Principles of Applied Clinical Chemistry Chemical Background and Medical Applications : Volume 1: Maintenance of Fluid and Electrolyte Balance

"Clinical Chemistry encompasses the study of the fundamental princi­ ples of chemistry as applied to an understanding of the functioning of the human organism in health and disease." 1 From its very definition, clinical chemistry is an applied science. Its scope includes the following: I. Studies designed to elucidate the chemical mechanisms whereby the human normally functions. 2. The application of this information to an understanding of the disease process in the human. 3. The development of methodology and instrumentation in order to facilitate data gathering so as to apply the above principles to the diagnosis and treatment of disease in the human. This book is an attempt to organize the information gathered relative to points I and 2 into a logical sequence so as to define the areas oj learning encompassed by the science oj clinical chemistry. It is constructed around the subject which is the target of this science, namely the human. The material is presented from the point of view of the clinical chemist, but since it is impossible to discuss a mechanism adequately without visualizing its parts, some schematic anatomical drawings are included to simplify the discussion of responses to chemical challenges. The book is partly a curriculum which has been worked out by the authors for the training of clinical chemists and clinical pathologists. It should also be useful for the training of medical technologists.

Section I Body Fluids and Electrolytes.- 1 Maintenance of the Steady State in the Human.- 1.1 The Steady State.- 1.2 Selected Reading―Equilibrium, Steady State Homeostasis.- 1.3 The Need for Constant pH in Body Fluids.- 1.4 References.- 2 Acids and Bases.- 2.1 Introduction.- 2.2 Selected Reading―Acids and Bases.- 2.3 Buffers.- 2.4 Indicators.- 2.5 Titration.- 2.6 Selected Reading―Buffers.- 2.7 The Bicarbonate Buffer System.- 2.8 Selected Reading―The Bicarbonate System.- 2.9 References.- 3 Partial Pressures (% MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$).- 3.1 Introduction.- 3.2 Measurement of % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$.- 3.3 Effect of Oxygenation of Hemoglobin on Blood % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$ Total CO2 and pH.- 3.4 Oxygen Content, Capacity and Percentage Saturation.- 3.5 Hemoglobin Affinity for Oxygen and Diphosphoglycerate.- 3.5.1 Effect of Change in % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$.- 3.5.2 Effect of Exercise.- 3.5.3 Shift of P50 by Drugs.- 3.5.4 Control of DPG Concentration.- 3.5.5 Stored Blood.- 3.5.6 Other factors Affecting the Shift of the Oxygen Dissociation Curve.- 3.5.7 Methods for Obtaining P50 from the Oxygen Saturation Curve.- 3.6 Selected Reading―Partial Pressures % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$.- 3.7 Blood and Alveolar % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$.- 3.8 Relationship Between Alveolar and Blood % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$.- 3.9 Effect of Decreased Blood Flow to the Lungs on % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$.- 3.10 Effect of Decreased Ventilation on % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$.- 3.11 Shunt Effects.- 3.12 Recapitulation.- 3.13 Selected Reading―Blood and Alveolar % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaaeaaaaaaaaa8 % qacaWGWbWdamaaBaaaleaapeGaam4qaiaad+eapaWaaSbaaWqaa8qa % caaIYaaapaqabaaaleqaaaaa!3A12! $${p_{C{O_2}}}$$ and % MathType!MTEF!2!1!+- % feaagCart1ev2aaatCvAUfeBSjuyZL2yd9gzLbvyNv2CaerbuLwBLn % hiov2DGi1BTfMBaeXatLxBI9gBaerbd9wDYLwzYbItLDharqqtubsr % 4rNCHbGeaGqiVu0Je9sqqrpepC0xbbL8F4rqqrFfpeea0xe9Lq-Jc9 % vqaqpepm0xbba9pwe9Q8fs0-yqaqpepae9pg0FirpepeKkFr0xfr-x % fr-xb9adbaqaaeGaciGaaiaabeqaamaabaabaaGcbaGaamiCamaaBa % aaleaacaWGpbWaaSbaaWqaaiaaikdaaeqaaaWcbeaaaaa!38DD! $${p_{{O_2}}}$$.