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CHAPTER Ⅰ Carbohydrate Metabolism1

DIGESTION AND ABSORPTION1

Fate of Absorbed Carbohydrate2

Endogenous Sources of Glucose3

UTILIZATION OF GLUCOSE3

Storage3

Oxidation3

Conversion to Fat4

Conversion to Other Carbohydrate4

Conversion to Amino Acids4

GENERAL PROCESSES IN CARBOHYDRATE METABOLISM5

Anaerobic Metabolism(Glycolysis)5

Aerobic Metabolism of Glucose7

ROLE OF LIVER IN CARBOHYDRATE METABOLISM8

Glycogenesis and Glycogenolysis8

Gluconeogenesis9

Assimilation of CO29

MUSCLE IN CARBOHYDRATE METABOLISM10

Glycogenesis10

Glycolysis11

Muscle Contraction11

INTERRELATION OF CARBOHYDRATE,LIPID,AND PROTEIN METABOLISM12

ENDOCRINE INFLUENCES IN CARBOHYDRATE METABOLISM14

Insulin14

Adrenocortical Hormone16

Anterior Pituitary Factors16

Epinephrine17

Thyroid Hormone17

Hyperglycemic Factor of Pancreas(HGF;Glucagon)17

NORMAL POSTABSORPTIVE BLOOD SUGAR17

Glucose in Body Fluids Other than Blood18

Sugars Other than Glucose in Body Fluids19

REGULATION OF BLOOD GLUCOSE CONCENTRATION20

Rate of Supply of Glucose to Blood20

Rate of Removal of Glucose from Blood21

Fundamental Regulatory Mechanism22

NORMAL ALIMENTARY REACTION(ABSORPTIVE RESPONSE)23

Sugar Tolerance23

Intravenous Glucose Tolerance Test25

Mechanism of Production of the Normal Glucose Tolerance Curve25

Factors Influencing Absorptive Blood Sugar Response27

The One-Hour,Two Dose Glucose Tolerance Test29

EFFECT OF OTHER SUGARS29

Galactose Tolerance30

Insulin Tolerance Test31

Insulin-Glucose Tolerance Test31

Epinephrine Tolerance Test31

Phenomena Associated with Normal Alimentary Glucose Reaction32

Decreased Serum Phosphate32

Decreased Serum Potassium32

Increased Respiratory Quotient32

ABNORMALITIES OF POSTABSORPTIVE BLOOD SUGAR LEVEL32

Fasting Hyperglycemia32

Diabetes Mellitus32

Hyperthyroidism34

Increased Secretion of Epinephrine35

Adrenal Cortical Hyperfunction36

Hyperpituitarism36

Anesthesia,Asphyxia,Hypnosis36

Acidosis37

Hepatic Disease38

Miscellaneous38

Fasting Hypoglycemia38

Hyperinsulinism39

Hepatic Disease40

Adrenal Cortical Insufficiency41

Anterior Pituitary Insufficiency41

Hypothyroidism42

Nervous System Disorders42

Miscellaneous42

ABNORMAL ALIMENTARY RESPONSE42

Exaggerated Response—Diminished Glucose Tolerance42

Diabetes Mellitus43

Hepatic and Biliary Tract Disease45

Hyperthyroidism46

Hyperfunction of the Anterior Pituitary and Adrenal Cortex46

Pregnancy47

Miscellaneous47

Decreased Response—Increased Glucose Tolerance48

Hyperinsulinism48

Adrenal Cortical Insufficiency49

Anterior Pituitary Hypofunction51

Hypothyroidism52

Miscellaneous52

Abnormal Insulin Tolerance53

Abnormal Epinephrine Tolerance Test54

Abnormal Tolerance for Other Sugars54

Abnormal Fructose Tolerance54

Abnormal Galactose Tolerance55

BLOOD LACTIC ACID AND PYRUVIC ACID56

GLYCOGEN STORAGE DISEASES57

Glycogen Storage Disease of Liver(von Gierke)57

Glycogen Disease of the Heart58

Galactosemia58

Cirrhosis with Excessive Glycogen58

EXCRETION OF SUGAR IN URINE58

Mechanism of Glycosuria(Glucosuria)58

Other Sugars in Urine59

ABNORMAL URINE SUGAR59

Melituria59

