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Chemistry, toxicology & urinalysis

Authors: Alaa Abdelrazik, M.B.B.Ch., M.Sc. (Clin Pharm), M.Sc. (Clin Path), M.D., Ph.D., Syeda F. Absar, M.D., M.P.H., Vishnu Amaram Samara, Ph.D., Larry Bernstein, M.D., Roger L. Bertholf, Ph.D., Andrey Bychkov, M.D., Ph.D., Mary O. Carayannopoulos, Ph.D., Lechuang Chen, Ph.D., Ahsan Farooq, M.D., Kornelia D. Galior, Ph.D., David F. Haddock, M.D., Rongrong Huang, Ph.D., Zhicheng Jin, Ph.D., Kathleen A. Kelly, Ph.D., David F. Keren, M.D., Sarrah Lahorewala, B.D.S., Ph.D., Derek B. Laskar, M.D., Felix Leung, Ph.D., Jieli (Shirley) Li, M.D., Ph.D., Olajumoke Oladipo, M.D., Nat Pernick, M.D., Archana Shetty, M.B.B.S., M.D., Junyan Shi, Ph.D., Panudda Srichomkwun, M.D., M.Sc., Qian Sun, Ph.D., Patricia Tsang, M.D., M.B.A., Renu Virk, M.D., Jingcai Wang, M.D., Ph.D., Ruhan Wei, Ph.D., Yusheng Zhu, Ph.D.
Resident / Fellow Advisory Board: Frido Bruehl, M.D.
Board of reviewers: Jieli (Shirley) Li, M.D., Ph.D.
Editorial Board Members: Andrey Bychkov, M.D., Ph.D., Melissa R. George, D.O., Catherine E. Hagen, M.D., Patricia Tsang, M.D., M.B.A.
Deputy Editors-in-Chief: Andrey Bychkov, M.D., Ph.D., Raul S. Gonzalez, M.D., Patricia Tsang, M.D., M.B.A.
Editor-in-Chiefs: Patricia Tsang, M.D., M.B.A., Debra L. Zynger, M.D.

Copyright: 2007-2024, PathologyOutlines.com, Inc.

Chemistry related: Jobs, Fellowships, Conferences, CME, Board Review

Editorial Board oversight: Melissa R. George, D.O. (last reviewed December 2023)
Superpage Topics
Adrenal insufficiency-diagnosis Aldosterone Anticardiolipin antibodies Calcitonin Creatine kinase Drugs of abuse Hepatitis B testing Hyperaldosteronism Hypercortisolism Hyperlipidemia Interference in protein electrophoresis Parathyroid hormone Rheumatoid arthritis Screening thyroid disorders Syphilis Systemic lupus erythematosus (SLE) Therapeutic drug monitoring Toxicology-general Urine crystals & microscopy Vitamin D lactate dehydrogenase
Adrenal insufficiency-diagnosis
Diagrams / tables

Contributed by Sarrah Lahorewala, B.D.S., Ph.D. and Roger L. Bertholf, Ph.D.
Adrenal insufficiency testing flowchart

Adrenal insufficiency testing flowchart

Primary adrenal insufficiency testing flowchart

Primary adrenal insufficiency testing flowchart

Adrenal steroid metabolism

Adrenal steroid metabolism

Aldosterone
Diagrams / tables

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Aldosterone biosynthetic pathways

Aldosterone biosynthetic pathways

Anticardiolipin antibodies
Diagrams / tables

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2023 ACR / EULAR APS classification criteria

2023 ACR / EULAR APS classification criteria

Calcitonin
Diagrams / tables

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Procalcitonin and calcitonin molecule

Procalcitonin and calcitonin molecule

Calcitonin function

Calcitonin function

Interpretation of serum calcitonin measurement

Interpretation of serum calcitonin measurement

Follow up of MTC

Follow up of MTC

Calcium stimulation test

Calcium stimulation test

Videos

Regulation of blood calcium via PTH and calcitonin

Customizing imaging based on calcitonin levels in medullary thyroid cancer

Creatine kinase
Diagrams / tables

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Creatine kinase

Drugs of abuse
Diagrams / tables

Contributed by Vishnu Amaram Samara, Ph.D.

