Clinical Biochemistry Fifth EditionPDF电子书下载

CHAPTER Ⅰ Carbohydrate Metabolism 1

DIGESTION AND ABSORPTION 1

Fate of Absorbed Carbohydrate 2

Endogenous Sources of Glucose 3

UTILIZATION OF GLUCOSE 3

Storage 3

Oxidation 3

Conversion to Fat 4

Conversion to Other Carbohydrate 4

Conversion to Amino Acids 4

GENERAL PROCESSES IN CARBOHYDRATE METABOLISM 5

Anaerobic Metabolism(Glycolysis) 5

Aerobic Metabolism of Glucose 7

ROLE OF LIVER IN CARBOHYDRATE METABOLISM 8

Glycogenesis and Glycogenolysis 8

Gluconeogenesis 9

Assimilation of CO2 9

MUSCLE IN CARBOHYDRATE METABOLISM 10

Glycogenesis 10

Glycolysis 11

Muscle Contraction 11

INTERRELATION OF CARBOHYDRATE,LIPID,AND PROTEIN METABOLISM 12

ENDOCRINE INFLUENCES IN CARBOHYDRATE METABOLISM 14

Insulin 14

Adrenocortical Hormone 16

Anterior Pituitary Factors 16

Epinephrine 17

Thyroid Hormone 17

Hyperglycemic Factor of Pancreas(HGF;Glucagon) 17

NORMAL POSTABSORPTIVE BLOOD SUGAR 17

Glucose in Body Fluids Other than Blood 18

Sugars Other than Glucose in Body Fluids 19

REGULATION OF BLOOD GLUCOSE CONCENTRATION 20

Rate of Supply of Glucose to Blood 20

Rate of Removal of Glucose from Blood 21

Fundamental Regulatory Mechanism 22

NORMAL ALIMENTARY REACTION(ABSORPTIVE RESPONSE) 23

Sugar Tolerance 23

Intravenous Glucose Tolerance Test 25

Mechanism of Production of the Normal Glucose Tolerance Curve 25

Factors Influencing Absorptive Blood Sugar Response 27

The One-Hour,Two Dose Glucose Tolerance Test 29

EFFECT OF OTHER SUGARS 29

Galactose Tolerance 30

Insulin Tolerance Test 31

Insulin-Glucose Tolerance Test 31

Epinephrine Tolerance Test 31

Phenomena Associated with Normal Alimentary Glucose Reaction 32

Decreased Serum Phosphate 32

Decreased Serum Potassium 32

Increased Respiratory Quotient 32

ABNORMALITIES OF POSTABSORPTIVE BLOOD SUGAR LEVEL 32

Fasting Hyperglycemia 32

Diabetes Mellitus 32

Hyperthyroidism 34

Increased Secretion of Epinephrine 35

Adrenal Cortical Hyperfunction 36

Hyperpituitarism 36

Anesthesia,Asphyxia,Hypnosis 36

Acidosis 37

Hepatic Disease 38

Miscellaneous 38

Fasting Hypoglycemia 38

Hyperinsulinism 39

Hepatic Disease 40

Adrenal Cortical Insufficiency 41

Anterior Pituitary Insufficiency 41

Hypothyroidism 42

Nervous System Disorders 42

Miscellaneous 42

ABNORMAL ALIMENTARY RESPONSE 42

Exaggerated Response—Diminished Glucose Tolerance 42

Diabetes Mellitus 43

Hepatic and Biliary Tract Disease 45

Hyperthyroidism 46

Hyperfunction of the Anterior Pituitary and Adrenal Cortex 46

Pregnancy 47

Miscellaneous 47

Decreased Response—Increased Glucose Tolerance 48

Hyperinsulinism 48

Adrenal Cortical Insufficiency 49

Anterior Pituitary Hypofunction 51

Hypothyroidism 52

Miscellaneous 52

Abnormal Insulin Tolerance 53

Abnormal Epinephrine Tolerance Test 54

Abnormal Tolerance for Other Sugars 54

Abnormal Fructose Tolerance 54

Abnormal Galactose Tolerance 55

BLOOD LACTIC ACID AND PYRUVIC ACID 56

GLYCOGEN STORAGE DISEASES 57

Glycogen Storage Disease of Liver(von Gierke) 57

Glycogen Disease of the Heart 58

Galactosemia 58

Cirrhosis with Excessive Glycogen 58

EXCRETION OF SUGAR IN URINE 58

Mechanism of Glycosuria(Glucosuria) 58

Other Sugars in Urine 59

ABNORMAL URINE SUGAR 59

Melituria 59

Tests for the Detection of Sugars 59