Tests for the Detection of Sugars59

Metallic Oxide Reduction Tests59

Fermentation Test60

Phenylhydrazine Reaction60

Specific Rotation60

Glycosuria61

Nonhyperglycemic Glycosuria61

Hyperglycemic Glycosuria64

Fructosuria65

Pentosuria66

Lactosuria67

Galactosuria67

Maltosuria67

DIABETES MELLITUS67

Experimental Diabetes Mellitus68

Total Pancreatectomy68

Subtotal Pancreatectomy69

Alloxan Administration69

Administration of Adrenocortical Hormones70

Anterior Pituitary Extracts70

Thyroid Administration70

Carbohydrate Metabolism in Hypophysectomized-Depan-creatized Animals71

Clinical Diabetes Mellitus71

Hyperglycemia71

Decreased Carbohydrate Tolerance72

Glycosuria73

Decreased Respiratory Quotient74

Lipemia and Ketosis74

Acidosis75

Electrolyte and Water Balance76

Negative Nitrogen Balance-Hypoproteinemia77

Nitrogen Retention78

REFERENCES78

CHAPTER Ⅱ Lipid Metabolism80

NATURE OF LIPIDS81

Fats(Triglycerides)81

Phospholipids(Phosphatides)82

Glycolipids84

Steroids84

Lipoproteins85

DIGESTION AND ABSORPTION86

METABOLISM OF FAT88

Immediate Fate of Dietary Lipid88

Anabolism and Catabolism of Fatty Acids88

Anabolism and Catabolism of Lipids90

Lipid Mobilization90

ENDOCRINE INFLUENCES IN LIPID METABOLISM91

Insulin91

Adrenocortical Hormones91

Anterior Pituitary Hormones92

Thyroid Hormone92

METABOLIC INTERRELATIONS OF LIPIDS,CARBOHYDRATES AND PROTEINS92

KETOSIS94

FAT IN FECES96

FAT IN URINE98

METABOLISM OF PHOSPHOLIPIDS98

Turnover98

Catabolism99

METABOLISM OF STEROLS AND BILE ACIDS99

Catabolism and Excretion of Cholesterol;Conversion to Bile Acids100

TRANSPORT OF LIPIDS101

State of Lipids in Blood:Lipoproteins101

Postabsorptive Plasma Lipid Concentration102

Influence of Food and Nutrition104

Influence of Age and Sex105

Pregnancy105

DEPOSITION AND STORAGE OF LIPIDS105

Role of Liver in Lipid Metabolism105

Fatty Liver and Lipotropism106

LIPOIDOSIS,XANTHOMATOSIS109

ⅠPrimary(Essential) Xanthomatosis110

ANormocholesterolemic Type110

BHypercholesterolemia Type110

CCombined Types A and B110

Ⅱ Xanthomatosis Secondary to Hyperlipemia110

ABNORMALITIES OF PLASMA LIPIDS110

PLASMA LIPOPROTEIN ABNORMALITIES AND ATHEROSCLEROSIS111

Increase in Sf 12-20 Lipoproteins112

Beta-Lipoprotein Increase112

Effect of Heparin113

HYPERCHOLESTEROLEMIA113

Diabetes Mellitus113

Anesthesia115

The Nephrotic Syndrome115

Hepatic and Biliary Tract Disease116

Hypothyroidism117

Atherosclerosis118

Xanthomatosis118

Idiopathic(Essential) Hyperlipemia119

Miscellaneous119

HYPOCHOLESTEROLEMIA120

Anemia120

Hepatic Disease120

Infection121

Hyperthyroidism121

Inanition122

Terminal States122

Miscellaneous123

REFERENCES123

CHAPTER Ⅲ Protein Metabolism124

DIGESTION AND ABSORPTION125

Dynamic State126

Metabolic Pool127

OVER-ALL METABOLISM OF PROTEIN128

Nitrogen of the Food129

Nitrogen of the Body129

Excretion of Nitrogen129

Nitrogen Balance129

Essential Amino Acids130

Biological Value of Proteins131

Dietary Protein Requirements132

INTERMEDIARY METABOLISM134

Protein Turnover134

General Pathways of Protein Metabolism134

INTERRELATIONS OF THE METABOLISM OF PROTEINS AND OTHER FOOD-STUFFS138

