LAB FT TEST 7 on Carbs & PFF In this test, the proteins in the sample are What happens when

What happens when glucose levels drop

precipitated using metallic salt below 20-30 mg/dL?
What is hyperglycemia?
Folin-Wu Central nervous system dysfunction.
High blood sugar. It is most often due to
diabetes mellitus. Somogyi-Nelson

Both Folin-Wu & Somogyi-Nelson Define glycolysis, glycogenesis,

glycogenolysis, and gluconeogenesis.
What patient preparation is required for
an oral glucose tolerance test (OGTT)? Glycolysis - conversion of glucose to
This test is applicable for anticoagulated pyruvic acid or lactic acid
An overnight fast. A fasting specimen is blood.
drawn and the patient is given a glucose Glycogenesis - production of glycogen
Folin-Wu
load (75 grams for an adult, 1.75 grams/kg from glucose
body weight for a child, and 100 grams for Somogyi-Nelson Glycogenolysis - production of glucose
a pregnant woman). The 3-hour OGTT is
falling out of favor because of its poor Both Folin-Wu & Somogyi-Nelson from glycogen
reproducibility and the inconvenience to Gluconeogenesis - production of glucose
the patient. New guidelines from the from non-carbohydrate sources
American Diabetes Association This method requires freezing after
recommend a baseline and 2-hour proteins have been removed when testing
specimen only except during pregnancy. is delayed. The method that ensures the removal of
Folin-Wu non-glucose reducing substances is:

What are the most common causes of Somogyi-Nelson Somogyi-Nelson

hypoglycemia?
Both Folin-Wu & Somogyi-Nelson
Inappropriate insulin production, insulin
injection, or ingestion of oral
hypoglycemic agents.
What is the most common method for Compare the normal blood glucose level Early detection and tight glycemic control
glycated hemoglobin (hemoglobin A1c) in for newborns and adults. retard progression to nephropathy.
the U.S.? Detection is by an immunochemical
The mean blood glucose level for neonates measurement of the albumin excretion
Affinity chromatography. Glycated is 35 mg/dL. Glucose is lower in newborns rate on a 24-hour urine specimen using
hemoglobin binds to the column; because of the small glycogen reserve in antibodies to human albumin.
nonglycated hemoglobin does not. The the liver. Adults have 90-110 mg/dL.
absorbances of the bound and unbound
fractions are measured at 415 nm. HPLC is
the reference method for glycated When are ketones present in the blood?
How does the oral glucose tolerance test
hemoglobin. differ for a pregnant woman? Whenever there is impaired carbohydrate
metabolism with breakdown of fatty acids,
The glucose load is 100 grams and a such as uncontrolled diabetes mellitus,
fasting, 1-hour, 2-hour, and 3-hour
What is the purpose of the D-xylose starvation, vomiting, or low carbohydrate
absorption test? specimen are drawn. Gestational diabetes diet. The ketones are acetone, acetoacetic
is diagnosed by two or more of the acid (diacetic acid), and beta-
It differentiates malabsorption of following venous plasma glucose values: hydroxybutyric acid. High levels lead to
intestinal origin from malabsorption due fasting >=105 mg/dL, 1-hour >=190 mg/dL, metabolic acidosis (ketoacidosis).
to pancreatic insufficiency. D-xylose is a 2-hour >=165 mg/dL, and 3-hour >=145
pentose sugar that is absorbed in the small mg/dL.
intestines without the action of pancreatic
enzymes. Following oral administration of A 60-year-old diabetic has a blood glucose
of 210 mg/dL. His urine glucose is
D-xylose, blood or urine (collected over a 5 What is microalbuminuria?
hour period) is obtained. Low levels of negative. Assuming there are no
Excretion of urinary albumin at a rate of substances in his urine to inhibit the
xylose a re suggestive of an absorptive
defect in the jejunum. 20-200 ug/minute or 30-300 mg/24 hours. glucose reaction, what might account for
These low levels are below the sensitivity the apparent discrepancy in these test
of routine urine screening methods. results?
Microalbuminuria is highly predictive of Diabetics may develop elevated renal
diabetic nephropathy in type 1 diabetes. thresholds. That is why urine testing is not
a good screening test for diabetes What is the reference range for a fasting
mellitus. glucose in an adult?
This method requires the use of a serum
sample. 70-110 mg/dL

