Okay so let's have electrolytes part 3 The Final part of electrolytes and the final parts cc2 laboratory so the final three electrolytes class i-discuss are bicarbonate lactate and phosphate so let's Begin with bicarbonate bicarbonate class na-discuss natin isya sa Arterial blood gas ang acid base disorders na discussion so some of some of the concepts here Actually gibalik na bicarbonate is the second most abundant an ion in the ecf Kinsa ang first chloride so Actually pwede ninyo siya buhatan o bago ngon ba piso Pwede po na siya bicarbonate outside chloride outside or since una man si chloride then second si bicarbonate Cobo pwede naman mo Okay so we have here bicarbonate but as you can see class kayo ang difference sa levels intracellular and extracellularly but What's important discussion Class is the fact that bicarbonate is coming from carbon dioxide dis in the blood remember that blood is 90% water Uh mga around inana 90 90 to 93% water and because carbon dioxide is a gas Okay it pwede siyang ma-dismiss nakapansin man siguro mo ' ba that when you open your bottle of coca-cola or any other soft drinks kay ' ba mag-bible up man siya k ano man Asan m gikan ang hanging CL ng mag Bubble Up man siya I know kabalo ko bata pa mo k siya ginatan Asan ni gikan ' ba m palit na siya pop up then lutaw ' ba okay that's because the gas there is dissolved in the liquid by dissolved meaning m siya na- dissolve na salt in the water gases can be dissolved also in with glass given that there is enough pressure that is why the coca-cola bottles are Actually pressurized so pagano mo pag-release sa pressure dito na lang siya mafee out angang mga dissolved na gases so in the same way ang hum SP class natin dissolve na gases because dili man coca-cola But we are under an immense pressure of 100 km High up na atmosphere sa inan ng 100 km of atmosphere na to class to the carman line car Anyway that pressure class would Actually exert is exerted in your body na tay ma-solve na gases fun fact lang not so fun on my example if maglabay kang tao sa space na wala si space suit every gas every gas in his or her body class time mag phase out or magb out mag Buble out just like your soft drinks nagopen Okay so inan siya negosyo na pagon sa gra pinasakay ano remember ko sa ako ang friend nga ka ng Chin Chinese pa pa Chinese ang Balay kay kung Magcharge ka bayad bayad OP charge ka bayad um nauso mo to sa una to magburn burn o CD niya nangayo po nangayo po siang series na Avatar dito ko una Nakakita ang Avatar na an book one book two book 3 pabayad ko na yan tag 70 ang isa ka disk mamunit na sa ka ng mga water bottle kahang ipun sa balay kahang ibaligya every after General Assembly organization Med students as mga friends [Tawanan] seryoso naala Ah yun Salamat tayay saver Okay So um yeah Ano Nam review exam ay nagdalag sa par p naghanap magt kid But anyway total carbon dioxide Okay Listen carbon dioxide class a gas that can be dissolved in the blood Okay sa blood ang tawag ised Carbon Dio carb dioxide carbon dioxide Okay sugod nabo Okay so aside sa dissolved carbon dioxide okay ang disolf carbon dioxide mangod it physically mixed lang with water again physically mixed there is no chemical reaction happening but if there is chemical reaction ang mahitabo Class is carbon dioxide becomes Okay sakit mahitabo carbon dioxide plus water in the presence of carbonic anhydrase as an enzyme may mo siyang carbonic acid and then carbonic acid being being an acid it dissociates into hydrogen ion plus bicarbonate Okay so pasagot lang ng statement class na total carbon dioxide is by carbonic carbonic acid dissolve carbon dioxide ang kasabot ng an CL is These are the three forms of carbon dioxide in our body Okay these are just carbon dioxide na lahi-lahi ang porma and more than 90% of the total carbon dioxide Class is in the form of bicarbonate and kani ha timan k naingon naman ako n sa previously but the main function of your bicarbonate Class is for the Saan maintenance of the normal PH which is 7.35 to 7.45 thus Later on ma-discuss na to that measuring the total carbon dioxide is indicative of bicarbonate measurement okay Ha the fact that carbon dioxide can have can exist in three forms dissolved carbon dioxide by carbonic and carbonic acid means that we could measure bicarbonate by measuring the carbon dioxide content sa blood Okay m naung pasagutan so yun pinaka major function niya major component of the buffering system in the blood What is the second major buing system in the blood okay it's the phosphate buffer system phosphate buffer system ang major na to is the Uh bicarbonate carbonic acid buffer system ginoo ko grabe na ni katulo na ni so discus pa ba ni ha del na ha o kanip What happens sa renal tub ninyo in cases of acidosis kay acidosis class this will try to excrete hydrogen ion in exchange for bicarbonate as to the details on how this happens kab review siya singer diagram singer kung makamata sa inyong in alkalosis seee What happens in alkalosis with a relative increase in bicarbonate ion compared to carbon dioxide It Could result in alkalosis class i-review lang ako sa inyo ha because it is essential for you to understand kung asa sa duha carbonic acid carbonic acid carbon dioxide carbon dioxide and bicarbonate ang maka-concentrate bag equation pede na siya i shorted into PH is directly proportional to the amount of carbonic Acid and indirectly proportional or inversely proportional to the amount of carbon dioxide or the partial pressure of carbon dioxide k Saan may pasabot an class that when bicarbonate is low PH is low naman it's just mathematics if the numerator is low l value okay k bicarbonate is also High Alpha ang labas pero if the pco2 is low taas ang PH if the pco2 is high baba ang PH so ang isa po sa conclusion Pwede niy makuha ang trabaho ni bicarbonate is to give alkalinity ang trabaho ni pco2 is to give acidity to the blood and kung balance ang level sa duha then normal ang level sa ah PH sa dugo so na iincrease in bicarbonate compared to carbon dioxide kung mash si bicarbonate then alkalosis ang labas so buhat sa kidneys class kidneys increase excretion of bicarbonate into the urine carrying along a cut ion like sodium so ang trabaho k ni kidney is just to normalize as a compensatory mechanism pababa si bicarbonate so that bumalik sa normal ang PH but What's important here because electrolytes discuss pag excrete ni bicarbonate nao