ENDOCRINE INFLUENCES IN PROTEIN METABOLISM140

Growth Hormone140

Androgen140

Adrenal II-Oxysteroids140

Insulin141

Thyroxine141

NITROGENOUS CONSTITUENTS OF THE BLOOD141

The Plasma Proteins141

Identity and Properties141

Metabolism144

Functions145

NONPROTEIN NITROGEN148

Urea148

Uric Acid148

Creatinine148

Amino Acids148

Ammonia149

Undetermined Nitrogen(Rest Nitrogen)149

NITROGEN EXCRETION149

Urea149

Uric Acid150

Creatine and Creatinine150

Amino Acids151

Ammonia151

ABNORMAL PROTEIN METABOLISM152

Total Plasma(Serum) Protein152

Fibrinogen153

Albumin154

Globulins158

Globulin Reactions163

Zinc Sulfate Turbidity163

Formol-Gel Reaction163

Colloidal Gold Curve163

CO2 Saturation Test164

Cephalin-Cholesterol Flocculation Test164

Thymol Turbidity Test164

Other Globulin Reactions165

Protein Diagnostic Tests for Cancer165

NONPROTEIN NITROGEN OF BLOOD166

Urea Nitrogen166

Uric Acid168

Creatinine168

Amino Acid Nitrogen168

Ammonia169

Undetermined or Residual Nitrogen169

Total Nonprotein Nitrogen169

ABNORMAL URINARY NITROGEN170

Protein in Urine170

The Nature and Origin of Urinary Proteins170

Functional Albuminuria172

Organic Albuminuria173

Quantity of Protein in Urine176

Other Proteins in Urine177

Urinary Nonprotein Nitrogen179

Urinary Urea179

Uric Acid in Urine180

Creatine and Creatinine in Urine180

Amino Acids in Urine182

Ammonia in Urine185

Negative Nitrogen Balance in Disease186

Urinary Nitrogen Partition187

Congo Red Test for Amyloidosis188

REFERENCES189

CHAPTER Ⅳ Nucleic Acid Metabolism190

INTERRELATIONS OF METABOLISM OF NUCLEIC ACIDS WITH OTHER FOODSTUFFS191

BIOLOGICAL SIGNIFICANCE OF NUCLEIC ACIDS192

Viruses193

Chromosomes—Genes193

Transforming Substance of Bacteria194

Role of Nucleic Acids in Mutation and Carcinogenesis194

Role of Nucleic Acids in Protein Synthesis195

FREE NUCLEOTIDES OF BIOLOGICAL IMPORTANCE196

Adenylic Acid System196

Coenzymes196

DIGESTION AND ABSORPTION196

INTERMEDIARY METABOLISM197

Nonnitrogenous Constituents197

Purines and Pyrimidines197

Uric Acid199

REFERENCES202

CHAPTER Ⅴ Metabolism of Hemoglobin and Porphyrins203

Synthesis of Porphyrins204

Synthesis of Hemoglobin205

Catabolism of Hemoglobin206

Abnormal Hemoglobins206

HEMOGLOBINEMIA207

ABNORMAL HEMOGLOBIN DERIVATIVES208

Methemoglobin208

Sulfhemoglobin209

Carboxyhemoglobin209

Hematinemia209

PORPHYRIA AND PORPHYRINURIA210

Porphyria210

Acquired Porphyrinurias211

REFERENCES212

CHAPTER Ⅵ Biochemical Aspects of Diet213

Caloric Content of Diet215

Dietary Carbohydrates216

Dietary Lipid217

Dietary Protein218

REFERENCES223

CHAPTER Ⅶ Calcium and Inorganic Phosphate Metabolism224

ABSORPTION224

BLOOD CALCIUM AND PHOSPHATE225

Parathyroid Hormone226

Vitamin D228

Plasma Proteins228

Plasma Phosphate228

Acid-Base Equilibrium228

Miscellaneous229

DEPOSITION AND MOBILIZATION OF BONE MINERALS229

Mineralization of Bone229

Mobilization of Calcium230

MISCELLANEOUS FACTORS231

EXCRETION231

CALCIUM AND PHOSPHORUS REQUIREMENT232

CALCIUM CONTENT OF OTHER BODY FLUIDS232

ABNORMAL SERUM CALCIUM233

Hypercalcemia233

Hyperparathyroidism233