Metallic Oxide Reduction Tests 59

Fermentation Test 60

Phenylhydrazine Reaction 60

Specific Rotation 60

Glycosuria 61

Nonhyperglycemic Glycosuria 61

Hyperglycemic Glycosuria 64

Fructosuria 65

Pentosuria 66

Lactosuria 67

Galactosuria 67

Maltosuria 67

DIABETES MELLITUS 67

Experimental Diabetes Mellitus 68

Total Pancreatectomy 68

Subtotal Pancreatectomy 69

Alloxan Administration 69

Administration of Adrenocortical Hormones 70

Anterior Pituitary Extracts 70

Thyroid Administration 70

Carbohydrate Metabolism in Hypophysectomized-Depan-creatized Animals 71

Clinical Diabetes Mellitus 71

Hyperglycemia 71

Decreased Carbohydrate Tolerance 72

Glycosuria 73

Decreased Respiratory Quotient 74

Lipemia and Ketosis 74

Acidosis 75

Electrolyte and Water Balance 76

Negative Nitrogen Balance-Hypoproteinemia 77

Nitrogen Retention 78

REFERENCES 78

CHAPTER Ⅱ Lipid Metabolism 80

NATURE OF LIPIDS 81

Fats(Triglycerides) 81

Phospholipids(Phosphatides) 82

Glycolipids 84

Steroids 84

Lipoproteins 85

DIGESTION AND ABSORPTION 86

METABOLISM OF FAT 88

Immediate Fate of Dietary Lipid 88

Anabolism and Catabolism of Fatty Acids 88

Anabolism and Catabolism of Lipids 90

Lipid Mobilization 90

ENDOCRINE INFLUENCES IN LIPID METABOLISM 91

Insulin 91

Adrenocortical Hormones 91

Anterior Pituitary Hormones 92

Thyroid Hormone 92

METABOLIC INTERRELATIONS OF LIPIDS,CARBOHYDRATES AND PROTEINS 92

KETOSIS 94

FAT IN FECES 96

FAT IN URINE 98

METABOLISM OF PHOSPHOLIPIDS 98

Turnover 98

Catabolism 99

METABOLISM OF STEROLS AND BILE ACIDS 99

Catabolism and Excretion of Cholesterol;Conversion to Bile Acids 100

TRANSPORT OF LIPIDS 101

State of Lipids in Blood:Lipoproteins 101

Postabsorptive Plasma Lipid Concentration 102

Influence of Food and Nutrition 104

Influence of Age and Sex 105

Pregnancy 105

DEPOSITION AND STORAGE OF LIPIDS 105

Role of Liver in Lipid Metabolism 105

Fatty Liver and Lipotropism 106

LIPOIDOSIS,XANTHOMATOSIS 109

ⅠPrimary(Essential) Xanthomatosis 110

ANormocholesterolemic Type 110

BHypercholesterolemia Type 110

CCombined Types A and B 110

Ⅱ Xanthomatosis Secondary to Hyperlipemia 110

ABNORMALITIES OF PLASMA LIPIDS 110

PLASMA LIPOPROTEIN ABNORMALITIES AND ATHEROSCLEROSIS 111

Increase in Sf 12-20 Lipoproteins 112

Beta-Lipoprotein Increase 112

Effect of Heparin 113

HYPERCHOLESTEROLEMIA 113

Diabetes Mellitus 113

Anesthesia 115

The Nephrotic Syndrome 115

Hepatic and Biliary Tract Disease 116

Hypothyroidism 117

Atherosclerosis 118

Xanthomatosis 118

Idiopathic(Essential) Hyperlipemia 119

Miscellaneous 119

HYPOCHOLESTEROLEMIA 120

Anemia 120

Hepatic Disease 120

Infection 121

Hyperthyroidism 121

Inanition 122

Terminal States 122

Miscellaneous 123

REFERENCES 123

CHAPTER Ⅲ Protein Metabolism 124

DIGESTION AND ABSORPTION 125

Dynamic State 126

Metabolic Pool 127

OVER-ALL METABOLISM OF PROTEIN 128

Nitrogen of the Food 129

Nitrogen of the Body 129

Excretion of Nitrogen 129

Nitrogen Balance 129

Essential Amino Acids 130

Biological Value of Proteins 131

Dietary Protein Requirements 132

INTERMEDIARY METABOLISM 134

Protein Turnover 134

General Pathways of Protein Metabolism 134

INTERRELATIONS OF THE METABOLISM OF PROTEINS AND OTHER FOOD-STUFFS 138

