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Medical Forum / General / Laboratory / June 2005Questions: Blood level/ Total Body levels?
Hello, Under routine tests, we meausre blood/serum levels of any bio-chemical. But there can be some difference in understanding on blood/serum level & total body level. I want to know; 1. What are blood/serum levels & total body levels of bio-chemicals? 2.What can be the difference in understanding an imbalance/disease by measuring at blood/serum level & whole body level of any biochemical? 3. Can measurements of blood/serum level are sufficient to judge any disease? 4. Is it possible that inspite of blood levels of biochemicals are within normal range but still these are imbalanced at total body/other body sites levels? 5. Whether body stores excess acidity during day time & excrete during night time? Where body stores excess of acidity or other biochemicals till it excrete via urine etc? Can you please tell me about these aspects? Are you reading one of those body pH sites too? How would you propose to measure "body" levels? Stick a probe through your skin or something? How would YOU measure a body pH? Which fluid would YOU choose? Levels of body analytes are always in flux but stay within certain normal ranges unless there's some disease or trauma interfering. Medical laboratories measure analytes on serum, urine, and body fluids (paracentesis, thoracentesis, pleural, knee fluid, spinal fluid, etc. if these are aspirated and send for analysis). Analyte levels differ depending on the fluid sent. All fluids have known normal ranges of analytes sent for testing. The normals for these fluids are not all the same, but differ by the type of fluid. Which one would you pick for testing your body level? Analyte levels don't measure disease per se. They give results which, combined with a patient's history and symptoms, can lead the doctor into diagnosing a disease. Sometimes the doc also needs xrays and other scans to come to a firm diagnosis. Sometimes diagnosis is easy. Sometimes it takes years to diagnose certain conditions. http://web2.iadfw.net/uthman/lab_test.html This is a good page to start on for information regarding common lab results. Dr. Uthman is a pathologist - a type of physician that does work both with tissues and is qualified to be the head of a clinical laboratory. These pages are somewhat technical but full of information. The tests he talks about are ordered millions of times a day in laboratories all over the world, and are basic metabolic tests. What you have asked is that, if your blood work is normal, is your "body level" (whatever that means) abnormal? These people are just trying to sell you their STUFF. They're dumbing down body chemistry to sell you STUFF. Don't be led on. Judy Dilworth, M.T. (ASCP) Microbiology > Hello, > > 4. Is it possible that inspite of blood levels of biochemicals are > within normal range but still these are imbalanced at total body/other > body sites levels? > Hello, > [quoted text clipped - 3 lines] > > 1. What are blood/serum levels & total body levels of bio-chemicals? ??? Why? It's more important to eat healthy than to look at any single level. If you have disease then it is more important to get a diagnosis and deal with it that way. It is not important for you or anyone to know how or what the normal laboratory values are. There are many differences in serum and total body stores and it is impossible for somebody not in the health field to understand it. There are laboratory tests that are measured independent of carrier proteins which can reflect more the total body stores. Ionized calcium, ionized magnesium free T4, free dilantin are examples of that. Unless you want to have a brain biopsy everytime you want to know brain stores then you must live with CSF and blood levels. > 2.What can be the difference in understanding an imbalance/disease by > measuring at blood/serum level & whole body level of any biochemical? Analytes can be altered by the carrier proteins and total calcium levels may be high or low because of the carrier protein and not the actual total calcium stores. These are usually really sick people with very low albumin levels in the intensive care rooms. The blood total calcium is low because the albumin is low. If you do an ionized calcium which is the free form of the calcium then it is normal. > 3. Can measurements of blood/serum level are sufficient to judge any > disease? Disease usually has a constellation of laboratory findings and not only one single analyte level. A negative finding is just as signficant as a positive finding and each is related to a particular disease. In terms of diagnosis each has a negative predictive factor in terms of percent and a postive predictive factor. Doctors know which test are sensitive to detect disease and which tests are highly specific in diagnosing disease. They have been doing this for years and years. > 4. Is it possible that inspite of blood levels of biochemicals are > within normal range but still these are imbalanced at total body/other > body sites levels? It is possible but like I said you look at all tests and the complete picture of the disease. Keep in mind that most diagnosis is done with a history. The lab only confirms that diagnosis. You never diagnose with lab tests alone. > 5. Whether body stores excess acidity during day time & excrete during > night time? Where body stores excess of acidity or other biochemicals > till it excrete via urine etc? Last I heard people still sleep at night and yes pH changes as a normal part of life. People also urinate as a normal part of life. > Can you please tell me about these aspects? Judy