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Written in a concise, readable style, the Fourth Edition of this leadi ng text continues to set the standard in the constantly evolving field of clinical chemistry. Completely revised and updated, this text refl ects the latest developments in clinical chemistry. Recent advances in quality assurance, PCR and laboratory automation receive full coverag e. The immunochemistry chapter has been expanded to reflect the latest technological advances, and two entirely new chapters on cardiac func tion and point of care testing have been added. Chapters have been com bined and restructured to match the changes that have occurred in the clinical laboratory. Plus, the contributors continue to be the leaders in the field of clinical chemistry. Other text features include outli nes, objectives, case studies, practice questions and exercises, a glo ssary and more.

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• Part 1 Basic Principles and Practice of Clinical Chemistry
• Chapter 1 Basic Principles and Practice of Clinical Chemistry
• Units of Measure(p. 2)
• Temperature(p. 3)
• Reagent Preparation(p. 3)
• Clinical Laboratory Supplies(p. 6)
• Basic Separation Techniques(p. 14)
• Laboratory Mathematics and Calculations(p. 15)
• Specimen Considerations(p. 22)
• Summary(p. 26)
• Exercises(p. 26)
• References(p. 27)
• Chapter 2 Laboratory Safety and Regulations
• Laboratory Safety and Regulations(p. 28)
• Safety Awareness for Clinical Laboratory Personnel(p. 29)
• Safety Equipment(p. 30)
• Biologic Safety(p. 32)
• Chemical Safety(p. 32)
• Radiation Safety(p. 34)
• Fire Safety(p. 35)
• Control of Other Hazards(p. 35)
• Disposal of Hazardous Materials(p. 37)
• Accident Documentation and Investigation(p. 38)
• Summary(p. 38)
• Review Questions(p. 38)
• Suggested Readings(p. 39)
• Chapter 3 Quality Control and Statistics
• Statistical Concepts(p. 40)
• Reference Intervals (Normal Range)(p. 47)
• Diagnostic Efficacy(p. 51)
• Method Selection and Evaluation(p. 53)
• Quality Assurance and Quality Control(p. 58)
• Practice Problems(p. 71)
• Review Questions(p. 73)
• References(p. 74)
• Chapter 4 Analytical Techniques and Instrumentation
• Spectrophotometry and Photometry(p. 77)
• Electrochemistry(p. 88)
• Electrophoresis(p. 91)
• Chromatography(p. 94)
• Osmometry(p. 100)
• Analytical Techniques for POCT(p. 101)
• Summary(p. 101)
• Exercises(p. 102)
• References(p. 103)
• Chapter 5 Immunoassays and Nucleic Acid Probe Techniques
• Immunoassays(p. 105)
• Nucleic Acid Probes(p. 118)
• Summary(p. 121)
• Review Questions(p. 121)
• References(p. 122)
• Chapter 6 Principles of Clinical Chemistry Automation
• History of Automated Analyzers(p. 124)
• Driving Forces Toward More Automation(p. 125)
• Basic Approaches to Automation(p. 125)
• Steps in Automated Analysis(p. 126)
• Selection of Automated Analyzers(p. 137)
• Total Laboratory Automation(p. 137)
• Future Trends in Automation(p. 139)
• Summary(p. 140)
• Review Questions(p. 140)
• References(p. 140)
• Chapter 7 Point-of-Care Testing
• Point-of-Care Testing (POCT)(p. 142)
• Use and Applications for POCT(p. 142)
• Implementation and Monitoring of POCT(p. 144)
• Cost Issues(p. 147)
• Regulatory Issues(p. 148)
• Summary(p. 148)
• Review Questions(p. 149)
• References(p. 149)
• Part 2 Clinical Correlations and Analytical Procedures
• Chapter 8 Amino Acids and Proteins
• Amino Acids(p. 152)
• Proteins(p. 158)
• Summary(p. 182)
• Review Questions(p. 182)
• References(p. 183)
• Chapter 9 Enzymes
• General Properties and Definitions(p. 185)
• Enzyme Classification and Nomenclature(p. 186)
• Enzyme Kinetics(p. 186)
• Enzymes of Clinical Significance(p. 192)
• Pathophysiologic Conditions(p. 208)
• Summary(p. 212)
• Review Questions(p. 213)
• References(p. 213)
• Suggested Readings(p. 214)
• Chapter 10 Carbohydrates
