Clinical Biochemistry: Metabolic and Clinical Aspects

Citation

Marshall, W. J., Lapsley, M., Day, A., & Ayling, R. (2014). Clinical Biochemistry: Metabolic and Clinical Aspects (3rd ed.). Churchill Livingstone (Elsevier).

Chapter Summary

The third edition runs to about 930 pages with roughly 290 illustrations and is accompanied by an Expert Consult electronic version. The publisher presents it as a text that concentrates on the clinical side of the subject, in contrast with the many clinical chemistry books that concentrate on laboratory technology. It is organised by clinical area rather than by analytical method, and the headings below group its chapters by area.

Using and interpreting biochemical data

The book opens with chapters on how biochemical data are used in clinical medicine, how they are acquired, and how they are interpreted. The publisher's description lists the acquisition and interpretation of clinical biochemical data among the topics treated in detail, and the third edition adds a chapter on data quality management.

Water, electrolytes, acid-base balance, calcium and the kidney

Early in the contents come sodium, water and potassium; hydrogen ion homoeostasis and tissue oxygenation; and calcium, phosphate and magnesium. These are followed by the kidneys, renal function and renal failure, then renal tubular disorders and renal stone disease. Renal calculi are one of the conditions the publisher names explicitly.

Nutrition, gastrointestinal tract and liver

The clinical biochemistry of nutrition and the management of nutritional disorders are followed by chapters on the gastrointestinal tract and on the assessment of liver function, jaundice, and acute and chronic liver disease.

Diabetes, hypoglycaemia and endocrinology

Diabetes mellitus is treated in chapters on its pathophysiology and biochemical background and on its clinical management, followed by hypoglycaemia. The endocrine chapters cover hypothalamic, pituitary and adrenal disorders; the thyroid; hormonal aspects of non-endocrine disease; sexual development; and female and male reproductive function, including pregnancy, oral contraception and hormone replacement therapy.

Inherited metabolic disease and paediatric biochemistry

Inherited metabolic disease and paediatric clinical biochemistry have their own chapters, and the publisher highlights inherited metabolic disease in its description.

Blood, immunology, bone, joint and muscle

The contents include biochemical aspects of anaemia, disorders of haem synthesis, the haemoglobinopathies and immunology for clinical biochemists. Metabolic bone disease, articular disease and muscle disease follow. The publisher notes that the third edition expands the haematology and immunology sections.

Nervous system, lipids and cardiovascular system

Cerebrospinal fluid, psychiatric disorders and neurological disease are covered, followed by lipid metabolism and the hyper- and hypolipidaemias, which the publisher names as a headline topic, and by the clinical biochemistry of the cardiovascular system.

Drugs, tumours and molecular methods

The closing groups of topics address therapeutic drug monitoring and poisoning, the metabolic effects of tumours, tumour markers and molecular clinical biochemistry. The publisher lists the metabolic response to stress and forensic aspects of clinical biochemistry as new chapters in this edition.

Key Concepts

Data and interpretation

• Acquisition and interpretation of biochemical data: how results are obtained and read in a clinical setting.
• Data quality management: a topic added in the third edition.

Fluids, electrolytes and organ systems

• Homoeostasis of sodium, water, potassium, hydrogen ion, calcium, phosphate and magnesium: the basis for interpreting disturbances of body fluids.
• Renal function, renal failure and renal stone disease: the biochemical assessment of the kidney.
• Liver function and jaundice: how hepatic disease is assessed.

Metabolic and endocrine disease

• Diabetes mellitus and hypoglycaemia: pathophysiology and clinical management.
• Inherited metabolic disease: disorders of metabolism with their investigation.
• Dyslipidaemias and metabolic bone disease: conditions the publisher specifically names.

Specialised areas

• Therapeutic drug monitoring and poisoning, tumour markers, and molecular clinical biochemistry: laboratory support for treatment, cancer and genetic testing.

Critical Analysis

Strengths

• A clinical emphasis. The publisher stresses that, unlike many competing clinical chemistry texts that concentrate on technology, this book concentrates on the clinical aspects, with detailed coverage of the conditions in which clinical biochemistry is used in diagnosis and management.
• Breadth across conditions. The contents run from fluids and electrolytes through each organ system and endocrine disease to inherited metabolic disease, drug monitoring and tumour markers, giving a single reference across the specialty.
• Aimed at postgraduate examination preparation. The publisher describes it as ideally suited for MRCPath and similar examinations and as essential reading for specialty trainees.
• Practical orientation. A review quoted by the publisher, from Elizabeth Hall in Annals of Clinical Biochemistry, calls the book wide-ranging and detailed but very practical, applicable to the questions that arise with real patients, with many tables for quick reference.

Limitations

• Specialist level. The stated readership is trainee and practising clinical chemists and those training in metabolic medicine, so it goes beyond a first biochemistry text and concentrates on clinical aspects rather than on teaching basic biochemistry from scratch.
• Length. At about 930 pages it is a reference as much as a course text; most readers will use selected chapters.

Where It Fits in the Course

This book belongs at the clinical end of the biochemistry course. Marks' Basic Medical Biochemistry: A Clinical Approach teaches metabolism and molecular biology through patient cases and is a natural preparation, and Lippincott Illustrated Reviews: Biochemistry offers a shorter illustrated review. Crash Course Metabolism and Nutrition and Metabolism at a Glance are lighter introductions to pathways that are useful before opening a text at this level.

Human Metabolism: A Regulatory Perspective is the closest companion in depth: it explains how metabolism is regulated across organs, while Marshall and colleagues show how those disturbances present and how they are investigated in the laboratory. The two complement rather than replace each other, and the regulatory text is a sensible partner for the diabetes, nutrition and inherited metabolic disease chapters here.

How to Use This Book

The book is for specialty trainees in chemical pathology and clinical biochemistry, clinical scientists, and established practitioners who interpret biochemical results; advanced medical students can use individual chapters. A working knowledge of preclinical biochemistry and physiology, and some clinical exposure, make the chapters easier to follow.

A practical plan:

• Start with the data chapters on the use, acquisition and interpretation of biochemical results, which give the general background for the later chapters.
• Read by problem, not front to back. Pick the chapter that matches the clinical question: electrolytes and acid-base, kidney, liver, diabetes, endocrine, bone, lipids or inherited metabolic disease.
• For examination preparation, work systematically through the organ-system and endocrine chapters and use the tables for revision; the Expert Consult version allows searching.
• Pair it with a basic text from the same course when a pathway or mechanism needs refreshing before the clinical chapter makes sense.