sa inyo ha pag opposite ang charge magsabay sabay bicarbonate is negatively charg sodium is positively charged opposite sila sabay sila gawas Pero kung same charge kambyo magkamot Okay loss of this ion from the body helps correct PH So how about acidosis class un saung may tabo or what is the what is the cause of acidosis mas taas ang Okay relatively mas increase ang carbon dioxide that is why mas acidic siya So sa buhaton Saang kidney class instead of excreting bicarbonate just like for alkalosis ang may tabo is mag-ex siya of hydrogen ion into the urine and exchange or yun bicarbonate is reabsorbed virtually completely now you Might Be thinking sir negative Manya sir hydrogen is positive Well that's not how it works Okay kanina Naay mga exchange exchange at ang mga mga ions the exchange naabo because balik mo sa diagram investigate ng si hydrogen gaas then bicarbonate Okay mechanism nga magdungan or mag-exchange again ha bicarbonate Is reabsorb Pag acidosis as siya G reabsorb pct and DCT 90% sa pct and 10% sa DCT almost virtually all of the bicarbonate is being conserved just to Combat the acidity acid acid base imbalances it causes changes in bicarbonate and carbon dioxide levels decrease bicarbonate may occur from Metabolic acidosis as bicarbonate combines with hydrogen to produce carbon dioxide which is exhaled By the By the lungs CL ha i-review na lang too akong video regarding an Okay kung sa may reason ngo kung taas ang bicarbonate baba ang ah PH or baba ba h mataas ang PH an k inon kung mataas ang bicarbonate mataas ang PH meaning mababa ang hydrogen ion tama B ha Hwag kalimutan when it comes to PH and hydrogen ion concentration baliktaran siya because the p stands for baliktad kapalitan siya Okay so kung taas ang PH baba ang hydrogen kung baba ang ph taas ang hydrogen and just a brief explanation nga naman sir kung taas ang bicarbonate mahurot ang hydrogen ion mababa ang hydrogen mataas ang PH ano lang sa pinaka na answer to the question ngan naman makataas ang PH ang bicarbonate kung taas ang bicarbonate halos mahurot or kaang gamay ang hydrogen kayang magin kaon pasabot sa kaon ako gin combine may may mic acid then G na exhale sobrang mawala ang hydrogen It seems as go nawala ang hydrogen Okay pero what about kung baba ang bicarbonate kung baba ang bicarbonate then mag-build up si hydrogen k wala may mo wala may mo tanggal saah ang itanggal mag kay canis bicarbonate carbonic acid then maexpel as carbon dioxide Okay so ang compensation class sa ang siya acidosis is hyperventilation a I hope nakasabot na m ano hyperventilation in hyperventilation you have rapid deep breaths ting an naman mo siyang GT expel ang carbon dioxide because again acidic baan So you're trying to lower the acidity and the reverse through pag Metabolic alkalosis it results from a gain in bicarbonate kung daghan kay bicarbonate then mag-alala is baliktad hypo ventilation hypoventilation which increases the carbon dioxide so diretso na sa toang determination the specimen is Venus serum or heparinized plasma as usual heparin It's heparin kabalo mo joke naingon na ba Ayaw na lang Okay maot na dili pang 7 ng [Musika] joke k mo Bes akong delivery ay ang akong akong It's heparin si mal It's he ma Okay Seryoso na okay plasma Okay we have to make sure na anaerobic ang collection sa other electrolytes ang dapat anaerobic ang collection calcium ba Okay Let me explain masabot pag anaerobic ang collection explain mo sa inyo dapat close system siya pagot sa close system mag gamit ka two way needle yung ginabuhat CL magkuha mo from syringe ginatang ang nle and then gabano ang cap sa iong tube then gabos lang siya open system na siya okay sa clos system is dapat Exposed sa air or sa outside environment ang atuang blood na gin collect And that's the ano um that's one of the reasons why ets evacuated tube system is still Uh preferred over se R method kay closed system man siya especially for kan Uh collection for bicarbonate if the sample is left unc before analysis carbon dioxide escapes because carbon dioxide just like how you open your Uh your bottle of coca-cola mga gawas ang ang gases kung ma-expose po na sa air class ang blood manggawas ang dissolved carbon dioxide at a rate of 6 millimoles per L per hour By the way ang kasagaran nagakuha N is Uh respiratory therapies resp therapies n okay okay we can use ion selective electr class to measure for bicarbonate it uses an acid to convert all forms of all forms of carbon dioxide to carbon dioxide gas is measured by a pco2 electrode can you still remember pco2 electrode atong dito sa onong electrochemistry mas say other name ni pco2 electrode starts with okay St letter C saing house s na siya s ang sing house sing house electrode Okay the idea here is this bao kanina that your bicarbonate and carbonic acid as well as carbon dioxide are just three forms of carbon dioxide ang ginabuhat Class is to measure for bicarbonate is kuha si i-convert pa ng forms of carbon dioxide back to CO2 Okay na ako i-drawing ha or Naisulat if you apply an acid magad acid sa sample class all forms of carbon dioxide carbon dioxide Okay including bicarbonate now in this method class acid ang sample ma-convert ka ng forms of carbon dioxide back to CO2 gas and then imuhang gamit pco2 electrode by measuring the pco2 levels can in directly measured bicarbonate because remember 90% of your total carbon dioxide is bicarbonate or kung h ka gustong indirect method You can also use the direct method in which ang bicarbonate J ang imuhang i- measure directly using enzymatic method but instead of okay k acidify ni mo n mo siyang Uh CO2 gas and then magamit k pco2 electrode Okay pco2 electrode k kung magbutang ka alkaline reagent si alal aliz mahimo na siyang bicarbonate dissolve carbon dioxide carbonic acid siyang bicarbonate and this timey bicarbonate ang method is enzymatic method Okay so in si P measure my Carbon is used to carboxylate po pyrate in presence of phospho pyrate carboxylase which catalyzes the formation of oxaloacetate and then ang next step is just pareho siya sa Carmen method you you can still remember Carmen method we make use of mal de hydrogen to convert oxaloacetate to Malate with the use of coenzyme reduce nadh back to nad ni Nam may nadh pila ang wavelength 340 nanometers kasi 430 ah d Okay o dili Okay Pate plus Carbon ah carbon dioxide carbonate in the presence of tanawa Mali mali na po si Bishop This is pep