• General Description of Carbohydrates(p. 215)
• Hyperglycemia(p. 220)
• Hypoglycemia(p. 224)
• Role of Laboratory in Differential Diagnosis and Management of Patients With Glucose Metabolic Alterations(p. 226)
• Summary(p. 230)
• Review Questions(p. 230)
• References(p. 231)
• Chapter 11 Lipids and Lipoproteins
• Lipid Chemistry(p. 233)
• Lipoprotein Physiology and Metabolism(p. 237)
• Lipid and Lipoprotein Analyses(p. 241)
• Lipid and Lipoprotein Distribution in the Population(p. 248)
• Disease Prevention, Diagnosis, and Treatment(p. 250)
• Summary(p. 254)
• References(p. 255)
• Chapter 12 Nonprotein Nitrogen
• Urea(p. 261)
• Creatinine/Creatine(p. 263)
• Uric Acid(p. 267)
• Ammonia(p. 270)
• Summary(p. 272)
• Review Questions(p. 272)
• References(p. 273)
• Chapter 13 Porphyrins and Hemoglobin
• Porphyrins(p. 275)
• Hemoglobin(p. 280)
• Myoglobin(p. 291)
• Summary(p. 291)
• Review Questions(p. 292)
• References(p. 293)
• Chapter 14 Electrolytes
• Water(p. 294)
• The Electrolytes(p. 297)
• Anion Gap(p. 318)
• Electrolytes and Renal Function(p. 318)
• Summary(p. 320)
• Review Questions(p. 320)
• References(p. 320)
• Chapter 15 Trace Elements
• Iron(p. 322)
• Copper(p. 326)
• Zinc(p. 328)
• Cobalt(p. 328)
• Chromium(p. 328)
• Fluorine(p. 328)
• Manganese(p. 329)
• Molybdenum(p. 329)
• Selenium(p. 329)
• General Considerations in Laboratory Determinations of Trace Elements(p. 330)
• Summary(p. 330)
• Review Questions(p. 330)
• References(p. 331)
• Chapter 16 Blood Gases, pH, and Buffer Systems
• Definitions: Acid, Base, Buffer(p. 335)
• Acid-Base Balance(p. 335)
• Assessment of Acid-Base Homeostasis(p. 338)
• Oxygen and Gas Exchange(p. 340)
• Measurement(p. 344)
• Quality Assurance(p. 347)
• Summary(p. 350)
• Review Questions(p. 350)
• References(p. 350)
• Part 3 Assessment of Organ System Functions
• Chapter 17 Liver Function
• Anatomy(p. 354)
• Physiology(p. 354)
• Disorders of the Liver(p. 358)
• Assessment of Liver Function(p. 359)
• Summary(p. 368)
• Review Questions(p. 368)
• References(p. 369)
• Chapter 18 Endocrinology
• Hormones(p. 373)
• Methodologies(p. 375)
• Components of the Endocrine System(p. 378)
• Summary(p. 398)
• Review Questions(p. 399)
• References(p. 401)
• Chapter 19 Thyroid Function
• Thyroid Anatomy and Physiology(p. 403)
• Biosynthesis, Secretion, Transport, and Action of Thyroid Hormones(p. 404)
• Regulation of Thyroid Hormones(p. 405)
• Assays for Thyroid Function(p. 406)
• TSH(p. 409)
• Thyroid Disorders and Correlation of Laboratory Data(p. 413)
• Summary(p. 420)
• Review Questions(p. 420)
• References(p. 420)
• Chapter 20 Cardiac Function
• The Heart(p. 423)
• Symptoms of Heart Disease(p. 425)
• Congenital Heart Disease(p. 425)
• Congestive Heart Failure(p. 427)
• Coronary Heart Disease(p. 429)
• Hypertensive Heart Disease(p. 430)
• Infective Heart Disease(p. 431)
• Diagnosis of Heart Disease(p. 432)
• Treatment(p. 436)
• Summary(p. 438)
• Review Questions(p. 438)
• References(p. 439)
• Chapter 21 Renal Function
• Renal Anatomy(p. 440)
• Renal Physiology(p. 441)
• Analytical Procedures(p. 447)
• Pathophysiology(p. 453)
• Summary(p. 461)
• Review Questions(p. 462)
• References(p. 462)
• Chapter 22 Pancreatic Function
• Physiology of Pancreatic Function(p. 463)
• Diseases of the Pancreas(p. 464)
• Tests of Pancreatic Function(p. 466)
• Summary(p. 469)
• Review Questions(p. 469)
• References(p. 470)
• Suggested Readings(p. 470)
• Chapter 23 Gastrointestinal Function
• Physiology and Biochemistry of Gastric Secretion(p. 471)
• Clinical Aspects of Gastric Analysis(p. 471)
• Tests of Gastric Function(p. 472)
• Intestinal Physiology(p. 472)
• Clinicopathologic Aspects of Intestinal Function(p. 473)
• Tests of Intestinal Function(p. 473)
• Summary(p. 475)
• Review Questions(p. 475)
• References(p. 476)
• Suggested Readings(p. 476)
• Chapter 24 Body Fluid Analysis
