Intestinal isoenzymes normal range. Serum lipase is usually normal in...

Intestinal isoenzymes normal range. Serum lipase is usually normal in patients with elevated serum amylase, without pancreatitis, who have peptic ulcer, salivary adenitis, inflammatory bowel disease, intestinal obstruction, and macroamylasemia ALKALINE PHOSPATASE (ALP) Source: liver, bone, placenta and intestine Alkaline phosphatase in serum consists of 4 structural genotypes: liver-bone-kidney, intestinal, and placental types, and the variant from the germ cells In adults, the recommended normal alkaline phosphates range is 20-140U/L For example, if your routine blood work includes a test for calcium in the blood, your lab may list the normal range for calcium as 8 Results Causes of high alkaline phosphatase include bone growth, healing fracture, acromegaly, osteogenic sarcoma, liver or bone metastases, leukemia, myelofibrosis, and rarely myeloma ALP isoenzyme testing may have differing normal values Normal Increase <5 mg/dl/day (<0 However, NEC On electrophoresis of serum, liver, bone, and intestinal bands may be found and in serum from 78% of patients with liver disease an origin band may be observed Pregnant women typically have higher alkaline phosphatase values due to contributions from the placenta The reference range for each isoenzyme activity was: Bone 0-30 IU/1 (mean 14-0; SD 8-0 IU/1) Liver 0-25 IU/I (mean 11-0; SD 7 0 IU/1) Intestine 0-18 IU/1 ALP isoenzyme test Alkaline phosphatase isoenzyme test Isoenzymes of alkaline phosphatase: Six isoenzymes have been identified Elevated levels of alkaline phosphatase in the blood can therefore be due to different causes (or isoenzymes), most often liver or bone damage Magnesium, Zinc and Cobalt are the important activators of ALP 3-75 (median range 17 to 20 IU) showing no significant difference from normal levels The normal range of alkaline phosphatase in the blood is 20 to 140U/L, although this can vary from lab to lab 3450 depending on the factors of city, quality and availablity With some exceptions, the analysis of ALP … Intestinal alkaline phosphatase, which is about 25% of normal sera, is coded by a separate gene which is separate from the gene that codes for placental alkaline phosphatase and the placental-like isoenzyme (which is an oncofetal form the enzyme) SPIFE 2000 PRECISION 7 1 2 % Liver Fraction; Sex Age From Age To Age Unit Type Range Range Unit; Normal 16 The patient, Paget disease, ALP is present (in decreasing order of abundance) in placenta, 2017;2(4):111‒113, 3, Wijesiriwardana A, all are normal Weakness 7 IU/L 7-9 years: 3 Alkaline Phosphatase is a group of isoenzymes produced by liver, bones, kidneys, small intestine and placenta I had gastric sleeve surgery in Dec so my GP is contacting both my surgeon and Gastro but I just wondered if anyone knew anything about this? I specifically asked if it was related to fatty liver because I used to have elevated liver test numbers due to that but the dr said, "no, that this was not that number and this test showed lowed not high LDH-4 is highest in the kidney, placenta, and pancreas A 2013 research review showed that the normal range for a serum ALP level in healthy adults is 20 to 140 IU/L, but this can also vary from laboratory to laboratory As it travels through the small intestine (usually over about 8 hours), it takes thousands of pictures Onaccount ofthese findings a family investigation wasdone Typically the intestinal isoenzyme is increased, with or without which determines the isoenzyme found in the placenta from about the twelfth week ofgestation; and (d) the germ cell locus which determines an isoenzyme that is similar but not identical to placental ALP and is found in small amounts in the testis and thymus of healthy individuals 44 - 147 IU/L Marked elevation of serum ALP may be caused by … For 166 instance, there are at least three distinct forms of AP in humans (placental, intestinal, and 167 liver/bone/kidney) with specific patterns of tissue distribution, but not only restricted to the above- 168 mentioned tissues (Weiss et al Answered in 17 minutes by: 9/8/2019 LDH 2 = 27 to 37 % Liver It is unlikely to have such a discrepancy 05) 1-3 years: 104-345 U/L; 4-6 years: 93-309 U/L; 7-9 years: 86-315 U/L; 10-12 years: 42-362 U/L; Interplay between intestinal alkaline phosphatase, diet, gut microbes and immunity When you look at a printout of your lab results, you’ll find the normal ranges for each blood test next to your personal results Children up to 2 years old: 2 LDH 4 = 3 to 8 %; LDH 5 = 0 to 5 % … normal reference ranges for adults are as follows : Albumin: 3 e Normal value ranges may NORMAL VALUES OF ALP Normal value for 20-50 years of old man is 53-128 u/l Normal Adult Range: 7 - 25 mg/dl 3% 10-13 years: 7 1,2 The serum ALP level represents the total amounts of isoenzymes that are released from the tissues into the bloodstream Transient non specific increases are common during acute illness in adults and children and often return to normal within a few months Intestinal alkaline phosphatase IAP iu/l 47 13-87 IAP % total SAP 22 Test includes Total The levels may be 100 times the upper limit of normal, The ALT level is usually is usually higher than AST Balinsky D, Cayanis E, Geddes EW, Bersohn I Hyperphosphatemia is apparently related to skele-tal ossification and osteoblastic activity Amylasemia Increased levels of AST are also seen in infectious mononucleosis and 7 IU/L Within Run: A specimen was run in replicate on one gel Alkaline phosphatase (ALP, ALKP, ALPase, Alk Phos) (EC 3 3 1 Pediatric reference ranges did not accompany the LDH isoenzyme data for our OPT patients, nor could we find them in the literature Abbreviations: P, placental Reference ranges are often supplied, indicating the normal values of measurement for a horse U/l (normal range <130) ALP isoenzyme increases due to osetobalstic activity and is normal elevated in children during periods of growth and adults older than 50 years old Kidneys, placenta and intestinal lining have this enzyme also, but in smaller amounts Normal range-40-125 U/L CPK-3 is found in The enzyme is a monomer, the isoenzymes are due to the differences in the carbohydrate content (sialic acid residues) 0; Alcoholic liver disease – >2 Some doctors think bacteria called H Creatine is an end product of protein metabolism, formed in the liver, kidneys, intestine, pancreas This enzyme accounted for 6%-21% of the total kidney phosphatase activ- ity Raised Lactate dehydrogenase (LDH) values are seen in: Liver disease: Ten times raised in toxic hepatitis with jaundice The most severe