carboxylase fpo pyr carboxylase it becomes oxaloacetate and I don't know ano naive as B phosphate pero sige bip phosphate and then ang oxaloacetate with the Uh with the presence in the presence of mal hydrogen ise it converts oxaloacetate nadh plus h into Malate and oxidized nad now asa sa duha Ang gina measure sa 340 nanometer sa spectro is it the nadh or nad n nadh since n siya sa substrate na side Increasing or decreasing decc decreasing ang atoang um absorbance absorbance reading Now let's go to phosphate akong in skip ko sa lactate ay kabala wala kaang nakatulog Okay so si aven nakatulog w lagpas ako nakatulog ko oh wala kinan driver Okay f fate ang function sa phosphate class is since wid spread siya eff function um I'd like to think of magnesium class as something as kaang function wise wid spread pero location wise phosphate is M wid spread sa body location wise K ano man all of your cells in your body is made up of cell membrane and cell membrane is made up of phospholipid by layer pa lang sa cell membrane nag kay phosphate not to mention the phosphate sa ATP source of energy not to mention the the ATP sa muscle kaang creatine phosphate na mga other Uh biomolecules like your DNA RNA ba k phosphate sugar phosphate sugar backbone Okay not to mention all other processes in your metabolism that makes use of phosphate the kayo Ayun participates in many of the most of the important biochemical processes in the body to name a few just a you we have Glycolysis ng I hope inyo ha pa siyang Familiar Familiar I hope at the very least Familiar sa inyo ha glucose ah with the help of hexokinase hexokinase may siyang glucose 6 phosphate and then with the help of I don't know kungan na to siyang ah um base phosphofructokinase nakalimot ko isomerase ni siya may mo siyang fructose then another kinase here and so on pansinan niyo k p that's phosphate okay specific functions it serves as a reservoir of biochemical energy for example adenosine triphosphate in sa sa muscles we have creatin phosphate and sa at Glycolysis we have the phospho pyrate okay and also the two 2 3 dpg in red blood cells ng 23 dpg 23 di phosphoglycerate What's the other name for 23 bpg 23 B phosphoglycerate or 23 bpg un specific function ni 23 dpg sa cell is related to oxygen What oxygen affinity sa hemoglobin oxygen affinity hemoglobin Okay na Remember ninyo ang curve mga oxygen dissociation curve isa si 23 dpg is nagaa affect sa Oxygen dissociation curve another question as in produce si 23 dpg na ba siya dire tawag pathway and then mayor hof pathway katong sh In which ano katong gluc gluc phosphate ah Hex monos but you still haven answered my question asway c23 bpj na buhat starts with R zer ra ring pathway raping pathway bearing spelling sa L bearing ha leu bearing Okay Fate may be absorbed okay how does your phosphate being regulated sa inyong body phosphate may be absorbed in the intestine from dietary sources Okay so Malamang for as long as mukaon ka tinuod ng pagkaon Nandyan na siya phosphate Okay so now question sa inyo ha na ba Food ng d Gan sa living thing living organism virtually all food is coming from living organism ' ba and all living organisms are made up of cells and all cells contain cell membrane and cell membranes are made up of phospholipid by layer so nandyan a phosphate ang food Okay Nandyan na phosphate ang food I think ang bread we Yeah Wala siyang cell pero gikan siya sa living organism pero wala siy cell wala siy cell starch lang Ana ang yeast un Liven bread gamit unlv bread walang yeast anyway okay phosphate is also regulated lango ko makalusot regulated by kidneys It's released from cells into the blood and lost from bone class pina just like magnesium and calcium phosphate is also stored in the bones specifically your calcium and phosphate makes up the mineral hydroxyapatite which is the main mineral sa inyong bones Okay what are the hormones or conditions that regulate your phosphate your phosphate in the blood feeling sikat every mag dapat butangan ninyo ano butangan ninyo flash Mar okay ayaw na okay hormones conditions affecting phosphate levels we have Vitamin D Later we will talk about un sa iyang effect calcitonin Yes just like your calcium ng yapon growth hormone and acid based status Okay Depende kung alkalosis or acidosis parathyroid hormone overall lowers flood concentration by Increasing renal excretion so baligtad ang effect ni calcium sa yaha kung si parathyroid hormone nagpapataas sa calcium levels si si parat hormone nagpapababa TY phosphate Okay how by Increasing the renal excretion but even though pth lowest phosphate class Actually Hwag po iabot si parathyroid gland sa levels ni pth ang nag-kontrol gapon kung whether the parathyroid gland releases parathyroid hormone It's still calcium si calcium n diapo na siya damay-damay lang si phosphate so specifically pth decreases phosphate reabsorption at the proximal convoluted tubule so effect ni Vitamin D class Vitamin D acts to increase phosphate in the blood ginapas niya si phosphate how increases both phosphate absorption in the intestine and phosphate reabsorption in the kidney kan ang medyo ano ko baang ah whenever I I Uh read or i kanang teach about phosphate and calcium class mura sila away bati kumbaga kay nga naman si Vitamin D pareho og effect kay phosphate calcium pero pagabot sa pth opposite Okay growth hormone Uh increase secretion or administration of growth hormone phosphate concentrations in the blood may increase because of decreased renal excretion of phosphate so si growth hormone po if it's administered sa patient or even ka nam mutaas siya in cases of ka ng mga um hyper hyper secretion of growth hormone like acromegaly or gigantism then it results in increased levels of phosphate Because growth hormone increases phosphate reabsorption You are very familiar with this because n siya sa slide sa calcium nap siya sa slides sa ang calcium homeostasis pero at ang Focus kon is on the phosphate parathyroid hormone CL sa yung effect sa phosphate sa bones ang effect niya is invol pth stimulates osteoclasis activity releasing releasing calcium and phosphate Okay ah sa kidney na kidney pth promotes absorption of calcium but also excretion of phosphate so dito siya kalaban dito siya kontra kumbaga lahi siya calcium meanwhile your Vitamin B promotes intestinal absorption of phosphate okay ang phosphate Class is po4 na siya po4 a 3 po4 TH ka by kataan langat