Second Edition

Prof. Jacob Anthikad MA (Psy), BEd, MS (Chem), DTech (Biochem)

Wing Commander, IAF (Retd) And Visiting Professor Kempa Gowda College of Nursing, Bangalore MS Ramiah College of Nursing St. John's College of Nursing St. Philomina's College of Nursing

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All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher. Every effort is made to ensure accuracy of material, but the publisher, printer and author will not be held responsible for any inadvertent error(s). In case of any dispute, all legal matters to be settled under Delhi jurisdiction only. First Edition: 1998 Second Edition: 2004 ISBN 81-8061-214-7 Typeset at JPBMP typesetting unit

To The Nurses of the 21st Century And my teachers at Loyola College, Chennai, Central College, Bangalore, Indian Institute of Sciences, Bangalore, and Bangalore Medical College

The present edition has been updated with the addition of more and latest available material. Most of the chapters have been rewritten in the light of friendly suggestions from the students and teachers. teachers and students are always welcome to further improve the contents. The author is extremely grateful to M/s Jaypee Brothers Medical Publishers (P) Ltd., Mr. JP Vij, Chairman and Managing Director and Mr. Tarun Duneja, General Manager Publishing for bringing out this second edition, after many reprints of the first which had proved to be immensely popular in India and abroad.

Wg. Cdr. (Retd.) Jacob Anthikad

During the last hundred years of its independent existence, a practising doctors and are not readily useful for nursing students. Universities.

judge how far I have been successful. I shall be happy to receive suggestions from students and teachers. I am particularly grateful to Mr. J.P. Vij Chairman and Managing Director, Mr. R.K. Yadav, Editorial Consultant and other staff of M/s Jaypee Brothers Medical Publishers, New Delhi for

Wing Cdr. (Retd.) Jacob Anthikad

1. Biochemical Perspective to Medicine 2. Chemistry of Carbohydrates 3. Chemistry of Lipids 4. Amino Acids 5. Chemistry of Proteins 6. Nucleic Acids and Nucleotides 7. Enzymology 8. Digestive Enzymes and their Action 9. Vitamins 10. Basic Concepts of Metabolism 11. Metabolism of Carbohydrates 12. Metabolism of Lipids 13. Metabolism of Proteins 14. Water and Mineral Metabolism 15. Hormones: Outline Chemistry and Functions 16. Nutrition 17. Blood Chemistry 18. Urinalysis and Renal Function Tests 19. Tests for Gastric Functions 20. Liver Function Tests University Exam Question Papers Index

212 221

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Biochemistry for Graduate Nurses

Normal Values Test

Normal values

Test

Normal values

FBS

70-100 mg%

Calcium

8.5-10.5 mg%

RBS

80-120 mg%

Phosphorus LIPID PROFILE

2.5-5 mg%

PPBS

100-140 mg%

Urine Sugar

Nil

Cholesterol

150-250 mg%

Glycosylated Hb.

4.5-8%

HDL Cholesterol

30-70 mg%

Urea

10-45 mg%

Triglyceride

10-160 mg%

Creatinine

0.7-1.5 mg%

VLDL

6-40 mg%

Uric Acid

3-7 mg%

Acid Phosphatase 0-3 KAU/dl Amylase

Blood non-protein Nitrogen (NPN)

25-125 U/dl

20-40 mg%

LIVER FUNCTIONS TESTS

IRON PROFILE

Total Protein

6-8 g/dl

Iron

60-150 ug/dl

Albumin

3.4-5 g/dl

TIBC

230-380 ug/dl

A/G Ratio

1.2-1.7

Transferrin

1.2-2 g/dl 20-50%

Total

Bilirubin

0.2-1.2 mg%

Transferrin Satn.

Conj.

Bilirubin

0.1-0.4 mg%

URINE

SGOT (AST)

5-50 IU/L

Reducing sugars

SGPT (ALT)

5-50 IU/L

Gamma G.T. (GGT) 10-45 IU/L

100 mg/day

Urea

30 gm/day

Uric acid

0.8 gm/day

Chloride as NaCl

10-15 gm/day 0.4 gm/day

CPK

0-192 IU/L

Urobilinogen

CPK - B

0-13 IU/L

Ketone bodies

1 mg/day

CPK - MB

0-25 IU/L

Phosphorus

10 gm/day

LDH

200-400 IU/L

Titrable

200-400 ml N/10 acid

acidity

(Nursing) degree of Indian Universities is a serious handicap for the to fill in this gap. All the relevant information needed by the student has been included in a precise and concise manner. Even though year 1998-99, the coverage is such that it can be used as the

Wg. Cdr. Jacob Anthikad Has been teaching chemistry including biochemistry to BSc and MSc students during the last forty years. While serving the Indian Centre and Institute of Aerospace Medicine as well as Bowring and Lady Curson Hospitals, Bangalore. After retirement from the IAF, include the immensely popular Psychology for Nurses.