Hypervitaminosis(Vitamin D)234

Multiple Myeloma235

Neoplastic Disease of Bone235

Acute Bone Atrophy236

Kidney Disease236

Miscellaneous236

Hypocalcemia236

Hypoparathyroidism236

Pseudohypoparathyroidism238

Vitamin D Deficiency(Rickets and Osteomalacia)238

Steatorrhea(Sprue,Celiac Disease)238

Hunger Osteopathy238

Nephrosis238

Nephritis239

Maternal Tetany239

Magnesium,Phosphate,Oxalate and Citrate Tetany239

Acute Pancreatitis239

Alkalosis240

ABNORMAL URINE CALCIUM240

Increased Urinary Calcium240

Hyperparathyroidism240

Hyperthyroidism241

Acidosis241

Hypervitaminosis D241

Idiopathic Hypercalciuria241

Decreased Urinary Calcium241

Hypoparathyroidism241

Vitamin D Deficiency241

Hypothyroidism242

Ingestion of Bases242

Miscellaneous242

ABNORMAL FECAL CALCIUM242

HYPERPHOSPHATEMIA242

Hypervitaminosis242

Hypoparathyroidism242

Renal Failure242

Healing Fractures243

HYPOPHOSPHATEMIA243

Rickets243

Osteomalacia244

Idiopathic Steatorrhea244

Hyperparathyroidism244

Fanconi Syndrome244

Increased Carbohydrate Utilization245

ABNORMAL URINARY PHOSPHATE245

DISTURBANCES OF BONE FORMATION AND MINERALIZATION246

REFERENCES247

CHAPTER Ⅷ Phosphatase Activity248

NORMAL SERUM ALKALINE PHOSPHATASE249

Skeletal Diseases249

Rickets250

Hyperparathyroidism(Generalized Osteitis Fibrosa Cystica)250

Osteitis Deformans(Pagets Disease)251

Miscellaneous Bone Disorders251

ALKALINE PHOSPHATASE ACTIVITY IN JAUNDICE,HEPATIC AND BILIARY DISEASE251

Obstructive and Hepatocellular Jaundice251

Other Biliary Tract Conditions252

MISCELLANEOUS CONDITIONS252

SERUM ACID PHOSPHATASE252

REFERENCES254

CHAPTER Ⅸ Magnesium Metabolism255

ABSORPTION AND EXCRETION255

BLOOD MAGNESIUM255

Abnormal Serum Magnesium256

CHAPTER Ⅹ Iron Metabolism257

ABSORPTION AND EXCRETION257

TRANSPORT258

UTILIZATION;STORAGE259

REQUIREMENT260

ABNORMAL IRON METABOLISM260

REFERENCES261

CHAPTER Ⅺ Sulfur Metabolism262

ABSORPTION262

INTERMEDIARY METABOLISM262

SULFUR IN BLOOD262

EXCRETION263

CHAPTER Ⅻ Iodine Metabolism264

ABSORPTION AND EXCRETION264

BLOOD IODINE265

DISTRIBUTION AND INTERMEDIARY METABOLISM265

IODINE METABOLISM AND THYROID HORMONE266

BIOSYNTHESIS AND SECRETION OF THYROID HORMONE266

Accumulation of Iodine in Thyroid266

Synthesis of Thyroid Hormone267

Secretion of Thyroid Hormone267

Circulating Thyroid Hormone268

Fate of Thyroxine268

ANTITHYROID AGENTS268

Thyroid Hormone268

Iodine268

Thiocyanate268

Antithyroid Agents269

ABNORMAL EXCRETION OF IODINE269

ABNORMAL BLOOD IODINE270

RADIOIODINE STUDIES271

Thyroid Uptake of I131272

Urinary Excretion of I131272

Conversion Ratio of I131273

REFERENCES273

CHAPTER ⅩⅢ Sodium,Potassium and Chloride Metabolism274

ABSORPTION AND EXCRETION275

Excretion in Urine275

Excretion by the Skin276

Excretion in Digestive Fluids276

NORMAL BLOOD Na,Cl AND K277

DISTRIBUTION AND INTERMEDIARY METABOLISM278

ABNORMAL Na,Cl AND K METABOLISM279

Routes of Loss of NaCl and K279

General Principles in Electrolyte Abnormalities281

DECREASED PLASMA SODIUM(HYPONATREMIA) AND CHLORIDE(HYPOCHLOREMIA)283

Gastrointestinal Disorders283

Diabetes Mellitus284

Kidney Disease284

Excessive Sweating284

