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Clinical Chemistry also known as chemical pathology, clinical bio chemistry or medical biochemistry is the analysis of different enzyme levels in the blood, urine, and other body fludis that shows significant potential pathology that may need immediate treatment.

It is use to identify and evaluate the different system of the body mainly monitoring electrolytes (Sodium, Potassium, Chloride, and Bicarbonate) kidney function (Creatinine, BUN), liver function (Total protein, Bilirubin, Aspartate Transaminase, Alanine Transaminase, Gamma-glutamyl transpeptidase, and Alkaline Phosphatase), cardiac markers (Troponin, Myoglobin, CK-MB, B-Type natriuretic peptide), minerals (Calcium, Phosphate, Potassium, and Magnesium), blood disorders (Iron, Transferrin, TIBC, Vitamin B12, and Folic Acid), and other miscellaneous (Glucose, C-Reactive Protein, Glycosylated Hemoglobin, Uric Acid, Arterial Blood Gases, Adrenocorticotropic Hormone, Toxicology Screening or Forensic Toxicology, Neuron-specific enolase, and Fecal Occult Blood Test) tests that plays integral parts in the body.

Identify patient's name. Label test tube and the test to be done. Explain procedure to the patient and assess patient's understanding. 

Amount of specimen required will depend on the number of tests to be done. Diet will vary on the tests chosen to be done. For preparation and specific diet, check each test for instructions. Inform patient that test might cause discomfort, pain and swelling at the puncture site. To alleviate pain, apply warm, moist compress. Watch out for signs of infection.

Sodium (Na)

It is responsible for maintaining osmotic pressure, acid-base balances, and transmitting nerve impulses. Some causes of low sodium levels are excessive water intake, burn, kidney failure, malnutrition, and liver cirrhosis. Some causes of high sodium levels are gaining sodium in excess of water, diabetes, malfunctioning of hemodialysis, increase insensible fluid loss (talking, sweating, excessive urination, etc.), congestive heart failure, dehydration, diaphoresis (sweating), diarrhea, and vomiting If specimen needed is blood, patient don't need to fast. If specimen needed is urine, discard first morning void. Start collecting next 24 hrs, include the void at the end of 24 hours and record the time.

Potassium (K)

It is responsible for the conduction of electrical impulses in cardiac and skeletal muscle. Influences the acid-base balance, enzyme reaction of carbohydrates and protein metabolism and also influences the level of sodium. If sodium is high, potassium is low and if sodium is low, potassium is high. Causes of increase potassium are insulin deficiency, trauma, burn, and kidney failure. Causes of decrease potassium are alkaline state of fluids in body, insulin excess, vomiting, diarrhea, and excessive diuresis (urination). Extreme low and high levels of potassium leads to cardiac arrest. Patient don't need to fast.

Chloride (Cl)

It is responsible for maintaining osmolality and water balance and is very important in maintaining acid-base balance. Causes of low chloride (hypochloremia) are vomiting, prolonged diarrhea, excessive sweating from fever or heat exhaustion, diabetes, infection, prolonged infusion of IV solution leading to dilution. Causes of high chloride (hyperchloremia) are losses of bicarbonate from diarrhea, acidic kidney tubes, and thyroid disorders. Patient don't need to fast. Take note that high temperature affects the results.

Bicarbonate (HCO3)

Bicarbonate is measured to test the level in venous and arterial blood. They are responsible for the transport of carbon dioxide from tissues to the lungs, and considered a strong buffer in the ABG and an accurate indicator of conditions involving pH regulation of the body fluids. Causes high bicarbonate are chronic obstructive pulmonary disease, congestive heart failure, fluid in lungs, thyroid disorder, and vomiting. Causes of low bicarbonate are diabetes, burns, Myocardial Infarction (heart attack), severe malnutrition, diarrhea, and kidney failure. After test, apply pressure 10-15 minutes after the specimen is obtained to ensure coagulation at the site.


