Lab Values: Post Conference key

Sodium

136-145 mmol/L

High Sodium

Diet affects this, and IV fluids

Vascular fluid deficit (increased concentration, free water loss)

Diabetes insipidus

Hyperglycemia (osmotic diuresis)

Low Sodium

Vascular fluid overload (decreased concentration)

Decrease with NG suction

Burns (loss of serum)

Diuretic administration

Vomiting, diarrhea

Chloride

98 – 106 mmol/l

Low Chloride

Drugs that may lower serum chloride measurements include: Aldosterone, Bicarbonates, and certain diuretics

Decrease with NG, Diet affects this, and IV fluid

High Chloride

Drugs that may increase serum chloride measurements include:

Acetazolamide, Ammonium chloride Androgens, Cortisone, Estrogen, Guanethidine, Methyldopa, (NSAIDs)

Potassium

3.5-5.0 mmol/l

Low Potassium

Decrease with NG, Diuretic administration

Vascular fluid (increased and decreased concentrations)

High Potassium

Increased with IV fluid administration with potassium added

CO2

21 – 28 mmol/l

Changes in your CO2 level suggest you may be losing or retaining fluid, causing an imbalance in your body's electrolytes.

High CO2

Breathing disorders (COPD), Cushing syndrome, Hyperaldosteronism, Vomiting

Increase with NG

Low CO2

Addison disease, Diarrhea, Ethylene glycol poisoning, Ketoacidosis, Kidney disease, Lactic acidosis, Metabolic acidosis, Methanol poisoning, Salicylate toxicity (such as aspirin overdose)

BUN

10 – 20 mg/dl

High BUN

Increased production of urea is seen in cases of moderate or heavy bleeding in the upper gastrointestinal tract (e.g., from ulcers). The nitrogenous compounds from the blood are resorbed as they pass through the rest of the GI tract and then broken down to urea by the liver.

Enhanced metabolism of proteins will also increase urea production, as may be seen with high protein diets, patients on total parenteral nutrition, steroid use, burns, or fevers.

Low BUN

Usually has little significance, but its causes include liver problems, malnutrition (insufficient dietary protein), or excessive alcohol consumption. Overhydration from intravenous fluids can result in a low BUN.

Creatinine

0.5 – 1.3 mg/dl

High Creatinine

A rise in blood creatinine level is observed only with marked damage to functioning nephrons.

Glucose

70 - 110 mg/dl

High Glucose

Expect to high due to stress. Increase in catecholamine response

Administration of steroids

Diabetes

Calcium

9.0-10.5 mg/dL

Important for heart function and helps with muscle contraction, nerve signaling, and blood clotting.

Vitamin D is an important co-factor in the intestinal absorption of calcium.

Bone serves as an important storage point for calcium, as it contains 99% of the total body calcium.

Phosphorus

3.0 – 4.5 mg/dL

High Phosphorus

Hypoparathyroidism, renal failure, bone metastasis, hypocalcemia, acidosis, Rhabdomyolysis, hemolytic anemia

Low Phosphorus

Inadequate dietary ingestion, chronic antacid ingestion, hypercalcemia, alcoholism, vitamin D deficiency, Alkalosis, gram-negative sepsis, malnutrition

Magnesium

1.3 – 2.1 mEq/L

High Magnesium

Dehydration, Addison's disease, hyperparathyroidism,

Hypothyroidism

Kidney failure

Medicines that contain magnesium, such as antacids and laxatives

Low Magnesium

Alcohol abuse or withdrawal, diabetic ketoacidosis, malabsorption in the intestines (ex., sprue)

High blood calcium levels (hypercalcemia).

Infection and swelling of the pancreas (pancreatitis).

Kidney disease.

Long-term diarrhea.

Not getting enough magnesium in the foods you eat.

hypoparathyroidism

Albumin

3.5 – 5.0 g/dL

Low albumin

Liver disease> hepatocytes lose ability to produce albumin, overhydration, third-space losses, inflammatory disease (burns, necrosis)

Total Protein

6.4 – 8.3 G/DL

Measures the amounts of two major groups of proteins in the blood: albumin and globulin.

Albumin is made mainly in the liver and helps keep the blood from leaking out of blood vessels. Albumin helps carry some medicines and other substances through the blood and is important for tissue growth and healing.

Globulin is made up of different proteins (alpha, beta, and gamma). Some globulins are made by the liver, while others are made by the immune system. Certain globulins bind with hemoglobin. Other globulins transport metals, such as iron, in the blood and help fight infection. Serum globulin can be separated into several subgroups by serum protein electrophoresis.

