Clinical chemistry : principles, techniques, and correlations

"Medical Lab Science students need a strong foundation in applied chemistry need to learn and demonstrate mastery of the required knowledge, skills and competencies as specified by certifying bodies and accreditation organizations to be prepared for certification and employment as a professional medical assistant. ear explanations that balance analytic principles, techniques, and correlation of results with coverage of disease states. For over 30 years and 8 editions Bishop has gained the reputation in the market as the trusted resource written by Clinical Lab Scientists specifically for CLS students. Many of the leading books on the market are adapted from general chemistry textbooks, while Bishop sets itself apart from the competition by its logical organization reorganize the chapter order to reflect clinical chemistry flow in most courses today. Individual chapter content will be based on the ASCLS Entry Level Curriculum. A map of how the textbook correlates to the ASCLS curriculum will be provided as an instructor resource. Bishop not only demonstrates the how of clinical testing, but also the what, why, and when of testing correlations to help students develop the knowledge and interpretive and analytic skills they will need in their future careers"-- Provided by publisher Cover Page Title Page Copyright Page Disclaimer Brief Contents Contents Dedication Page Foreword Preface New to This Edition Acknowledgments Contributors Ancillary Contributors Reviewers PART 1 Basic Principles and Practice in Clinical Chemistry CHAPTER 1 Basic Principles and Practices of Clinical Chemistry Kathryn Dugan and Elizabeth Warning Units of Measure Reagents Chemicals Reference Materials Water Specifications Solution Properties Concentration Colligative Properties Redox Potential Conductivity pH and Buffers Laboratory Equipment Heating Units Glassware and Plasticware Desiccators and Desiccants Balances Centrifuges Laboratory Mathematics and Calculations Significant Figures Logarithms Concentration Dilutions Simple Dilutions Serial Dilutions Water of Hydration Graphing and Beer’s Law Specimen Collection and Handling Types of Samples Sample Processing Sample Variables Chain of Custody Electronic and Paper Reporting of Results CHAPTER 2 Laboratory Safety and Regulations Brandy Greenhill Laboratory Safety and Regulations Occupational Safety and Health Act Other Regulations and Guidelines Safety Awareness for Clinical Laboratory Personnel Safety Responsibility Signage and Labeling Safety Equipment Chemical Fume Hoods and Biosafety Cabinets Chemical Storage Equipment PPE and Hygiene Biologic Safety General Considerations Spills Bloodborne Pathogens Airborne Pathogens Shipping Chemical Safety Hazard Communication Safety Data Sheet OSHA Laboratory Standard Toxic Effects from Hazardous Substances Storage and Handling of Chemicals Radiation Safety Environmental Protection Personal Protection Nonionizing Radiation Fire Safety The Chemistry of Fire Classification of Fires Types and Applications of Fire Extinguishers Control of Other Hazards Electrical Hazards Compressed Gas Hazards Cryogenic Materials Hazards Mechanical Hazards Ergonomic Hazards Disposal of Hazardous Materials Chemical Waste Radioactive Waste Biohazardous Waste Accident Documentation and Investigation CHAPTER 3 Quality Management in the Clinical Laboratory Yun L. Trull, Michael W. Rogers, Cyndy B. Levtzow, Matthew P. A. Henderson, Christopher R. McCudden, and Monte S. Willis Basic Concepts Descriptive Statistics: Measures of Center, Spread, and Shape Measurement of Precision Descriptive Statistics of Groups of Paired Observations Measurement of Bias Inferential Statistics Quality Control and Quality Improvement QC Charts Operation of a QC System Multi-Rules Rule! Proficiency Testing Lean Six Sigma Quality Assessment Individual Quality Control Program (IQCP): An Option to Streamline QCP Reference Range Studies Establishing