ENDOCRINE INFLUENCES IN PROTEIN METABOLISM 140

Growth Hormone 140

Androgen 140

Adrenal II-Oxysteroids 140

Insulin 141

Thyroxine 141

NITROGENOUS CONSTITUENTS OF THE BLOOD 141

The Plasma Proteins 141

Identity and Properties 141

Metabolism 144

Functions 145

NONPROTEIN NITROGEN 148

Urea 148

Uric Acid 148

Creatinine 148

Amino Acids 148

Ammonia 149

Undetermined Nitrogen(Rest Nitrogen) 149

NITROGEN EXCRETION 149

Urea 149

Uric Acid 150

Creatine and Creatinine 150

Amino Acids 151

Ammonia 151

ABNORMAL PROTEIN METABOLISM 152

Total Plasma(Serum) Protein 152

Fibrinogen 153

Albumin 154

Globulins 158

Globulin Reactions 163

Zinc Sulfate Turbidity 163

Formol-Gel Reaction 163

Colloidal Gold Curve 163

CO2 Saturation Test 164

Cephalin-Cholesterol Flocculation Test 164

Thymol Turbidity Test 164

Other Globulin Reactions 165

Protein Diagnostic Tests for Cancer 165

NONPROTEIN NITROGEN OF BLOOD 166

Urea Nitrogen 166

Uric Acid 168

Creatinine 168

Amino Acid Nitrogen 168

Ammonia 169

Undetermined or Residual Nitrogen 169

Total Nonprotein Nitrogen 169

ABNORMAL URINARY NITROGEN 170

Protein in Urine 170

The Nature and Origin of Urinary Proteins 170

Functional Albuminuria 172

Organic Albuminuria 173

Quantity of Protein in Urine 176

Other Proteins in Urine 177

Urinary Nonprotein Nitrogen 179

Urinary Urea 179

Uric Acid in Urine 180

Creatine and Creatinine in Urine 180

Amino Acids in Urine 182

Ammonia in Urine 185

Negative Nitrogen Balance in Disease 186

Urinary Nitrogen Partition 187

Congo Red Test for Amyloidosis 188

REFERENCES 189

CHAPTER Ⅳ Nucleic Acid Metabolism 190

INTERRELATIONS OF METABOLISM OF NUCLEIC ACIDS WITH OTHER FOODSTUFFS 191

BIOLOGICAL SIGNIFICANCE OF NUCLEIC ACIDS 192

Viruses 193

Chromosomes—Genes 193

Transforming Substance of Bacteria 194

Role of Nucleic Acids in Mutation and Carcinogenesis 194

Role of Nucleic Acids in Protein Synthesis 195

FREE NUCLEOTIDES OF BIOLOGICAL IMPORTANCE 196

Adenylic Acid System 196

Coenzymes 196

DIGESTION AND ABSORPTION 196

INTERMEDIARY METABOLISM 197

Nonnitrogenous Constituents 197

Purines and Pyrimidines 197

Uric Acid 199

REFERENCES 202

CHAPTER Ⅴ Metabolism of Hemoglobin and Porphyrins 203

Synthesis of Porphyrins 204

Synthesis of Hemoglobin 205

Catabolism of Hemoglobin 206

Abnormal Hemoglobins 206

HEMOGLOBINEMIA 207

ABNORMAL HEMOGLOBIN DERIVATIVES 208

Methemoglobin 208

Sulfhemoglobin 209

Carboxyhemoglobin 209

Hematinemia 209

PORPHYRIA AND PORPHYRINURIA 210

Porphyria 210

Acquired Porphyrinurias 211

REFERENCES 212

CHAPTER Ⅵ Biochemical Aspects of Diet 213

Caloric Content of Diet 215

Dietary Carbohydrates 216

Dietary Lipid 217

Dietary Protein 218

REFERENCES 223

CHAPTER Ⅶ Calcium and Inorganic Phosphate Metabolism 224

ABSORPTION 224

BLOOD CALCIUM AND PHOSPHATE 225

Parathyroid Hormone 226

Vitamin D 228

Plasma Proteins 228

Plasma Phosphate 228

Acid-Base Equilibrium 228

Miscellaneous 229

DEPOSITION AND MOBILIZATION OF BONE MINERALS 229

Mineralization of Bone 229

Mobilization of Calcium 230

MISCELLANEOUS FACTORS 231

EXCRETION 231

CALCIUM AND PHOSPHORUS REQUIREMENT 232

CALCIUM CONTENT OF OTHER BODY FLUIDS 232

ABNORMAL SERUM CALCIUM 233

Hypercalcemia 233

Hyperparathyroidism 233

Hypervitaminosis(Vitamin D) 234

