Ganong's Review of Medical Physiology, 23rd - WordPress.com

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Ranges of Normal Values in Human Whole Blood (B), Plasma (P), or Serum (S)a
Normal Value (Varies with Procedure Used) Determination Traditional Units SI Units
Normal Value (Varies with Procedure Used)
Determination Traditional Units SI Units
Acetoacetate plus acetone (S) 0.3–2.0 mg/dL 3–20 mg/L
Aldosterone (supine) (P) 3.0–10 ng/dL 83–227 pmol/L
Alpha-amino nitrogen (P) 3.0–5.5 mg/dL 2.1–3.9 mmol/L
Aminotransferases
Alanine aminotransferase 3–48 units/L
Aspartate aminotransferase 0–55 units/L
Ammonia (B) 12–55 μmol/L 12–55 μmol/L
Amylase (S) 53–123 units/L 884–2050 nmol s–1/L
Ascorbic acid (B) 0.4–1.5 mg/dL (fasting) 23–85 μmol/L
Bilirubin (S) Conjugated (direct): up to 0.4 mg/dL Up to 7 μmol/L
Total (conjugated plus free): up to 1.0 mg/dL Up to 17 μmol/L
Calcium (S) 8.5–10.5 mg/dL; 4.3–5.3 meq/L 2.1–2.6 mmol/L
Carbon dioxide content (S) 24–30 meq/L 24–30 mmol/L
Carotenoids (S) 0.8–4.0 μg/mL 1.5–7.4 μmol/L
Ceruloplasmin (S) 23–43 mg/dL 240–430 mg/L
Chloride (S) 100–108 meq/L 100–108 mmol/L
Cholesterol (S) < 200 mg/dL < 5.17 mmol/L
Cholesteryl esters (S) 60–70% of total cholesterol
Copper (total) (S) 70–155 μg/dL 11.0–24.4 μmol/L
Cortisol (P) (AM, fasting) 5–25 μg/dL 0.14–0.69 μmol/L
Creatinine (P) 0.6–1.5 mg/dL 53–133 μmol/L
Glucose, fasting (P) 70–110 mg/dL 3.9–6.1 mmol/L
Iron (S) 50–150 μg/dL 9.0–26.9 μmol/L
Lactic acid (B) 0.5–2.2 meq/L 0.5–2.2 mmol/L
Lipase (S) 3–19 units/L
Lipids, total (S) 450–1000 mg/dL 4.5–10 g/L
Magnesium (S) 1.4–2.0 meq/L 0.7–1.0 mmol/L
Osmolality (S) 280–296 mosm/kg H2O 280–296 mmol/kg H2O
PCO2 (arterial) (B) 35–45 mm Hg 4.7–6.0 kPa
Pepsinogen (P) 200–425 units/mL pH (B) 7.35–7.45
Phenylalanine (S) 0–2 mg/dL 0–120 μmol/L
Phosphatase, acid (S) Males: 0–0.8 sigma unit/mL
Females: 0.01–0.56 sigma unit/mL
Phosphatase, alkaline (S) 13–39 units/L (adults) 0.22–0.65 μmol s–1/L
Phospholipids (S) 9–16 mg/dL as lipid phosphorus 2.9–5.2 mmol/L
Phosphorus, inorganic (S) 2.6–4.5 mg/dL (infants in first year: up to 6.0 mg/dL) 0.84–1.45 mmol/L
PO2 (arterial) (B) 75–100 mm Hg 10.0–13.3 kPa
Potassium (S) 3.5–5.0 meq/L 3.5–5.0 mmol/L
Protein
Total (S) 6.0–8.0 g/dL 60–80 g/L
Albumin (S) 3.1–4.3 g/dL 31–43 g/L
Globulin (S) 2.6–4.1 g/dL 26–41 g/L
Pyruvic acid (P) 0–0.11 meq/L 0–110 μmol/L
Sodium (S) 135–145 meq/L 135–145 mmol/L
Urea nitrogen (S) 8–25 mg/dL 2.9–8.9 mmol/L
Uric acid (S)
Women 2.3–6.6 mg/dL 137–393 μmol/L
Men 3.6–8.5 mg/dL 214–506 μmol/L
aBased in part on Kratz A, et al. Laboratory reference values. N Engl J Med 2004;351:1548. Ranges vary somewhat from one laboratory to another depending on the details of
the methods used, and specific values should be considered in the context of the range of values for the laboratory that made the determination.