Saan ba phosphate then you Might Be wondering ano nagingon ko total phosphorus because class phosphorus is an element pero as an ion ang form sa phosphorus onong body is either bip phosphate or phosphate Okay so ang gining is ang total phosphorus content body is about 12 mg per DL and 3 to 4 m per DL of that is in organic phosphate kami ha p inorganic phosphate the is not connected to any organic molecule so ka ng phospholipid by layer organic phosphate na siya k phospholipid man lipid Is an organic molecule so mga example sa inorganic phosphate free and unionized phosphate together with other anons or C rather like calcium calcium phosphate so siy mga inorganic phosphate okay it's the predominant cellular intracellular an ion so 80% of the phosphate in your body is in the bones 20% is in the soft tissues including all all Actually all soft tissues in your body and less than 1% is active in serum or plasma now plus since present man siya sa Asan na to Ayun Mas daghang siya sa intracellular daghang siya sa intracellular atom phosphate Now let's jump to the clinical significance agag clinical significance I Am narrating Here the different conditions or diseases that might lead to hypophosphatemia so cause effect Okay hypophosphatemia occurs in about 1 to 5% of hospitalized patients so 1 to 5% of hospitalized patients have hypophosphatemia and that percentage increases to around 60 to 80% in icu patients with sepsis Okay mas taas ang incidence of hypophosphatemia in icu patients with sepsis ang sepsis Okay active na active na infection micro espcially bacterial infection sa dugo your dugo is supposed to be aseptic pero k bacteria together with its toxins gase then that is sepsis hypophosphatemia occurs also in diabetic keto acidosis copd asthma malignancy naun siya sa malignancy longterm treatment with total parenteral nutrition Are you familiar with parenteral nutrition okay ang parenteral nutrition Class is nutrition given to a patient na di nakakaon o wala siya iagi sa gastrointestinal tract niya iagi siya sa IV iagi siya sa IV si mag Yeah kung mo IV line I learned from IV line should be replaced every 3 days at the very least kay makaa na siya sepsis But anyway parental parental nutrition class Is Pag iagi siya sa IV line ang nutrition vitamins micro nutrients and macronutrients Especially if ang patient kili na makakaon longterm treatment with toya inflammatory bowel disease inflammatory bowel disease is P na inflammation sa colon Okay Nat anor nervosa I think Nation na ko siya sa inyo ha What's the difference and also alcoholism So what are the mechanisms at which hypophosphatemia Could Happen it can caused by increased renal excretion as with hyperparathyroidism nga naman does it makes sense hyperparathyroidism it creates hypophosphatemia Sige daw pagtaas ang parathyroid hormone increase ang renal excretion sa phosphate Okay so makakuha siyang hypophosphatemia decrease intestinal absorption as with Vitamin D deficiency or antd use Okay on the other side of the coin we have hyper fpa with okay with maybe caused by acute or chronic renal failure increase intake so mag-increase intake of phosphate that is especially especially susceptible ang mga neonates ng nag breast milk because na phosphate ang milk and since pa Mature ang ilang parathyroid gland Okay so basah na lango because they may not have yet developed mature pth and Vitamin D metabolism neonates are especially susceptible to hyperphosphatemia cause by increase intake such as from milk or even laxatives increased release of cellular phosphate Ano Saan mag-increase o release ang cellular cellular Uh membrane or ang cell mismo o phosphate class in cases of Breakdown of cells K ang Breakdown ng cells pag ma-damage ang cells s infection intensive exercise Yeah even intensive exercise It Could damage your sense Actually have you heard about athletes class na too much ang intense King exercise nagpula ilang ih Okay nag-ano din na-release ang myoglobin myoglobinuria sila okay some of their muscles kay na nagka Wear and tear ba Okay ah neoplasm cancer and intravascular hemolysis Sige daw What are examples of diseases that causes intravascular hemolysis pasabot sa intravascular hemolysis first ang RBC dur phlebotomy but suod sa body intravascular intod sa vascular vascular pertaining to blood vessels in cases of diseases give me three k na ha give me three lang Mal correct Depende sa lukimya Depende sa lukimya duhan na lang auto inun Huli ninya pwede Yes Wala dito ak nadungog sa answer name pwede Okay seal cell anemia pede kay siya in naka ano siya in naka pronounced ang ano pag hemo Pero pwede nga pwede Okay so those are the some of the conditions that might result in intravascular hemolysis Okay kani determination of inorganic phosphate so ang specimen na to is Zum Lithium heparin plasma TH shall not use oxalate citrate or d it can interfere with the analysis and Kat inon ako kanina Since intravascular siya intravascular intracellular siya Hindi siya pwede ang holed because mag false increase ang atoang phosphate levels Okay circulating phosphate levels are subject to circadian rhythm and Okay there are certain rules of th class there is discussion clinical chemistry or even Medical Technology in General and one of the very common ng rule common na rule of thumb pa okay rule of thumb na to Class is kung Nain circadian rhythm G ang analy kailangang urine for the determination of that analyte 24h urine specimen J again ha k circadian rhythm for example King phosphate highest in Uh late morning and lowest in evening then kailangan na 24 hour ur Why variation hindi hindi siya f sa time tagtag Sige kan nagig out true Ah tama to siya So the idea is if you're going to think about it depending on the time of day nagataas o nagbababa siya Okay hindi mo ka pwedeng kaa lang ka kukuha because that would be depending on the time of the day either taas or baba so put do na lang para mo average out siya Okay para mo average ang atuang levels of ah analy Ako na lang ring for those of you visual na ta so siang levels siang time of the day kung siya circadian rhythm for example Nana ka pwedeng mamilig time kung sa magkuha so and then mag aage out siya okay Gan kay kung sa method class sa phosphate Okay determination of organic phosphate involves the formation of ammonium phosphate complex okay pamin ang atuang reagent class sa determination of inorganic phosphate is ammonium