Infectious Diseases285

Adrenocortical Insufficiency(Addisons Disease)285

Low Salt Syndrome285

Adrenocortical Hyperfunction(Cushings Syndrome)286

Miscellaneous286

INCREASED PLASMA SODIUM(HYPERNATREMIA) AND CHLORIDE(HYPERCHLOREMIA)286

DECREASED PLASMA POTASSIUM(HYPOKALEMIA;HYPOPOTASSEMIA)287

Starvation;Malnutrition288

Administration of NaCl and Glucose Solutions288

Gastrointestinal Disorders289

Diabetic Acidosis290

Adrenocortical Hormones290

Postoperative States290

Kidney Disorders291

Familial Periodic Paralysis291

INCREASED PLASMA POTASSIUM(HYPERKALEMIA;HYPERPOTASSEMIA)292

ABNORMAL URINE SODIUM,CHLORIDE,AND POTASSIUM292

REFERENCES293

CHAPTER ⅩⅣ Water Balance295

WATER INTAKE295

WATER OUTPUT295

Feces295

Insensible Perspiration295

Perspiration296

Urine296

Equilibrium Requirements297

BODY FLUID COMPARTMENTS297

Volume of Body Fluid Compartments298

Blood and Plasma Volume298

Total Extracellular Fluid Volume299

Total Body Water300

Composition of Body Fluid Compartments300

Milliequivalents(mEq)300

Osmolar Concentration300

EXTRACELLULAR FLUID302

INTRACELLULAR FLUID303

EXCHANGES BETWEEN FLUID COMPARTMENTS305

Gibbs-Donnan Equilibrium305

Plasma:Interstitial Fluid Exhange306

Interstitial Fluid:Intracellular Fluid Exchange307

ABNORMAL BLOOD VOLUME309

Increased Blood Volume309

Decreased Blood Volume309

CHANGES IN INTERSTITIAL FLUID310

Dehydration311

Increased Interstitial Fluid(Edema)314

TRANSUDATES AND EXUDATES317

Specific Gravity317

Protein317

Glucose319

Chloride319

Lipid319

Other Constituents320

BIOCHEMICAL CHANGES IN SHOCK321

REFERENCES322

CHAPTER ⅩⅤ Acid-Base(Anion-Cation) Balance(Neutrality Regulation)323

PHYSIOLOGICAL BUFFER SYSTEMS324

Buffer Action of Hemoglobin325

Buffer Systems for H2CO3(CO2)325

Buffer Systems for Fixed Acids327

Net Effect of Buffer Mechanisms328

Respiratory Regulation of Acid-Base Balance328

Renal Regulation of Acid-Base Balance329

ABNORMALITIES OF”ACID-BASE(ANION-CATION) BALANCE332

Acidosis333

Primary H2CO3 Excess(Respiratory Acidosis)334

Primary Alkali Deficit(Metabolic Acidosis)335

Alkalosis340

Primary H2CO3 Deficit(Respiratory Alkalosis)340

Primary Alkali Excess(Metabolic Alkalosis)341

METHODS OF STUDYING ACID-BASE BALANCE343

CO2 Content of Plasma344

Carbon Dioxide Capacity of the Plasma345

Alveolar CO2 Tension347

Determination of pH of Blood Plasma or Serum348

Other Methods of Investigation348

REFERENCES351

CHAPTER ⅩⅥ Respiratory Exchange and Basal Metabolism352

CHEMICAL CONTROL OF RESPIRATION354

Influence of CO2 Tension and pH354

Influence of O2 Tension354

TRANSPORT OF OXYGEN355

Dissociation of Oxyhemoglobin356

TRANSPORT OF CARBON DIOXIDE358

CO2 in Arterial Blood358

Entrance of CO2 in Tissues359

ANOXEMIA(HYPOXEMIA)360

Anoxic Anoxia360

Anemic Anoxia362

Stagnant Anoxemia362

Histotoxic Anoxia362

ENERGY METABOLISM363

Caloric Value of Foods363

Heat Production363

Respiratory Quotient364

CALORIMETRY367

Direct Calorimetry367

Indirect Calorimetry368

BASAL METABOLISM368

Physiological Variations in BMR369

Specific Dynamic Action(SDA) of Foods370

Total Metabolism(Caloric Requirement)371

Clinical Significance of BMR372