a LANGE medical book
Ganong’s
Review of
Medical Physiology
Twenty-Third Edition
Kim E. Barrett, PhD Scott Boitano, PhD
Professor Associate Professor, Physiology
Department of Medicine Arizona Respiratory Center
Dean of Graduate Studies Bio5 Collaborative Research Institute
University of California, San Diego University of Arizona
La Jolla, California Tucson, Arizona
Susan M. Barman, PhD Heddwen L. Brooks, PhD
Professor Associate Professor
Department of Pharmacology/Toxicology Department of Physiology
Michigan State University College of Medicine
East Lansing, Michigan University of Arizona
Tucson, Arizona
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Dedication to
WILLIAM FRANCIS GANONG
William Francis (“Fran”) Ganong was an outstanding scien- among physiologists. He was an excellent writer and far ahead
tist, educator, and writer. He was completely dedicated to the of his time with his objective of distilling a complex subject into
field of physiology and medical education in general. Chair- a concise presentation. Like his good friend, Dr. Jack Lange,
man of the Department of Physiology at the University of Cal- founder of the Lange series of books, Fran took great pride in
ifornia, San Francisco, for many years, he received numerous the many different translations of the Review of Medical Physi-
teaching awards and loved working with medical students. ology and was always delighted to receive a copy of the new edi-
Over the course of 40 years and some 22 editions, he was the tion in any language.
sole author of the best selling Review of Medical Physiology, and He was a model author, organized, dedicated, and enthusias-
a co-author of 5 editions of Pathophysiology of Disease: An tic. His book was his pride and joy and like other best-selling
Introduction to Clinical Medicine. He was one of the “deans” of authors, he would work on the next edition seemingly every
the Lange group of authors who produced concise medical text day, updating references, rewriting as needed, and always ready
and review books that to this day remain extraordinarily popu- and on time when the next edition was due to the publisher. He
lar in print and now in digital formats. Dr. Ganong made a did the same with his other book, Pathophysiology of Disease:
gigantic impact on the education of countless medical students An Introduction to Clinical Medicine, a book that he worked on
and clinicians. meticulously in the years following his formal retirement and
A general physiologist par excellence and a neuroendocrine appointment as an emeritus professor at UCSF.
physiologist by subspecialty, Fran developed and maintained a Fran Ganong will always have a seat at the head table of the
rare understanding of the entire field of physiology. This greats of the art of medical science education and communi-
allowed him to write each new edition (every 2 years!) of the cation. He died on December 23, 2007. All of us who knew
Review of Medical Physiology as a sole author, a feat remarked him and worked with him miss him greatly.
on and admired whenever the book came up for discussion
iii
Key Features of the 23rd Edition of
Ganong’s Review of
Medical Physiology
•Thoroughly updatedto reflect the latest research and developments in important areas such as the
cellular basis of neurophysiology
•Incorporates examples from clinical medicinethroughout the chapters to illustrate important
physiologic concepts
•Delivers more detailed, clinically-relevant, high-yield information per pagethan any similar text
or review
•NEW full-color illustrations—the authors have worked with an outstanding team of medical
illustrators, photographers, educators, and students to provide an unmatched collection of 600
illustrations and tables
•NEW boxed clinical cases—featuring examples of diseases that illustrate important physiologic
principles
•NEW high-yield board reviewquestions at the end of each chapter
•NEW larger 8½ X 11” trim-sizeenhances the rich visual content
•NEW companion online learning center (LangeTextbooks.com) offers a wealth of innovative
learning tools and illustrations
NEW iPod-compatible
review—Medical PodClass
offers audio and text for
study on the go
Full-color illustrations
enrich the text
iv
KEY FEATURES v
Clinical Cases illustrate essential
physiologic principles
Summary tables and charts
encapsulate important information
Chapters conclude with Chapter
Summaries and review questions
About the Authors
KIM E. BARRETT American Physiological Society (APS) and recently served on its
council. She has also served as Chair of the Central Nervous
Kim Barrett received her PhD in biological
System Section of APS as well as Chair of both the Women in
chemistry from University College London
Physiology and Section Advisory Committees of APS. In her
in 1982. Following postdoctoral training at
spare time, she enjoys daily walks, aerobic exercising, and
the National Institutes of Health, she joined
mind-challenging activities like puzzles of various sorts.
the faculty at the University of California,
San Diego, School of Medicine in 1985, rising
SCOTT BOITANO
to her current rank of Professor of Medicine
in 1996. Since 2006, she has also served the Scott Boitano received his PhD in
University as Dean of Graduate Studies. Her genetics and cell biology from
research interests focus on the physiology and pathophysiology Washington State University in
of the intestinal epithelium, and how its function is altered by Pullman, Washington, where he
commensal, probiotics, and pathogenic bacteria as well as in acquired an interest in cellular signaling.
specific disease states, such as inflammatory bowel diseases. She He fostered this interest at University
has published almost 200 articles, chapters, and reviews, and has of California, Los Angeles, where
received several honors for her research accomplishments he focused his research on second
including the Bowditch and Davenport Lectureships from the messengers and cellular physiology of the lung epithelium. He
American Physiological Society and the degree of Doctor of continued to foster these research interests at the University of
Medical Sciences, honoris causa, from Queens University, Belfast. Wyoming and at his current positions with the Department of
She is also a dedicated and award-winning instructor of medical, Physiology and the Arizona Respiratory Center, both at the
pharmacy, and graduate students, and has taught various topics University of Arizona.