Multiple Myeloma 235

Neoplastic Disease of Bone 235

Acute Bone Atrophy 236

Kidney Disease 236

Miscellaneous 236

Hypocalcemia 236

Hypoparathyroidism 236

Pseudohypoparathyroidism 238

Vitamin D Deficiency(Rickets and Osteomalacia) 238

Steatorrhea(Sprue,Celiac Disease) 238

Hunger Osteopathy 238

Nephrosis 238

Nephritis 239

Maternal Tetany 239

Magnesium,Phosphate,Oxalate and Citrate Tetany 239

Acute Pancreatitis 239

Alkalosis 240

ABNORMAL URINE CALCIUM 240

Increased Urinary Calcium 240

Hyperparathyroidism 240

Hyperthyroidism 241

Acidosis 241

Hypervitaminosis D 241

Idiopathic Hypercalciuria 241

Decreased Urinary Calcium 241

Hypoparathyroidism 241

Vitamin D Deficiency 241

Hypothyroidism 242

Ingestion of Bases 242

Miscellaneous 242

ABNORMAL FECAL CALCIUM 242

HYPERPHOSPHATEMIA 242

Hypervitaminosis 242

Hypoparathyroidism 242

Renal Failure 242

Healing Fractures 243

HYPOPHOSPHATEMIA 243

Rickets 243

Osteomalacia 244

Idiopathic Steatorrhea 244

Hyperparathyroidism 244

Fanconi Syndrome 244

Increased Carbohydrate Utilization 245

ABNORMAL URINARY PHOSPHATE 245

DISTURBANCES OF BONE FORMATION AND MINERALIZATION 246

REFERENCES 247

CHAPTER Ⅷ Phosphatase Activity 248

NORMAL SERUM ALKALINE PHOSPHATASE 249

Skeletal Diseases 249

Rickets 250

Hyperparathyroidism(Generalized Osteitis Fibrosa Cystica) 250

Osteitis Deformans(Pagets Disease) 251

Miscellaneous Bone Disorders 251

ALKALINE PHOSPHATASE ACTIVITY IN JAUNDICE,HEPATIC AND BILIARY DISEASE 251

Obstructive and Hepatocellular Jaundice 251

Other Biliary Tract Conditions 252

MISCELLANEOUS CONDITIONS 252

SERUM ACID PHOSPHATASE 252

REFERENCES 254

CHAPTER Ⅸ Magnesium Metabolism 255

ABSORPTION AND EXCRETION 255

BLOOD MAGNESIUM 255

Abnormal Serum Magnesium 256

CHAPTER Ⅹ Iron Metabolism 257

ABSORPTION AND EXCRETION 257

TRANSPORT 258

UTILIZATION;STORAGE 259

REQUIREMENT 260

ABNORMAL IRON METABOLISM 260

REFERENCES 261

CHAPTER Ⅺ Sulfur Metabolism 262

ABSORPTION 262

INTERMEDIARY METABOLISM 262

SULFUR IN BLOOD 262

EXCRETION 263

CHAPTER Ⅻ Iodine Metabolism 264

ABSORPTION AND EXCRETION 264

BLOOD IODINE 265

DISTRIBUTION AND INTERMEDIARY METABOLISM 265

IODINE METABOLISM AND THYROID HORMONE 266

BIOSYNTHESIS AND SECRETION OF THYROID HORMONE 266

Accumulation of Iodine in Thyroid 266

Synthesis of Thyroid Hormone 267

Secretion of Thyroid Hormone 267

Circulating Thyroid Hormone 268

Fate of Thyroxine 268

ANTITHYROID AGENTS 268

Thyroid Hormone 268

Iodine 268

Thiocyanate 268

Antithyroid Agents 269

ABNORMAL EXCRETION OF IODINE 269

ABNORMAL BLOOD IODINE 270

RADIOIODINE STUDIES 271

Thyroid Uptake of I131 272

Urinary Excretion of I131 272

Conversion Ratio of I131 273

REFERENCES 273

CHAPTER ⅩⅢ Sodium,Potassium and Chloride Metabolism 274

ABSORPTION AND EXCRETION 275

Excretion in Urine 275

Excretion by the Skin 276

Excretion in Digestive Fluids 276

NORMAL BLOOD Na,Cl AND K 277

DISTRIBUTION AND INTERMEDIARY METABOLISM 278

ABNORMAL Na,Cl AND K METABOLISM 279

Routes of Loss of NaCl and K 279

General Principles in Electrolyte Abnormalities 281

DECREASED PLASMA SODIUM(HYPONATREMIA) AND CHLORIDE(HYPOCHLOREMIA) 283

Gastrointestinal Disorders 283

Diabetes Mellitus 284

Kidney Disease 284

Excessive Sweating 284