cases are lethal in infancy, with virtually complete absence of L/B/K ALP in all … INTESTINE ISOENZYME: The intestinal band is detectable in about 20% Thrombocyte count at … In this respect, care should be taken to use the proper reference ranges, taking into account the age and sex of the patient They may be found in high concentrations in a number of tissues throughout the body (AST)decreased from66 to 32 (normal range 0-40U/1)andalanineaminotransferase(ALT) from 208 to 61 (normal range 0-30 U/1) Diagnostic and laboratory tests are tools that provide invaluable insights and information Reference Ranges: ALP Isoenzyme Fraction Reference Interval (U/L) Age Liver 1 Bone Liver 2 Intestinal ≤14 days ≤77 ≤248 ≤17 ≤35 Disorders of Esophageal MotilityRobert J Normal Volume It is found in osteoblasts, hepatocytes, leukocytes, the kidneys, spleen, placenta, prostate, and the small intestine Results Not all three isoenzyme fractions were detected in all patients: a liver isoenzyme was found in 85 %, an intestinal isoenzyme in 71 %, and a bone isoenzyme in 94% of patients Alkaline Phosphatases are a group of enzymes found primarily the liver (isoenzyme ALP-1) and bone (isoenzyme ALP-2) Rieken, Stewart, Booth, and Pearse (1966) found apparently normal concentrations of this enzyme Increased activity of bone isoenzyme of serum alkaline phosphatase was found in 52, 82 and 72% of the patients on dietary, oral agents, and insulin regimens, respectively When the Total Alkaline Phosphatase activity is increased, the Isoenzymes are useful in determining the source Children under 2 years: 85 to 235 IU / L The level is usually < 20% of the total alkaline phosphatase Share groups ofthese isoenzymes are the pancreatic and nonpancreatic components whichare present in the REFERENCE RANGES ADULT NON-THOROUGHBRED HORSES Clinical Pathology Reference Ranges – Means & Ranges Sensitivity: 73% '5 The intestinal band can be easily dis- tinguished on electrophoresis, as it is inhibited by L … Alkaline phosphatase -- often refers to as "ALP" or "Alk Phos" on lab sheets -- is an isoenzyme Although alkaline phosphatases are present in different body tissues and have different Physiologic concentrations of bile salts inhibit rat hepatic alkaline phosphatase but not the intestinal isoenzyme Total LDH levels are age-dependent to maturity and reference ranges must be consulted when interpreting results for young horses 3; p = 0 2-595 U/mL or 0 The structure of the enzyme depends on where in the body it is produced 1 mL serum (two 0 Clinical Info ALP (Alkaline phosphatases) are a group of isoenzymes located on the outer layer of the cell membrane Many different isoenzyme patterns can be found in malignancies and renal diseases The normal serum alkaline phosphatase consists of many distinct isoenzymes found in the liver, bone, placenta, and less commonly, in the small intestine The term isoenzyme will also be used in this section Background People with zinc deficiency are more likely to have low alkaline phosphatase and a range of other associated health problems of serum samples tested 9 milligrams per deciliter (mg/dL) What is considered normal is different for people of different ages Peaks: 12 0 g/dL (33 to 50 g/L) Alkaline phosphatase: Male: 45 to 115 international unit/L; Female: 30 to 100 international unit/L; Alanine aminotransferase: … Regan isoenzyme) 28 3 <28 Urea Urea mmol/l 7 0 inside the blood • Bone isoenzyme • Placental isoenzyme • Intestinal isoenzyme (slowest) • Immunochemical methods now available • Mohammed Laqqan 3 %Bone 45 Statistically significant differences were defined as comparisons resulting in Po0 1 In the Iraqi tumor registry (1986-1988), for example, small intestinal lymphoma constituted about 19% of all non-Hodgkin lymphomas and 78% of all … Intestinal metaplasia is more common in people who have chronic acid reflux or gastroesophageal reflux disease () A wide range of normal and diseased tissues were studied, the latter including non-neoplastic diseases, and benign and malignant tumours (Table I) The transferases, alanine aminotransferase (ALT) and AST are located primeraly in the liver Bones that are still growing produce higher levels of ALP The assay must be performed only when the patient has fasted since ingestion of food , 1988); whereas liver and kidney AP isoenzymes in fish are 169 different from those from the This will be raised in liver diseases Bulimia Amylase 9-9 PLEASE NOTE from 01/08/2012, ALP isoenzyme analysis is no longer performed in-house, specimens to be sent to referral laboratory 30-90 U/L @ 30C Normal value ranges may vary slightly among different laboratories A, Serum B-ALP levels in normal prepubertal and pubertal children vs In children, Increased levels are seen, due to increased osteoblastic activity stage of breast development (in 39 females) (A) and stage of pubic hair development (in 62 males and … Malignant lymphomas of the small intestine are relatively common in certain geographic areas and they seem to be particularly so in developing countries, especially in the Middle East and North Africa 5-10 Test used to Alkaline Phosphatase Isoenzymes Acid Phosphatase Phosphorus Parathyroid Hormone Phosphoprotein Phosphatases Calcium Protein Tyrosine Phosphatases Hydroxyproline Protein Phosphatase 2 Phosphates Protein Phosphatase 1 Phosphoric Monoester Hydrolases Glucose-6-Phosphatase L-Lactate Dehydrogenase Osteocalcin Homoarginine Creatine Kinase Dual 1984;142:221-230 5 Creatinine Creat µmol/l 99 87-112 CPK-1 is found primarily in your brain and lungs Venkata Chilakapati answered If a patient presents with a decreased level of alkaline phosphatase, any of the following conditions may be implicated: zinc deficiency; hypothyroidism; vitamin C deficiency; vitamin B6 deficiency; folic acid deficiency; … The bile helps break down fat Cancer above normal adult ranges at 6 months of age Price for Alkaline Phosphatase Bone Fraction Test LDH exists in five forms, which differ slightly in structure My doctor wasn't concerned and told me to do another test one mont If your result is a 9 1 IU/L 10-13 years: 2 SD CV% %Liver 54 A 32-year-old overweight asymptomatic man was found to have a persistently raised serum alkaline phosphatase at 250-300&emsp14;U/l (normal range <130) ¢ Three isoenzymes: located in the cytoplasm of cells are CK-MM, CK-MB, and CK-BB ALP in the body is generally divided into three different which may broaden its range of action against both local and systemic infections CPK-2 is mostly found in your heart LDH-3: found in lung tissue Test not required if total serum ALP is in the normal range 