Creatinine is use in clearance for glomerular filtration rate (GFR). Creatininine is most commonly use as Creatinine clearance, measurement of rate at which the kidneys are able to clear creatinine from the blood. Causes of increased creatinine are variety of kidney disorders. Bicarbonate is measured to test the level in venous and arterial blood. They are responsible for the transport of carbon dioxide from tissues to the lungs, and considered a strong buffer in the ABG and an accurate indicator of conditions involving pH regulation of the body fluids. Causes high bicarbonate are chronic obstructive pulmonary disease, congestive heart failure, fluid in lungs, thyroid disorder, and vomiting. Causes of low bicarbonate are diabetes, burns, Myocardial Infarction (heart attack), severe malnutrition, diarrhea, and kidney failure. After test, apply pressure 10-15 minutes after the specimen is obtained to ensure coagulation at the site.

Blood, Urea, Nitrogen (BUN)

Is use to measure the nitrogen fraction of the urea and the chief end product od protein metabolism. BUN reflects protein intake, liver metabolism, and renal excretory function. BUN rise together with serum creatinine in pathological condition. When BUN rises first, it can indicate as the timing of the renal disorder. Causes of high BUN are congestive heart failure, shock, kidney disease, infection, myocardial infarction (heart attack), diabetes mellitus, excessive protein ingestion, gout, pancreatitis, and GI bleeding. Causes of low BUN are hemodialysis, inadequate protein intake, severe liver disease, water intoxication, malabsorption syndrome, and pregnancy. After test, assess history of kidney or liver disease, intake, hydration, drug history and advice patient to fast for 8 hrs before the test.

Total Protein

It is use to measure the total protein in the blood: albumin and globulin. It is use to identify the root of a condition such as Giomeruli damage. Low level causes are kidney failure, fluid shifting in outside blood vessels, lungs and abdomen, Kwashiorkor (severe protein deficiency), kidney disease liver cirrhosis, high levels of chloride, high levels of triglycerides, and hypertension. Advice patient to fast for 8 hrs before the blood is obtained. Advice patient to follow a low fat diet for several days before test.

Bilirubin; Direct; Indirect; Total

Bilirubin is produced in the liver, spleen and bone marrow, a by-product of hemoglobin metabolism. Direct Bilirubin is excreted by the gastrointestinal tract. Indirect Bilirubin normally circulates in the bloodstream. Causes of high direct, indirect and total bilirubin are alcoholism, bile obstruction, stone, anemia, hepatitis, malaria, myocardial infarction (heart attack), pancreatitis, cirrhosis, clot in lungs, sickle cell anemia. Causes of low direct, indirect, and total bilirubin are not clinically significant. Advice patient to eat less yellow foods for 3-4 days before the test. Patient need to fast for 4 hrs before test.

Aspartate Transaminase (AST)

AST is found in the heart muscle, liver and with moderate amounts in the skeletal muscle, kidney and pancreas. High concentration indicates cellular damage. It is commonly called as Serum Glutamic Oxaloacetic Transaminase (SGOT). Causes of high AST are are myocardial infarction (heart attack), liver disease, severe angina (chest pain), hepatitis, liver necrosis, cancer of liver, alcoholism, musculoskeletal disease, recent convulsions, heat stroke, severe burns, acute pancreatitis, strenous exercise, toxic shock syndrome, brain infarction (tissue death), trauma, and intramuscular injection. Causes of low AST are diabetes, hemodialysis and chronic liver disease. Patient don't need to fast.

Alanine Transaminase (ALT)

ALT are found in liver cells and little amount in cardiac, renal, and skeletal tissues. It is commonly called as Serum Glutamic Pyruvic Transaminase. It is very useful in identifying liver diseases due to the hepatocellular enzyme that's been release when there is injury or disease that affects the liver. Causes of high ALT are drug toxicity, alcoholic hepatitis, liver cirrhosis, gallbladder obstruction, and hepatic cancer. They slightly increase more with chronic cirrhosis, pancreatitis. ALT is ordered with AST to separate liver and cardiac disease. AST rises when there is cardiac damage than ALT. AST is more sensitive to alcoholic liver damage. Advice patient to avoid alcohol for 24 hrs before the test.