Infectious Diseases 285

Adrenocortical Insufficiency(Addisons Disease) 285

Low Salt Syndrome 285

Adrenocortical Hyperfunction(Cushings Syndrome) 286

Miscellaneous 286

INCREASED PLASMA SODIUM(HYPERNATREMIA) AND CHLORIDE(HYPERCHLOREMIA) 286

DECREASED PLASMA POTASSIUM(HYPOKALEMIA;HYPOPOTASSEMIA) 287

Starvation;Malnutrition 288

Administration of NaCl and Glucose Solutions 288

Gastrointestinal Disorders 289

Diabetic Acidosis 290

Adrenocortical Hormones 290

Postoperative States 290

Kidney Disorders 291

Familial Periodic Paralysis 291

INCREASED PLASMA POTASSIUM(HYPERKALEMIA;HYPERPOTASSEMIA) 292

ABNORMAL URINE SODIUM,CHLORIDE,AND POTASSIUM 292

REFERENCES 293

CHAPTER ⅩⅣ Water Balance 295

WATER INTAKE 295

WATER OUTPUT 295

Feces 295

Insensible Perspiration 295

Perspiration 296

Urine 296

Equilibrium Requirements 297

BODY FLUID COMPARTMENTS 297

Volume of Body Fluid Compartments 298

Blood and Plasma Volume 298

Total Extracellular Fluid Volume 299

Total Body Water 300

Composition of Body Fluid Compartments 300

Milliequivalents(mEq) 300

Osmolar Concentration 300

EXTRACELLULAR FLUID 302

INTRACELLULAR FLUID 303

EXCHANGES BETWEEN FLUID COMPARTMENTS 305

Gibbs-Donnan Equilibrium 305

Plasma:Interstitial Fluid Exhange 306

Interstitial Fluid:Intracellular Fluid Exchange 307

ABNORMAL BLOOD VOLUME 309

Increased Blood Volume 309

Decreased Blood Volume 309

CHANGES IN INTERSTITIAL FLUID 310

Dehydration 311

Increased Interstitial Fluid(Edema) 314

TRANSUDATES AND EXUDATES 317

Specific Gravity 317

Protein 317

Glucose 319

Chloride 319

Lipid 319

Other Constituents 320

BIOCHEMICAL CHANGES IN SHOCK 321

REFERENCES 322

CHAPTER ⅩⅤ Acid-Base(Anion-Cation) Balance(Neutrality Regulation) 323

PHYSIOLOGICAL BUFFER SYSTEMS 324

Buffer Action of Hemoglobin 325

Buffer Systems for H2CO3(CO2) 325

Buffer Systems for Fixed Acids 327

Net Effect of Buffer Mechanisms 328

Respiratory Regulation of Acid-Base Balance 328

Renal Regulation of Acid-Base Balance 329

ABNORMALITIES OF”ACID-BASE(ANION-CATION) BALANCE 332

Acidosis 333

Primary H2CO3 Excess(Respiratory Acidosis) 334

Primary Alkali Deficit(Metabolic Acidosis) 335

Alkalosis 340

Primary H2CO3 Deficit(Respiratory Alkalosis) 340

Primary Alkali Excess(Metabolic Alkalosis) 341

METHODS OF STUDYING ACID-BASE BALANCE 343

CO2 Content of Plasma 344

Carbon Dioxide Capacity of the Plasma 345

Alveolar CO2 Tension 347

Determination of pH of Blood Plasma or Serum 348

Other Methods of Investigation 348

REFERENCES 351

CHAPTER ⅩⅥ Respiratory Exchange and Basal Metabolism 352

CHEMICAL CONTROL OF RESPIRATION 354

Influence of CO2 Tension and pH 354

Influence of O2 Tension 354

TRANSPORT OF OXYGEN 355

Dissociation of Oxyhemoglobin 356

TRANSPORT OF CARBON DIOXIDE 358

CO2 in Arterial Blood 358

Entrance of CO2 in Tissues 359

ANOXEMIA(HYPOXEMIA) 360

Anoxic Anoxia 360

Anemic Anoxia 362

Stagnant Anoxemia 362

Histotoxic Anoxia 362

ENERGY METABOLISM 363

Caloric Value of Foods 363

Heat Production 363

Respiratory Quotient 364

CALORIMETRY 367

Direct Calorimetry 367

Indirect Calorimetry 368

BASAL METABOLISM 368

Physiological Variations in BMR 369

Specific Dynamic Action(SDA) of Foods 370

Total Metabolism(Caloric Requirement) 371

Clinical Significance of BMR 372