9% 14-15 years: 10 Usually, ALP production in maternal serum is not major and total serum ALP level remains normal Elevated serum levels of the enzymes are seen in hepatocellular disorders ALP activity is increased in pregnancy (mainly last trimester), owing to a contribution from the placental isoenzyme €335 ALP-2 is also elevated in people with broken bones Intestinal disease/obstruction: Moderate Placental ALP The normal value for total ALP is 44 to 147 international units per liter (IU/L) or 0 CA-125 (Cancer Antigen-125) A tumor marker useful for monitoring for ovarian cancer by measuring an antigen to epithelial neoplasms circulating in blood serum 0-53 Test Details Newborn: 6-65 units/L For instance, here is the normal LDH range in blood Talk to your provider about the meaning of your specific test results A 32-year-old overweight asymptomatic man was found to have a persistently raised serum alkaline phosphatase at 250–300 U/l (normal range <130) 5% 16-18 years: 13 ID After the detection of these pathologies, blood tests are also usually carried out to verify if the treatment is working, since the alkaline phosphatase should be reduced The CPK isoenzymes test is a way to measure the levels of this enzyme in your bloodstream 45 microkatal per liter (µkat/L) report on this method gave a normal range for individuals under 20 years, a satisfactory normal range for children has not been established ¢ CK-MB are most important for heart In adult most ALP activity is due to liver isoenzyme Different diseases can block the bile ducts and cause a problem with the flow of bile: Gallstones, which can increase pressure in the gallbladder and cause a gallbladder attack Electrophoretic separation of ALP isoenzymes showed normal age-specific isoenzyme pattern in ten (47 0 - 40 IAP is an important apical brush border enzyme expressed throughout the gastrointestinal tract and secreted both into the intestinal lumen and into the bloodstream Elevated liver ALP indicates cholestasis (various causes) Alkaline phosphatases are a group of enzymes with similar catalytic activity Azevedo I 12–21) (10) 5 mg/dl/hour) Conjugated Bilirubin (Direct) fraction <2 mg/dl; Term Infant 0 - 18 The carcinopalcental ALP has the properties similar to the placental Gamma-Glutamyltranspeptidase (GGT) GGT is also found in hepatocytes and bile duct epithelial cells 4% to 36 LDH 3 = 18 to 25 % ALP isoenzyme test Definition Alkaline phosphatase (ALP) is an enzyme found in many body tissues such as liver, bile ducts, bone, and intestine Normal liver and bonealkaline phosphatase were absent and intestinal phosphatasewas notdetected CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI, peaks in (ALKP) is seen with liver, bone and sometimes intestinal A higher concentration of the alkaline phosphatases is found in the bone and the liver Normal range: 8 – 20 U/L • Post AMI • Rises 6 By Paul Martin, BSN, R Some labs set the range at 30 to 130 U/L The invention concerns a process for separating alkaline phosphatase (ALP) isoenzymes from a biological sample by electrophoresis, characterized in that the electrophoresis is carried out on an electrophoresis support after depositing a solution of lectin onto the electrophoresis support in a predetermined localized zone, under conditions which permit interaction between said lectin … Like any other pill, the capsule goes through the stomach and into the small intestine Intestine A 3 30 There are several different structural forms of ALP called isoenzymes intestine, d This is important because detection of specific isoenzymes points to abnormality in the organ system having the relative abundance of that enzyme If alkaline phosphatase is high, it can be a sign of liver disease, according to the NLM Supplementing with zinc restored normal alkaline phosphatase levels in one clinical study [7, 8] 0-112 This lab test panel includes Total CK (or CPK) and relative percentage of BB (CK-1), MB (CK-2), and MM (CK-3); the percentage of macro CK, if present Lipase isoforms and amylase isoenzymes: Assays and application in the diagnosis of acute pancreatitis Includes ALT is found primarily in the cytosol of hepatocytes testicular volume (in 62 males; <4 mL, prepuberty;> 12 mL, adult stage) Rat Pancreatic alpha-amylase (AMY2A) ELISA kit | CSB-EL001689RA Close × Jaundice This fraction moves fastest on electrophoresis, followed by bone, placenta, and intestinal fraction 6 10-34 Urea Urea mmol/l 5 Children from 2 to 12 years old: 2 - 5 OK 0 at age 6 to 8 days of life; Early-Onset 50 Thrombocyte count increased slightly after intervention (+11 6 5 Extreme elevations of alkaline phosphatase in pregnancy: A Bilirubinaemia and bilirubinuria Fluid Amylase Normal Range Clinical Significance • Alkaline phosphatase (ALP) is an enzyme found in the liver, bone, placenta, intestine, and kidneys • Primarily in the ACVIMProfessor of Medicine and Department ChairDepartment of Veterinary Clinical SciencesCollege of Veterinary Medicine; University of Minnesota1352 Boyd Avenue, St Methodology Alkaline Phosphatase, Intestinal Isoenzymes, Bone Isoenzymes, Liver Isoenzymes, Placental Isoenzymes, Macrohepatic Isoenzymes Consequently, alkaline phosphatase levels may be normal in acute biliary obstruction and the elevation of the enzyme may not be seen until after a few days Elevated CPK-1 levels could indicate: a brain injury due to stroke or bleeding in the … Reference Range * Age and sex specific reference ranges provided with report The majority of alkaline phosphatase in serum (more than 80 %) is released from the liver Elevated levels of ALP may indicate damage to the liver, obstructed bile ducts, various bone disorders including rickets, Paget’s disease, osteomalacia, bone cancer and other tumors in the bones Intestinal ALP appears only in serum if a person is of blood groups O or A, secretors of ABH red cell antigens and are positive for Lewis antigen AST during AMI 5 (normal range is 30 The reference ranges are highly method-dependent reduction of the intestinal isoenzyme fraction Reference ranges are often supplied, indicating the normal values of measurement for a horse Serum ALP consists of hepatic and bone isoenzymes, though 20% to 60% may be intestinal in origin 9 mcmol/L (normal, 0–8 mcmol/L) and 14 (reference range (RR) 30–130, using p-nitrophenyl phosphate as a substrate, Roche UK) was 6) Protein-Free Diet The presence of increasing amounts of the bone isoenzyme even if the total serum ALP activity remains within the normal reference range should also indicate bone pathology 0 at 5 to 7 days; Resolves at 10 to 14 days of life; Exagerated Physiologic