Gamma-Glutamyl Transpeptidase (GGT)

GGT is an isoenzyme of Alkaline Phosphatase that could be found in liver, kidney, pancreas, brain, heart, salivary glands, and prostate. Causes of high GGT are hepatobiliary tract disorders, liver cancer, hepatitis, congestive heart failure, acute myocardial infarction (heart attack) after 4-10 days, diabetes mellitus with hypertension, seizure disorder, and severe deficiency of lipoprotein. It is use in diagnosing jaundice in newborns. Before test, assess patient's drugs and alcohol. Advice patient to fast for 8 hrs except with water (varies with different lab procedure).

Alkaline Phosphatase (ALP)

Alkaline Phosphatase are a group enzymes found in the liver, gallbladder, intestine, and bone tissues. It is done to assist in diagnosing hepatic and bone disease. High levels are found in placenta due to increasing levels during pregnancy. Causes of highly elevated ALP are obstructive jaundice, liver cancer, cirrhosis, bile obstruction, bone cancer, bone disease, and thyroid disorder. Causes of moderately elevated ALP are infectious mononucleosis (kissing disease), pancreatitis, pregnancy, bone disease, bone infections, and extrahepatic duct obstruction. Causes of mildly elevated ALP are are viral hepatitis, chronic hepatitis, growing children, large doses of vitamin D, and leukemia. Causes of low ALP are low levels of phosphate, malnutrition, thyroid disorder, pernicious anemia, placental insufficiency, and congestive heart failure. Advice patient to fast 12 hrs before the test, access medications and check for IV albumin administration for 10 days


It is a protein found in cardiac muscle. Calcium attaches with troponin to permit contraction of the heart muscle. If there is a disturbance in the levels of troponin, pathology occurs quickly. Troponin appears in even small cardiac injury as quick as 1-3 hours and remain elevated for 2 weeks after the injury. Causes of high troponin levels are myocardial infarction (heart attack), chronic muscle disease, and muscle trauma. It also helps in distinguishing the severity of the disorder for autocorrection and timely intervention. Explain to patient that this test is sensitive to heart muscle damage.


It is an oxygen binding protein in skeletal muscle and in the myocardium (heart muscle). It is released when there is injury at the skeletal or cardiac muscle. It can be filtered in the kidney and may block the kidney structures in high levels. Peak levels are found in blood 8-12 hours after the muscle tissue damage and remain in the urine up to 7 days. It is use to diagnose muscle enzyme deficiencies, injury, and dystrophy, myocardial infarction (heart attack) if taken between 2 and 12 hours after MI. It starts to elevate until after 2 hrs and go back to normal after 12 hours. Patient don't need to fast. If specimen needed is urine, take note of quantity, date, and time of collection.

Creatinine kinase-MB (CK-MB)

CK-MB is a cardiac-specific isoenzyme release from the cardiac muscle when there is an injury which is indicative of tissue damage. It detects, diagnose and monitors acute myocardial infarctions (Heart Attack). It rises 4-8 hour after an infarction at 12-24 hours and may remain high up to 72 hours after the infarction. Patient don't need to fast.

Brain Natriuretic Peptide (BNP)

Is being secreted by the ventricles of the heart when stretching. Depending on the levels, it identifies screening and prognosis of heart failure, prognosis of diabetes, and assessing congestive heart failure. Patient need to fast for 8-12 hrs but water is allowed. Stop taking cardiac medications unless he is being monitored by his physician.

Calcium (Ca)

It is essential in the intra and extracellular fluid exchange, blood clotting, normal nerve conduction of nerve impulses, maintains the regular heartbeat, excitation of the skeletal muscles, conduction of neuromuscular impulses and bone formation. Causes of high calcium are thyroid disorder, cancer, vitamin D intoxication, overuse of calcium antacids, polycythemia vera, dehydration, acidosis, and milk-alkali syndrome. Causes of low calcium are thyroid disorder, vitamin D deficiency, alcoholism, massive blood transfusions, acute pancreatitis, malnutrition, kidney tubes disease, and alkalosis. Clinical manifestations that lead to abnormal calcium levels are tetany, cardiac arrhythmias, and carpopedal spasms. Instruct client to fast for 8 hrs prior to test. Water is allowed.