Dilworth, Robert, Many thanks for detailed replies. Let us understand Iron. Iron is not easily excreted in urine or other physiological system except 1mg per day in sweat etc. If excess or imbalanced, body may trigger its stores in liver or other sites still keeping blood levels at normal range. What about other biochemicals? Are all can act alike this or this is specific to Iron only? In chronic stages can it be possible that in & out of biochemicals from blood vessels is effected resulting false or more in or more out of BVs? Do biochemicals are present in salt/compound form or in Ionic form in tissues other than in blood? Robert, About acid stored in some tissue(may be epithillum) in day time & releases ar night time: I read somewhare but lost this link. Is it there or not? It can be important to know it because there are many conditions which are related/specific to night or day time as night excess urination, cortisol etc. Can't some night activities be related to excess acidity in night time? > Judy Dilworth, Robert, > > Many thanks for detailed replies. Let us understand Iron. Iron is not > easily excreted in urine or other physiological system except 1mg per > day in sweat etc. If excess or imbalanced, body may trigger its stores > in liver or other sites still keeping blood levels at normal range. There are a variety of lab tests pertaining to iron. The total iron level, the total binding capacity of or for iron and ferritin. There are specific genetic testing for hemochromatosis. The storage form of iron, ferritin can be elevated or normal in the blood in the presence of iron deficiency as a result of inflammation. The total iron level may be reduced in chronic disease. You can have specific target organs like the liver damaged by alcohol produce local iron overload and an elevated iron. (MILT) increased MCV,iron,Liver enzymes, triglycerides in alcohol damage. The reticuloendothelial system keeps the blood iron and storage pool in constant change. > What about other biochemicals? Are all can act alike this or this is > specific to Iron only? The blood is the transport system to and from storage sites throughout the body. The exception being the blood brain barrier. In chronic stages can it be possible that in & > out of biochemicals from blood vessels is effected resulting false or > more in or more out of BVs? Do biochemicals are present in > salt/compound form or in Ionic form in tissues other than in blood? Ionic forms are dependent on pH or acidity. You have osmosis and active transport of many chemicals. Blood vessels are not dead but are quite active metabolically. One example would be the presence of cholesterol crystals in pseudochylous effusions or pleural fluid. With chronic disease such as tuberculosis or rheumatoid arthritis the pleural effusion may be chronic or long standing and result in a thickened plueral membrane which can not transport the cholesterol adequatetly resulting in cholesterol crystals in the fluid. These crystals are important diagnostically. Cholesterol is not normally found in crystal form so the form is very important. > Robert, About acid stored in some tissue(may be epithillum) in day time > & releases ar night time: I read somewhare but lost this link. Is it > there or not? You breathe more shallow at night and thus retain more acid along with reduced oxygen tension and circulation. It can be important to know it because there are many > conditions which are related/specific to night or day time as night > excess urination, cortisol etc. Can't some night activities be related > to excess acidity in night time? As you state certain conditions may be worse at night. One such disease is paroxsymal nocturnal hemoglobinemia in which red cells are destroyed because of the body changes related to night time. Some worms can detect these body changes such as microfilaria and come out from deep in the tissues to the circulating blood in order to time it right for a mosquito to come along and go for a ride. "The blood is the transport system to and from storage sites throughout the body. The exception being the blood brain barrier." Robert, thanks again. Can you tell more about these storage sites? I think bone are for Ca,P,Mg. Which are others? Whether this storage will be in salt/compound form as in bones? "Ionic forms are dependent on pH or acidity." Do you mean pH or acidity can only convert biochemicals in their Ionic form? I have a serious thought on this; Is it possible that all or most medicines effects by making changes in acid/base & water(mucus) balances? Do all or most medicines effects these balances on total body's levels(because in blood these are in quite narrow range? "One example would be the presence of cholesterol crystals in pseudochylous effusions or pleural fluid. With chronic disease such as tuberculosis or rheumatoid arthritis the pleural effusion may be chronic or long standing and result in a thickened plueral membrane which can not transport the cholesterol adequatetly resulting in cholesterol crystals in the fluid. These crystals are important diagnostically. Cholesterol is not normally found in crystal form so the form is very important." Yes, it is very important. Probably, changes in other membranes can be very important in understanding many disorders. "You breathe more shallow at night and thus retain more acid along with reduced oxygen tension and circulation." Do you know what is overall body acid levels during day or night? Can acid be stored in other than blood? If Isoenzymes are related to this acid levels in specific parts? "As you state certain conditions may be worse at night. One such disease is paroxsymal nocturnal hemoglobinemia