Clinical Biochemistry Practical Assignment Sample

Clinical Biochemistry Practical Exercises: Mr. Kumar's Case Assignment

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Introduction Of Clinical Biochemistry Practical Exercises On Mr. Kumar’s Case

The report is based on a case study of Mr. Kumar who is 58 years old. He has visited his GP for a check-up as he has some issues with frequent urination, and being thirst, and tired feelings. He has recognized with unhealthy lifestyle due to his unhealthy diet and poor physical activities. The GP further suggests BMI measurement, POCT Urine test, cholesterol test, POCT blood glucose test, and “oral glucose tolerance test (OGTT)” to diagnose the actual reason for his problems (Cekovska et al. 2022). This report will provide brief information on the aforementioned tests and their methodologies. This information will help to understand the purpose of performing these tests and to identify the proper disease. The results of these tests will be provided in this report for better evaluation. In addition, a brief discussion of the results will be portrayed in this report for a better understanding of the results.

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Methods

BMI measurement

BMI refers to body mass index which is a trustworthy marker of body fatness. BMI is used to screen for weight types that potentially direct to health issues (CDC, 2021). BMI is the ratio between the weight of a person in kilograms and the square of that person’s height in meters.

Point Of Care Test (POCT)

POCT is a type of test where the evaluation is conducted in relation to healthcare adjacent to or beside the patient (Labtestsonline.org.uk, 2019). It is helpful when the focus of medical care turns to preventing, detecting, and controlling chronic illnesses.

Urine test using LABSTIX and MICROALBLUSTICX

LABSTIX is a coupled reaction that is useful for the detection of UTIs, renal disease, injury of the urinary tract, or diabetes. In this test, LABSTIX sticks consist of two enzymes. The first one is glucose oxidase which is attached at the terminal position of the stick onto the paper pad. This glucose oxidase oxidizes particularly glucose from the urine to produce H2O2 and gluconic acid. The second enzyme presents on the pad is a peroxidase which oxidizes a coloured stain into another colour by utilizing the produced H2O2. This change in colour exhibits the glucose quantity.

During the identification of ketone bodies, acetoacetate is dried on one of the LABSTIX pads. In this test, acetoacetate reacts with sodium nitroprusside to exhibit a maroon colour. In some cases, this test exhibits null or slightly positive results due to the conversion of acetoacetate into Β-hydroxybutyrate (Hendy, 2021). When there is any possibility of this conversion, a further alternative assay for the confirmation of b-hydroxybutyrate is performed. While testing for proteinuria, the albumin is charged positively at a pH value that is lower than its isoelectric point. At this moment, albumin binds anions which are indicated by tetrabromophenol blue (TBB). When protein is present in the blood, the outcome is the change of yellow colour into blue colouration. This helps in detecting renal disease. MICROALBLUSTIX test is also similar to this test but in this test, a sulphonephthalein-derivative dye is used where the pale green colour changes to aqua blue if albumin is present in urine.

Blood glucose test

This test is performed with the help of a POCT blood glucose meter. This device tests blood glucose levels with the help of test strips. There are multiple substances present on the strip which participate in a string of enzyme oxidation reactions” when coming in contact with the blood sugar (Lascaris et al. 2021). These reactions further create an electrical current and its strength reflects the amount of glucose in Mr. Kumar’s blood sample. Lastly, this recorded electrical current converts into digital reading that shows glucose level.

Serum cholesterol test

In this test, the blood serum of Mr. Kumar is compared with the normal control to measure the level of cholesterol. During this test, the serum sample is introduced with magnesium chloride or dextran sulfate which leads to the precipitation of non-HDL. This is further discarded with the help of high-speed centrifugation (Lee and Siddiqui, 2023). The remaining cholesterol in HDL is further resuspended as the exact amount of the actual serum sample in “phosphate buffered saline” which further provides information regarding cholesterol.

OGTT test

In this test, the major objective is to examine the possibility of diabetes or IGT in a patient. This test is performed by providing 75g of glucose orally to an adult patient who is in fasting overnight. The blood sample is taken in different time intervals i.e., from 0 to 2 hours (Information et al., 2016). The blood glucose level is diagnosed from all these samples by plotting a curve and calculating the concentration of each sample.

Results

Evaluation of BMI level

According to the case study, the height of Mr. Kumar is 1.77 m and his weight is 135.4 kg. Therefore, his BMI is = 135.4/(1.77)2 = 43.219 kg/m2.

LABSTIX (CLINISTIX)

The result of LABSTIX AND MICROALBUSTIX of Mr. Kumar has revealed that the glucose test shows a positive result which is 300mf/dL and the level of ketones is 10mg/dL although he has a normal protein value.

MICROALBUSTIX

The result of MICROALBUSTIX also exhibits a normal result which is 10mg/L.

Result of blood glucose test through blood glucose meter

The result of the blood glucose test of Mr. Kumar when checking with the help of a blood glucose meter has shown 10.2mmol/L while the control value is 3.7.

Result of serum cholesterol test

The report of the serum cholesterol test has revealed that his “total cholesterol concentration” is 8.653 mmol/L while the evaluated HDL-cholesterol is 0.971 mmol/L. The ratio of total cholesterol and HDL cholesterol is 8.91.

Result of OGTT test

From the OGTT test results, the evaluation of average glucose concentration is performed which is 12.4807mmol/L.