Increased Basal Metabolic Rate 374

Hyperthyroidism 374

Other Endocrine Disorders 374

Pregnancy 375

Fever 375

Diseases of the Blood 375

Essential Hypertension 375

Myocardial Insufficiency 376

Diabetes Insipidus 376

Decreased Basal Metabolic Rate 376

Hypothyroidism 376

Other Endocrine Disorders 376

The Nephrotic Syndrome 376

Shock 376

Malnutrition 376

Miscellaneous 377

REFERENCES 377

CHAPTER ⅩⅦ Hormone Assay and Endocrine Function(with AERakoff) 378

PITUITARY HORMONES 378

ANTERIOR PITUITARY HORMONES 379

Regulation of Anterior Pituitary Function 379

Gonadotrophic Hormones 381

Follicle-Stimulating Hormone 381

Interstitial Cell-Stimulating Hormone 381

Lactogenic Hormone 382

Chorionic Gonadotrophin 382

Physiological Considerations 382

Determination of Gonadotrophic Hormones 385

Normal Gonadotrophin Values 386

Abnormal Gonadotrophs Values 389

Thyrotrophic(Thyroid-Stimulating) Hormone 393

Assay 393

Actions 394

Abnormal Thyrotrophin(TSH) Secretion 394

Adrenocorticotrophic Hormone 394

Assay 395

Actions 395

Abnormal Adrenocorticotrophin(ACTH) Secretion 395

Growth Hormone(Somatotropin) 395

Assay 395

Actions 396

Excessive Growth Hormone Secretion 396

Decreased Growth Hormone Secretion 397

POSTERIOR PITUITARY HORMONES 398

Assay 398

Functions 398

MELANOPHORE-EXPANDING(DISPERSING) HORMONE(INTERMEDIN) 400

STEROID HORMONES 401

ESTROGENS 401

Occurrence 401

Site of Formation 402

Metabolism 402

Excretion 402

Actions 402

Assay Procedures 403

Estrogens at Different Ages 405

Estrogens in Pregnancy 405

Increased Estrogen Values 407

Increased Production 407

Decreased Destruction 407

Decreased Estrogen Values 408

PROGESTERONE 408

Metabolism 409

Excretion 409

Actions 409

Methods of Assay 409

Increased Pregnanediol Values 410

Diminished Pregnanediol Values 411

Menstrual Disorders and Sterility 411

Threatened and Habitual Abortion 411

Intra-uterine Fetal Death 411

Toxemias of Late Pregnancy 411

Diabetes in Pregnancy 411

ANDROGENS 411

Metabolism 413

Metabolic Actions 413

Methods of Assay 414

Normal Values for Androgens(Bioassay by Capon Method) 414

Abnormal Androgen Values 415

17-KETOSTEROIDS 416

Normal Values for 17-Ketosteroids 417

Decreased 17-Ketosteroid Values 418

Increased 17-Ketosteroids 419

ADRENAL HORMONES 420

Adrenal Medullary Hormones 421

Regulation of Epinephrine Secretion 421

Biosynthesis and Metabolism of Epinephrine 421

Metabolic Actions 421

Assay 422

Adrenal Medullary Hyperfunction 422

Adrenal Cortical Hormones 423

Corticoids 423

Androgenic 17-Ketosteroids 425

Estrogen 425

Progesterone 426

Synthesis of Adrenal Hormones 426

The”Alarm Reaction;the Adrenal Cortex under Stress 427

Methods of Assay 429

Metabolism and Excretion 430

Metabolic Effects 431

Adrenocortical Hyperfunction 433

Cushings Syndrome 434

Adrenogenital Syndrome 435

Feminizing Syndrome in Men 436

Miscellaneous Conditions 436

Adrenocortical Hypofunction 436

Corticoids 436

Carbohydrate Metabolism 436

Electrolyte and Water Metabolism 438

Miscellaneous Abnormalities 440

Special Diagnostic Procedures 441

THYROID HORMONE 442

Calorigenic Effect 442

Protein Metabolism 442

Carbohydrate Metabolism 442

Lipid Metabolism 443

Electrolyte and Water Metabolism 443

Vitamins 443