Reference Ranges Determining Whether to Establish or Transfer and Verify Reference Ranges Data Analysis to Establish a Reference Range Data Analysis to Transfer and Verify a Reference Range Method Evaluation Regulatory Aspects of Method Evaluation Allowable Analytical Error Method Evaluation Acceptance Criteria Diagnostic Efficiency Measures of Diagnostic Efficiency CHAPTER 4 Analytic Techniques Karen K. Apolloni Spectrophotometry Beer’s Law Spectrophotometric Instruments Components of a Spectrophotometer Spectrophotometer Quality Assurance Atomic Absorption Spectrophotometry Fluorometry Fluorometry Instrumentation Fluorescence Polarization Advantages and Disadvantages of Fluorometry Chemiluminescence Turbidimetry Nephelometry Laser Applications Electrochemistry Galvanic and Electrolytic Cells Half-Cells Ion-Selective Electrodes pH Electrodes Gas-Sensing Electrodes Enzyme Electrodes Coulometric Titration Anodic Stripping Voltammetry Electrophoresis Procedure Support Materials Treatment and Application of Sample Detection and Quantitation Electroendosmosis Isoelectric Focusing Immunofixation Electrophoresis Capillary Electrophoresis Two-Dimensional Electrophoresis Osmometry Freezing Point Osmometer Newer Optical Techniques Chromatography Modes of Separation Chromatographic Procedures High-Performance Liquid Chromatography Gas Chromatography Mass Spectrometry Sample Introduction and Ionization Mass Spectrometer Analyzer Detector Applications of MS in the Clinical Laboratory Small Molecule Analysis Mass Spectrometry in Proteomics and Pathogen Identification Mass Spectrometry at the Point of Care CHAPTER 5 Clinical Chemistry Automation Nikola A. Baumann and Brooke M. Katzman History and Evolution of Automated Analyzers Driving Forces and Benefits of Automation Steps in Automated Analysis Specimen Preparation and Identification Specimen Measurement and Delivery Reagent Systems and Delivery Chemical Reaction Phase Measurement Phase Signal Processing and Data Handling Additional Considerations for Automated Immunoassays Immunoassay Basics Turbidimetry and Nephelometry Labeled Immunoassays Total Laboratory Automation Preanalytic Phase Analytic Phase Postanalytic Phase Future Trends in Automation PART 2 Analytic Procedures and Clinical Correlation CHAPTER 6 Proteins and Heme Derivatives Takara L. Blamires and Kristina Jackson Behan Amino Acids Overview Basic Structure Metabolism Classification Aminoacidopathies Methods of Analysis Proteins Overview Basic Structure General Chemical Properties Synthesis Catabolism and Nitrogen Balance Hormonal Regulation of Protein Metabolism Classification Plasma Proteins Prealbumin Albumin Globulins Other Proteins of Clinical Significance Troponin Natriuretic Peptides Fibronectin Cross-Linked C-Telopeptide Cystatin C Plasma Total Protein Abnormalities Hypoproteinemia Hyperproteinemia Methods of Analysis Sample Requirements Total Protein Albumin Immunochemical Assays Electrophoresis Proteins in Other Body Fluids Urine Cerebrospinal Fluid Hemoglobin Synthesis and Degradation of Hemoglobin Myoglobin Heme Synthesis of Heme Disorders of Heme Biosynthesis Clinical Application Analytical Methods CHAPTER 7 Nonprotein Nitrogen Compounds Shawn H.W. Luby Urea Biochemistry Clinical Application Analytical Methods Pathophysiology Uric Acid Biochemistry Clinical Application Analytical Methods Pathophysiology Creatinine/Creatine Biochemistry Clinical Application Analytical Methods Pathophysiology Ammonia Biochemistry Clinical Application Analytical Methods Pathophysiology CHAPTER 8 Enzymes Donna J. Spannaus-Martin General Properties and Definitions Enzyme Classification and Nomenclature Enzyme Kinetics Enzyme Catalysis Factors That Influence Enzymatic Reactions Measurement of Enzyme Activity Calculation of Enzyme Activity Measurement of Enzyme Mass Enzymes as Reagents Enzymes of Clinical Significance Creatine Kinase Lactate Dehydrogenase Aspartate Aminotransferase Alanine Aminotransferase Alkaline Phosphatase Acid