Analytes and Their Clinical Significance

This contains reference ranges as well as clinical significance of measured analytes regarding diagnosis/symptoms

Reference Range: Total Bilirubin

0.2-1mg/dL

Reference Range: BUN

6-20mg/dL

Reference Range: Calcium, total

8.6-10mg/dL

Reference Range: Chloride

98-107mEq/L

Reference Range: Creatinine, general

(Varies between men and women)

0.6-1.2mg/dL

Reference Range: Glucose, fasting

70-99mg/dL

Reference Range: Potassium

3.5-5.1 mEq/L

Reference Range: Sodium

136-145mEq/L

Reference Range: Total Protein

6.4-8.3g/dL

Reference Range: Uric Acid (Male)

3.5-7.2 mg/dL

Reference Range: Uric Acid (Female)

2.6-6 mg/dL

Analytes that increase in the A.M. (Diurinal Variation)

ACTH (Adrenocorticotropic Hormone)

Cortisol

Iron

Analytes that increase in the P.M. (Diurinal Variation)

Growth hormone

PTH (Parathyroid Hormone)

TSH (Thyroid Stimulating Hormone)

Analytes that vary DAY-TO-DAY

>20% for:

ALT (Alanine Aminotransferase)

Bilirubin (Bili)

Creatinine Kinase (CK)

Steroid Hormones

Triglycerides

Analytes INCREASED by recent food ingestion

Glucose

Insulin

Gastrin

Triglycerides 

Sodium

Uric Acid

Iron

Lactate Dehydrogenase (LD)

Calcium

Analytes DECREASED by recent food ingestion

Chloride

Phosphate

Potassium

Analytes that REQUIRE FASTING

Fasting glucose

Triglycerides

Lipid Panel

Analytes INCREASED by ALCOHOL consumption

Triglycerides

GGT (Gamma Glutamyl Transferase)

Analytes DECREASED by ALCOHOL consumption

Glucose

Analytes increased by POSTURE

Albumin

Cholesterol

Calcium (when standing)

Analytes increased by ACTIVITY in ambulatory patients

(meaning able to walk)

CK

Analytes increased by EXCERCISE

Potassium

Phosphate

Lactic acid

Creatinine/ Creatinine Kinase

Protein

AST (Aspartate aminotransferase)

LD

Analytes increased by STRESS

ACTH

Cortisol

Catecholamines

Using Isopropyl alcohol wipes to disinfect a venipuncture site can…

Compromise blood alcohol determination

Which analyte is increased when the site of capillary puncture is squeezed?

Potassium

Which analytes are increased when a fist is pumping during venipuncture?

Potassium

Lactic acid

Calcium

Phosphorus

Which analytes are decreased when a fist is pumping during venipuncture?

pH

Which analytes are increased when the tourniquet is on >1 min?

Potassium

Total protein

Lactic acid

Analytes increased by IV fluid contamination

Glucose

Potassium

Sodium

Chloride (depending on IV)

Possible dilution of other analytes

In the K₂EDTA tube, what happens when the incorrect anticoagulant or contamination from the incorrect order of draw occurs?

Increased: Potassium

Decreased: Calcium, Magnesium

In the Sodium heparin tube, what happens when the incorrect anticoagulant or contamination from the incorrect order of draw occurs?

Sodium increased if tube is not completely filled

In the Lithium heparin tube, what happens when the incorrect anticoagulant or contamination from the incorrect order of draw occurs?

Lithium increased

In the Gel tubes, what happens when the incorrect anticoagulant or contamination from the incorrect order of draw occurs?

Some gels may interfere with trace metals and certain drugs

Inadequate centrifugation leads to poor barrier formation in gel tubes, which can result in the increase of which analytes?

Potassium

LD

AST

Iron

Phosphorus

Recentrifugation of primary tubes can effect..

Hemolysis and increase potassium

What analytes are increased when there is a delay in separating serum/plasma? (unless gel tubes are used)

Ammonia

Lactic acid

Potassium 

Magnesium

LD

What analytes are decreased when there is a delay in separating serum/plasma? (unless gel tubes are used)

Glucose (Unless collected in fluoride tubes)

Analytes that are decreased when kept at room temp

Glucose (Unless collected in fluoride)

Analytes that are increased when kept at room temp

Lactic acid

Ammonia

Analytes that are decreased at 4C

LD

Analytes that are increased at 4C

ALP (Alkaline Phosphatase)

Which analytes are higher in plasma than serum?

Total Protein

LD

Calcium

Which analytes are higher in serum than plasma?

Potassium

Phosphate

Glucose

CK

Bicarbonate

ALP

Albumin

AST

Triglycerides

Which analytes are higher in plasma than whole blood?

Glucose

Which analytes are higher in capillary blood than venous blood?

Glucose (in postprandial specimen)

Potassium

Which analytes are higher in venous blood than capillary blood?

Calcium

Total protein

Which analytes are higher in red blood cells than plasma?

Potassium

Phosphate

Magnesium

Which analytes are higher in plasma than red blood cells?