Chemical structures of a few common drugs of abuse



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Benzodiazepine metabolic pathways

Amphetamine metabolic pathway

Cannabinoid metabolic pathway

Opioid metabolic pathways




General cutoff limit concentrations of common drug classes by immunoassay screening and LC-MS / MS quantitative confirmation
Drug class / metabolites
Immunoassay screening
typical cutoff limits
(ng/mL)
Quantitative cutoff
limits using LC-MS / MS
(ng/mL)
Amphetamine
1,000
50
Barbiturates
200
50
Benzodiazepines
200
5
Cannabinoids
50
15
Cocaine
300
50
Opiates
300
20
Phencyclidine
25
10
Hepatitis B testing
Diagrams / tables

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Hepatitis B serologic course

Hepatitis B serologic course

Hyperaldosteronism
Diagrams / tables

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Synthesis pathway

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Renin-angiotensinal-dosterone axis

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Diagnostic pathways

Hypercortisolism
Clinical images

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Physical features

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Patient description

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Buffalo hump

Gross images

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Adrenal adenoma

Hyperlipidemia
Diagrams / tables

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Schematic of a chylomicron

Clinical images

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Xanthelasma palpebrarum

Interference in protein electrophoresis
Diagrams / tables

Contributed by Ahsan Farooq, M.D. and Yusheng Zhu, Ph.D.
Fibrinogen

Fibrinogen

Patient with IgG4 RD

Patient with IgG4 RD

Patient on 5 fluorocytosine

Patient on 5 fluorocytosine

Multiple myeloma patient on daratumumab

Multiple myeloma patient on daratumumab

Parathyroid hormone
Diagrams / tables

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Biologic effects of PTH and
vitamin D on calcium and
phosphate metabolism

Rheumatoid arthritis
Diagrams / tables

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Clinical manifestations of RA

2010 RA classification criteria

2010 RA classification criteria

Classifying definite rheumatoid arthritis

Classifying definite RA

Screening thyroid disorders
Diagrams / tables

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Diagnostic algorithm full

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Diagnostic algorithm simplified

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Classification of congenital hypothyroidism

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Thyroid imaging and serum Tg in congenital hypothyroidism

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Reference ranges


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Genetic screening

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Genetic diagnosis

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Pregnancy and fetal hypothyroidism

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Heel stick diagram

Syphilis
Diagrams / tables

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Serology response

Serology response

Serologic testing algorithms

Serologic testing algorithms

Systemic lupus erythematosus (SLE)
Diagrams / tables

Contributed by Jieli Shirley Li, M.D., Ph.D.
Fundamental principle of IFA ANA methods

Fundamental principle of IFA ANA methods



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Comprehensive view of pathogenesis

Comprehensive view of pathogenesis

IFA ANA testing classification tree

IFA ANA testing classification tree

Classification criteria

Classification criteria

Definitions of classification criteria

Definitions of classification criteria

Therapeutic drug monitoring
Diagrams / tables

Contributed by Jingcai Wang, M.D., Ph.D.
Drug concentration versus half lives

Drug concentration versus half lives

Toxicology-general
Diagrams / tables

Contributed by Derek B. Laskar, M.D.

1: TLC for separation of major drugs of abuse

2: HPLC for separation of opiate analogs

3: Zero order and first order elimination kinetics

4: Window of detection for common drugs

Urine crystals & microscopy
Diagrams / tables

Contributed by Archana Shetty, M.B.B.S., M.D.
Urine sediment microscopy

Urine sediment microscopy

Steps in urine dipstick test

Steps in urine dipstick test

Microscopic (histologic) images

Contributed by Archana Shetty, M.B.B.S., M.D.
Calcium oxalate crystals

Calcium oxalate crystals

Uric acid crystals

Uric acid crystals

Sulfa drug crystals

Sulfa drug crystals

Triple phosphate crystals

Triple phosphate crystals


Squamous epithelial cells

Squamous epithelial cells

Red blood cells

Red blood cells

Red blood cell casts

Red blood cell casts

Amorphous urates in urine

Amorphous urates in urine

Vitamin D
Diagrams / tables

Contributed by Zhicheng Jin, Ph.D.

Structure and biological activation

lactate dehydrogenase
Diagrams / tables

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Pyruvate to Lactate conversion

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Recent Chemistry, toxicology & urinalysis Pathology books

Haschek: 2022

Haschek-Hock: 2023

Magnani: 2020

Makowski: 2017

McPherson: 2021

Rifai: 2022

Snyder: 2020

Wagar: 2019



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