Phosphatase γ-Glutamyltransferase 5′-Nucleotidase Amylase Lipase Glucose-6-Phosphate Dehydrogenase Macroenzymes Drug-Metabolizing Enzymes CHAPTER 9 Carbohydrates Vicki S. Freeman General Description of Carbohydrates Classification of Carbohydrates Stereoisomers Monosaccharides, Disaccharides, and Polysaccharides Chemical Properties of Carbohydrates Glucose Metabolism Fate of Glucose Regulation of Carbohydrate Metabolism Hyperglycemia Diabetes Mellitus Pathophysiology of Diabetes Mellitus Criteria for Testing for Prediabetes and Diabetes Criteria for the Diagnosis of Diabetes Mellitus Criteria for the Testing and Diagnosis of GDM Hypoglycemia Genetic Defects in Carbohydrate Metabolism Role of the Laboratory in Differential Diagnosis and Management of Patients with Glucose Metabolic Alterations Methods of Glucose Measurement Self-Monitoring of Blood Glucose Glucose Tolerance and 2-Hour Postprandial Tests Glycosylated Hemoglobin/HbA1c Ketones Albuminuria Islet Autoantibody, Insulin Testing, and C-Peptide Testing CHAPTER 10 Lipids and Lipoproteins Kathleen M. Kenwright Lipid Chemistry Fatty Acids Triglycerides Phospholipids Cholesterol General Lipoprotein Structure Chylomicrons Very-Low-Density Lipoprotein Intermediate-Density Lipoproteins Low-Density Lipoproteins Lipoprotein (a) High-Density Lipoproteins Lipoprotein X Lipoprotein Physiology and Metabolism Lipid Absorption Exogenous Pathway Endogenous Pathway Reverse Cholesterol Transport Pathway Lipid and Lipoprotein Population Distributions National Cholesterol Education Program Dyslipidemia and Children National Heart, Lung, and Blood Institute Diagnosis and Treatment of Lipid Disorders Arteriosclerosis Hyperlipoproteinemia Hypercholesterolemia PCSK9 Hypertriglyceridemia Combined Hyperlipidemia Lp(a) Elevation Non-HDL Cholesterol Hypobetalipoproteinemia Hypoalphalipoproteinemia Lipid and Lipoprotein Analyses Lipid Measurement Cholesterol Measurement Triglyceride Measurement Lipoprotein Methods HDL Methods LDL Methods Apolipoprotein Methods Phospholipid Measurement Fatty Acid Measurement Standardization of Lipid and Lipoprotein Assays Precision Accuracy Matrix Interactions CDC Cholesterol Reference Method Laboratory Network Analytic Performance Goals Quality Control Specimen Collection CHAPTER 11 Electrolytes James March Mistler Water Osmolality The Electrolytes Sodium Potassium Chloride Bicarbonate Calcium Magnesium Phosphate Lactate Anion Gap Electrolytes and Renal Function CHAPTER 12 Blood Gases, pH, and Buffer Systems Kyle B. Riding Acid–Base Balance Maintenance of H+ Buffer Systems: Regulation of H+ and the Henderson-Hasselbalch Equation Regulation of Acid–Base Balance: Lungs and Kidneys (Transport of Carbon Dioxide) Assessment of Acid–Base Homeostasis The Bicarbonate Buffering System Acid–Base Disorders: Acidosis and Alkalosis Determining Patient Acid–Base Status Oxygen and Gas Exchange Oxygen and Carbon Dioxide Oxygen Transport Assessment of a Patient’s Oxygen Status Hemoglobin–Oxygen Dissociation Measurement Blood Gas Analyzers: pH, pCO2, and pO2 Measurement of pO2 Measurement of pH and pCO2 Types of Sensors Calibration Correction for Temperature Calculated Parameters Spectrophotometric Determination of Oxygen Saturation (CO-Oximetry) Quality Assurance Preanalytic Considerations Analytic Assessments: Quality Control and Proficiency Testing PART 3 Endocrinology and Clinical Correlation CHAPTER 13 Basic Endocrinology Scott Moore Hormone Classification Amine Peptide Protein Glycoprotein Steroid Fatty Acid Introduction to Hormones Growth Hormone (GH) Adrenocorticotropic Hormone (ACTH) and the Adrenal Cortical Hormones Follicle Stimulating Hormone and Luteinizing Hormone Prolactin (PRL) Androgens Progesterone Estrogens/Estradiol/Estriol Catecholamines Thyroid Hormone (T3, T4) and Thyroid Stimulating Hormone (TSH) Posterior Pituitary Hormones Calcitonin and Procalcitonin Parathyroid Hormone (PTH) Insulin Glucagon Gastrin and Secretin Human Chorionic Gonadotropin (hCG) Serotonin/5-hydroxyindolacetic Acid (5-HIAA) Hormone Metabolism Alcohol Consumption Adrenal Steroid Hormone Synthesis Mechanisms of Elimination Hormone Transport Solubility Carrier Proteins Micelles Feedback Mechanisms Negative Feedback Mechanisms Positive Feedback Mechanisms Primary, Secondary, and Tertiary Disorders Other Factors That Affect Hormone Levels Emotional Stress Time of Day Menstrual Cycle Menopause Food Intake/Diet Drugs CHAPTER 14 Thyroid Function Yukari Nishizawa-Brennen The Thyroid Thyroid Anatomy and Development Thyroid Hormone Synthesis Protein Binding of Thyroid Hormone Control of Thyroid Function Actions of Thyroid Hormones Tests for Thyroid Function Thyroid-Stimulating Hormone Thyroxine (T4) Triiodothyronine (T3) Free Thyroxine (FT4) Free Triiodothyronine (FT3) Thyroglobulin Antibody Thyroperoxidase Antibody Thyrotropin Receptor Antibody Other Tools for Thyroid Evaluation Nuclear Medicine Evaluation Thyroid Ultrasound Fine-Needle Aspiration Disorders of the Thyroid Hypothyroidism Thyrotoxicosis Hyperthyroidism Toxic Adenoma and Multinodular Goiter Drug-Induced Thyroid Dysfunction Amiodarone-Induced Thyroid Disease Subacute Thyroiditis Nonthyroidal Illness Thyroid Nodules CHAPTER 15 Hypothalamic and Pituitary Function Stephanie L. Jacobson Embryology and Anatomy Functional Aspects of the Hypothalamic–Hypophyseal Unit Pituitary Tumors Hypophysiotropic or Hypothalamic Hormones Anterior Pituitary Hormones Growth Hormone Actions of GH Testing GH Excess GH Deficiency Prolactin Prolactinoma Other Causes of Hyperprolactinemia Clinical Evaluation of Hyperprolactinemia Management of Prolactinoma Idiopathic Galactorrhea Hypopituitarism Etiology of Hypopituitarism Treatment of Panhypopituitarism Posterior Pituitary Hormones Oxytocin Arginine Vasopressin CHAPTER 16 Adrenal Function Stephanie L. Jacobson Embryology and Anatomy The Adrenal Cortex Glucocorticoid Physiology Cortex Steroidogenesis Congenital Adrenal Hyperplasia Primary Aldosteronism Etiology Diagnosis Treatment Adrenal Insufficiency Symptoms Diagnosis Treatment Isolated Hypoaldosteronism Hypercortisolism (Cushing’s Syndrome) Etiology Diagnosis Treatment Adrenal Androgens Androgen Excess Diagnosis Treatment The Adrenal Medulla Embryology Biosynthesis, Storage, and Secretion of Catecholamines Metabolism and Excretion of Catecholamines Pheochromocytoma and Paraganglioma Epidemiology Clinical Presentation Diagnosis Result Interpretation Treatment Adrenal Incidentaloma CHAPTER 17 Gonadal Function Jane R. Semler The Testes Functional Anatomy of the Male Reproductive Tract Physiology of the Testicles Disorders of Sexual Development and Testicular Hypofunction Diagnosis of Hypogonadism Testosterone Replacement Therapy Monitoring Testosterone Replacement Therapy The Ovaries Early Ovarian Development Functional Anatomy of the Ovaries Hormonal Production by the Ovaries The Menstrual Cycle Hormonal Control of Ovulation Pubertal Development in the Female Precocious Sexual Development Menstrual Cycle Abnormalities Evaluation of Female Infertility Hirsutism Estrogen Replacement Therapy CHAPTER 18 Parathyroid Function Rebbecca Silva Parathyroid Glands Parathyroid Hormone Vitamin D Effects of the Parathyroid Hormone GI Regulation Role of Kidneys Bone Physiology Parathyroid Disorders Primary Hyperparathyroidism Secondary Hyperparathyroidism Secondary and Tertiary Hyperparathyroidism in Renal Failure Familial Hypocalciuric Hypercalcemia Hyperthyroidism Addison’s Disease Medications That Cause Hypercalcemia Hypervitaminosis Parathyroid Hormone–Related Protein Hypoparathyroidism Metabolic Bone Diseases Rickets and Osteomalacia Osteoporosis PART 4 Organ Systems and Clinical Correlation CHAPTER 19 Liver Function Janelle M. Chiasera Anatomy Gross Anatomy Microscopic Anatomy Biochemical Functions Excretory and Secretory Functions Metabolism Detoxification and Drug Metabolism Liver Function Alterations During Disease Jaundice Cirrhosis Tumors Reye’s Syndrome Drug- and Alcohol-Related