Ganong's Review of Medical Physiology

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  • Ganong's Review of Medical Physiology

    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


    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


    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


    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 (“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


    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


    •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



    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


    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


    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


    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



    Preface ix


    S E C T I O N 15. Electrical Activity of the Brain, Sleep–Wake

    CELLULAR & MOLECULAR BASIS FOR States, & Circadian Rhythms 229


    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


    II S E C T I O N

    S E C T I O N





    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


    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


    10. Pain & Temperature 167 S E C T I O N


    11. Somatosensory Pathways 173


    12. Vision 181

    26. Overview of Gastrointestinal

    13. Hearing & Equilibrium 203 Function & Regulation 429

    14. Smell & Taste 219


    viii CONTENTS


    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


    S E C T I O N




    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

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