Trace Elements and other Electrolytes

Question 1

What are the toxic trace elements?

Answer 1

-aluminum
-Arsenic
-Cadmium
-Lead
-Mercury

Question 2

What are the essential trace elements tested in the lab?

Answer 2

-chromium
-copper
-Fluorine
-Iodine
-Manganese
-Molybdenum
-Selenium
-Zinc

Question 3

increased copper absorption is facilitated by binding to ____________

Answer 3

amino acids
-can be used as treatment to increase levels

Question 4

Copper source dietary (~___% of intake is absorbed)

Answer 4

50

Question 5

Copper is Excreted mainly in ______, with some excretion via urine

around ______ug/day

Answer 5

bile, <40

Question 6

Copper is important for enzymatic activity and is a ___________.

Answer 6

cofactors

Question 7

examples of copper cofactors

Answer 7

Ceruloplasmin***, cytochrome oxidase, dopamine β-hydroxylase, tyrosinase, and many
others.

Fe2+ —-> Fe3+

Question 8

copper carrier that is important for iron

Answer 8

Ceruloplasmin***

(ferroxidase?)

Question 9

Copper:

In plasma, _____% bound to ceruloplasmin (ferroxidase, an enzyme important in
Fe2+ oxidation prior to “transferrin” binding)

Answer 9

95

-small amount associated with albumin (not strong binding)

Question 10

Copper induces ____________ synthesis (complexes with Cd2+, Cu2+, and Zn2+)

Answer 10

Metallothionein

Question 11

What is the function of Cysteine (-SH) rich low MW protein?

Answer 11

unclear
Research indicate that protection against metal toxicity
against oxidative stress (similar to how transferrin prevents damage from iron)

Question 12

Glutathione is reduced from _____ oxidized from GS.

2GSH/GSSG ratio

What does an increased ratio mean? a decreased?

Answer 12

GSH

-can handle more oxidative stress
-increased in cells, could have damage by oxidative stress

Question 13

diet contains about ____ mg/d of copper

Answer 13

1.2

Question 14

During the last 3 months of
pregnancy, liver development
occurs. A premature baby has less ______ storage in the liver.

Answer 14

copper

-also abnormal hematological characters and abnormal bone formation

Question 15

Typically in male infant
@ 2-3 month
X-linked genetic defect

Answer 15

Menke’s Kinky Hair Syndrome

Question 16

• Impaired Cu2+ intestinal absorption
• Severe cerebellar & cerebral degeneration, failure to thrive, osteoporosis,
  motor delay, and death within the first decade of life (about 3 year)

Answer 16

Menke’s Kinky Hair Syndrome:

Question 17

how is Menke’s Kinky Hair Syndrome treated?

Answer 17

Cu-histidine if caught ealry

Question 18

causes of copper deficiency?

Answer 18

Decreased dietary intake
▪ ↓ Activities of various Enzymes
- Microcytic-hypochromic anemia, neutropenia, heart disease, bone & joint
osteoarthritis, hypothermia, hypercholesterolemia.
- decreased antioxidant protection and metabolic activity

Question 19

What levels are considered copper deficiency for plasma and ceruloplasmin?

Answer 19

< 10μM (70mg/dl) : [Cu++]
plasma
< 220mg/L: ceruloplasmin

Question 20

Copper excess Can be detected with
* ____ Liver function
* “ [Cu2+] in urine (> _______)

Answer 20

decreased, 500μg/L

Question 21

copper excess is associated with _____________ disease

Answer 21

Wilson’s

Question 22

↑ copper accumulation in
liver, brain, kidney, & cornea of the eye (rings of Cooper-Kayser-Fleisher rings).
* No copper found in serum due to a decrease in “ceruloplasmin”
-with increased non-ceruloplasmin bound Cu2+

Answer 22

Wilson’s disease

Question 23

What is the treatment for Wilson’s disease?

Answer 23

chelating agents, .V administration, e.g. Penicillamine

Question 24

increased copper causes….

________ Vit. C
________ Zinc
_________Vit. A

Answer 24

decrased
decreased
increased

Question 25

◆Factors that increase serum [Cu2+]

Answer 25

oral contraceptives, pregnancy, infections.

Question 26

Increased serum Cu, __________ hepatic synthesis of ceruloplasmin.

Answer 26

increased

Question 27

With Wilson's disease, is copper increased in tissue or serum?

Answer 27

increased in tissues to toxic levels

Question 28

What is it called when there is a copper ring in the eyes associated with Wilson's disease

Answer 28

Cooper-Kayser-Fleisher rings

Question 29

Copper levels in ________ is not a reliable indicator of copper status.

Answer 29

serum

Question 30

* Measurement of [Cu2+]serum is ______ indicative of copper status

Answer 30

NOT

Question 31

What is a more accurate indicator of copper levels?

Answer 31

Examination of decreased cytochrome oxidase activity in leukocytes******

Question 32

Three ways copper can be measured?