- 3.14 References.- 4 Maintenance of Constant pH in the Human.- 4.1 The Lungs.- 4.2 The Hemoglobin-Oxyhemoglobin System.- 4.3 The Bicarbonate System.- 4.4 Protein as a Buffer.- 4.5 Phosphate Buffer.- 4.6 Chloride Shift.- 4.7 Isohydric Shift.- 4.8 Organic Acids.- 4.9 Carbonic Anhydrase.- 4.10 Recapitulation.- 4.11 Selected Reading―Maintenance of Constant pH in the Human.- 4.12 References.- 5 Maintenance of Constant Osmotic Pressure in Body Fluids.- 5.1 Definition and Units of Osmotic Pressure.- 5.2 Body Water.- 5.3 Maintenance of Osmotic Balance Between Intravascular and Interstitial Fluid.- 5.4 Variation in Extracellular Fluid Volume in Defense of Intracellular Osmotic Pressure.- 5.5 Mechanisms for Maintaining Constant Volume and Osmotic Pressure.- 5.5.1 Stretch Receptors.- 5.5.2 Osmoreceptors.- 5.5.3 Other Mechanisms for Maintaining Constant Volume and Osmotic Pressure in the Extracellular Fluid.- 5.6 Recapitulation.- 5.7 Selected Reading―Constant Osmotic Pressure and Body Fluids.- 5.8 References.- 6 Maintenance of Constant Ion Concentration in Body Fluids : Sodium, Potassium, and Chloride.- 6.1 Introduction.- 6.2 Sodium and Chloride.- 6.3 Electrolyte Balance Between Bone and Extracellular Fluids.- 6.4 The “High Salt Syndrome”.- 6.5 The “Low Salt Syndrome”.- 6.6 Disparity between Sodium and Chloride Excretion.- 6.7 Potassium.- 6.8 Hypokalemia and Hyperkalemia.- 6.9 Selected Reading―Maintenance of Constant Ion Concentration in Body Fluids: Sodium, Potassium and Chloride.- 6.10 References.- 7 Maintenance of Constant Ion Concentration in Body Fluids Calcium, Magnesium, Phosphate, and Sulfate.- 7.1 Plasma Calcium.- 7.2 Calcium Transport.- 7.3 Maintenance of Constant Serum Ca2+ Concentration.- 7.3.1 Parathormone.- 7.3.2 Calcitonin.- 7.3.3 Vitamin D.- 7.4 Other Factors Affecting Plasma Calcium Levels.- 7.4.1 Pituitary Extracts.- 7.4.2 Sugars.- 7.4.3 Effect of Amino Acids.- 7.5 Abnormal Serum Calcium Concentration.- 7.5.1 Hypercalcemia.- 7.5.2 Hypocalcemia.- 7.5.3 Magnesium Deficiency.- 7.6 Magnesium.- 7.7 Mechanisms Controlling Serum Phosphate Levels.- 7.8 Abnormal Serum Phosphate Levels.- 7.8.1 Hyperphosphatemia.- 7.8.2 Hypophosphatemia.- 7.9 Plasma Inorganic Sulfate.- 7.9.1 Sulfatase Transport.- 7.9.2 Sulfate Activity.- 7.9.3 Sulfate and Molybdenum.- 7.10 Recapitulation.- 7.11 Selected Reading―Maintenance of Constant Ion Concentration in Body Fluids: Calcium, Magnesium, Phosphate, and Sulfate.- 7.12 References.- 8 Mechanisms for Maintenance of a Steady State Between Plasma and Interstitial Fluid.- 8.1 The Capillary Bed.- 8.2 The Lymphatic System.- 8.2.1 Drainage.- 8.2.2 Absorption.- 8.2.3 Transport.- 8.3 Abnormal Distribution of Extracellular Fluid (Edema).- 8.4 Recapitulation.- 8.5 Selected Reading―Steady State Between Plasma and Interstitial Fluid; Lymph, Edema.- 8.6 References.- 9 Abnormal Blood pH (Acidosis and Alkalosis).- 9.1 Metabolic Acidosis.- 9.1.1 Calculation of Base Excess and Base Deficit.- 9.1.1.1 From Na+, K+, and Chloride Concentrations.- 9.1.1.2 From Bicarbonate Base Levels.- a. Method of Singer and Hastings.- b. Method of Hastings, Astrup and Siggaard-Andersen.- 9.1.2 Direct Calculation of Total Sodium Bicarbonate Required to Bring to Normal pH.- 9.2 Respiratory Acidosis.- 9.3 Metabolic Alkalosis.- 9.4 Respiratory Alkalosis.- 9.5 Recapitulation.- 9.6 Selected Reading―Abnormal Blood pH: Acidosis and Alkalosis.- 9.7 References.- 10 Fluid and Electrolyte Applications.- 10.1 Water Requirements.- 10.1.1 By Body Weight.- 10.1.2 Water Replacement.- 10.1.3 The Infant.- 10.1.4 Surface Area.- 10.1.5 By Caloric Expenditure.- 10.2 Recirculating Fluids.- 10.3 Maintenance Fluids.- 10.3.1 The Adult.