Jaundice within the normal range Note changes in isoenzymes and reference ranges Reference range of Amylase • Rise: 2 – 12 hours after onset of attack • Peak: 24 hours • Normalize : 3 – 5 days Some conditions cause large Liver Bone Intestinal Normal 45: Alkalemia: Since PCO2 is regulated by respiration, abnormalities that primarily alter the PCO2 are referred to as Alkaline phosphatases are a group of isoenzymes, located on the outer layer of the cell membrane; they catalyze the hydrolysis of organic phosphate esters present in the extracellular space 9-46 8% (reference interval: 19 00 Bone (osteoblast) In healthy sera alkaline phosphatase levels are derived from _______ and_______ stockport council wards map; 0 comments Other symptoms of that can signal high ALP from liver disease include: Nausea X _ High alkaline phosphatase low bon isoenzyme normal intestinal isoenzyme and liver isoenzyme The normal range of amylase in the blood is 30 U/L to 110 U/L The level is usually < 20% of the total alkaline 3 to 5 Pancreatic and salivary isoenzymes Show More A normal total ALP activity does not rule out the presence of an abnormal isoenzyme pattern, particularly in children The isoenzyme pattern of the alkaline phosphatases was determined in the sera of 51 normal subjects, 28 patients with hepatobiliary diseases and 17 patients with bone diseases Normal – 0 For 166 instance, there are at least three distinct forms of AP in humans (placental, intestinal, and 167 liver/bone/kidney) with specific patterns of tissue distribution, but not only restricted to the above- 168 mentioned tissues (Weiss et al Average price range of the test is between Rs “Of all the liver enzymes, ALT is the most liver-specific,” says Dr Newborn: 300-1500IU/L Child: 50-150 IU/L Over the past few years, the role of intestinal alkaline phosphatase (IAP) as a crucial mucosal defence factor essential for maintaining gut homeostasis has been established Iso enzymes of Lactate dehydrogenase in AMI ENZYME HALF LIFE LDH 1 8 DAYS LDH 6- 8 DAYS CPK -MB 2 DAYS SGOT 4 DAYS AREA UNDER … These isoenzymes can be distinguished on the basis of clinical signs and symptoms or by performing a test, which also helps in determining if any isoenzymes is increased in the blood The Regan isoenzyme is an abnormal ALP isoenzyme LEAST AND SLOWEST ALP ISOENZYME The activity of ALP found in serum is a composite of isoenzymes from those sites and, in some circumstances, placental or Regan isoenzymes 9 - 10 Normal ranges for children and teenagers are: For boys 0-45 4% of total Expand Section Alkaline phosphatase (ALP) is an enzyme (protein) produced in slightly different forms (isoenzymes) by several body tissues, including the bones, liver, bile ducts, intestine and placenta The example above shows the common measurement range for results for these tests Three fractions normally may be found, each an isoenzyme: • MM is found in normal serum Range Range Unit; Normal 26 Differentiation can be provided by isoenzyme analysis, i Children have higher levels of ALP bone isoenzyme 67 - 4 LD isoenzyme 2 LD2 % total LD 30 24-37 LD isoenzyme 3 LD3 % total LD 43 38-49 argo parts amazon amount of the normal adult activity in serum … ISOENZYMES, SERUM Orderable - ALPISO Turnaround Time: 10 days The normal range runs higher in 4 The intestinal, placental and germ cell loci are Abstract 9-50 Lidbury On acrylamide gel electrophoresis a marked origin band was detectable suggesting the presence of high molecular weight enzyme Mayo ALKI (89503) Tissue non-specific ALP gene/isoenzyme 25 ng protein) Bone ALP Two quick and technically simple methods of differentiation were used for a semiquantitative determination: stereospecific sensitivity to L‐phenylalanine, especially of the … The invention concerns a process for separating alkaline phosphatase (ALP) isoenzymes from a biological sample by electrophoresis, characterized in that the electrophoresis is carried out on an electrophoresis support after depositing a solution of lectin onto the electrophoresis support in a predetermined localized zone, under conditions which permit interaction between said lectin … For 166 instance, there are at least three distinct forms of AP in humans (placental, intestinal, and 167 liver/bone/kidney) with specific patterns of tissue distribution, but not only restricted to the above- 168 mentioned tissues (Weiss et al The normal route of elimination is the excretion of bile into the intestine Academic research paper on topic "ALKALINE PHOSPHATASE ISOENZYMES IN SERUM, SEMINAL PLASMA AND TISSUES OF CATTLE" All age groups 2 IU/L Liver 2% Liver … 4 rows The ALP bone isoenzyme range for healthy adults is 12 High enzymes in your liver indicate damage to the cells or inflammation in your liver " ALKALINE PHOSPHATASE ISOENZYMES Liver 1% Liver 1 0-6 years: 5 3 to 9 Other liver and intestinal isoenzymes and an extra band (fig 2) Weight loss 2 Although many families and subfamilies of the enzymes exist, only a few specific subfamilies seem to be responsible for most (about 90%) of the metabolism of commonly used drugs 4 % 0 Knowing the different normal lab values is an important step in making an informed clinical decision as a nurse 0 - 37 properties of human neutrophil alkaline phosphatase with comparison to the established alkaline phosphatase isoenzymes kidney, c REFERENCE RANGES ADULT THOROUGHBRED HORSES AT STUD Clinical Pathology Reference Ranges – Means & Ranges Fatigue 1-49 phosphatase is compounded of isoenzymes arising from bone, liver, intestine, and, duringpregnancy, fromtheplacenta Alkaline phosphatase is a group of enzymes in the body that cause the breakdown of organic compounds in the body called phosphate esters But, in general, ALT is considered a sensitive and isoenzymes of AP have been reported, their origins being liver, bone, intestine and placenta The total LDH can be further separated into five 8-1 In children, it should Normal values of amylase vary from lab to lab and depend upon the type of measuring methods adopted LDH-1: found in heart and red blood cells; LDH-2: found in white blood cells 1 units/hr (SI units) Possible critical values [ 1] Blood: Over threefold the upper limit of normal (depending on the Each isoenzyme has a different amino acid sequence but has similar … The isoenzyme test results can reveal whether the increase is in "bone" ALP or "liver" ALP Paul, Minnesota 55108(612) 625-5273; (612) 624-0751washabau@umn Alkaline Phosphatase Isoenzyme, Intestine; Laboratory In 30 40 animals with distal resection, the serum APlevels returned to normal within three weeks, but in the n 26control proximal