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Labs Are Vital - Home Page

Resources and ideas for promoting and celebrating the work of clinical laboratories in medicine.  We are not just a black box - sample in, result out!

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Clinical biochemistry
Good quality clinical biochemistry online learning resources and links
Curated by Duncan Cole
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Welcome to Clinical Biochemistry!

Welcome to Clinical Biochemistry! | Clinical biochemistry | Scoop.it

I have curated a variety of online sources of information on clinical biochemistry, suitable for medical students, doctors and other health professionals. I am a senior lecturer and consultant in medical biochemistry and metabolic medicine in Cardiff, and lead the Special Chemistry section of the Cardiff and Vale NHS lab. You can find information about the Department of Medical Biochemistry in Cardiff University from the link here, which includes a link to my personal profile.

Each of the posts have been reviewed, and so should contain good, useful, and interesting information. If any of them don't please let me know!

The content is searchable - click on the "Filter" button above and enter your search terms.

If you want updates, click on the blue "Follow" button at the top right. You can also follow me on Twitter @DuncanMedBio where I will also be sharing posts.

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Normal Acid-Base Regulation (Understanding ABGs - Lecture 2)

A lecture on the physiology of normal acid-base regulation, including a discussion of the bicarbonate buffering system, the Henderson-Hasselbalch equation, a...
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Duncan Cole's curator insight, November 14, 2013 6:28 AM

Well explained, easy to follow lecture on acid-base physiology.  This is ideal for year 1 medical students, and for all those who need to brush up on the underlying principles of acid-base homeostasis.  It is a little long for an online video, but it is worth the effort.

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Investigating mildly abnormal serum aminotransferase values | BMJ

What is the next investigation?  An initial history and clinical examination are necessary for determining the likely aetiology of the raised alanine aminotransferase value, the presence of any comorbidity that may accelerate disease progression, and...
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A helpful article outlining the investigation and management strategy for an asymptomatic abnormality in the LFT profile, presented in the context of a clinical case.  It highlights some of the difficulties in managing such patients, and contains a good discussion of Non-Alcoholic Fatty Liver Disease (NAFLD).

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Abnormal Liver Function Tests | Doctor | Patient.co.uk

Abnormal Liver Function Tests | Doctor | Patient.co.uk | Clinical biochemistry | Scoop.it
Interpreting abnormal liver function tests (LFTs) and trying to diagnose any underlying liver disease is a common scenario in Primary Care. Abnormal LFTs...
Duncan Cole's insight:

A good summary of the main points in how to interpret LFTs.  It is primary care orientated, and will give students a good introduction to the area.

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Lab Tests Online-UK: app release

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The app from Lab Tests Online is just as good as the web-based resource - highly recommended for all healthcare professionals.  Clear, easy to search, and good quality information. It is also available for Android devices.

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Clinical biochemistry: sodium & water disorders · Storify

Disorders of sodium and water are common in clinical practice and often difficult to investigate and manage appropriately.
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The same resources as you'll find here on Scoop.it, but arranged as a tutorial on Storify.  See what you think...

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Journal of Medical Case Reports: Water intoxication presenting as maternal and neonatal seizures: a case report

Journal of Medical Case Reports:  Water intoxication presenting as maternal and neonatal seizures: a case report | Clinical biochemistry | Scoop.it

An unusual case of fitting in the mother and newborn child, and the challenges faced in the management of their hyponatraemia due to water intoxication.

Duncan Cole's insight:

Fascinating case report on hyponatraemia.  I learnt something from this: that the unborn baby can be affected by maternal water intoxication. So if a neonate has severe hyponatraemia then it would be reasonable to investigate the mother for hyponatraemia as well.

 

This is a good article for those studying sodium and water disorders as it presents the biochemistry clearly in a Table and discusses the interpretation and diagnosis clearly.

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Hypernatraemia | Doctor | Patient.co.uk

Hypernatraemia | Doctor | Patient.co.uk | Clinical biochemistry | Scoop.it

From the Professional Reference section of the website, this page provides a summary of the presentation, investigation and management of hypernatraemia.