- 10.3.2 Repair and Maintenance Solutions.- 10.4 Maintenance Fluids in Infants.- 10.5 Repair Solutions.- 10.5.1 To Correct Erythrocyte Deficit.- 10.5.2 To Correct Na, K, and Cl Deficit.- 10.5.3 To Correct Plasma Protein Deficit.- 10.5.4 Correction of Blood pH.- 10.5.4.1 Metabolic Acidosis.- 10.5.4.2 Metabolic Alkalosis.- 10.5.4.3 Respiratory Alkalosis and Acidosis.- 10.6 Recapitulation.- 10.7 Selected Reading―Fluid and Electrolyte Applications.- 10.8 References.- Section II The Kidney and Sweat Glands in Fluid and Electrolyte Balance.- 11 The Kidney.- 11.1 Kidney Function and Maintenance of the Steady State.- 11.2 Kidney Structure.- 11.3 Blood Flow to the Kidney.- 11.3.1 Filtration to Bowman’s Capsule.- 11.3.2 Glomerular Filtration Rate (GFR).- 11.4 Function of the Uriniferous Tubules (General Survey).- 11.4.1 The Proximal Tubule.- 11.4.2 The Loop of Henle.- 11.4.3 The Distal Convoluted Tubules.- 11.4.4 The Collecting Ducts.- 11.5 Mechanism for Urine Formation.- 11.5.1 Introduction.- 11.5.2 Proximal Tubule Reabsorption.- 11.5.2.1 The Osmotic Multiplier (Loop of Henle.- 11.5.2.2 The Countercurrent Osmotic Exchanger (Vasa Recta).- 11.5.2.3 The Osmotic Exchanger (Distal Tubules and Collecting Ducts).- 11.5.2.4 The Effect of Albumin Concentration in the Interstitium.- 11.6 The Juxtaglomerular Apparatus.- 11.7 Renal Potassium Excretion.- 11.8 Hydrogen Ion Excretion.- 11.8.1 Proximal Tubule.- 11.8.2 Ammonia Excretion.- 11.8.3 Carbonic Anhydrase.- 11.8.4 The Distal Tubule.- 11.8.5 Diuretics.- 11.9 Renal Function Tests.- 11.9.1 Urea Nitrogen.- 11.9.2 Nonprotein Nitrogen.- 11.9.3 Creatinine.- 11.9.4 Other Guanidino Compounds.- 11.9.5 Proteins in Urine.- 11.10 Procedures for the Renal Function Tests.- 11.10.1 Introduction.- 11.10.2 Renal Blood Flow (RBF) and Renal Plasma (RPF).- 11.11 Glomerular Filtration Rate (GFR) (Creatinine and Urea Clearance).- 11.11.1 Clearance.- 11.11.2 Procedure (Creatinine or Urea Clearance).- 11.12 Calculations.- 11.13 The Proximal Tubule: Procedures for Measuring Its Function.- 11.13.1 Tubular Maximum Excretory Capacity (Tm).- 11.13.2 Tubular Maximum Reabsorption Capacity (Tm).- 11.13.3 Phenolsulfonephthalein (PSP) Dye Excretion Test.- 11.13.4 Tubular Phosphate Reabsorption (TRP).- 11.14 Distal Tubule: Procedures for Measuring its Function.- 11.14.1 The Urine Concentration Test.- 11.14.2 Titratable Acidity.- 11.14.3 Renal Acid Excretion Test.- 11.15 Other Kidney Function Tests.- 11.16 Laboratory Findings in Various Renal Diseases.- 11.16.1 Acute Glomerulonephritis.- 11.16.2 Chronic Glomerulonephritis.- 11.16.3 The Nephrotic Syndrome.- 11.16.4 Lipoid Nephrosis.- 11.16.5 Diabetic Glomerulosclerosis.- 11.16.6 Disseminated Lupus Erythematosus.- 11.16.7 Arteriolar Nephrosclerosis.- 11.16.8 Pyelonephritis.- 11.16.9 Amyloidosis.- 11.16.10 Neoplastic Disease of the Urinary Tract.- 11.16.11 Multiple Myeloma.- 11.17 Recapitulation.- 11.18 Selected Reading―Kidney in Water and Electrolyte Balance.- 11.19 References.- 12 The Sweat Glands.- 12.1 Function of the Exocrine (Eccrine )Sweat Glands.- 12.2 Structure of the Exocrine (Eccrine) Sweat Glands.- 12.3 Neurological Control of Sweating.- 12.4 Factors Involved in Determining the Volume and Composition of the Sweat.- 12.5 Excretion of Electrolytes in the Sweat Glands.- 12.6 Cystic Fibrosis (Mucoviscidosis).- 12.7 Sweat and Cystic Fibrosis.- 12.8 Laboratory Test for Cystic Fibrosis.- 12.9 Nonprotein Nitrogen and Total Nitrogen Excretion.- 12.10 Selected Reading―Human Sweat.- 12.11 References.- Section III Appendix and Index.- Bibliography on Analytical Clinical Chemistry.- Derivation of Equation for Calculating Amount of Alkali to Bring to Normal pH.- Table A.5 Sample Calculations for Preparing Table 9.3.- Table A.6 Normal Range for Components of Major Importance in Fluid and Electrolyte Balance.