in which red cells are destroyed because of the body changes related to night time. Some worms can detect these body changes such as microfilaria and come out from deep in the tissues to the circulating blood in order to time it right for a mosquito to come along and go for a ride." Good information. Can you tell some more conditions which may worse or improve during day or night time or are seasonal? Regards. > "The blood is the transport system to and from storage sites throughout > the body. The exception being the blood brain barrier." > > Robert, thanks again. Can you tell more about these storage sites? I > think bone are for Ca,P,Mg. Which are others? Whether this storage will > be in salt/compound form as in bones? I think you would best be taking a physiology course that would get down to the basics with that. Just about any structure can be in equilibrium with it's surrounding. One of the theories of calcium pyrophosphate crytal disease is the mobilization of calcium from the cartlidge into the joint space due to low serum calcium levels. Salt or ionic forms are dependent on the redox potentionals, hormonal influences and local physiology such as cytokines and inflammation. > "Ionic forms are dependent on pH or acidity." > > Do you mean pH or acidity can only convert biochemicals in their Ionic > form? I have a serious thought on this; Is it possible that all or most > medicines effects by making changes in acid/base & water(mucus) > balances? Medicines are impacted by the pH and can be excreted based on pH in some instances. Some over-dose treatments involve giving base to increase renal excretion. Medicines require good circulation and thus good redox potentials. With tissue damage the redox potential decreases with reduced oxygen and poor circulation in the damages tissues thus tetanus or other infections are hard to treat. Some tissues such as the prostate have very specific pH normals and only certain antibiotics can penetrate into the prostate. You might want to review some pharm dynamics. Do all or most medicines effects these balances on total > body's levels(because in blood these are in quite narrow range? Each drug is dependent on the unique physiology of that drug. Statins can deplete Coenzyme Q levels and lead to muscle damage. Some TM medicines can deplete pyridoxine. Some BP meds can deplete potassium. > "One example would be the presence of cholesterol crystals in > pseudochylous effusions or pleural fluid. With chronic disease such as [quoted text clipped - 7 lines] > Yes, it is very important. Probably, changes in other membranes can be > very important in understanding many disorders. Membrane permeability is a big research thing right now with the blood brain barrier drugs. > "You breathe more shallow at night and thus retain more acid along with > reduced oxygen tension and circulation." > > Do you know what is overall body acid levels during day or night? Can > acid be stored in other than blood? If Isoenzymes are related to this > acid levels in specific parts? Stored acid? You need to review again your physiology. At the cellular level oxygen is combined with hydrogen H+ to form water (respiration). Excess H because of decreased oxygen can be temporarily exchanged with potassium at the red cell level and thus a high potassium associated with metabolic acidosis. With hyperventilation a decrease CO2 causes alkalosis with resulting decrease in ionized calcium and muscle twitching. Isoenzymes are pH specific and are thus located in tissues that the pH is appropriate. Alkaline phosphatase is optimal in alkaline pH and acid phosphatases are optimal in acid mediums. All enzymes are pH dependent via enzyme kinetics. > "As you state certain conditions may be worse at night. One such > disease is paroxsymal nocturnal hemoglobinemia in which red cells are [quoted text clipped - 5 lines] > Good information. Can you tell some more conditions which may worse or > improve during day or night time or are seasonal? Not so much in difference in symptoms but in physiology as most as you state are hormonal catabolic and anabolic cycles, estrogens, and most are reflected in laboratory parameters although not stated as such in the normal range. > Regards. Good luck and start taking some classes. Robert, thanks. "Isoenzymes are pH specific and are thus located in tissues that the pH is appropriate" Let us check LDH isoenzme specific to heart. Can it be effected by excess lactic acid in cardiac muscles? Can there be excess LA in heart muscles but still normal in blood, causing heart damage & increase the cardiac enzymes LDH etc? Can it be possible that total body level of any bio-chemical is normal/defficient, but still higher in blood OR lower in blood still higher in tissues(total body level)? Will this be considered as store/accumulation OR imbalance OR defficiency of any biochemical? Blood levels can be indicative of later/emergency stage esp. of macro-minerals, so we may need to understand levels at other sites also for early assesment of any condition. Moreover blood levels can be effected due to disorders in BVs walls for exchange of bio-chemicals. Is it not so? Eg; suppose a person with persistant high blood glucose levels can have it or not, by more tissues-vessels exchange of BG if blood is thin(low HCT) & if cell walls of BVs favour it(more preamble)--still total body BG levels are normal (person feels no symptoms even on very high BG levels) . Regards. > Robert, thanks. > [quoted text clipped - 3 lines] > Let us check LDH isoenzme specific to heart. Can it be effected by > excess lactic acid in cardiac muscles? Without wishing to appear rude, why are you asking such a specific question ? > > Robert, thanks. > > [quoted text clipped - 6 lines] > Without wishing to appear rude, why are you asking such a specific question > ? I am backing out of this and saying that such things are better covered in a biochem class and not here. So I apologize to the group. I thought he had a specific question but it seems as though it is much more extensive. >> > Robert, thanks. >> > [quoted text clipped - 12 lines] > So I apologize to the group. I thought he had a specific question but it > seems as though it is much more extensive. Which is what prompted me ! Manky, "Without wishing to appear rude, why are you asking such a specific question ?" I posted following case in other form. I hope it will clear my intentions. A diabetic patient on insulin & metformin1000mg, taken many mangos & some heavy foods on previous days got his cardiac enzymes elevated (LDH near to higher normal level) CK & troponinI, (g) normal) elevated with no abnormality in ECG, lipids some elevated, no hypertention, no undue exertion on stress/walking, some circle is noted on 2D eco(not confirmed as yet). Can it be thought it can be due to higher lactic acid due to metformin & eating acidic foods? > Manky, > [quoted text clipped - 12 lines] > confirmed as yet). Can it be thought it can be due to higher lactic > acid due to metformin & eating acidic foods? We are not doctors here and it has been said by many that we have just enough knowledge to be dangerous. Here is a site that mentions precautions. http://www.diabetesselfmanagement.com/article.cfm?sid=5&tid=34&stid=61&aid=700&s k=5WZ5 Alcohol can cause LA also in people taking glucophage. You really didn't mention any symptoms that would be consistent with LA. You did not mention a lactate level. It is more appropriate to do an arterial lactate level and not a venous sample. Some what unclear about the nature of the LDH level and would be interested to see the LDH1 LDH2 flip normally seen in the heart fraction.. An SGOT or AST would also shoot up. Depending on the location of an infarction the total CK may or may not be elevated. The troponin I and CKMB are time dependent. A BNP would be good to check for CHF, cirrhosis and nephrosis all of which would be contra indicated in using glucophage. If you look at the classic criteria to rule out LA. [Kruze JA ] are not met which are: severe acidosis with hyperventilation, blood pH < 7.3, serum lactic acid > 5 mmol/L and large anion gap > 15 meq / L. Metformin toxicity therefore can be ruled out. Kruse JA. Metformin associated lactic acidosis. The Journal of Emergency Medicine. 2001;20(3):267-272. This medicine is contraindicated in people with lung function problems indicating ventilation is important in handling the normal acid load. This would imply that all acid loads may be of concern. The creatinine is important in judging renal excretion obviously. The older the patient is the higher the chance of developing LA. and you mention no age of that patient. If the lipid panel is apparently normal you might want to expand the coronary risk panel if confirmed AMI and you make no mention if LDL target values were present in that patient or if glycohemoglobin values were controlled. A directly measured LDL would be more appropriate for diabetes. Apart from that diabetics have known complications even when everything is done. Hope you get some input from the other doctors out there. Good luck I forgot to mention the previous LDH questions. I dusted off my old book and it only took a minute. The pyruvate plus NADH plus H to pyruvate is optimal at pH 7.5-8.5 (isoenzymes 1,3 and 5 all similar pH). The reverse reaction is greater at pH 9.5 (isoforms optima LD1,2 and 3 are about 0.15 pH apart) The LDH has no function in the serum. The majority is from RBC's and platelets and LDH appears to be inactivated in the circulation and the inactive enzyme appear in the small intestine, excreted through biliary tract. There are 5 isoforms and in tissues rich in LD1 such as heart and RBC's , lactate could not form in the presence of excess pyruvate, whereas in skeletal muscle which is rich in LD5, lactate could form. Based on that LD1 was termed the aerobic isoenzyme and LD5 the anaerobic isoform. It turned out not to be the case under normal physiology. Pyruvate concentrations do not control whether anaerobic or aerobic pathways are followed, rather the redox state of the tissues. Lactate accumulates in the tissue during anaerobic metabolism regardless of which LD isoenzyme is predominant. As far as tissue concentrations go the brain has the highest, heart,RBC's, kidney, lung then skeletal muscle. The heart has about 25000 units/g with LD1,LD2,LD3 and very little LD4 and LD5 skeletal muscle is 9000 units/g and pretty much even distribution of all five isoforms. Robert, many thanks again. God bless you. Actually patient went for daily morning walk, experianced heavy sweat, weakness but no chest pain or any other symptom. He went for check up but doctor prefer to keep him in observation. ECG was normal with BP normal. Doctors not considered for acidosis. Unfortunetely, Total LDH, CK, troponin I & (g) was done. Blood lactate test was not done. All liver, kidney tests including AST was normal. Under lipids, Triglyceride, LDL & HDL were mildly abnormal. He is ok now(after 10 days) but will go for re-check up, when he will be suggested to go for angiography or not. But when all symptoms do not indicated blockades, I just suspect, whether this is due to some mild LA toxicity. LDH 582U (normal 350-618) mat indicate something. Probably LDH heart isoenzmes might be higher at that time--so some symptoms occured. |
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