Sodium 

Chloride

What analytes are tested in a Basic Metabolic Panel? (8)

Sodium

Potassium

Chloride

CO₂

Glucose

Creatinine

BUN

Calcium

What analytes are tested in a Comprehensive Metabolic Panel? (12)

The 8 from the Basic Metabolic Panel with:

Albumin

Total Protein

ALP

AST

Bilirubin

What analytes are tested in an Electrolyte Panel? (4)

Sodium

Potassium

Chloride

CO₂

What analytes are tested in a Hepatic Function Panel? (7)

Albumin

ALT

AST

ALP

Total Bilirubin

Direct Bilirubin

Total Protein

What analytes are tested in a Lipid Panel? (4)

Total Cholesterol

High-Density Lipoprotein (HDL) Cholesterol

Low-Density Lipoprotein (LDL) Cholesterol

Triglycerides

What analytes are tested in a Renal Function Panel? (9)

Sodium

Potassium

CO₂

Glucose

Creatinine

BUN

Calcium

Albumin

Phosphate

Normal Ref Range for Glucose, fasting

<100mg/dL; 5.6mmol/L

Increased levels of Glucose, fasting cause…

Hyperglycemia which is seen in:

Diabetes mellitus

Other endocrine disorders

Acute stress

Pancreatitis

Decreased levels of Glucose, fasting cause…

Hypoglycemia which is seen in:

Insulinoma

Insulin-induced hypoglycemia

hypopituitarism

Desirable Ref Range for Cholesterol, total

<150 mg/dL; 5.2mmol/L

What is the clinical significance of Cholesterol, total? What is it tested in conjunction with?

It is a limited value for predicting risk of coronary artery disease (CAD)  ALONE

Tested in conjunction with HDL & LDL

Desirable Ref Range for HDL Cholesterol

> 60mg/dL; 1.5mmol/L

What is the clinical significance of HDL cholesterol?

It appears INVERSELY related to CAD

Optimal Ref Range for LDL cholesterol

< 100mg/dL; 2.6mmol/L

Which analytes clinical significance regard being a risk factor for Coronary Artery Disease?

LDL cholesterol

Triglycerides

Desirable Ref Range for Triglycerides

<150 mg/dL; 1.7mmol/L

Ref range for Total protein

6.4-6.3g/dL; 64-83g/L

Increased levels of Total protein may cause…

Dehydration

Chronic inflammation

Multiple Myeloma

Decreased levels of Total protein may cause…

Nephrotic syndrome

Malabsorption

Overhydration

Hepatic Insufficiency

Malnutrition

Agammmaglobulinemia

Ref Range for Albumin

3.5-5g/dL; 35-50g/L

Increased levels of Albumin may cause…

Dehydration

Decreased levels of Albumin may cause…

Malnutrition

Liver Disease

Nephrotic Syndrome

Chronic Inflammation

Ref Range for Microalbumin

What is it predictive of?

30-300mg/ 24hr

Predictive of diabetic nephropathy (Microalbuminuria)

Increased levels of Microalbumin may cause…

A risk of nephropathy in diabetics

What analyte decreases glucose levels by being responsible for entry of glucose into cells and increasing glycogenesis?

Insulin

What analyte increases glucose levels by stimulating glycogenolysis & gluconeogenesis and inhibiting glycolysis?

Glucagon

What analyte increases glucose levels by being an insulin antagonist and increasing gluconeogenesis?

Cortisol

What analyte increases glucose levels by promoting glycogenolysis & gluconeogenesis?

Epinephrine

What analyte increases glucose levels by being an insulin antagonist ONLY?

Growth hormone

What analyte increases glucose levels by increasing glucose absorption from gastrointestinal (GI) tract and stimulating glycogenolysis?

Thyroxine

Hormones of PRIMARY relative importance when regulating glucose..

Insulin 

Glucagon

Hormones of SECONDARY relative importance when regulating glucose..

Cortisol

Epinephrine

Growth Hormone

Hormones of NEGLIGIBLE relative importance when regulating glucose..

Thyroxine

Ref Range of BUN

8-26mg/dL; 2.1-7.1mmol/L

Increased BUN levels may cause…

Kidney disease

Decreased levels of BUN may cause…

Overhydration

Liver disease

Ref Range of Creatinine may cause…

0.6-1.2mg/dL; 53-106mmol/L

Increased Creatinine levels may cause…

Kidney disease

Ref Range of Uric Acid in MALES

3.5-7.2mg/dL

Ref range of Uric Acid in FEMALES

2.6-6mg/dL

Increased levels of Uric acid may cause…

Gout

Renal failure

Ketoacidosis

Lactate excess

High nucleoprotein diet

Leukemia

Lymphoma

Polycythemia

Decreased levels of Uric Acid may cause…

Administration of ACTH

Renal Tubular Defects

Ref Range for Ammonia

19-60mcg/dL

Increase levels of Ammonia may cause..

Liver disease

Hepatic coma

Renal failure

Reye Syndrome

Ref Range of Sodium

136-145 mmol/L

Increased levels of Sodium causes..

Hypernatremia which is seen in:

Increased intake of IV administration

Hyperaldosteronism

Excessive sweating

Burns

Diabetes Insipidus

What does hypernatremia cause?

Tremors

Irritibility

Confusion

Coma

Decreased levels of Sodium cause..

Hyponatremia which is seen in:

Renal or extrarenal loss (vomiting, diarrhea, sweating, burns)

Increased extracellular fluid volume

What does Hyponatremia cause?

Weakness

Nausea

Affected mental status

Ref Range for Potassium

3.5-5.1 mmol/L

Increased levels of Potassium cause…

Hyperkalemia which is seen in:

Increased intake or decreased excretion of potassium

Crush injuries

Metabolic acidosis

Symptoms of Hyperkalemia are…

Muscle weakness

Confusion

Cardiac Arrythmia

Cardiac arrest