in medical and systems physiology to these groups for more than
20 years. Her teaching experiences led her to author a prior
HEDDWEN L. BROOKS
volume (Gastrointestinal Physiology, McGraw-Hill, 2005) and
she is honored to have been invited to take over the helm of Heddwen Brooks received her PhD from
Ganong. Imperial College, University of London
and is an Associate Professor in the
Department of Physiology at the University
SUSAN M. BARMAN
of Arizona (UA). Dr Brooks is a renal
Susan Barman received her PhD in physiologist and is best known for her
physiology from Loyola University School development of microarray technology
of Medicine in Maywood, Illinois. Afterward to address in vivo signaling pathways
she went to Michigan State University involved in the hormonal regulation of
(MSU) where she is currently a Professor renal function. Dr Brooks’ many awards include the American
in the Department of Pharmacology/ Physiological Society (APS) Lazaro J. Mandel Young Investigator
Toxicology and the Neuroscience Program. Award, which is for an individual demonstrating outstanding
Dr Barman has had a career-long interest in promise in epithelial or renal physiology. She will receive the
neural control of cardiorespiratory function APS Renal Young Investigator Award at the 2009 annual
with an emphasis on the characterization meeting of the Federation of American Societies for
and origin of the naturally occurring discharges of sympathetic Experimental Biology. Dr Brooks is a member of the APS
and phrenic nerves. She was a recipient of a prestigious National Renal Steering Section and the APS Committee of
Institutes of Health MERIT (Method to Extend Research in Committees. She is on the Editorial Board of the American
Time) Award. She is also a recipient of an Outstanding University Journal of Physiology-Renal Physiology (since 2001), and she
Woman Faculty Award from the MSU Faculty Professional has also served on study sections of the National Institutes of
Women's Association and an MSU College of Human Medicine Health and the American Heart Association.
Distinguished Faculty Award. She has been very active in the
vi
Contents
Preface ix
I
S E C T I O N 15. Electrical Activity of the Brain, Sleep–Wake
CELLULAR & MOLECULAR BASIS FOR States, & Circadian Rhythms 229
MEDICAL PHYSIOLOGY 1
16. Control of Posture & Movement 241
17. The Autonomic Nervous System 261
1. General Principles & Energy
Production in Medical Physiology 1 18. Hypothalamic Regulation of
Hormonal Functions 273
2. Overview of Cellular Physiology
in Medical Physiology 31 19. Learning, Memory, Language,
& Speech 289
3. Immunity, Infection, & Inflammation 63
IV
II S E C T I O N
S E C T I O N
ENDOCRINE & REPRODUCTIVE
PHYSIOLOGY OF NERVE
PHYSIOLOGY 301
& MUSCLE CELLS 79
20. The Thyroid Gland 301
4. Excitable Tissue: Nerve 79
21. Endocrine Functions of the
Pancreas & Regulation of
5. Excitable Tissue: Muscle 93
Carbohydrate Metabolism 315
6. Synaptic & Junctional Transmission 115
22. The Adrenal Medulla &
7. Neurotransmitters & Neuromodulators 129 Adrenal Cortex 337
8. Properties of Sensory Receptors 149 23. Hormonal Control of Calcium
and Phosphate Metabolism &
9. Reflexes 157
the Physiology of Bone 363
III
24. The Pituitary Gland 377
S E C T I O N
CENTRAL & PERIPHERAL 25. The Gonads: Development & Function
NEUROPHYSIOLOGY 167 of the Reproductive System 391
V
10. Pain & Temperature 167 S E C T I O N
GASTROINTESTINAL
11. Somatosensory Pathways 173
PHYSIOLOGY 429
12. Vision 181
26. Overview of Gastrointestinal
13. Hearing & Equilibrium 203 Function & Regulation 429
14. Smell & Taste 219
vii
viii CONTENTS
VII
27. Digestion, Absorption, & S E C T I O N
Nutritional Principles 451 RESPIRATORY PHYSIOLOGY 587
28. Gastrointestinal Motility 469
35. Pulmonary Function 587
29. Transport & Metabolic
36. Gas Transport & pH in the Lung 609
Functions of the Liver 479
37. Regulation of Respiration 625
VI
S E C T I O N
VIII
CARDIOVASCULAR S E C T I O N
PHYSIOLOGY 489 RENAL PHYSIOLOGY 639
30. Origin of the Heartbeat & the 38. Renal Function & Micturition 639
Electrical Activity of the Heart 489
39. Regulation of Extracellular Fluid
31. The Heart as a Pump 507 Composition & Volume 665
32. Blood as a Circulatory Fluid & the 40. Acidification of the Urine &
Dynamics of Blood & Lymph Flow 521 Bicarbonate Excretion 679
33. Cardiovascular Regulatory Mechanisms 555
Answers to Multiple Choice Questions 687
34. Circulation Through Special Regions 569 Index 689