• Amniotic Fluid(p. 477)
• Cerebrospinal Fluid(p. 482)
• Sweat(p. 485)
• Synovial Fluid(p. 486)
• Serous Fluids(p. 486)
• Summary(p. 487)
• Review Questions(p. 488)
• References(p. 489)
• Suggested Readings(p. 489)
• Part 4 Specialty Areas of Clinical Chemistry
• Chapter 25 Therapeutic Drug Monitoring
• Routes of Administration(p. 492)
• Absorption(p. 492)
• Free Versus Bound Drugs(p. 493)
• Drug Distribution(p. 493)
• Drug Elimination(p. 493)
• Pharmacokinetics(p. 495)
• Sample Collection(p. 497)
• Cardioactive Drugs(p. 497)
• Antibiotics(p. 499)
• Antiepileptic Drugs(p. 500)
• Psychoactive Drugs(p. 501)
• Bronchodilators(p. 502)
• Immunosuppressive Drugs(p. 502)
• Antineoplastics(p. 503)
• Summary(p. 503)
• Review Questions(p. 504)
• References(p. 505)
• Suggested Readings(p. 505)
• Chapter 26 Toxicology
• Exposure to Toxins(p. 506)
• Routes of Exposure(p. 507)
• Dose Response Relationship(p. 507)
• Analysis of Toxic Agents(p. 508)
• Toxicology of Specific Agents(p. 508)
• Toxicology of Therapeutic Drugs(p. 515)
• Toxicology of Drugs of Abuse(p. 516)
• Summary(p. 519)
• Review Questions(p. 519)
• References(p. 520)
• Suggested Readings(p. 521)
• Chapter 27 Tumor Markers
• Classification of Tumor Markers(p. 523)
• Tumor Markers in Cancer Management(p. 523)
• Properties of an Ideal Tumor Marker(p. 549)
• Oncofetal Antigens(p. 524)
• Placental Proteins(p. 530)
• Enzymes and Isoenzymes as Tumor Markers(p. 531)
• Hormones(p. 532)
• Steroid Receptors(p. 533)
• Immunophenotyping(p. 534)
• DNA Analyses(p. 534)
• Summary and Future Developments(p. 536)
• Review Questions(p. 536)
• References(p. 537)
• Chapter 28 Vitamins and Nutritional Assessment
• Vitamins(p. 540)
• Nutritional Assessment(p. 554)
• Summary(p. 566)
• Review Questions(p. 567)
• References(p. 568)
• Chapter 29 Clinical Chemistry and the Geriatric Patient
• The Impact of Geriatric Patients on the Clinical Laboratory(p. 572)
• Theories of Aging(p. 573)
• Biochemical and Physiological Changes of Aging(p. 574)
• Clinical Chemistry Results and Aging(p. 578)
• Summary(p. 581)
• Review Questions(p. 581)
• References(p. 581)
• Chapter 30 Pediatric Clinical Chemistry
• Age Related Development Changes(p. 583)
• Phlebotomy and Microchemistry for the Pediatric Patient(p. 584)
• Acid Base Balance in the Infant(p. 584)
• Electrolyte and Water Balance(p. 585)
• Energy Metabolism(p. 588)
• Developmental Changes in Hormone Balance(p. 594)
• Drug Therapy and Pharmacokinetics(p. 598)
• Inborn Errors of Metabolism(p. 598)
• Humoral and Cellular Immunity(p. 601)
• Summary(p. 607)
• Review Questions(p. 607)
• References(p. 608)
• Appendices(p. 609)
• A. Selected Laboratory Abbreviations(p. 610)
• B. Basic SI Units(p. 611)
• C. Prefixes to be Used with SI Units(p. 611)
• D. Basic Clinical Laboratory Conversions(p. 611)
• E. Conversion of Traditional Units to SI Units for Common Chemistry Analytes(p. 612)
• F. Greek Alphabet Table(p. 613)
• G. Concentrations of Commonly Used Acids and Bases with Related Formulas(p. 613)
• H. Examples of Incompatible Chemicals(p. 614)
• I. Nomogram for the Determination of Body Surface Area(p. 615)
• J. Relative Centrifugal Force Nomograph(p. 616)
• K. Centrifugation--Speed and Time Adjustment(p. 617)
• L. Percent Transmittance--Absorbance Conversion Table(p. 617)
• M. Selected Atomic Weights(p. 618)
• N. Selected Radioactive Elements(p. 619)
• O. Characteristics of Types of Glass(p. 619)
• P. Characteristics of Types of Plastic(p. 620)
• Q. Chemical Resistance of Types of Plastic(p. 620)
• R. Cleaning Labware(p. 621)
• S. Summary Table of Pharmacokinetic Parameters(p. 622)
• T. Selected Information on Commonly Abused Drugs(p. 624)
• U. Periodic Chart of the Elements(p. 626)
• Glossary(p. 627)
• Answers to Review Questions, Exercises, Practice Problems, and Case Studies(p. 639)
• Index(p. 661)