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Biochemical Perspective to Medicine The term "Biochemistry ions" was introduced by Carl Neuberg in 1903. Biochemistry is the chemical language of life, basic to the understanding of biological and medical sciences. It gives us information regarding the functioning of the cells at the molecular level and also helps in finding remedies for a variety of ailments that afflict men and animals. SCOPE OF BIOCHEMISTRY The study of biochemistry is essential to understand the basic functions of the body. It answers the following questions: a. What are the chemical compounds by which living things are composed of? What is the structure of megamolecules characteristics of living organism? b. How is the food which we eat digested, absorbed and used? c. How are the various metabolic functions interrelated? d. How does the body derive its energy for work? e. What is the molecular basis of immunological resistance? f. How do enzymes accomplish their catalystic task. g. What is the structure of a living cell and how is it organised to conduct its characteristic chemical functions? h. By what means do cells divide to yield identical daughter cells? i. What is the chemistry of inheritance? What is a gene and how does it function? j. How does an animal regulate the volume and composition of fluids that constitute the environment of its cells and of the blood that interconnects them. Biochemistry is the most rapidly developing branch of medicine of the twentieth century and hence Nobel prizes in medicine have largely gone to research workers in this field. Modern medical practice is highly dependent on the laboratory analysis of body fluids, especially of the blood and urine. The disease manifestations are reflected in the changed composition of

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blood and other body fluids. Hence the distinction of abnormal from the normal constituents of the body is the basic aim of biochemical studies. Since the time of Aristotle, students of biology had sought to correlate structure and function. The endeavour continues. The correlation of biological function and molecular structure is the main theme of biochemistry. The Cell A cell is the basic unit of life as life starts from a single cell. Cells are of many types. They are muscle cells, bone and cartilage cells, nerve cells, skin cells, visual cells in the eye and many others. Although each cell may show distinct characteristics for the particular functions performed, cells do show some fundamental characteristics. An ultrastructure of a cell is given in Figure 1.1. The living matter in the cells is the protoplasm, the physical basis of life. The cell consists of an outer limiting membrane, the plasma membrane. The membranes are made up of lipids (mainly of phospholipids), proteins and small amounts of carbohydrates in the form of glycoprotein and glycolipids. Inside the plasma membrane, there are two easily distinguishable regions, i.e. an outer watery granulated cytoplasm and an inner denser almost spherical region, the nucleus. The plasma membrane is important as it helps control the materials that go into and come out of the cell. The simple sugars, amino acids, potassium ions and water can pass through the membrane rapidly but sodium ions and other substances cannot. Cytoplasm: Organelles Cytoplasm are suspended various structures called orga–nelles. These are: Generally it occupies a central position in the cell. It is spherical or oval and much denser than the cytoplasm. It is the seat of all metabolic activities of the cell. All cells in the human body contain nucleus, except mature RBCs in circulation. Nucleus contains DNA, the chemical basis of the genes, which governs all the functions of the cell. The very long DNA molecules are complexed with proteins to form chromatin and are further organised into chromosomes. DNA replication and RNA synthesis (transcription) are taking place inside the nucleus.

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In some cells, a portion of the nucleus may be seen as lighter . This is the area for RNA shaded area. This is called processing and ribosome synthesis. The nucleus will be very prominent in cells actively synthesising proteins. This is an elaborate system of membranes containing small particles of ribonucleic acid (RNA). These structures provide a large surface area for cellular enzymes and control the entry and exit of substances into the cell.

Lysosome

Fig. 1.1: Ultrastructure of the cell

The absence of a single textbook for biochemistry for BSc (Nursing) degree of Indian Universities is a serious handicap for the teachers and students alike and this textbook is a sincere attempt to fill in this gap. All the relevant information needed by the student has been included in a precise and concise manner. Even though the book has been based mainly on the new syllabus of Rajiv Gandhi Health University of Karnataka, effective from the academic year 1998-99, the coverage is such that it can be used as the textbook for graduate nursing students in india and abroad.

Wg. Cdr. (Retd.) Jacob Anthikad Has been teaching chemistry including biochemistry to BSc and MSc students during the last forty years. While serving the Indian Air Force as an education officer, he had worked in prestigious institutions like the Air Force Command Hospital, Medical Training Centre and Institute of Aerospace Medicine as well as Bowring and Lady Curson Hospitals, Bangalore. After retirement from the IAF, he has worked for five years in St. Martha's Hospital, Bangalore before taking up the present teaching assignment. His other works include the immensely popular Psychology for Nurses.

ISBN 81-8061-214-7

9 788180 612145