Duncan Cole's insight:

This is a clear and concise summary.  The list of causes is helpful and well structured, and the article emphasises the at-risk groups for hypernatraemia to highlight the need to guard against it.

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Hyponatraemia | Doctor | Patient.co.uk

Hyponatraemia | Doctor | Patient.co.uk | Clinical biochemistry | Scoop.it

From the Professional Reference section of the website, this is an overview of the presentation, investigation and management of hyponatraemia.

Duncan Cole's insight:

Aimed at doctors and other healthcare professionals, this webpage contains a helpful discussion of hyponatraemia, with accessible references.  It is concise and easily understood, and contains a useful flow diagram for diagnosis.

 

The article also briefly covers management and complications.

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Sodium Homeostasis: Part 1

Presentation covering roles of sodium in the body, causes of hyponatraemia and hypernatraemia and their effects on cells.

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This is a clear, concise introduction to sodium homeostasis.  It has some helpful discussion on the effects of sodium disorders on cells, although no distinction is made between those that are important clinically and those not.  For example, cardiac effects are only seen in very severe hyponatraemia, and are not usually a clinical problem. 

 

The causes discussed are very much a brief introduction, but you can view a more detailed review on one of the other curated posts. Part 2 is also available on YouTube.

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Endobible - Advice on Endocrine Symptoms, Diagnosis, Treatment

Endobible - Advice on Endocrine Symptoms, Diagnosis, Treatment | Clinical biochemistry | Scoop.it

Endocrinology Guidance on Investigations, Diagnosis, Treatment and Management.  Helpful and easy to use, but doesn't always go into sufficient detail.

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Labs Are Vital - Home Page

Resources and ideas for promoting and celebrating the work of clinical laboratories in medicine.  We are not just a black box - sample in, result out!

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Lab Tests Online-UK: Welcome!

Lab Tests Online-UK: Welcome! | Clinical biochemistry | Scoop.it

This is a really good quality resource on biochemistry and other lab testing - it is aimed at patients, but is also very useful for healthcare professionals.

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cp-R Clinical Chemistry Software

cp-R Clinical Chemistry Software | Clinical biochemistry | Scoop.it
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This is a nice piece of software for regression analyses in clinical chemistry.  There are helpful tutorials on the website so you should be able to get up and running with it fairly easily.

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WEDINOS - About Us

WEDINOS - About Us | Clinical biochemistry | Scoop.it
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Fantastic project being run by colleagues in the toxicology laboratory in Cardiff in collaboration with clinicians and chemists to identify new psychoactive substances.

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Liver Function Tests (LFTs) Explained Clearly!

Understand the main functions of the liver and the associated clinical laboratory tests with this clear explanation from Dr. Roger Seheult. Includes discussi...
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This video clearly explains the clinical biochemistry of cholestatic liver disease, including the effects on bilirubin metabolism.  It is particularly good for medical students.  The bilirubin units are quoted in mg/dl - in the UK we use mmol/L.  He does discuss hyperbilirubinuria - it is important to also note that this is basis for asking about dark urine which occurs in biliary obstruction.

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Clinical biochemistry: disorders of calcium metabolism · Storify

This series of freely available online resources takes you through calcium and phosphate metabolism, its endocrine control, and the fundamentals of how to investigate hyper- and hypo-calcaemia.
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A second storify tutorial I have written/curated - hopefully useful to both medical students, doctors and other healthcare professionals.

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Duncan Cole's curator insight, August 22, 2013 7:25 AM

An example of how Storify can be used in medical education.