molybdate ammonium molybdate ammonium molybdate CL forms a complex with phosphate to form ammonium phosphate complex in a method known in the method known as fisc subo method Okay tut lang ako sa inyo ha alban Lane sodium lock head and personel potassium CM mag magnesium ocpc that is for [Musika] calcium sh and sh chch chlor iconnect Okay grabe kaulan kay mga nais kaang reak sorry this is for academic Okay sige paminaw pos reacts with ammonium mate to form ammonium phosphate complex and the ammon phos Complex ang ling is same wavelength k nadh 340 nanometers It's measured at UV light at 340 nanometers pero If by chance Wala kay UV spectr photometer sa inyang laboratory you can you can convert this to a colorimetric method sa siya ice IU mo ang ammonium phos complex using reducing Agents gamit kang reducing Agents to reduce ammonium phos complex para siyang Php moinum blue or in some textbooks moinum blue lang ang phos blue blue k color which isue that can be read between wave bls 600 and 700 nanometers CL question un sa ang reducing Agent para maus ang ammonium phosphate Complex to phos folin blue let me enumerate si reducing agents kumbong Okay we have piol or ang pangalan niya is ammonium naal sulfonic sulfonic acid sulfonic acid piol ammonium naol sulfuric acid Uy idol Idol pwede Papi tol yan sige na sila pa-picture ah that's that's enough tol Okay m ang pinaka Gina ginagamit na reducing Agent ang others kay nabutang siya sa others okay it starts with ilon don't mention that name that maxy Max Okay which is methyl amino phenol another celebrity penin diamine hydrochloride and lastly is ascorbic acid which is how anticlimactic so na siya ang mga reducing Agents that converts ammonium phos to phos yung blue piol ah ilon cine and ascorbic acid I forgot to mention phosphate is one of those electrolytes class or Actually siya lang yata siya lang ang electrolyte na lahi-lahi ang reference range Depende sa edad Depende sa edad sa pasyente which is kung gusto ninyo i-connect sa enzymology remember alkaline phosphatase is also that one enzyme na L lahi po ng reference range Depende sa edad pwede na to siyang connect kay phosphate okay last of the three lactate which is the the add add one out sa ang Uh electrolytes na discussion because lactate Class is a byproduct of an emergency mechanism that produces a small amount of ATP when oxygen delivery is severely diminish Okay Before I discuss to you That previous slide balikan for those of You forgot This is the metabolism of Glucose reaction okay okay we have the macronutrients carbohydrates proteins and fats just a review of how these are metabolized in your body to produce energy Let's start with carbohydrate Carbohydrate is Uh manch mch Digest Digest Digest May siyang from Uh polysaccharide may oligosaccharide and then may mo siyang monosaccharide specifically may siyang glucose then glucose through a series of enzymatic process ang end product sa Glycolysis is pyrate ang pyrate himuon siyang acetyl coenzyme a which enters the crb cycle How about proteins proteins can be digested into individual amino acids and then those amino acids could enter the CB cycle in so many ways including convert conversion to pyrate and conversion directly to as enzyme a How about your fats fats may be digested into individual Fatty acids and then through beta oxidation mah mo siyang atil coenzyme a ang pinakapunto the class Is everything would enter into the CB cycle na si crb cycle siya Ong series of enzymatic reaction gapon that produces carbon dioxide gamay ng ATP but most importantly daghan kayo ng nadh and fadh H 2 because kanis siya mun siyaang gamiton sa electron transport chain which is also a series of enzymatic processes which ends up creating ATP Okay ATP but most importantly saong discussion Grabe kag most important ang oxygen is used sa electron transport chain Okay ngan naman si oxygen ang final electron acceptor kay electron transport ch ba So electrons are being transported in a chain electron transport chain pero it's not It's not an Uh it's it's not an endless chain Pilar na siya ka enzyme ang mudawat pinaka final sa electron si oxygen converting oxygen to water and this is aerobic aerobic ni siya na ah aerobic na metabolism or also known as oxidation mait oxidation ang term because it makes of oxygen Okay duha ang gusto natim Nino Oxygen is needed in electron transfer chain meaning kung Wal oxygen Wal etc walang electron transport chain okay ikaduha ang trabaho po electron transport chain is to convert nadh and fadh2 back to nad plus and fad meaning from reduce k ba reduce man siya hydrogen ang trabaho Nic is to bring it back to its oxidized form ngo oxidized form k oxygen oxidize nadh fh so k Oxygen is needed in electron transfer chain and Uh Oxygen is needed for the oxidation of nadh back to oxidize nad balik sa first SL okay pa ta Okay Pa ta Pili na lami na uli ulan pa ba sayang okay so pake is the normal end product of glucose metabolism okay pamin Ha pyrate is the normal and product of glucose metabolism but conversion to lactate is activated when a deficiency of oxygen leads to accumulation of excess nadh Let me explain this final sentence here Okay na-remember nio Ong dring apart let's focus on this part everyone let's focus on this part p turning to a Okay so si glue slaps may na lang ba kay Batasan teach kung mga ta katawan koyo k okay sa spc ko sa kay akward is ang mga estudante exaggerated na onor since Beginning glucose glucose is converted to pyrate Okay Focus na dito sa pyrate itzy pamang ha ang Pate before siya enzyme kailangan oxidize n8 okay because this process C of converting pyr to acetyl coenzyme a kailang Poy subsequent conversion of oxidized nad to reduce nadh Okay and then ang a coenzyme a mulod sa creb cycle and then ang creb cycle itg mga nadh Okay want to sa electron transfer chain mahimo na po siyang oxidized Ned ang oxidize Ned balit para i-convert the Spy to aco enzyme a so in a way it's the conversion of oxidized nad to reduce and then oxidation back to oxidize nad that drives this reaction py a point and then the whole process creates 38 moles of ATP Grabe niya ka daghan na magharvest na ATP now What happens kung naay ah oxygen deprivation sa cells meaning hpx siya na kulangan o oxygen ngan naman sir daghan kay ways na makulangan o oxygen ang cells it may be there there is a blockage sa ang blood vessels ma ang RBC nakatulog oxygen or maybe that