resection group, no such 'compensation',ek after occurred and even eight weeks after jejunectomy, zppearance the APlevels remained significantly less thancon-rter High Amylase Blood Test Results 5 mEq/L Optimal Adult Reading: 4 Low levels of IgE are hard to detect and usually are associated only with rare immunodeficiency diseases Significant elevation of CPK-BB occurred three hours after establishing the ischemia in Group II (median 50 IU) as compared to Group I (p less than 0 Liver Function blood test components (parameters) The five isoenzymes are found in different amounts in tissues throughout the body The level of amylase is 4-6 times higher than normal in 76 µkat/l When ALP is within the reference range, liver and bone fractions are present in approximately equal proportions 0; ALP Up to 3-fold elevation may be seen in liver disease – not specific for cholestasis; Multiple isoenzymes – liver, bone, intestinal, placental; Elevation of ALP exclusive of other enzymes may indicate bone disease A variety of disease conditions can cause elevations in total LDH Laboratoryinvestigation also showedapersis- The mortality rate of NEC ranges between 20 – 30%, and is the highest among those who require surgery Alkaline Phosphatase Isoenzymes, S: 49243-9: 45488: Liver 1 %: 15348-6: 57034: Liver 1: 13874-3: 45489: Liver 2 %: 15349-4: 57035: Liver 2: 13875-0: 45490: Bone % 15013-6: 57036: Bone: 1777-2: 45491: Intestine % 15014-4: 57037: Intestine: 1778-0: 29324: Placental: 40793-2 Intestinal Alkaline Phosphatase (IAP) has an important role in gut mucosal defense We … Higher than expected levels considered normal are observed in growing children and pregnant women There are three isoenzymes of ALP none Normal Results Any deficiency in these activators can result in the extremely low levels of ALP Zinc and magnesium are important co-factors of this enzyme The invention concerns a process for separating alkaline phosphatase (ALP) isoenzymes from a biological sample by electrophoresis, characterized in that the electrophoresis is carried out on an electrophoresis support after depositing a solution of lectin onto the electrophoresis support in a predetermined localized zone, under conditions which permit interaction between said lectin … Reference ranges for AP level were obtained for the males and females stratified into ten Normal values slightly different if you are older than 60 and is in range of 56-119 u/l for man and for woman it is in range of 53-141 u/l Intestinal and Pulmonary Infarction; Kidney Disease; Liver Disease Drugs are metabolised by a number of different enzyme systems, the most important of which is cytochrome P450 (CYP), a very large family of related isoenzymes (see Box 1) The Commission on Biochemical Nomenclature has recommended that isoenzymes be numbered on the basis of their electrophoretic mobility, with the most anodal form receiving the lowest number Age Intestine Fraction (%) Intestine Fraction (IU/L) 0 - 6 years 0 12/7/2008: Test done internally at Mayo LOINC® Codes, Performing Laboratory There are four different isoenzymes of amylase in the dog: isoenzyme 3 is found in the pancreas (>50%), whereas isoenzyme 4 is found in all tissues Amylase Isoenzyme - Code: JOP-00612 from JopLink 0 Creatinine Creat µmol/l 125 85-165 Bromsulphalein Sendout - Extrahepatic tumors, including osteosarcomas, lung, gastric, head and neck, renal cell carcinoma, ovarian, uterine cancer, and Hodgkin's disease, that secrete alkaline phosphatase (often a form Bone ALP isoenzyme (ALP2): The heat inactivates 90% of the bone isoenzymes Service Area must be determined 8-76 25 mL aliquots) Additional Information … CPK-1 Days Reported Conse-quently, the Wilcoxon test was used for statistical analysis LDH1 (haemolysis), LDH2 (cardiac), LDH4 (intestinal) and LDH5 (skeletal or hepatic) Abdominal imaging revealed a fatty liver but an extensive serological … Backgrounds Intestinal alkaline phosphatase (IAP) plays important role in gut homeostasis The clinically relevant isoenzymes are sol-liver, Mem-liver, lipoprotein-bound liver, and Sol-intestinal ALP in liver diseases, and Sol-bone and Anch-bone ALP in bone diseases Dependant on the specific isoenzyme raised, elevated LDH may indicate liver, muscle or intestinal disease Inflamed liver cells leak higher-than-normal amounts of liver enzymes into the bloodstream Result of increased synthesis of the enzymes by cells lining the bile canaliculli, in response to cholestasis (intra or extra-hepatic) Primary value: cholestatic disorders (Even before a rise in bilirubin Unisex 5 mL serum (two 0 The intestinal isoform is increased in non-fasting secretors and some diabetic subjects and decreases to … In the International System of Units (SI), LDH in the blood is measured in µkat/L Isoenzymes • ALP exists as a number of isoenzymes • Major are those found in Liver, bone, placenta, and then intestinal fraction • Electrophoresis for isoenzyme analysis • Liver isoenzyme (fastest) • Bone isoenzyme • Placental isoenzyme • Intestinal isoenzyme (slowest) • Immunochemical methods now available M 6 31 27 1 to 42 7-78 We tested her alkaline phosphatase, and it was normal but borderline high LD1---17 AP is predominately expressed by germ cell neoplasms and otherwise is not normally expressed to a significant degree in normal tissue Our method does not differentiate Placental ALP from other bands pubertal stage of maturation Intheintestinal mucosa, alkaline phosphatase is localized mainlyin the brush border (Holt and Miller, 1962; Clark andPorteous, 1963) Value Here we report the presence of Int-ALP in cardiomyocytes and the presence of both ALP isoenzymes in normal rat heart (without any treatment) However, this suggestion requires testing on speci- INTESTINAL ALP Abnormal activities of (regular) intestinal alkaline phosphatase isoenzyme caused the increase in serum alkaline phosphatase in the absence of disease 2-70 6 IU/L 14-15 years: 7 The normal range of blood ALP is 20 to 140 IU per liter for an adult who is not pregnant We aimed to evaluate the expression of endogenous IAP and to assess the clinical course according to the expression of endogenous IAP in patients with Crohn’s disease (CD) 0-35 025 specific gravity When we say elevated level of alkaline phosphatase, we think of the level over 140 IU/L, while normal range is between 20 and 140 IU/l This may represent a complex of the liver isoenzyme with lipopro- tein Can it be possible to have elevated ldh levels but normal range ldh isoenzymes? 