Increased Basal Metabolic Rate374

Hyperthyroidism374

Other Endocrine Disorders374

Pregnancy375

Fever375

Diseases of the Blood375

Essential Hypertension375

Myocardial Insufficiency376

Diabetes Insipidus376

Decreased Basal Metabolic Rate376

Hypothyroidism376

Other Endocrine Disorders376

The Nephrotic Syndrome376

Shock376

Malnutrition376

Miscellaneous377

REFERENCES377

CHAPTER ⅩⅦ Hormone Assay and Endocrine Function(with AERakoff)378

PITUITARY HORMONES378

ANTERIOR PITUITARY HORMONES379

Regulation of Anterior Pituitary Function379

Gonadotrophic Hormones381

Follicle-Stimulating Hormone381

Interstitial Cell-Stimulating Hormone381

Lactogenic Hormone382

Chorionic Gonadotrophin382

Physiological Considerations382

Determination of Gonadotrophic Hormones385

Normal Gonadotrophin Values386

Abnormal Gonadotrophs Values389

Thyrotrophic(Thyroid-Stimulating) Hormone393

Assay393

Actions394

Abnormal Thyrotrophin(TSH) Secretion394

Adrenocorticotrophic Hormone394

Assay395

Actions395

Abnormal Adrenocorticotrophin(ACTH) Secretion395

Growth Hormone(Somatotropin)395

Assay395

Actions396

Excessive Growth Hormone Secretion396

Decreased Growth Hormone Secretion397

POSTERIOR PITUITARY HORMONES398

Assay398

Functions398

MELANOPHORE-EXPANDING(DISPERSING) HORMONE(INTERMEDIN)400

STEROID HORMONES401

ESTROGENS401

Occurrence401

Site of Formation402

Metabolism402

Excretion402

Actions402

Assay Procedures403

Estrogens at Different Ages405

Estrogens in Pregnancy405

Increased Estrogen Values407

Increased Production407

Decreased Destruction407

Decreased Estrogen Values408

PROGESTERONE408

Metabolism409

Excretion409

Actions409

Methods of Assay409

Increased Pregnanediol Values410

Diminished Pregnanediol Values411

Menstrual Disorders and Sterility411

Threatened and Habitual Abortion411

Intra-uterine Fetal Death411

Toxemias of Late Pregnancy411

Diabetes in Pregnancy411

ANDROGENS411

Metabolism413

Metabolic Actions413

Methods of Assay414

Normal Values for Androgens(Bioassay by Capon Method)414

Abnormal Androgen Values415

17-KETOSTEROIDS416

Normal Values for 17-Ketosteroids417

Decreased 17-Ketosteroid Values418

Increased 17-Ketosteroids419

ADRENAL HORMONES420

Adrenal Medullary Hormones421

Regulation of Epinephrine Secretion421

Biosynthesis and Metabolism of Epinephrine421

Metabolic Actions421

Assay422

Adrenal Medullary Hyperfunction422

Adrenal Cortical Hormones423

Corticoids423

Androgenic 17-Ketosteroids425

Estrogen425

Progesterone426

Synthesis of Adrenal Hormones426

The”Alarm Reaction;the Adrenal Cortex under Stress427

Methods of Assay429

Metabolism and Excretion430

Metabolic Effects431

Adrenocortical Hyperfunction433

Cushings Syndrome434

Adrenogenital Syndrome435

Feminizing Syndrome in Men436

Miscellaneous Conditions436

Adrenocortical Hypofunction436

Corticoids436

Carbohydrate Metabolism436

Electrolyte and Water Metabolism438

Miscellaneous Abnormalities440

Special Diagnostic Procedures441

THYROID HORMONE442

Calorigenic Effect442

Protein Metabolism442

Carbohydrate Metabolism442

Lipid Metabolism443

Electrolyte and Water Metabolism443