the organism or the human is is is in an environment na kulang ang oxygen ' ba Sige So what happens now magshutdown sa electron transport ch wala mo oxidize k nbh back to oxidize NB mag-build up si nadh now kung mag-build up si nadh last instead of pyrate turning to ayco enzyme a the reaction is now pyrate to lactate k na Remember yung discussion na to sa lactate dehydrogenase kung saama na ang invivo Reaction sa lactate dehydrogenase pyrate in the presence of nadh plus h then converted by lactate dehydrogenase to lactate and oxidized nad so in lang ang pyrate kung na oxidize sa nad padulong siya dir pero kung wala kaya ang naak reduce nadh then siya andan nagh siya agag naay loss of oxygen Okay nag-shutdown ng electron transport chain that is needed for the conversion of nadh back sa Des but in the process kay wala mo siyang naisulong CB cycle Wala siyang nudo sa elect transport chain walang ka ATP ang naproduce so meaning the loss of oxygen results in the loss of ATP not really loss kang na produce but comp sa 38 moles of ATP kanina ng na oxygen and then karon nga wala na oxygen 2 moles of ATP na lang na a huge loss and remember ATP is needed sa tanang cellular processes Okay production of DNA RNA ' ba population of certain enzymes and kinases the release of hormones kailangang ATP ' ba ang glucose para mahim mo siyang glucose 6 phosphate kailangang ATP not to mention the sodium potassium ATP is p Okay so k apektado na processes kung makulangan ng ATP nakulangan ng ATP because kulang ang or walay oxygen loss of oxygen results in cellular death Okay so ang ano ni byu of an emergency mechanism because in the loss of oxygen your body still try to create ATP no matter how hard it is Ito lang 2 moles of ATP lang produce so Moto siya no ah aerobic metabolism and then na po T anaerobic metabolism anaerobic pertaining to the loss of oxygen Okay there are instances class that there is build up of lactate even though kaang normal healthy ang person for example ha example na rin siya this is just one of the examples na mag-build up ang lactate intense exercise in intense exercise class Grabe ka hyperdrive sa imang Glycolysis scb cycle electron transport chain But there will come a point na sa sobraan ka- exercise n mo and then dili pa proper moong breathing mag-apas or wala ka wala kaapas ang imong oxygen so some of the glucose Class is being converted to ATP via anaerobic metabolism for example can Glycolysis sa toang skeletal muscle active na skeletal muscle so Since anaerobic siya kulang mag oxygen What happens now some of the pyrate becomes lactate pero class makadaot ba sa body ang lactate can your body recycle lactate Yes ang lactate sa blood stream ku ni liver It's mainly the liver's job to get rid of and convert it back to glucose in a process known as gluc neogenesis the production of new glucose from non carbohydrate sources lact is not a carbohydrate and The Cycle con continuous ang glucose na naproduce ni liver ibalik ni kay muscle k par libotlibot lang ang tawag cycle Cor cycle Cor cycle para Cory m or Okay ginon sa pag-regulate kay lactate m si gining ako ng add add one out ang atong lactate because it's never regulated at least not directly Kaya nga naman ma-produce namo ng lactate during anaerobic conditions so lactate is a byproduct of anaerobic metabolism TH it is not specifically regulated walang specific na other than Cor cycle of course pero kaang as to as to um un Saon siya pagr sa kidney un Saon siya pagano wala wala Iyung specific na mechanism as oxygen delivery decreases below critical level blood lactic concentrations rise rapidly and indicates tissue hypoxia earlier than PH okay to sum up kaning kaning ano kaning part sa onong discussion lactate is an indication of tissue hypoxia so meaning kung kulangan ng oxygen hypoxia low oxygen mag-build up si lactate and the major organ for removing lactate is of course liver converting lactate back to glucose by gluconeogenesis o meaning Sige daw coming from this discussion un clinical significance la kung doctor knowing that L isaas during hypoxic Uh St ano sa siya i-request ang naka ventilator Saan Okay clinical significance early sensitive and quantitative indicator of the severity of oxygen deprivation of the patient gusto ka makabalo how well oxygenated ang body sa pasyente you may use lactate as an indicator Okay na for Metabolic monitoring in critically ill patients for indicating the severity of illness and for objectively determining patient prognosis mag build up na Gan ng lactate sa pasyente class na nasa icu then okay ang prognosis so prognosis progress sa disease prognosis Okay isa-isa na-discuss na to kanina These are the Metabolic effects of hpo leading to sell them all starts with decrease supply of oxygen to the tissue who could give me two examples of instances or three na lang three examples of instances kulangan oxygen supply sa tissues haem correia pertains to the kulangan supply sa dugo dito sa an because of blockage what else trauma yes okay mechanical or physical trauma sor ha natigasan ang so loss of blood supply mga arteries kut off what else low blood pressure pwede naman low blood pressure low ang perfusion sa blood padulong sa organs hypothermia ang pagbaba ang um temperature sa environment class your body will try to preserve all of the heat towards the core body wala na siya sa extremities magstart na siy bluey okay leading to Frost bite in extreme cases magit na lang magang grose na siya So Ayun loss of oxygen supply to tissue it causes Okay it diminishes the oxidative metabolism rate m si k Ining loss of oxygen leads to mawala ang electron transport chain naminaw pa ba okay pa T mag accumulate si nadh k Nation ako kanina so instead of lactate Sorry instead of py becoming acy coenzyme it becomes lactate so py converts to lactate inad of lactate accumulates mag accumulate ng lactate class Okay lead sa tinatawag lactic acidosis because lactate can be also lactic acid depending on the pH Okay pero ang tawag is lactic acidosis so it lowers the pH much less ATP is produced ng ATP so disruption na nagkaroon sa cellular factory intracellular ionic environment is disrupted because of the sodium potassium at pump being fun wala shut down siya So what happens sodium it goes in potassium goes out instead So soin sipo sipo okay via the sodium potassium leak channels what else increase calcium and sodium decrease potassium and magnesium