Discussion

The BMI level of Mr. Kumar is extremely higher than the normal value according to CDC (2020) which is 18.5 to 24.9 g/m2. This high BMI level reflects that he is suffering from obesity as he consumes unhealthy foods and hardly eats any vegetables or fruits. This can further enhance various issues such as cardiovascular disease, type 2 diabetes, high BP, etc. (Fruh, 2017, Nuttall, 2015). The results of the above experiments have revealed that Mr. Kumar is a patient with “Type 2 diabetes” due to his elevated glucose level which is supported by the positive result for the glucose in the urine test (Szablewski, 2020). As his blood glucose level is extremely high, he is labeled as a type 2 diabetic patient on the scale of recommended blood glucose level coverage by the “National Institute for Clinical Excellence (NICE)”. This high level of glucose further facilitates the development of diabetes due to his unhealthy lifestyle. In the LABSTIX test, the normal range of ketone reduces the chance of developing any renal injury or DKA. In addition, the result of the MICROALBUSTIX test ensures the non-impairment of his renal activities

Furthermore, Mr. Kumar has a high risk of developing cardiovascular diseases due to diabetic complications and cholesterol levels. His calculated HDL cholesterol is very lower than the normal range. According to “Institute for Quality and Efficiency in Health Care” (2017), the normal range of HDL is above 1mmol/L but in Mr. Kumar, it is 0.971 mmol/L. As HDL is referred to as good cholesterol, the shortage or deficiency of HDL in the body provokes heart disease. The total cholesterol level of Mr. Kumar is significantly higher than the control value reflecting the presence of a high amount of “LDL cholesterol” in his blood. “LDL cholesterol” is mentioned as bad cholesterol. The normal range of “total cholesterol is under 5.2 mmol/L” while his “total cholesterol” level is 8.653 mmol/L (Institute for Quality and Efficiency in Health Care, 2017). This high level of total cholesterol lead to the formation of plaque inside blood vessels which further blocks the arteries. Long-time formation of plaque can fully block the arteries which will further cause a heart attack in Mr. Kumar. The OGTT result revealed that the blood glucose level of Mr. Kumar is higher than 11.1 mmol/L after diagnosis for 2 hours. According to Eyth et al. 2019, the normal range blood glucose concentration for non-diabetic patients is 7.8 mmol/L, and for a diabetic patient is 11.1 mmol/L. As Mr. Kumar has a 12.4807 mmol/L concentration of blood glucose, which is above the level of “impaired glucose tolerance level”, it is clear that he is a patient with type 2 diabetes.

Conclusion

Multiple tests are performed to examine the current health condition of Mr. Kumar. Based on the symptoms stated by Mr. Kumar to the GP during his check-up, mostly tests for diabetes, renal problems, and cardiovascular diseases. The reports revealed that he is a patient with type 2 diabetes with a high risk of cardiovascular disease due to high BMI, high amount of total cholesterol, and low amount of HDL. The report has provided a brief idea about the experiments which are performed to come to this conclusion.

Reference lists

Books

  • Lee, Y. (2023). Cholesterol Levels. Available at: https://www.ncbi.nlm.nih.gov/books/NBK542294/#:~:text=Total%20and%20HDL%20cholesterol%20are [Accessed on: 17.04.23]

Journals

  • Cekovska, S., Aleksandra, J., Jordanova, O., Tasic, V., Irena, K., Tosheska Trajkovska, K., Topuzovska, S., Hristina, A., Melda, E. and Elena, P.S., 2022. EARLY URINARY MARKERS FOR RENAL INJURY IN OVERWEIGHTED AND OBESE CHILDREN AND ADOLESCENTS.
  • Hendy, J., 2021. Ancient protein analysis in archaeology.Science Advances,7(3), p.eabb9314.
  • Lascaris, B., Freling, H.G., Edens, M.A., Fokkert, M.J., Olthof, C.G. and Slingerland, R.J., 2021. Comparison of Accu Chek Inform II point-of-care test blood glucose meter with Hexokinase Plasma method for a diabetes mellitus population during surgery under general anesthesia.Journal of Clinical Monitoring and Computing, pp.1-7.
  • Nuttall, F.Q., 2015. Body mass index: obesity, BMI, and health: a critical review.Nutrition today,50(3), p.117.

Online Articles

  • Eyth, E., Hajira Basit and Smith, C.J. (2019). Glucose Tolerance Test. [online] Nih.gov. Available at: https://www.ncbi.nlm.nih.gov/books/NBK532915/. [Accessed on: 17.04.23]
  • Fruh, S.M. (2017). Obesity: Risk factors, complications, and strategies for sustainable long-term weight management. Journal of the American Association of Nurse Practitioners, [online] 29(1), pp.S3–S14. doi:https://doi.org/10.1002/2327-6924.12510. [Accessed on: 17.04.23]
  • CDC (2020). Assessing Your Weight. [online] Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/healthyweight/assessing/index.html#:~:text=If%20your%20BMI%20is%20less. [Accessed on: 17.04.23]
  • Information, N.C. for B., Pike, U.S.N.L. of M. 8600 R., MD, B. and Usa, 20894 (2016). Glucose tolerance tests: What exactly do they involve? [online] www.ncbi.nlm.nih.gov. Institute for Quality and Efficiency in Health Care (IQWiG). Available at: https://www.ncbi.nlm.nih.gov/books/NBK279331/. [Accessed on: 17.04.23]
  • Labtestsonline.org.uk. (2019). Point-of-Care Testing | Lab Tests Online-UK. [online] Available at: https://labtestsonline.org.uk/articles/point-care-testing#:~:text=Point%2Dof%2Dcare%20testing%20is%20useful%20as%20medical%20care%20shifts [Accessed on: 17.04.23]

Website

  • Ncbi.nlm.nih.gov, 2023. Institute for Quality and Efficiency in Health Care (2017). High cholesterol: Overview. [online] National Library of Medicine. Available at: https://www.ncbi.nlm.nih.gov/books/NBK279318/. [Accessed on: 17.04.23]
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