Vitamins443

Hypothyroidism443

Basal Metabolism443

Plasma Cholesterol444

Creatine Excretion445

Miscellaneous445

Iodine Metabolism445

Hyperthyroidism446

Basal Metabolism446

Plasma Cholesterol446

Carbohydrate Metabolism446

Miscellaneous447

Iodine Metabolism447

PARATHYROID HORMONE447

REFERENCES448

CHAPTER ⅩⅦ Vitamins451

VITAMIN A452

Deficiency in Man454

Detection of Deficiency in Man454

Effects of Excess of Vitamin A455

Carotenemia456

THIAMINE457

Metabolism of Thiamine457

Demonstration of Deficiency457

RIBOFLAVIN459

Demonstration of Deficiency460

NIACIN(NICOTINIC ACID)460

Demonstration of Deficiency461

ASCORBIC ACID461

Detection of Deficiency in Man462

VITAMIN D465

Deficiency Manifestations466

Effects of Excess Vitamin D467

VITAMIN K467

Deficiency469

Demonstration of Vitamin K Deficiency470

REFERENCES470

CHAPTER ⅩⅨ Chemical Investigation of Gastric Function471

Psychic or Cephalic Phase471

Gastric Phase471

Intestinal Phase471

Other Factors472

NORMAL GASTRIC JUICE472

Gastric Residuum472

INVESTIGATION OF GASTRIC SECRETORY ACTIVITY474

Basal Gastric Secretion474

Test Meals475

Alcohol Stimulation476

Caffeine Stimulation476

Histamine Stimulation476

Insulin(Hypoglycemia) Stimulation477

Abnormal Response477

Achlorhydria477

Hypoacidity479

Hyperacidity(Hypersecretion)479

Tubeless Gastric Analysis481

Peptic Activity482

Total Chloride483

Bile484

Vomitus484

REFERENCES484

CHAPTER ⅩⅩ Pancreatic Function485

EXAMINATION OF PANCREATIC JUICESECRETIN TEST485

Volume486

Bicarbonate486

Amylase(Diastase)486

Trypsin487

Lipase487

Abnormal Findings with the Secretin Test487

EXAMINATION OF THE FECES488

Protein in Feces489

SERUM AMYLASE(DIASTASE)490

Serum Amylase After Stimulation491

SERUM LIPASE491

AMYLASE IN URINE492

MISCELLANEOUS FINDINGS IN PANCREATIC DISEASE493

REFERENCES493

CHAPTER ⅩⅪ Hepatic Function495

CARBOHYDRATE METABOLISM496

Fasting Blood Sugar Level497

Glucose Tolerance498

Epinephrine Hyperglycemia499

Fructose Tolerance500

Galactose Tolerance500

Blood Lactic Acid502

PROTEIN METABOLISM503

Amino Acids503

Urea504

Uric Acid505

Ammonia505

Plasma Proteins505

Thymol Turbidity and Flocculation509

Cephalin-Cholesterol Flocculation510

Zinc Sulfate Turbidity510

Other Globulin Reactions511

Plasma Prothrombin511

LIPID METABOLISM513

Fat in Feces513

Plasma Cholesterol514

PIGMENT METABOLISM—JAUNDICE516

Serum Bilirubin518

Qualitative van den Bergh Reaction518

Serum Bilirubin Concentration520

Hyperbilirubinemia522

Total Serum Bilirubin522

Extrahepatic Obstructive jaundice525

Hepatocellular Jaundice526

Hemolytic Jaundice527

Bilirubinuria528

Bilins and Bilinogens in the Urine and Feces529

Urobilinogen in Feces530

Urobilinogen in Urine530

Bile Pigments in feces533

Porphyrin in Urine and Feces534

BILE ACID METABOLISM535

DETOXIFICATION-CONJUGATION537

Hippuric Acid Synthesis537

THE LIVER AND HORMONE METABOLISM539

ELIMINATION OF DYES541

Bromsulfalein(BSP) Excretion541

Significance of Abnormal BSP Retention543

Rose Bengal Excretion545

SERUM ALKALINE PHOSPHATASE ACTIVITY545

SERUM CHOLINESTERASE548

BLOOD AMYLASE(DIASTASE)549

