
plasma glucose when the patient is fasting
 A plasma glucose level of >140mg/dl or 7.8mmol/L on 3 or more
occasions confirmed as diabetes mellitus
 Diabetes mellitus is a chronic disease characterized by abnormally high
[glucose] in plasma, glucosuria and thickening of capillary basement
membranes
 Diabetic patients have increased risk of blindness, kidney disease,
peripheral vascular disease, peripheral neuropathy and heart disease
(myocardial infarction)
 Infection usually occur at foot

Hypoglycemia:
 Syndrome that characterized by low plasma glucose and associated
group of symptoms that are relieved by ingestion of food especially
carbohydrates
 Overnight fasting plasma glucose should be result <2.5mmol/L or
45mg/dl

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  However this value may be vary from each person

Common cause of hypoglycemia:

 No anatomic lesions
1. Fasting plasma glucose normal
Functional hypoglycemia
Aliment organ hypoglycemia
Diabetic and impaired glucose tolerance
2. Fasting plasma glucose low
Ethanol induced hypoglycemia
Sulfonylurea
Insulin
Salicylates
Combination of the above
 Anatomic lesion present
Insulinemia
Extrapancreatic neoplasms
Adrenocorticol insufficiency
Hypopituitarism
Massive liver disease

Hypoglycemia and premature infants:

 Premature and small for gestational age neonates have increase
susceptibility to hypoglycemia
 Children are more susceptible than adults
 Children have larger brain / body weight ratio and the brain uses high
amounts of glucose than the rest of the body
 Newborn infants can’t make ketogenesis process. It is because the
transport of long – chain fatty acids into mitochondria is poorly developed
 Brain (in neonates) completely dependent on glucose
So, glycogenolysis makes glucose
Gluconeogenesis makes glucose. This is also limited (especially utilization
of lactate alanine) because the rate limiting enzyme phosphoenolpyruvate
carboxykinase is low in infant (low birth weight) especially during the
first few hours after birth
 Fasting depletes the glycogen stores more rapidly

Hyperglycemia:
 Normal (acceptable) fasting plasma glucose:
50 – 110mg/dl (2.8 – 6.2mmol/L) normal should be 80 – 120mg/dl
 Hyperglycemia may result from primary diabetes mellitus cause or
secondary cause

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  Primary:
o Insulin dependent diabetes mellitus
o Non – insulin dependent diabetes mellitus
 Secondary:
o Disease of pancreas:
Acute pancreatitis
Chronic pancreatitis
Pancreatitis due to mumps
Autoimmune disease
Pancreatectomy
Pancreatic infiltration
Hemochromatosis
Tumors, trauma to pancreas
o Related to major disease states:
Chronic renal failure
Chronic liver disease
Infection
o Miscellancous:
Pregnancy
Related to insulin receptor antibodies
Abnormal insulin
o Related to major endocrine disease:
Acromegaly
Cushing’s syndrome
Thyrotoxicosis
Hyperaldosteronism
Glucagonoma
o Caused by drugs:
Steroids
Thiazide diuretucs, propranolol, phenytoin, diazoxide
Oral contraceptive
Alloxan and streptozotocw

Oral glucose tolerance test (OGTT):

 This is a commonly used glucose load test
 After a load of glucose, plasma glucose value are determined
 It lacks specificity. The glucose tolerance can be abnormal in a variety
disease and diet and other variable such as stress
 For meaningful data, conditions of performing the test must be controlled
rigidly
 For 3 days prior to the GTT, a diet of at least 150g/day of carbohydrate is
required

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 If a person has anorexia – invalidates the test
 Inactivity: low glucose tolerance
 Alcoholism: low glucose tolerance
 Many disease
 Overnight fast (about 12 hours – no coffee, no smoking and no exercise)
 The size of glucose load 50g, 75g, or 100g. for pediatrics (1.75g/kg body
weight)
 Blood sample for baseline glucose
 Ingest glucose within 5 minutes
 Draw sample every 30 minutes for blood glucose 2-3 hours

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