Magnesium (Mg)

Is a mineral found in soft tissue, muscles, bones, and some body fluids. It is measured to identify metabolic activity of the body, renal function, blood coagulation, metabolism of calcium, regulation of neuromuscular irritability, it is also involve in protein and carbohydrates metabolism, and acts as sedative to neuromuscular junction. Causes of low Mg are high levels of calcium, diabetic, chronic kidney disease, pregnancy, thyroid disorder, hemodialysis, chronic pancreatitis, severe dehydration, malabsorption problems, severe alcoholism, malnutrition, and thyroid disorder. Causes of high Mg are poor kidney function, dehydration, thyroid disorder, adrenalectomy (removal of adrenal gland), insulin deficiency, consumption of Mg-rich antacids, and IV therapy of magnesium sulfate. Clinical manifestations that may lead to high or low levels are lethargy, flushing, hypotension, nausea and vomiting for high levels, and twitching, muscle tremors, and tetany for low levels. Patient don't need to fast.

Phosphate (Ph)

Is Phosphorus that is stored in the bones of the body. Important in nerve and muscle function, in production of energy, maintain acid-base balance. It is measure to identify and diagnose in high level are renal failure, post chemotherapy, neoplastic disease, tetany due to low levels of calcium. Advice patient to fast for 12-14 hrs.

Iron (Fe)

Iron is use to diagnose iron deficiencies and to support diagnosis of conditions with abnormal high levels of iron. Causes of high iron are acute iron poisoning, lead poisoning, acute hepatitis, acute leukemia, anemias, iron overload syndromes, and hepatic necrosis (tissue death). Causes of low iron are iron deficiency, severe, frequent or prolonged blood loss, pregnancy (third trimester), thyroid disorder,rheumatoid arthritis, and pernicious anemia. Advice patient to fast for 8 hrs prior to test. Explain to patient that rest and relaxation won't affect test results. After test, advice patient that he may need to follow up for further testing. Take note if patient is taking oral contraceptives and estrogen and inform the laboratory.


Transferrin is use to measure iron stores. It is a globulin and it helps in transporting iron. It is use to diagnose anemia, and other hematologic disorders. Causes of high transferrin are iron deficiency anemia, pregnancy, estrogen, therapy, and oral contraceptives. Causes of low iron are microcytic anemia, protein deficiency, severe burns, malnutrition, renal disease and chronic infection. Before test, take note on lab slip if patient is taking estrogen or oral contraceptives. After test, observe for signs and symptoms of anemia.

Total Iron-Binding Capacity (TIBC)

Is use to measure all proteins available for binding mobile iron. TIBC is an indirect measurement of transferrin. If there is increase iron intake, TIBC change in small amounts. TIBC reflects liver function rather than iron metabolism. Causes of high TIBC are oral contraceptives, pregnancy, polycythemia, and iron deficiency anemia. Causes of low TIBC are hypoproteinemia, cirrhosis, and anemia. Advice patient to fast for 8 hrs prior to test. Stop taking medications such as flourides, birth control pills, ACTH and chloramphenicol. Talk to doctor about the best option for stop taking medications that might be critical to your health.

Vitamin B12, Cyanocobalamin

It is needed for normal development of RBC, DNA synthesis. It is used to measure vitamin B12 levels in the body to diagnose anemia, megaloblastic anemia, pernicious anemia, Advice patient to fast for 12 hrs before test.

Vitamin B9, Folic Acid

It is needed for formation of RBC and of DNA which assures normal replication of cells. Low level causes macrocytic anemia, diarrhea, loss of appetite, heart palpitation, and behavior disorders. Advice patient to fast for 12 hrs before test.


