Lab Values (normal ranges)

serum albumin

3.5 - 5.0 g/dl

• visceral protein (blood and organs)

• maintains colloidal osmotic pressure

• hypoalbuminemia associated with edema surgery

• levels above normal range likely due to dehydration

• long half-life, does not reflect current protein intake

serum transferrin

>200 mg/dl

• visceral protein (transports iron to bone marrow)

• serum level controlled by iron storage pool; rises with iron deficiency

• can be determined from TIBC (Total Iron Binding Capacity)

• not useful as measure of protein status

TTHY transthyretin, PAB prealbumin

16-40 mg/dl

• short half-life; picks up changes in protein status quickly

• during inflammation, liver synthesizes CRP at expense of PAB

• limited usefulness in screening or assessment

RBP Retinol-Binding Protein

3-6 mg/dl

• circulates with prealbumin; shortest half-life (12 hours)

• binds and transports retinol

Hct Hematocrit

Men: 42-52%, Women: 35-48%, Pregnant women: 33%, Newborn: 44-64%

• volume of packed cells in whole blood

Hgb Hemoglobin

Men: 14-18 g/dl, Women: 12-15 g/dl, Pregnant women: ≥11

• iron-containing pigment of red blood cells

• erythrocytes are produced in bone marrow

serum ferritin

Men: 12-300 ng/ml, Women: 10-150 ng/ml

• indicates size of iron storage pool

serum creatinine

Men: 0.6-1.2 mg/dl, Women: 0.5-1.1 mg/dl

• related to muscle mass; measures somatic protein

• may indicate renal disease, muscle wastage

CHI Creatinine Height Index

80% normal

• ratio of creatinine excreted / 24 hours to height

• estimates lean body mass - somatic protein

• 60-80% muscle depletion

BUN Blood Urea Nitrogen

“A Hamburger BUN is between $10-$20”

Normal range: 10-20 mg/dl

• related to protein intake

• indicator of renal disease

• BUN:Creatinine ratio

  • normal: 10-15:1

Urinary Creatinine Clearance

115±20 ml/minute

• measures GFR - glomerular filtration, renal function

• estimate includes body surface area (height and weight)

TLC Total Lymphocyte Count

>2700 cells/cu mm

• measures immunocompetency

• moderate depletion 900-1800, severe depletion <900

• decreased in protein-calorie malnutrition

CRP C-reactice protein

• marker of acute inflammtory stress

• as it declines, indicates when nutritional therapy would be beneficial

• when elevated CRP decreases, PAB

FEP Free erthrocyte protoporphyrin

• direct measure of toxic effects of leads on heme synthesis (leading to anemia)

• increased in lead poisoning

• lead and calcium compete at plasma membrane for transport

PT prothrombin time

11.0-12.5 seconds; 85-100% of normal

• anticoagulants prolong PT

• evaluates clotting adequacy; change in vitamin K intake will alter rate

Glucose (fasting)

70-100 mg/dL

Calcium (Ca)

Normal range: 4.5 – 5. 5 mEq/L , 9 – 11 mg/dL

Hypocalcemia:

• Caused by Vit. D deficiency, Loop diuretics, renal failure, glucocorticoids, hyperphosphatemia, hypoalbuminemia (*calcium in serum is bound to protein).

Hypercalcemia

• Caused by Hyperparathyroidism, malignancy, calcium supplements, excessive vit. D intake.

Potassium (K)

“3 to 5 bananas in a bunch!”

Normal Range: 3.5 - 5.0 mEq/L

Hypokalemia: Certain meds, Insulin, Loop and Thiazide diuretics, Refeeding syndrome

Hyperkalemia: Certain meds like Cyclosporine, uncontrolled renal, disease, metabolic acidosis, deficiency of adrenal steroid (Addison’s disease)

Sodium (Na)

Normal range: 136-145 mEq/L

Hyponatremia = Overhydration (LOW SODIUM)

• Caused by Diuretic use (Loop), Heart failure, CHF, Renal disease, Cirrhosis, Edema

Hypernatremia = Dehydration (HIGH SODIUM)

• Caused by Kidney dysfunction, Fever, Burns, Thirst, Prolonged vomiting, Sweating, Diarrhea

Best assessment for fluid status

Phosphorus (P)

Normal range: 3.0 - 4.5 mg/dl

Hypophosphatemia:

• Caused by Increased phos., binders, Refeeding synd., low intake Tums (calcium antacid *lowers Po4 via the BM), hyperparathyroidism

Hyperphosphatemia:

• Not enough binders, high phos. diet.

Magnesium (Mg)

Hemoglobin (Hg)

Hematocrit

pCO₂

35-45

HCO₃

22-26