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* * * * * * Ammonia Formed from the breakdown of amino acids and bacterial metabolism Metabolized by the liver Increases due to renal failure or liver disease are toxic to the CNS Specimen Requirements: Ammonia Whole blood EDTA Heparin Patient should not smoke several hours prior to collection, results in contamination Ammonia: Methodology Glutamate dehydrogenase- enzymatic procedure 2 Oxoglutarate + NH4+ + NADPH Glutamate + NADP+ + H2O 2. NADP + is measured at 340 nm and it is directly proportional to ammonia. Glutamate dehydrogenase One final note… Remember the Renal panel Albumin Glucose BUN Creatinine Calcium Chloride Potassium CO2 Sodium Phosphorus References Bishop, M., Fody, E., Schoeff, l. (2010). Clinical Chemistry: Techniques, principles, Correlations. Baltimore: Wolters Kluwer Lippincott Williams Wilkins. Sunheimer, R., Graves, L. (2010). Clinical Laboratory Chemistry. Upper Saddle River: Pearson . * * * * * * * * * * * * * * * * * * * * * * * * * * * * MLAB 2401: Clinical Chemistry Renal Assessment Nonprotein Nitrogen Compounds What are they? Products from the catabolism of proteins and nucleic acids Consist of a molecule that contains nitrogen but are not part of a protein Useful to evaluate renal function Clinically Significant NPN’s Analyte Plasma Concentration (%) Blood Urea Nitrogen (BUN) 45 Amino Acids 20 Uric Acid 20 Creatinine 5 Creatine 1-5 Ammonia 0.2 BUN Blood Urea Nitrogen Urea is the nitrogenous end-product of protein AA metabolism. Urea is formed in the liver when ammonia (NH3) is removed and combined with CO2. Rises quickly as compared to creatinine Majority excreted in urine Most widely used screening test of kidney function BUN: Clinical Significance Reference range 7-18 mg/dL Decreased BUN Late pregnancy Decreased protein intake Severe liver disease Overhydration Increased BUN Azotemia Occurs when BUN concentration exceeds 20 mg/dL Not always due to kidney malfunction BUN / Creatinine