Disorders Assessment of Liver Function/Liver Function Tests Bilirubin Methods Urobilinogen in Urine and Feces Serum Bile Acids Enzymes Tests Measuring Hepatic Synthetic Ability Tests Measuring Nitrogen Metabolism Hepatitis CHAPTER 20 Cardiac Function Teresa A. Mortier Pathophysiology of Atherosclerosis Cardiac Ischemia, Angina, and Heart Attacks Markers of Cardiac Damage Initial Markers of Cardiac Damage Cardiac Troponins Myoglobin Cardiac Injury Cardiac Biomarkers in Heart Failure Diagnosis and Risk Stratification of Heart Failure Cardiac Troponins Markers of Coronary Heart Disease Risk and Plaque Instability C-Reactive Protein Homocysteine Markers of Pulmonary Embolism Use of D-Dimer Detection in PE Value of Assaying Troponin and BNP in Acute PE Coronary Heart Disease CHAPTER 21 Renal Function Peter O’Brien Renal Anatomy Renal Physiology Glomerular Filtration Tubular Function Elimination of Nonprotein Nitrogen Compounds Water, Electrolyte, and Acid–Base Homeostasis Endocrine Function Analytic Procedures Creatinine Clearance Estimated GFR Cystatin C β2-Microglobulin Myoglobin Albuminuria Neutrophil Gelatinase–Associated Lipocalin NephroCheck Urinalysis Pathophysiology Glomerular Diseases Tubular Diseases Urinary Tract Infection/Obstruction Renal Calculi Renal Failure CHAPTER 22 Pancreatic Function Gerald D. Redwine, John E. Lee Sang, and Amanda Rivera-Begeman Physiology of Pancreatic Function Diseases of the Pancreas Tests of Pancreatic Function Cholecystokinin (CCK) Test Fecal Fat Analysis Fecal Enzymes Sweat Electrolyte Testing Serum Enzymes Tests of Gastric Secretion and Intestinal Function PART 5 Specialty Areas of Clinical Chemistry CHAPTER 23 Body Fluid Analysis Kyle B. Riding Cerebrospinal Fluid Serous Fluids Pleural Fluid Pericardial Fluid Peritoneal Fluid Amniotic Fluid Hemolytic Disease of the Fetus and Newborn Neural Tube Defects Fetal Lung Maturity Phosphatidylglycerol Lamellar Body Counts Sweat Synovial Fluid CHAPTER 24 Pregnancy and Prenatal Testing Heather L. Phillips and Michelle R. Campbell Pregnancy Conception and Embryonic Development Fetal Development Delivery Transformation During Pregnancy Plasma Volume Increase Renin–Angiotensin–Aldosterone System Natural Decreases in Analytes Upregulation of Hormones and Steroids Increased Glomerular Filtration Rate Hyperventilation Endocrine Cholesterols Immune System Neuroactive Hormones Analytes for Maternal and Fetal Health Assessment Human Chorionic Gonadotropin α-Fetoprotein (AFP) Fetal Amniotic Fluid α-Fetoprotein Unconjugated Estriol Inhibin A The Triple and Quadruple Screen Test Acetylcholinesterase Pregnancy Associated Plasma Protein A (PAPP-A) Progesterone Glucose Fetal Fibronectin Common Diseases Associated with the Developing Fetus Neural Tube Defects Down Syndrome Trisomy 18 Isoimmunization Preterm Delivery Common Diseases Associated with the Mother and Pregnancy Preeclampsia Hyperemesis Gravidarum Ectopic Pregnancy Analyte Deficiency Other Clinical Impairments CHAPTER 25 Therapeutic Drug Monitoring Jie Gao and Floyd Josephat Pharmacokinetics Routes of Administration Drug Absorption Drug Distribution Free Versus Bound Drugs Drug Metabolism Drug Elimination Elimination Example Pharmacodynamics Specimen Collection Pharmacogenomics Cardioactive Drugs Digoxin Quinidine Procainamide and N-acetylprocainamide Disopyramide Antibiotics Aminoglycosides Gentamicin Tobramycin Amikacin Vancomycin Antiepileptic Drugs Primidone Phenobarbital Phenytoin and Free Phenytoin Valproic Acid Carbamazepine Ethosuximide Felbamate Gabapentin Lamotrigine Levetiracetam Oxcarbazepine Tiagabine Topiramate Zonisamide Psychoactive Drugs Lithium Tricyclic Antidepressants Clozapine Olanzapine Immunosuppressive Drugs Cyclosporine Tacrolimus Sirolimus Everolimus Mycophenolic Acid Antineoplastics Methotrexate Bronchodilators Theophylline CHAPTER 26 Toxicology Christopher R. Swartz Xenobiotics, Poisons, and Toxins Routes of Exposure Dose–Response Relationship Acute and Chronic Toxicity Analysis