PLASMA VITAMIN A AND CAROTENE(CAROTENOID)549

THE LIVER IN WATER AND SALT METABOLISM549

LIVER FUNCTION STUDIES IN DIFFERENTIAL DIAGNOSIS550

CHEMICAL EXAMINATION OF BILE556

Bile Acids556

Lipids557

Inorganic Elements558

Miscellaneous Constituents558

Bile Pigment558

White Bile559

Gallstones559

REFERENCES559

CHAPTER ⅩⅫ Renal Function561

MORPHOLOGICAL FEATURES OF FUNCTIONAL IMPORTANCE561

GLOMERULAR FILTRATION562

TUBULAR FUNCTION564

Reabsorption564

Tubular Excretion and Synthesis568

Competition for Transport Mechanism569

CHARACTERISTICS OF NORMAL URINE569

Volume569

Specific Gravity570

Acidity570

Nonprotein Nitrogenous Constituents571

Allantoin575

Oxalic Acid575

Glucuronic Acid575

Hippuric Acid(Benzoylglycine)576

Citric Acid576

Other Organic Acids576

Ketone Bodies577

Sulfur-Containing Compounds577

Phosphate577

Chloride578

Sodium;Potassium578

Calcium;Magnesium579

Carbohydrates579

Miscellaneous580

CLINICAL STUDY OF RENAL FUNCTION580

CLEARANCE TESTS581

Glomerular Filtration581

Renal Blood Flow584

Maximum Tubular Excretory Capacity587

Percentage Tubular Reabsorption588

Filtration Fraction588

Maximum Tubular Reabsorption Capacity589

Other Clearance Procedures589

ELIMINATION OF WATER590

Comparison of Fluid Intake and Fluid Output590

Oliguria;Anuria591

Water Function Test(Dilution Test)592

ELIMINATION OF SOLIDS—URINE SPECIFIC GRAVITY593

Concentration Test of Renal Function594

The Two-Hour Specific Gravity Test594

The Urine Concentration Test595

Significance of Hyposthenuria596

ELIMINATION OF NONPROTEIN NITROGENOUS SUBSTANCES598

Urinary Studies598

Simultaneous Study of Blood and Urine598

Urea Excretion Ratio598

Blood Urea Clearance599

Blood Nitrogen Studies603

Renal Functional Impairment603

Prerenal Deviation of Water604

Excessive Protein Catabolism604

Relative Degree of Retention of Individual Nitrogenous Elements in Renal Disease605

Blood Nonprotein Nitrogen in Renal Disease606

Necrotizing Nephroses610

Urea in Other Body Fluids611

ELIMINATION OF FOREIGN SUBSTANCES612

The Phenolsulfonphthalein Test612

LOCALIZATION OF RENAL FUNCTIONAL DEFECT614

Acute Glomerulonephritis615

Chronic Glomerulonephritis617

Necrotizing Nephroses(Acute Renal Failure)618

Pyelonephritis619

Benign Nephrosclerosis(Essential Hypertension)619

Malignant Nephrosclerosis(Necrotizing Arteriolitis)620

Lipoid Nephrosis620

Toxemias of Pregnancy621

Congestive Heart Failure622

OTHER BIOCHEMICAL MANIFESTATIONS OF RENAL INSUFFICIENCY622

Na and Cl Depletion;Dehydration622

Serum K Abnormalities622

Hypocalcemia;Hypercalciuria;Osteomalacia623

Acidosis623

Hypoproteinemia625

Magnesium625

Plasma Cholesterol625

Phenol and Other Organic Substances626

REFERENCES627

CHAPTER ⅩⅩⅢ Cerebrospinal Fluid629

PROTEIN629

Meningitis629

Serous Meningitis630

Convulsive States630

Organic Disease of Brain and Cord631

Myxedema631

GLUCOSE631

Hyperglycorachia632

Hypoglycorachia633

NONPROTEIN NITROGENOUS CONSTITUENTS633

CHLORIDE634

INORGANIC PHOSPHATE635

CHOLESTEROL635

LACTIC ACID635

HYDROGEN ION CONCENTRATION635

SODIUM,POTASSIUM,CALCIUM AND MAGNESIUM636

XANTHOCHROMIA636

REFERENCES638

Index639