Is use to measure the level of glucose in the blood after fasting for 12 hours to diagnose hypoglycemia, hyperglycemia and for self-adjustment of insulin dosage at home. High level causes are diabetes mellitus, thyroid disorder, pregnancy (gestational diabetes), severe liver disease, shock, and trauma. Low level causes are insulin deficiency, thyroid disorder, insulin-producing tumors, acute alcohol ingestion, and fluid shifting in body. Advice patient to fast for 8-12 hrs before a fasting test but 8 hrs is acceptable. Patients taking injectable insulin or oral hypoglycemics, they need to do the test first before taking there medications.

C-Reactive Protein (CRP)

Is an abnormal protein that appears in the blood at the beginning stage of inflammation. High level causes are bacterial infections, active rheumatic fever, postoperative wound infections, kidney or bone marrow transplant rejection, active rheumatoid arthritis, TB, acute myocardial infarction (heart attack), and blood transfusions. Advice patient to fast for 8 hrs. Water is allowed.

Glycosylated Hemoglobin (HBA1C)

It's a HbA molecule with an attach glucose molecule to its beta chain. It is the amount of glucose bound to hemoglobin. It is measured to monitor blood glucose level, and is use as evaluation for patient's adherence to the treatment for controlling the level of glucose in their blood. After test, update patient regarding test results and if there's a need to change his diabetic regimen and self-care.

Uric Acid

Is excreted by the kidneys, also an end product of protein breakdown, dietary and body protein. High level causes are kidney disease, gout, leukemia, cancer, Down's syndrome, starvation, alcoholism, congestive heart failure, lead poisoning,chemotherapy, and radiation therapy. Low level causes are some malignancies. Patient don't need to fast.

Arterial Blood Gases (ABG)

Arterial Blood Gas also known as ABG. ABG is used to assess the heart and lungs dysfunctions, acid-base imbalance in the body, if the oxygen is enough for the body. ABG are taken from patients that has abnormal acid-base imbalances, heart and disorders, such as acute respiratory disorder, diabetes, congenital heart defects, asthma, alkali ingestion, salicylate intoxication, emphysema, pneumonia, sepsis and shock. Explain to patient that radial puncture will be done after anesthesia. If there's no anesthesia, it will cause a brief, sharp pain. Take note of patient's temperature. After test, monitor puncture for bleeding for 30 minutes every 5-10 minutes. Check for signs of nerve impairment distal to the puncture. Apply pressure for 5-10 minutes to the arterial puncture site. Apply warm compress after the puncture site stop bleeding.

Adrenocorticotropic Hormone (ACTH)

ACTH is secreted from the anterior lobe of the pituitary. Maintains function of the renal adrenal glands, stimulating the adrenals to secrete glucocorticoids, androgens, and mineralocorticoids. High level causes adrenal disorders and cancer, and ACTH-producing tumors. Low level causes are adrenal cancer, and secondary adrenocortical insufficiency due to pituitary or hypothalamus disease. Advice patient to follow a 24 hrs low calorie diet and fast for 12 hrs before the test. Obtain specimen at 6-8 AM because ACTH levels are high at this time. Explain to patient that glucose levels in the blood affect test results and not to do strenuous activities.

Toxicology Screening/ Forensic Toxicology (drugs/ toxins)

It is use to identify if the patient had taken any drugs through the metabolites of the drugs that are excreted in the urine. Indication of a positive results are amphetamines, barbiturates, benzodiazepines, cannabenoids, cocaine metabolite, codeine, methadone, methaqualone, morphine, phenycyclidine, and propoxyphene. After test, take note of urine, quantity, date, and time collected. If body is going to be autopsied, transport the body to the morgue to preserve cool temperature.

Neuron-Specific Enolase (NSE)

A cancer marker that is found in patients with tumors, lung cancer, medulla thyroid cancer, endocrine tumors of the pancreas, and melanoma. It helps in diagnosing the extent and prognosis of the disease, and the patient's response to treatment. Patient don't need to fast.

Fecal Occult Blood Test (FOBT)

Also known as Guaiac Test. It is used to detect bleeding from the Upper Gastrointestinal bleeding. Advice patient to avoid dark colored food for three days and stop taking iron because it will give false positive results.

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