and then mag swell ang cell patay cell there are two types of lactic acidosis Okay ako na lang daan ha type a of type B if the condition is halata tayo na Uh the lactic acidosis is caused by loss of oxygen or hypoxic condition then that is type a but if bil sa halata na ang condition is Uh could cause hypoxic conditions But rather any condition class that could somewhat in an indirect way increase the la lactate levels sa iong dugo that's type B okay Ha so type a lactic acidosis in hypoxic conditions type B is in Metabolic conditions example sa mga type a lactic acidosis Uh diseases that could lead to type a lactic acidosis again associated with hypoxic conditions such as shock myocardial infarction ba my card infraction There's a blockage sa coronary artery leading to loss of blood supply TH cellular deaths sa myocardium severe congestive heart failure congestive heart failure pertains to the fact that your heart more congested na siya h naay ataka pump of blood so low perfusion pulmonary edema Saan ang pulmonary edema there is an accumulation of fluid sa lungs murang malumos ang pasyente because nanay loss of or Dili na efficient ang ang pags sa imong oxygen padong sa red blood cells or severe blood loss which is can be also considered as hypovolemic shock hypovolemic shock type B is type B lactic acidosis is Metabolic in origin again these are conditions na siya explicitly you would say na hypoxic condition Okay so in direct na kay siya So these are Metabolic in origin for example Diabetes militus severe infection you would not think of hypoxia when it comes to severe infection Leukemia liver or renal disease maybe sa liver disease d kayo Siya maconvert ang lactate back to glucose and toxin such as ethanol methanol or cicel poisoning very very very good to know lang type B lactic acidosis has three subtypes B1 B2 b3 tataman specimen handling Okay specimen handling sa atang lactate take of ammonia kay pare-pareho siya pag collect k ammonia teric should not be used just like ammonia and un sa pa Ong d pwede teric potassium Pero in in practice nagamit ng internity sa potum Okay after sample collection anaerobic Glycolysis will occur so ep pariz plasma mas mas Ha Ah okay may par plasma but must be delivered on ice and the plasma must be separated quickly pati ako nangangaso anguk ng PowerPoint Okay pariz plasma but must be delivered on ice B siya pareh sa Disney on ice ha nak skating kaab mo ang tuang tube dito sa ice water slurry ako siyang i-emphasize sa inyo ha do not use ice Cubes dapat ice water slurry na siya naag shake consistency no ha kung nagamit kang ice cube class let's say this is ice cube na ako siya himuong ano geometrically correct ice cube Okay snowflakes Ayan na Okay so na test tube the notice class that at the points of contact sa Ong ice cube dito sa onong test tube class naa but for those portions nga wala in contact sa atong ice cube Dili siya bu now so there are differences in temperature sa different contact point sa to ang specimen so ang pinakin na buhat Class is to put water here Okay para equal ang ano equal um distribution sa low sa low temperature plasma must be separate separated quickly k nga naman siyang lahi sa red blood cell because of this anaerobic Glycolysis will occur and remember Okay kan pa un metabolism or is Glycolysis ang ina prefered sa inyuhang red blood cell aerobic anaerobic at aerobic k an Nam manag reasons number one kung saan pag electron transport ch RBC mitochondria and number two mag aerobic metabolism oxygen consume sa Oxygen G deliver murag nagp nagp grab food ang driver kutom sion pa-deliver ha so your red blood cell won't consume the oxygen that it delivers so mag anaerobic metabolism fluoride and iodo acetate inhibits Glycolysis but the specific method directions must be consulted so na mention si fluoro acetate ambot lang siguro si fluoride antig glycolic Agent siya remember sodium floride Okay ako discussing si not be us Venus stasis pag magpundo ang dugo will increase lactate levels if aic is used blood should be collected immediately and the patient should not Exercise the hand before or during collection bawal na siya just like and ammonia so siya Tim siya mga mga kailangan nakaalis ammonia lactate pa ba um Pwede po 24 hour urin ipab siya para walay bacterial proof ah ma-suggest ako sa inyo ha makatabang siya sa board examp Pag ipon parod mga flash cards index card Like for example isulat nyo dito ang mga M summ for exle anal That must be transported on ice pwede ilist enzymes e number execu summary how to enzymatic method lang siya it uses lactate oxidase to produce fire weight and hydrogen peroxide and then since hydrogen peroxide trinder reaction siya ang next onong trind reaction hydrogen peroxide plus chromogen plus kalimot ko sa isa ka plus converts to bi the um peroxidase na enzyme may mo siyang colored reaction plus water so Mayon siya lactate plus oxygen halata kay lactate oxidase man siya may siyang Pate and hydrogen peroxide and then next is blinders reaction hydrogen peroxide plus Okay Malin siya h donor donor na siya okay and chromogen example sa trinder reaction is wala nakalimutan ko um hydrogen peroxide Plus phenol plus help me for amino antipyrine then k5 n if I remember [Musika] Wal Pam ginagamit hpal Okay paminaw di ba an kung lactate is para ma-determine ang oxygen or ang oxygenation level sa pasyente which is di ba kuha pa kang dugo mag-turn around time pa 2 hours Max na may real time class na makait sa Oxygen fse oximeter kinang Soo nawala na siya method ang l still some value to it if ang gusto the oxygen levels then go for Go for the real time monitoring for Oy any questions gamit ammonium molate magreact kay phosphate to become ammonium phos p wavelength 340 Nom pce into blue orum blue which can be measured at 700 formol B2 phos phos blue number one is piol Elon cenin and ascorbic acid Okay um what is the what is the enzyme used sa enzymatic method for lactate determination lactate oxidase angang ka partner na enzyme is peroxidase how about for Uh enzymatic method for bicarb p carboxylase coupled with Malate dehydrogenase How do you convert convert all forms of carbon dioxide into bicarbonate add alkaline how to convert all forms of carbon dioxide to carbon dioxide gas acidify Okay what's the function of bicarbonate PH it serv a buffer system What is the main function of phosphate Wal main kadaghan serves as an energy reservoir isa