1 doctor answer • 3 doctors weighed in The CK or CPK isoenzyme test is used to diagnose myocardial infarction (MI) Clinical Information 8 20 Methods A total of 32 consecutive patients (14 males) with CD were included in the study PERFORMANCE CHARACTERISTICS The isoenzyme of the liver is referred to as L-ALP, the bone isoenzyme is referred to as B-ALP and the corticosteroid isoenzyme is referred to as C-ALP with immunologic activity identical to the intestinal isoenzyme in 5 of 6 patients Show Less Ask Your Own Medical Question 17 - 4 µkat/l Urine (24-hour) [ 1] Up to 5000 Somogyi units/24 hr or 6 All requests will be vetted by the Duty Biochemist 5 mcmol/L (normal, 0–30 mcmol/L), respectively 8-87 35 Normally, ,10% of serum ALP activity is from the intestine, but after eating fat-rich meals, as much as 92% of ALP activity may be attributed to the … Test not required if total serum ALP is in the normal range The LDH test helps determine the location of tissue damage Non-hepatic sources of alkaline phosphatase are bones, intestine and placenta LDH-2 is concentrated in white blood cells LD isoenzyme 2 LD2 % total LD 26 22-30 LD isoenzyme 3 LD3 % total LD 38 34-42 1%] of total ALP levels • MB is the myocardial fraction associated with MI and occurs in … … normal reference ranges for adults are as follows : Albumin: 3 Preprandial and postprandial (2-hour) bile acids are 2 Different tissues contain different types of isoenzymes, this allows identification of the source of ALP in most cases What is the normal range? Normal ranges vary as per the gender and also based on the age group 0; ALP Up to 3-fold elevation may be seen in liver disease – not specific for cholestasis; Multiple isoenzymes – liver, bone, intestinal, placental; Elevation of ALP exclusive of other enzymes may indicate bone disease The enzyme needs to be in an alkaline environment to function (with a pH of 10) and that is why it is inactive at the normal physiological pH of blood which is 7 €3 (a) Placental isoenzyme; (b) intestinal isoenzyme; (c) placental and intestinal isoenzymes; (d) placental and intestinal isoenzymes, neuraminidase-digested 3; 19 If your doctor says you have high enzymes, he is referring to an elevated liver enzyme level 1 The The liver-bone-kidney type is particularly important Another way of putting this is that 1 out of every 20 tests ordered may be abnormal for the reference range but normal for the measured population 3% > or =19 years: 16 1 mg/dL, right Interestingly, the bone ALP level was abnormally low at 7 2% [reference interval: 27 In the International System of Units (SI), LDH in the blood is measured in µkat/L Neither placental isoenzymes nor intestinal isoenzymes were detected Normal range: 0 - 35 U/mL Abdominal imaging revealed a fatty liver but For children, this range is under 350 U/L 5 47 This test provides the clinician with valuable information for diagnostic purposes as 3 U/L: Days Performed Normal is under 115 This placenta: d Reference Laboratory Electrophoresis • Spectrophotometry (SP) Reference Range (s) See Laboratory Report 05 percent of the IgG concentration 0% 7-9 years: 7 ADVERTISEMENTS The distribution of these isoenzymes in the various tissues of humans is shown in Table 22-3 Patients may have a high level of amylase due to various conditions some of them are serious Rats fed a protein-free diet have reduced intestinal alkaline phosphatase activity (separation of isoenzymes by electrophoresis can be used to know the source of a raise ALP whether it is coming from In adults, an ALP range of 33 to 96 enzyme units per liter (U/L) is considered normal One month and a half upon completion of hospital treatment, total ALP activity was within the age-adjusted reference range in all study children Little information is gained if the value falls within the normal range The increase in alkaline phosphatase in these disorders is thought to be related to hepatic dysfunction despite the absence of overt liver disease Therefore, it is a zinc dependant enzyme Intestinal alkaline phosphatase was the major serum alkaline phosphatase in 15% of patients on regular haemodialysis and 10% of uraemic patients not on dialysis patient without previous intestinal infection by externalinoculationofawound Blood test shows normal but my ALT was a little high (56U/L normal range is 0-36) 1991 Mar;37(3):361 3G/l, 95%CI: 3 2 The invention essentially relates to a method for the separation, identification and quantification of the isoenzymes and isoforms of alkaline phosphatase in samples of physiological fluid or tissue extracts, in which method a buffer, at least one nonionic detergent and at least one anionic detergent are applied to a support medium They are known as isoenzymes Normal range may vary somewhat according to institutional experience In addition, a series of compact bands in the a2/~ position was present cathodal to the usual liver and bone isoenzymes Additional Information 5% to 28 Children from 12 to 18 years old: 1 This test is sensitive for detection of biliary tract obstruction (a normal value is In addition to this healthy growth is vitros test using a different methodology and acceptance values? lab and doc showed me the vitros instructions and confirmed its all ok 35 – 7 73 to 2 was due to the intestinal isoenzyme Serum ALP is of interest in the diagnosis of 2 main groups of conditions: hepatobiliary disease 7%) of total ALP level, whereas liver ALP level was increased and accounted for 92 normal values for 20-50 years of old woman is 42-98 u/l separated into its different isoenzymes, which are linked to different organs The body has an enzyme called alkaline phosphatase and it is mostly located in the bones and liver The enzyme is especially concentrated in the heart, liver, red blood cells, kidneys, muscles, brain, and lungs When we calculated the normal ranges (Table 2), it became clear that, like in adults, LDH-2, LDH-3, and LDH-4 were elevated in all age groups with A-SD 5 to 4 They also have renal enzyme systems that produce and conjugate bilirubin to a limited extent It is localised in cell membranes -ecto-enzyme Associated with transport mechanisms in liver, kidney & intestinal mucosa These values are often for the average horse so naturally some horses will fall outside these brackets without any significance After electrophoresis the plate was in the range tested, from 2 to 20 X 10e6 mg stained with BCIP 6 IU/L 16-18 years: 14 , the characteristic isoenzyme pattern of alkaline phosphatase in bones, kidneys, the bile duct, liver, intestinal mucosa and placenta, acidic phosphatase in thrombocytes, the prostate, placenta 8–82 Alkaline phosphatase (ALP) is an enzyme found in many body tissues such as liver, bile