What is glycated hemoglobin? Somogyi-Nelson

Hemoglobin A with glucose attached to What is the clinical significance of an

the beta chains (hemoglobin A1). It is elevated glycated hemoglobin
comprised of hemoglobin A1a, A1b, and A diabetic patient who performs home (hemoglobin A1c)?
monitoring of his glucose is ordered by his
A1c. Hemoglobin A1c is the largest
fraction. Some procedures to measure physician to be tested by the local hospital It indicates poor glucose control overt the
laboratory. The patient is suspicious of the past 6-8 weeks. Values >=12% are typical
total glycated hemoglobin while others
measure only hemoglobin A1c. Other quality of care he receives from his HMO, of poor diabetic control. The therapeutic
so immediately before going to the lab to goal is less than 6.5%.
names used are glycohemoglobin,
glycosylated hemoglobin, and fast have his blood drawn, he tests it himself.
His result is 128 mg/dL. The laboratory
hemoglobin. Glycated hemoglobin is a
useful indicator of long-term glucose result is 150 mg/dL. Assuming that both Which test is recommended by the
testes were performed correctly and that American Diabetes Association for
control.
controls were within the acceptable range, screening for diabetes, except during
what might account for the discrepancy in pregnancy?
values?
What is the clinical significance of A fasting plasma glucose.
fructosamine levels? Home testing uses capillary whole blood;
laboratory methods use venous plasma or
Fructosamine is a glycated protein that serum. Whole blood glucose is 10-15%
can be used to determine glycemic control This test will, after addition of barium
lower than plasma glucose. In additiion,
over the past 2-3 weeks. The assay can be hydroxide, produces a brown mixture.
different methodologies are used.
automated and is more precise and less
Folin-Wu
expensive than glycated hemoglobin but
there is currently no consensus on its Somogyi-Nelson
clinical value.
Both Folin-Wu & Somogyi-Nelson reliable method of determining lactose a nursing home. It is placed in a rack for
absorption is the measurement of the pickup by the courier. The sample is
amount of hydrogen in exhaled breath picked up at 9 AM, delivered to the lab at
The protein precipitant uses 2.3N sulfuric after the oral administration of lactose. 10:30 AM, and analyzed at 11:30 AM. Will
acid and a metallic salt are used in: Levels are above normal with lactase the results be adversely affected by the
deficiency because hydrogen is one of the handling of the specimen?
Neither Folin-Wu and Somogyi-Nelson by-products of bacterial metabolism of
Yes. Serum should be removed from cells
lactose. The definitive diagnosis of lactase
deficiency is made by tissue enzyme within 1 hour of collection to prevent a
decrease in glucose due to glycolysis. A
What reagent is used to detect ketones? assays on biopsies of the intestinal
mucosa. preservative such as sodium fluoride or
Sodium nitroprusside. lithium iodoacetate should be used when
testing will be delayed. Other options are
to centrifuge the blood and remove the
How do glucose levels differ in venous and serum or to use serum-separator tubes.
What is the purpose of the lactose capillary specimens? With serum-separator tubes, following
tolerance test?
Following ingestion of sugar, glucose levels centrifugation, the gel forms a barrier
It aids in the diagnosis of lactase are a little higher in capillary blood. In a between the cells and the serum,
deficiency. Lactase is the enzyme that fasting specimen, values are the same. preventing glycolysis.
cleaves lactose into glucose and galactos.
Why is the 5 hour oral glucose tolerance
Following ingestion of milk or milk
test no longer recommended for the
products, affected individuals experience
The precipitation of hemoglobin requires diagnosis of hypoglycemia?
cramps and diarrhea as lactose in the
vigorous shaking of the blood-reagent
intestines is metabolized by bacteria. In Because at least 10% of healthy individuals
mixture in this test:
the lactose tolerance test, glucose is have glucose levels below 50 mg/dL during
measured in the blood following oral Folin-Wu this procedure. Hypoglycemia is
administration of lactose. An increase in recognized by the presence of Whipple's
glucose of less than 20 mg/dL indicates triad: plasma glucose less than 40 mg/dL,
that lactose was not broken down and symptoms of hypoglycemia (nervousness,
A specimen for a fasting glucose is drawn
absorbed. It has been shown that the most in a tube without anticoagulant at 5 AM in anxiety, neurologic abnormalities), and
relief of symptoms by administration of (NOTE: Write the correct concentration
glucose. and name of the chemicals); 2) Sample
required (NOTE: Write the type of
specimen and volume used); and 3) Color
The original procedure will produce 15 mL of the Residue formed.
total volume. It is:

Folin-Wu

Somogyi-Nelson

Both Folin-Wu & Somogyi-Nelson

The better method for PFF is _________

because the 0.3N alkali used adsorbs
interfering substances.

Somogyi-Nelson

What is the end product of anaerobic

glycolysis?

Lactic acid

Compare & Contrast regarding the two

methods of PFF preparation (14 points)
FOLIN-WU METHOD & SOMOGYI-
NELSON METHOD according to the
following: 1) Protein Precipitants used