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Pathology harmony

Pathology harmony | Clinical biochemistry | Scoop.it
working towards harmonising standards in UK pathology services
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Pathology Harmony is an organisation that aims to standardise pathology testing across the UK.  This webpage describes their work and why it is being done. There is a particularly valuable guidance document on the use of tumour markers, which I would recommend reading if you request these tests.  Tumour markers are frequently requested on inadequate clinical grounds, and can be unhelpful and misleading if used inappropriately, causing confusion and unnecessary further investigation.  The key is in understanding what the tests can tell you, and this summary should help busy clinicians make good informed decisions when requesting these tests.

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Clinical Chemistry Training Resources

Clinical Chemistry Training Resources | Clinical biochemistry | Scoop.it

Resources from the AACC for trainees, including short presentations on analytes, podcasts, and clinical cases with questions around clinical chemistry isses.  Registrations is required, but is free.

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Excellent suite of resources for trainees in clinical biochemistry and chemical pathology.

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Prodigy - Clinical topic - Hyponatraemia

Prodigy - Clinical topic - Hyponatraemia | Clinical biochemistry | Scoop.it

This PRODIGY topic covers the diagnosis of hyponatraemia, how to determine the underlying cause, and the management of hyponatraemia.

Duncan Cole's insight:

PROGIDY used to be Clinical Knowledge Summaries in NHS England. This topic section provides a very good overview of hyponatraemia, with plenty of information which includes pathophysiology as well as sections on diagnosis and assessment, and management, of hyponatraemia.  Lots of hyperlinks mean you can sometimes become lost in the morass of information, but it is relatively easy to navigate back to the key pages. 

 

This site also provides clear statements on sources of evidence, and does indicate what level of evidence it is, although quite a lot is sourced from expert reviews.

 

Unfortunately there doesn't appear to be a similar topic for hypernatraemia on this site, which is a shame.

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Anne Marie Cunningham's comment, January 22, 2013 7:05 PM
Prodigy is very primary care orientated... hyponatraemia is a much more common problem that hypernataemia!
Duncan Cole's comment, January 23, 2013 2:48 PM
Thanks, a good point. Still a shame they don't have one for hypernaraemia as they have done a good job on this in my view.
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Osmolality: Test Sample

Osmolality: Test Sample | Clinical biochemistry | Scoop.it

Describes what osmolality is and how the sample is collected for testing

Duncan Cole's insight:

This is a commonly misunderstood test.  This entry in lab tests online goes through the definition of osmolality, how to calculate it (if you need to know the osmolar gap) and what the results mean.  To be able to properly interpret the results, plasma and urine osmolalities must be taken at the same time (this is often referred to as "paired" samples).  

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Sodium: At a Glance

Sodium: At a Glance | Clinical biochemistry | Scoop.it

Overview of Sodium (Na) blood or urine test which determines the cause of and monitors treatment for illnesses associated with abnormal sodium levels.

Duncan Cole's insight:

Good quality information, and although aimed at patients it is of sufficient detail to be useful to medical students in particular, and also doctors and other healthcare professionals. 

 

The webpage covers indications for requesting the test (in practice this is almost everybody who is admitted to hospital, and a good proportion of outpatients), the test itself, and a brief discussion of sodium and water disorders.

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Pure Water Homeostasis

A short video describing water homeostasis in the body. Causes, effects, and methods the body uses to mediate dehydration and over-hydration are discussed.

Duncan Cole's insight:

Combined with the presentations on sodium homeostasis, this provides a good introductory overview of sodium and water homeostasis. 

 

Viewing these three presentations are enough to get started on the clinical investigation of sodium and water disorders.  Their strength is the visual presentation of "loops" reinforcing the central concept of feedback in homeostatis mechanisms

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National Pathology Week / Year

National Pathology Week / Year | Clinical biochemistry | Scoop.it

RCPath initiative promoting pathology in all its forms to both the public and healthcare professionals.  Loads of great resources, and listings of events all over the country.

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Change to HbA1c values - Diabetes UK

Change to HbA1c values - Diabetes UK | Clinical biochemistry | Scoop.it

HbA1c unit changes - good updates on the Diabetes UK site, with information sheets for doctors, laboratory professionals, and patients.  Also has a quick converter!

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