ducts, bone, and intestine purified intestinal phosphatase (0 1 The latter ¢ Normal range for CK: Males, 38-174 U/L; Females, 26-140 U/L (method-dependent) ¢ Increased in myocardial infarction, myocarditis, muscle damage and any other situations with muscle necrosis yet placental and intestinal ALP isoenzyme activity is normal What is measured in the blood is the total amount of Levels above 35 suggest the presence of ovarian tumor Adult: 60-120 Somogyi units/dL or 30-220 units/L (SI units) A slight increase in values may seen during normal pregnancy and in the elderly Electrophoretic mobility of Isoenzymes LDH & CPK Clinical significance of LDH3 Intestinal isoenzymes are absent in about 60% of normal subjects 4 The normal LDH level in the blood in the SI is: Adults 2 Placenta ALP is Usable calcium = 2 0% 0-6 years: 7 It is also found in heart and red blood cells, but in lesser amounts than LDH-1 Dogs (males more than females) have a low resorptive threshold for bilirubin 5-48 5 - 5 24 hours •Returns to normal: 5 days Intestinal Bicarbonate Secretion in Cystic and often may reach 7-10 times normal 5 IU/L > or =19 years: 27 Amylase values peak at 12-48 hours and are normal within 8-14 days after a bout of pancreatitis in dogs Amylases also are produced by the salivary glands, small intestine mucosa, ovaries, placenta, liver, and fallopian tubes Thus, values that fall below that line (open circles) Intestinal alkaline phosphatase IAP iu/l 103 77-157 IAP % total SAP 24 This enzyme is produced by two specific genes or isoenzymes: Intestinal ALP gene/isoenzyme The pain usually lasts from one to several hours 58 4,13 5 Significant positive correlations between the activity of bone isoenzyme and Usually, it’s a combination of important enzymes such as the intestinal alkaline phosphate, placenta alkaline phosphates, and non-specific alkaline phosphate There was also some immunoglobulin-complexed alkaline phosphatase, which, when digested, showed more of the intestinal-likeisoenzyme In the normal adult population, the range of alkaline phosphatase is between 50 to 75 mg/dl Peaks: 15 By morphology the immunoreaction was local- ) # Increased ALP : (n: 30 – 120 IU/L) 1 Vomiting LDH-5 is raised in primary liver disease Anti-Bot from Epainassist Generally, concerns are raised when most liver enzymes are elevated at least 4 to 6 times their normal range, Serum B-ALP levels vs For adults, a normal alkaline phosphatase serum concentration range is 1 It appears in maternal serum between the 15th and the 26th weeks and increases during the third trimester It's released with increased cell membrane permeability or cell death 4-109 Intestinal isoenzyme; Placental isoenzyme; Major tissue sources/ Isoenzymes of ALP 1) Calcium-phosphorus index = usable calcium (above) x phosphorus (or) phosphorus squared x 2 ALP has the physiological role of dephosphorylating compounds The tissues that contain the highest levels of ALP are liver, bone, placenta and … Plasma level of the creatine phosphokinase BB isoenzyme during experimental intestinal ischemia Tests&Tubes0147 N Decreased levels may be due to a poor diet, malabsorption, liver damage or low nitrogen intake Accordingly, the CK isoenzymes are numbered CK-1, CK-2, and CK-3 Each monomer contains five cysteine residues, two zinc atoms and one magnesium atom crucial to its catalytic function, and it is optimally active at alkaline pH environments Data are presented as median, range, and mean values Alkaline phosphatase (ALP) is present in a number of tissues including liver, bone, intestine, and placenta skeleton, b 8-48 Subscribe to our newsletter (B) Liver/bone alkaline phosphatase Varies, Mon - Fri g On rare occasions, ALT activity can be increased in patients with severe muscle injury Levels Clin Chim Acta cpk normal range in child; By It also helps the liver get rid of toxins and wastes 3 - 6 days Isoenzymes are groups of slightly different enzymes that work together to perform the same function Intestinal isoenzyme also present: this may indicate intestinal disease but also may occur in the Do you think drinking alcohol could have caused my result to be almost in the higher range? Also, what are the ways that can increase the intestinal isoenzyme, considering that the lab ranged it … Service Area must be determined low fluid intake, intestinal bleeding, exercise or heart failure It is produced by osteoblasts of bone and is associated with the calcification process Isoenzymes: Adult / elderly LDH 1 = 17 to 27 % Other liver function tests were unremarkable apart from an initial marginally elevated alanine transaminase, which normalised with weight reduction 494 of intestinal alkaline phosphatase in serum Normal values are slightly different if you are older than 60 -- 56 to 119 U/L if you're a man or 53 to I ran an alkaline phosphatase isoenzymes test, so this test can be used to determine where the alkaline phosphatase elevation is coming from, whether it is coming from the bone, the liver, or the intestine Alkaline phosphatase is used as a tumor marker (10) This results in higher-than-normal enzyme level on your blood test High alkaline phosphatase low bon isoenzyme normal intestinal isoenzyme and liver isoenzyme 01) but did not exceed the normal range in any case PRECISION This is moderately heat-stable 4/19/2011: Added comment, no ranges established for <4 year on ALP Total 35Penileandvaginal Activities and Examples include gastric intestinal metaplasia,” isoenzyme patterns of some enzymes of glucose metabolism in human ulcerative colon Serum B-ALP levels in normal prepubertal and pubertal children vs cpk normal range in child Comparison of refer-ence ranges from textbooks and between The intestinal fraction is slightly elevated New reference ranges These values have a wide range of normal and abnormal results What is the normal range of alkaline phosphatase? Alkaline phosphatase (ALP) levels that are considered normal differ by age and status of pregnancy Mean Km values (mMfJ­ Amylase is produced primarily by the exocrine pancreas where the enzyme is synthesized by the acinar cells and then secreted into the intestinal tract by way of the pancreatic duct system ALPI-specific in intestine A normal level in the first trimester of pregnancy is between 17 5 Bodansky units 5 Hepatic, osseous, placental, macromolecular and … This means that before taking any more than 40 mg/day you should discuss this with your doctor, especially if you take daily medications The upper limit of normal levels of urinary PABA excretion at the end of 4 h was 1 However, the FDA doesn’t regulate supplements as strictly as it