sa mga major ni energy reservoir maproduce ang lck kulang ang oxygen mag shutdown ng electron transport chain mag accumulate ang nadh so pyrate becomes lacky okay na sa last portion an ion gap okay if you're like me during my college days maconfuse ko sa an ion gap o os molal gap class lahi si og kay Ag si og os molal gap is the difference between the calculated and the measured osm how to calculate molality how to calculate molality What's the equation 2 times sodium plus glucose div 18 plus bu div 2.83 2.8 ak gag that's calculated osmolality and then on the other hand we measure directly the serum or plasma for measured osmolality and then get the difference kung Naig the po ng difference meaning there are other osmotically active substances in the body other than sodium sodium glucose and puha okay pa Okay so lahi angm gap ha kay anon gap let's discuss an ion gap Okay sige define sa an ion G is the concentration difference between commonly measured cat and commonly measured anion class based on the definition of an ion gap the two most commonly measured cat ions positively charged ions so sodium and potassium meanwhile the two most commonly measured anion are bicarbonate and chloride so the idea there is i-add ni mo ang sodium potassium i-add ni mo ang bicarbonate of chloride tanw mo kung nail difference that's an ion gap there are two ways to measure an ion gap the first equation or lang ni and so either or Okay an ion G could be measured using this formula sodium minus the sum of chloride and bicarbonate bicarbonate levels Okay we could also use the second equation in which you add namin ba sodium and potassium and then iad mo chloride and bicarbonate and then Mol per the differ and 7 to 16 Mol per for the second because as it Mak s 10 m per reference which eas to 10 now you Might Be wondering significance Min Okay forward okay a ang ang body saying have to maintain electron neutrality kung ang isa ka positive charge mulod ang isa ka positive charge dapat mo gawas or kung opposite charge sila Dapat dungan sila un sa pinakapunto an class to maintain electron neutrality because on a body level all and I mean all positively charged substances ions and substances and all and I mean all negatively charged ions and substances dapat pantay sila Dapat same Okay does it Make sense k an naman para walay net negative charge Wal net positive charge ang mga negatives i- counteract ung mga positives inyo nakuha ba nakuha ninyo dapat sa ito tanang negative charge same sa tanang positive charge kin naman ng mga positively charge ions sodium potassium calcium magnesium hinap pa na yung mga positively charged na proteins like immuno mga immunoglobulins mga positively charge mo na siya ba okay how about a negatively charged chloride bicarbonate phosphate lactate negatively Charge si lactate not to mention albumin albumin is a protein that is negatively charge not really an electrolyte But what the hell negative siya Okay so nega pant now in in sa gure pme ng negative positively charge dito lang ka sa two most common positively charge and most common negatively charge sodium potassium soan Okay and then chloride and bicarbonate So sir pantay it doesn't matter because we already know k sila Dapat kalayo 10 to 20 Mol per the difference si un gap y ler gap nak nyo okay normally 10 to 20 m per 142 4 142 for sodium 4 for potassium Min 103 for chloride 28 for bicarbonate 1038 142 4 the average of 10 Okay normally How about in certain conditions let's speak one condition that is lactic acidosis Sir latic acidosis example in lactic acidosis CL there is a buil up of la la is nega charge since lactate is negatively charged t kaning organic acid sige let's replace that with lactate lactate na si organic acid kan white siya si lactate in normal conditions tanawan siya in lactic acidosis na nag pagh na pwedeng lang ang daghan ng lactate because that would mean na mas daghan ng anon kay caton so there should be two things that will happen either paman sa atang body ang all other ions para lang to accommodate your latasan ni body ang atang amount of cat ions k again ang gusto ni body pantay sila neely char substance compensatory mechanism andat mechanism other sil notice from 14 141 from 4 142 4 1416 What happen to chloride 103 per bicarbonate became 22 from 28 so si bicarbonate ang more than 20 21 sign clinic significance useful in indicating an increase in one or more of the unmeasured un in the Ser by unmeasured bicarb bicarb chloride lang and then sodium is unmeasured in that sense so clas ang an gap na other unmeasured an okay but aside an CL an G is also a form of quality control for the Analyzer that we use in a laboratory especially is K kung ka nure electro ente There's something wrong with your machine not the pati What are the taas mas believable paang machine ang kuha ninyo laboratory mag PR No my machine is not wrong mali proud mali in ng ta Anyway malita mo Ong bridge ah come lang Ser as aort of quality control for the Analyzer used to measure electrolytes consistently of normal ag in the se for m persons may indicate an instrument problem elevated ang an g in the following conditions uren or renal failure phosphate and sulfate retention because phosphate and sulfate are negative ions so an iap increase keto acidosis What are the three ketone Bodies By the way acetone acetoacetic acid and beta hydroxybutyric acid kya ka ng basta acid Gan na siya pwede matanggal ng hydrogen may muna siyang beta hydroxy borate and acetoacetate puro na siyaang negatively charged so still katal ka in cases of starvation or Diabetes pag starvation or Diabetes pwede mag si Mak o two keto acidosis methanol ethanol ethyl glycol cic poisoning which is amazingly n put upat k ngao nam na siyang upat sa osmolar gap soa congratulations to you4 lactic acidosis hypernatremia oh an hypernatremia sir mataas ang sodium levels so try apy Uh negatively charge by putting other Uh Union other than fluoride bicarbonate or pinaka sad of all instrument error mas rare ang pagbaba sa anang gap but it may be seen with hypoalbuminemia hypoalbuminemia is low albin levels and Al being negatively charged it makes sense decrease in unmeasured anion and severe hypercalcemia which is increase in unmeasured cat hayat sa cc2 pamili MOA kung asa mo pag study mo ha this Monday ang exam maghatag ko sa inyo ang anoong love output para pang ano pang Sige question do the evaluation dismiss