of Toxic Agents Toxicology of Specific Agents Alcohols Carbon Monoxide Caustic Agents Cyanide Metals and Metalloids Pesticides Toxicology of Therapeutic Drugs Salicylates Acetaminophen Toxicology of Drugs of Abuse Amphetamines Sedatives–Hypnotics Barbiturates Benzodiazepines Cannabinoids: Tetrahydrocannabinol (THC) Cocaine Opioids Tricyclic Antidepressants Methylenedioxymethamphetamine Phencyclidine Anabolic Steroids CHAPTER 27 Trace Elements, Toxic Elements, and Vitamins Michelle R. Campbell Trace and Toxic Elements Instrumentation and Methods Aluminum Arsenic Cadmium Chromium Copper Iron Lead Manganese Mercury Molybdenum Selenium Zinc Vitamins Overview Fat-Soluble Vitamins Water-Soluble Vitamins CHAPTER 28 Tumor Markers Carleen Van Siclen Types of Tumor Markers Applications of Tumor Marker Detection Screening and Risk Assessment Prognosis Monitoring Effectiveness of Therapy and Disease Recurrence Laboratory Considerations for Tumor Marker Measurement Immunoassays High-Performance Liquid Chromatography Immunohistochemistry and Immunofluorescence Enzyme Assays Tumor Marker Tests α-Fetoprotein Cancer Antigen 125 (CA-125) Carcinoembryonic Antigen (CEA) Human Chorionic Gonadotropin (hCG) Prostate-Specific Antigen (PSA) Cancer Antigen 15-3 (CA 15-3) Carbohydrate Antigen 19-9 (CA 19-9) Immunoglobulin Free Light Chains Human Epididymis Protein 4 (HE4) Neuron-Specific Enolase (NSE) CHAPTER 29 Point-of-Care Testing Heather McNasby Laboratory Regulations Accreditation POCT Complexity Implementation Establishing Need POCT Implementation Protocol Personnel Requirements Quality Management Accuracy Requirements QC and Proficiency Testing POC Applications Informatics and POCT CHAPTER 30 Newborn and Pediatric Clinical Chemistry Khushbu Patel and Tracey G. Polsky Developmental Changes from Neonate to Adult Respiration and Circulation Growth Organ Development Problems of Prematurity and Immaturity Pediatric Sample Collection and Handling Phlebotomy Preanalytic Concerns Choice of Analyzer Point-of-Care Analysis in Pediatrics Turnaround Time Evaluation of POCT Devices Device Limitations for Pediatric Use Regulation of Blood Gases and pH in Neonates and Infants Blood Gas and Acid–Base Measurement Regulation of Electrolytes and Water: Renal Function Disorders Affecting Electrolytes and Water Balance Development of Liver Function Physiologic Jaundice Energy Metabolism Diabetes Nitrogen Metabolism Nitrogenous End Products as Markers of Renal Function Liver Function Tests Calcium and Bone Metabolism in Pediatrics Hypocalcemia and Hypercalcemia Endocrine Function in Pediatrics Hormone Secretion Hypothalamic–Pituitary–Thyroid System Hypothalamic–Pituitary–Adrenal Cortex System Growth Factors Endocrine Control of Sexual Maturation Development of the Immune System Basic Concepts of Immunity Components of the Immune System Neonatal and Infant Antibody Production Immunity Disorders Genetic Diseases Cystic Fibrosis Newborn Screening for Whole Populations Diagnosis of Metabolic Disease in the Clinical Setting Drug Metabolism and Pharmacokinetics Therapeutic Drug Monitoring Toxicologic Issues in Pediatric Clinical Chemistry CHAPTER 31 Geriatric Clinical Chemistry Laura M. Hickes and J. Marvin McBride The Aging of America Aging and Medical Science General Physiologic Changes with Aging Muscle Bone Gastrointestinal System Kidney/Urinary System Immune System Endocrine System Sex Hormones Glucose Metabolism Effects of Age on Laboratory Testing Muscle Bone Gastrointestinal System Urinary System Immune System Endocrine System Sex Hormones Glucose Metabolism Establishing Reference Ranges for Older Adults Preanalytical Variables Unique to Geriatric Patients Diseases Prevalent in Older Adults Age-Associated Changes in Drug Metabolism Absorption Distribution Metabolism Elimination Atypical Presentations of Common Diseases Geriatric Syndromes The Impact of Exercise and Nutrition on Chemistry Results in the Geriatric Population Appendix: Reference Ranges Glossary Index