Answer 32

1. Flame Atomic Absorption spectrophotometry (serum plasma or urine) 2. Colorimetric spectrophotometry using chromagen; 1) cuppizone or 2) bathocupoine 3. Immunoassay: Ceruloplasmin TRACE ELEMENTS: COPPER METHODOLOGY [Cu2+]serum is not reliable indicator of Cu2+ status * In the case of Cu2+ depletion: " free ceruloplasmi

Question 33

In the case of Cu2+ depletion: ________ free ceruloplasmin

Answer 33

increased

Question 34

What are the two chromagens that can be used with Colorimetric spectrophotometry?

Answer 34

1) cuppizone or 2) bathocupoine

Question 35

_______ is 2nd most abundant trace element in body (~2g in adult) (first is iron)

Answer 35

Zinc

Question 36

Zinc: ______% found in muscle, _____% in bone, _____% in blood.

Answer 36

50-60, 28, 0.5 (RBCs are 75-88%)

Question 37

Zinc: In serum, ________% bound to albumin, ________% to α2-macroglobulin & transferrin

Answer 37

60-70, 30-40 *small fraction in free from

Question 38

Zinc is an essential __________ for many enzymes. examples?

Answer 38

Cofactor carbonic anhydrase, alcohol dehydrogenase, RNA/DNA polymerase

Question 39

Zinc is necessary for cell _________________ and organ ________________.

Answer 39

Reproduction, development

Question 40

copper binds to protein more firmly than ____ does. ➢ Unabsorbable (zinc?) complex in GI tract ----> Decrease Cu++ absorption

Answer 40

zinc

Question 41

zinc fingers are formed from...

Answer 41

cysteine and histadine

Question 42

about ___ mg/d of zinc in diet

Answer 42

10

Question 43

* Required for the activity of enzyme that are critical for nucleic acid replication & protein synthesis -Necessary component for cell replication

Answer 43

zinc

Question 44

most common cause of zinc deficiency

Answer 44

Malabsorption & dietary deficiency (causes increased susceptibility to disease)

Question 45

effects of zinc deficiency

Answer 45

infections, trauma, sickle cell anemia, renal disease, and alcohol abuse * skin lesions (extremities and orifices), diarrhea, hair loss, growth retardation, and decreased immune system function.

Question 46

CLINICAL CASES OF Zn DEFICIENCY:

Answer 46

-IV feeding after surgery -delayed wound healing, dermatitis, mental depression, diarrhea

Question 47

Experimental evidences for Zinc deficiency - Fetal abnormalities...

Answer 47

Impaired embryogenesis * Impaired brain development * Impaired vision

Question 48

symptoms of zinc toxicity

Answer 48

Abdominal pain * Diarrhea * Nausea * Vomiting

Question 49

What is the major source of circulating ammonia?

Answer 49

action of Bacterial 1) proteases, 2) Urease, 3) Amine oxidase acting on GI tract content

Question 50

NH3 is absorbed into ________ circulation

Answer 50

portal

Question 51

ammonia is removed by the _______, urea synthesis, and eliminated in ________

Answer 51

liver, urine

Question 52

cirrhosis or severe hepatitis, or decreased liver function = _________

Answer 52

increased ammonia due to inability to convert to urea

Question 53

________ function determines the NH3

Answer 53

liver

Question 54

small amounts of ammonia are produced by _____________.

Answer 54

exercise

Question 55

Renal tubules produce their own NH3 from...

Answer 55

deamination of glutamine -NH3 diffuses from renal cells into tubule

Question 56

Does the kidney contribute to blood NH4?

Answer 56

NO****

Question 57

NH3 in urine binds to H+ to form...

Answer 57

NH4

Question 58

False elevation [NH3]: correction of sources of preanalytical error include...

Answer 58

1) Contamination 2) Collection process: prolonged tourniquet use 3) Delayed analysis

Question 59

causes of increased ammonia?

Answer 59

-infants (liver is still developing) -liver disease (acute viral hepatitis and "Reyes syndrome" -Chronic cirrhosis

Question 60

is a form of hepatic destruction following recovery from viral infection

Answer 60

REYES SYNDROME

Question 61

what can increased ammonia cause?

Answer 61

Causes neurological abnormalities because NH3 can cross BBB (coma, seizures)

Question 62

In pH of 9-9.6, Lactate dehydrogenase ______ ---> _______ by NAD+ to NADH + H+

Answer 62

L-Lactate -----> Pyruvate

Question 63

In pH of 7.5, Lactate dehydrogenase ______---> _______ by NADH + H to NAD+

Answer 63

Pyruvate -----> L-lactate

Question 64

_______ in blood, is a sensitive indicator of oxygen deprivation. Who should be monitored for this?

Answer 64

lactate critically ill patients

Question 65

Increased lactate may be caused by...

Answer 65

Decrease in 1) tissue blood perfusion which could decrease tissue oxygenation (coronary ischemia) * Defective carbohydrate metabolism * Respiratory disease

Question 66

what are the therapeutic levels of lithium? toxic levels?

Answer 66

-1-1.2 mEq/L ->1.5 mEq/L)

Question 67

How does lithium affect the CNS?

Answer 67

inhibiting effects of norepinephrine (NE) and serotonin release and increasing reuptake of NE.

Question 68

Toxicity of Lithium is associated with...

Answer 68

vomiting, ataxia, muscular rigidity, and EEG changes.