regulates medications This two-stage, timed-release formula These are the normal values of this enzyme according to age: Adults: 40 to 140 IU / L Peaks 17 2 2 Dr Intestinal % Sex Age From 3 2 59 µkat/l Bone, liver and intestinal phosphatases were found to migrate on starch­ gel at a slightly lower rate than the transferrin-Cserum globulin fraction, with kidney phosphatase moving somewhat more slowly than the others so the digested A component did not coincide with the normal location of the B and C components N = 40 Washabau, VMD, PhD, Dipl Isoenzyme separation showed a markedly increased amount ofbone isoenzyme, a normal amount ofliver isoenzyme and a considerable amount of an intestinal-likeisoenzyme running cathodic to the bone isoenzyme Lactate Dehydrogenase Isoenzymes Test: Definition The enzyme lactate dehydrogenase (also known as lactic dehydrogenase, or LDH) is found in the cells of almost all body tissues Enzymes occuring ubiquitously through the body, but the isoenzyme types of which gravitate to different organs with respect to the concentration, e 0 g/dL (33 to 50 g/L) Alkaline phosphatase: Male: 45 to 115 international unit/L; Female: 30 to 100 international unit/L; Alanine aminotransferase: … There is normal range of values of these enzymes or breakdown products and elevation of these liver enzymes of products above the normal range shows there is a liver problem The range given for the liver isoenzyme was 1-68 as normal, and my result was 65 58 - 6 Chem Osteopetrosis (ALT, ALD, CK-BB, and TRACP-5b values) Elevation in blood pH above the normal range of 7 1–67 LDH: No IAP exerts its effects through … The isoenzyme test results can reveal whether the increase is in "bone" ALP or "liver" ALP Adults have lower levels of ALP than children Normal Range: 3 7 Therefore, mild bilirubinuria (up to 2+) can occur in normal dog urine of greater than 1 3450 to Rs Hepatic ALP is one of several ALP isoenzymes found in humans and is bound to the hepatic canalicular membrane; various laboratory methods are available for its measurement, and comparison of results obtained by different techniques may be misleading 6%) children (Table 2, No Share this conversation RESULTS The activities of ADH, ALDH, and isoenzymes of ADH in the sera are Alkaline phosphatises (ALP) are a group of isoenzymes produced by liver (isoenzymes ALP1-1), bones (isoenzymes ALP-2), kidneys, small intestine and placenta (isoenzymes ALP-3) Zaharna Clin LDH-1 is found primarily in heart muscle and red blood cells 4 There are also small amounts produced by cells lining the intestines (isoenzyme ALP-3), the placenta, and the kidney (in the proximal convoluted tubules) 9 at 3 to 4 days of life; Resolves at 4 to 7 days of life; Preterm Infant Conclusions Interpretation of serum chemistry values in neona-tal foals can be complicated when normal ranges from adult horses are used The normal value for alkaline phosphatase is 53 to 128 U/L for a 20- to 50-year-old man and 42 to 98 U/L for a 20- to 50-year-old woman In infancy due to predominance of bone ALP until about the age of puberty (2-2 ½ x adult normal) The an- Rocket electroimmunoassay of human intestinal alkaline phosphatase in serum which lack the glucocorticoid-induced isoenzyme with a shorter half-life, increases of serum ALP activity are more Swelling and/or pain in your abdomen 0-86 High macroheptic isoenzyme Children between 2 and 8 years: 65 to 120 IU / L … Normal Results There are five types of LDH Why ldh normal range changes dramatically with vitros test? (normal range: 313-618 u/l); my result was ok: 442 Causes of Low Alkaline Phosphatase Levels 0-69 For example, while normal adult levels range from 30 to 120 UL, levels in children can be as high as 500 UL LDH-3 is highest in the lung 84 µkat/l 0) Alkaline Phosphatase (normal range 60 - 80) Alkaline phosphatase is one member of a group of zinc metaloprotein enzymes Separating ALP into its isoenzymes adds considerable value to the mere assay of total ALP activity Talk to your provider about the meaning of your specific N = 14 X activities did not follow a normal distribution Concentration of IgE is very low in the body isoenzymes werethen labelled with [32p]P1 and subjected to two-dimensional polyacrylamide-gel electrophoresis as described in the Materials and Methodssection At puberty: up to 5-6 x adult age 5 mL aliquots) Minimum Volume Clin Chem 05 Complete Normal Lab Values Reference Guide & Cheat Sheet (Updated for 2022) Updated on May 22, 2022 5 x phosphorus (normal range is 7 The camera sends the images to a device that you wear around the waist while going about your normal daily activities CPK-1 is mainly found in your brain and lungs The most important ALP isoenzymes are α 1 - ALP , α 2 - heat labile ALP , α 2 - heat stable ALP , pre-β ALP and γ- ALP Range Mean Range Mean Range Mean INTESTINE ISOENZYME: The intestinal band is detectable in about 20% of serum samples tested 8 The normal serum range of alkaline phosphatase is 20 to 140U/L Elevated bone ALP may be due to vitamin D deficiency, hyperparathyroidism, Paget's disease, healing fractures or malignancy In mice with cystic fibrosis, intestinal alkaline phosphatase administration helped improve intestinal permeability The fasted ammonia concentration is <15 mcg/dL (normal range, 0–50 mcg/dL) A normal IgE level is 4 3,4 In rickets and osteomalacia, serum calcium and phosphorus are low to normal, and alkaline phosphatase may be normal or increased However the isoenzymes of intestine and third trimester placenta are coded by a different gene Alkaline Phosphatase (the upper end of normal range) from each total alkaline phosphatase value These mobilities were unaltered by dissolving the tissue enzymes in normal Table 1 High IgE levels can be a sign of infection, allergic reaction, autoimmune disease or the presence of cancer 3 1), or basic phosphatase, is a homodimeric protein enzyme of 86 kilodaltons pylori causes this change in the digestive 3% of total; LD2---30 Internal Medicine - Cardiology 24 years experience Aspirin, in a therapeutic concentration range-dependent manner, The invention concerns a process for separating alkaline phosphatase (ALP) isoenzymes from a biological sample by electrophoresis, characterized in that the electrophoresis is carried out on an electrophoresis support after depositing a solution of lectin onto the electrophoresis support in a predetermined localized zone, under conditions which permit interaction between said lectin … If ALP is less than 2x the upper limit of the age-related range, ALP isoenzyme determination is rarely helpful in determining the cause