Hypothyroidism 443

Basal Metabolism 443

Plasma Cholesterol 444

Creatine Excretion 445

Miscellaneous 445

Iodine Metabolism 445

Hyperthyroidism 446

Basal Metabolism 446

Plasma Cholesterol 446

Carbohydrate Metabolism 446

Miscellaneous 447

Iodine Metabolism 447

PARATHYROID HORMONE 447

REFERENCES 448

CHAPTER ⅩⅦ Vitamins 451

VITAMIN A 452

Deficiency in Man 454

Detection of Deficiency in Man 454

Effects of Excess of Vitamin A 455

Carotenemia 456

THIAMINE 457

Metabolism of Thiamine 457

Demonstration of Deficiency 457

RIBOFLAVIN 459

Demonstration of Deficiency 460

NIACIN(NICOTINIC ACID) 460

Demonstration of Deficiency 461

ASCORBIC ACID 461

Detection of Deficiency in Man 462

VITAMIN D 465

Deficiency Manifestations 466

Effects of Excess Vitamin D 467

VITAMIN K 467

Deficiency 469

Demonstration of Vitamin K Deficiency 470

REFERENCES 470

CHAPTER ⅩⅨ Chemical Investigation of Gastric Function 471

Psychic or Cephalic Phase 471

Gastric Phase 471

Intestinal Phase 471

Other Factors 472

NORMAL GASTRIC JUICE 472

Gastric Residuum 472

INVESTIGATION OF GASTRIC SECRETORY ACTIVITY 474

Basal Gastric Secretion 474

Test Meals 475

Alcohol Stimulation 476

Caffeine Stimulation 476

Histamine Stimulation 476

Insulin(Hypoglycemia) Stimulation 477

Abnormal Response 477

Achlorhydria 477

Hypoacidity 479

Hyperacidity(Hypersecretion) 479

Tubeless Gastric Analysis 481

Peptic Activity 482

Total Chloride 483

Bile 484

Vomitus 484

REFERENCES 484

CHAPTER ⅩⅩ Pancreatic Function 485

EXAMINATION OF PANCREATIC JUICESECRETIN TEST 485

Volume 486

Bicarbonate 486

Amylase(Diastase) 486

Trypsin 487

Lipase 487

Abnormal Findings with the Secretin Test 487

EXAMINATION OF THE FECES 488

Protein in Feces 489

SERUM AMYLASE(DIASTASE) 490

Serum Amylase After Stimulation 491

SERUM LIPASE 491

AMYLASE IN URINE 492

MISCELLANEOUS FINDINGS IN PANCREATIC DISEASE 493

REFERENCES 493

CHAPTER ⅩⅪ Hepatic Function 495

CARBOHYDRATE METABOLISM 496

Fasting Blood Sugar Level 497

Glucose Tolerance 498

Epinephrine Hyperglycemia 499

Fructose Tolerance 500

Galactose Tolerance 500

Blood Lactic Acid 502

PROTEIN METABOLISM 503

Amino Acids 503

Urea 504

Uric Acid 505

Ammonia 505

Plasma Proteins 505

Thymol Turbidity and Flocculation 509

Cephalin-Cholesterol Flocculation 510

Zinc Sulfate Turbidity 510

Other Globulin Reactions 511

Plasma Prothrombin 511

LIPID METABOLISM 513

Fat in Feces 513

Plasma Cholesterol 514

PIGMENT METABOLISM—JAUNDICE 516

Serum Bilirubin 518

Qualitative van den Bergh Reaction 518

Serum Bilirubin Concentration 520

Hyperbilirubinemia 522

Total Serum Bilirubin 522

Extrahepatic Obstructive jaundice 525

Hepatocellular Jaundice 526

Hemolytic Jaundice 527

Bilirubinuria 528

Bilins and Bilinogens in the Urine and Feces 529

Urobilinogen in Feces 530

Urobilinogen in Urine 530

Bile Pigments in feces 533

Porphyrin in Urine and Feces 534

BILE ACID METABOLISM 535

DETOXIFICATION-CONJUGATION 537

Hippuric Acid Synthesis 537

THE LIVER AND HORMONE METABOLISM 539

ELIMINATION OF DYES 541

Bromsulfalein(BSP) Excretion 541

Significance of Abnormal BSP Retention 543

Rose Bengal Excretion 545

SERUM ALKALINE PHOSPHATASE ACTIVITY 545

SERUM CHOLINESTERASE 548

BLOOD AMYLASE(DIASTASE) 549

PLASMA VITAMIN A AND CAROTENE(CAROTENOID) 549

THE LIVER IN WATER AND SALT METABOLISM 549

LIVER FUNCTION STUDIES IN DIFFERENTIAL DIAGNOSIS 550

CHEMICAL EXAMINATION OF BILE 556

Bile Acids 556

Lipids 557

Inorganic Elements 558

Miscellaneous Constituents 558

Bile Pigment 558

White Bile 559

Gallstones 559

REFERENCES 559

CHAPTER ⅩⅫ Renal Function 561

MORPHOLOGICAL FEATURES OF FUNCTIONAL IMPORTANCE 561

GLOMERULAR FILTRATION 562

TUBULAR FUNCTION 564

Reabsorption 564

Tubular Excretion and Synthesis 568

Competition for Transport Mechanism 569

CHARACTERISTICS OF NORMAL URINE 569

Volume 569

Specific Gravity 570

Acidity 570

Nonprotein Nitrogenous Constituents 571

Allantoin 575

Oxalic Acid 575

Glucuronic Acid 575

Hippuric Acid(Benzoylglycine) 576

Citric Acid 576

Other Organic Acids 576

Ketone Bodies 577

Sulfur-Containing Compounds 577

Phosphate 577

Chloride 578

Sodium;Potassium 578

Calcium;Magnesium 579

Carbohydrates 579

Miscellaneous 580

CLINICAL STUDY OF RENAL FUNCTION 580

CLEARANCE TESTS 581

Glomerular Filtration 581

Renal Blood Flow 584

Maximum Tubular Excretory Capacity 587

Percentage Tubular Reabsorption 588

Filtration Fraction 588

Maximum Tubular Reabsorption Capacity 589

Other Clearance Procedures 589

ELIMINATION OF WATER 590

Comparison of Fluid Intake and Fluid Output 590

Oliguria;Anuria 591

Water Function Test(Dilution Test) 592

ELIMINATION OF SOLIDS—URINE SPECIFIC GRAVITY 593

Concentration Test of Renal Function 594

The Two-Hour Specific Gravity Test 594

The Urine Concentration Test 595

Significance of Hyposthenuria 596

ELIMINATION OF NONPROTEIN NITROGENOUS SUBSTANCES 598

Urinary Studies 598

Simultaneous Study of Blood and Urine 598

Urea Excretion Ratio 598

Blood Urea Clearance 599

Blood Nitrogen Studies 603

Renal Functional Impairment 603

Prerenal Deviation of Water 604

Excessive Protein Catabolism 604

Relative Degree of Retention of Individual Nitrogenous Elements in Renal Disease 605

Blood Nonprotein Nitrogen in Renal Disease 606

Necrotizing Nephroses 610

Urea in Other Body Fluids 611

ELIMINATION OF FOREIGN SUBSTANCES 612

The Phenolsulfonphthalein Test 612

LOCALIZATION OF RENAL FUNCTIONAL DEFECT 614

Acute Glomerulonephritis 615

Chronic Glomerulonephritis 617

Necrotizing Nephroses(Acute Renal Failure) 618

Pyelonephritis 619

Benign Nephrosclerosis(Essential Hypertension) 619

Malignant Nephrosclerosis(Necrotizing Arteriolitis) 620

Lipoid Nephrosis 620

Toxemias of Pregnancy 621

Congestive Heart Failure 622

OTHER BIOCHEMICAL MANIFESTATIONS OF RENAL INSUFFICIENCY 622

Na and Cl Depletion;Dehydration 622

Serum K Abnormalities 622

Hypocalcemia;Hypercalciuria;Osteomalacia 623

Acidosis 623

Hypoproteinemia 625

Magnesium 625

Plasma Cholesterol 625

Phenol and Other Organic Substances 626

REFERENCES 627

CHAPTER ⅩⅩⅢ Cerebrospinal Fluid 629

PROTEIN 629

Meningitis 629

Serous Meningitis 630

Convulsive States 630

Organic Disease of Brain and Cord 631

Myxedema 631

GLUCOSE 631

Hyperglycorachia 632

Hypoglycorachia 633

NONPROTEIN NITROGENOUS CONSTITUENTS 633

CHLORIDE 634

INORGANIC PHOSPHATE 635

CHOLESTEROL 635

LACTIC ACID 635

HYDROGEN ION CONCENTRATION 635

SODIUM,POTASSIUM,CALCIUM AND MAGNESIUM 636

XANTHOCHROMIA 636

REFERENCES 638

Index 639