WBC

5,000 – 10,000/ mm3

High WBC

Increase is a response to acute infection and inflammation.

RBC

4.2 – 6.1 mil/ul

High RBC

Increased in administration of EPO or decreased in kidney failure.

Low RBC

Decreased with bone metastasis, hemorrhage, anemia, malnutrition

Decreased when bone marrow focused on other cells

Hgb

12 – 18 g/dL

Low Hgb

Decreased # RBC, hemorrhage, anemia, malnutrition

Hct

37 – 52%

% of RBC in plasma – bone marrow: 10 days to produce mature RBC’s

Low HCT

Dilution anemia, hemorrhage, decrease EPO, malnutrition

High HCT

Dehydration, fluid loss

Platelets

150,000 – 400,000 / mm3

Live 9 – 12 days – formed in bone marrow; when damaged, platelets circulate through the spleen; the attached antibody destroys them

Low Platelets

Aplastic anemia

Cancer in the bone marrow, such as leukemia

Cirrhosis (liver scarring)

Folate deficiency

HIT, thrombocytopenia

Bleeding, prolonged infection (sepsis),(used platelets during surgery)

PTT/ aPTT

60-70 sec

30-40 sec

High PTT/aPTT

Full Anticoagulant therapy (1.5 – 2 times control)

(Intrinsic pathways activation)

Heparin administration

Liver failure (cirrhosis)

Low PTT/aPTT

Extensive cancer (ovarian, pancreatic, colon)

PT

11 – 12.5 sec

High PT

Warfarin (Coumadin) therapy

Full Anticoagulant therapy (1.5 – 2 times control)

Hepatocellular Disease (cirrhosis, hepatitis, and neoplastic invasive prohepatocellular dysfunction)

Biliary disease (obstruction)

Extrinsic pathways activation

Vitamin K deficiency, DIC, massive blood transfusions, salicylate

intoxication

INR

0.8 – 1.1

High INR

Warfarin (Coumadin) therapy

DIC, Liver failure (cirrhosis)

D-dimer

<0.4 mcg/ml

High D-dimer

Increased when identifying intravascular clotting

Fibrinogen

200 – 400 mg/dl

High Fibrinogen

Acute infections , Cancer, Coronary heart disease, myocardial infarction, Stroke

DIC

Inflammatory disorders (like rheumatoid arthritis and glomerulonephritis- a form of kidney disease)

Trauma

Cigarette smoking

Peripheral artery disease

Neutrophil

55-70%

High Neutrophils

Increase is the body’s response to bacterial infections or physiological stress. Increase in bands or stabs – new and immature and a shift to the left.

Lymphocytes

20-40%

High Lymphocytes

Increase in viral infections

Monocytes

2 – 8.0%

High Monocytes

Act as phagocytes in some inflammatory diseases

Eosinophils

1-4%

High Eosinophils

Antigen- antibody reaction – allergic reactions, hay fever, asthma, drug sensitivity

Basophils

0.5-1%

Contain heparin, histamines, and serotonin; “mast cells” analyze allergic reactions

AST

10-35 u/L

High AST

Very high elevations (more than 20 times normal) may indicate acute viral hepatitis, severe skeletal muscle trauma, extensive surgery, drug- induced hepatic injury, and severe liver congestion.

High levels (ranging from 10 to 20 times normal) may indicate severe heart attack, severe infectious mononucleosis, and alcoholic cirrhosis. High levels may also occur during the resolving stages of conditions that cause maximal elevations.

Moderate-to-high levels (5 to 10 times normal) may indicate chronic hepatitis and other conditions.

Low-to-moderate levels (ranging from 2 to 5 times normal) may indicate metastatic hepatic tumors, acute pancreatitis, pulmonary emboli, alcohol withdrawal syndrome, and fatty liver (steatosis)

Alakine Phosphate

30 – 120 u/L

Found in liver and bone and with biliary obstruction and cirrhosis most sensitive for metastatic tumor

ALT

4.0-36 u/L

High ALT

A very high ALT level (up to 50 times normal) suggests viral or severe drug-induced hepatitis, or other hepatic disease with extensive death of liver cells.

Moderate-to-high levels may indicate infectious mononucleosis, chronic hepatitis, intrahepatic cholestasis, or cholecystitis, early or improving acute viral hepatitis, or severe hepatic congestion due to heart failure.

Slight-to-moderate elevations of ALT may appear in any condition that produces acute hepatocellular (liver cell) injury, such as active cirrhosis and drug-induced or alcoholic hepatitis.

Total Bilirubin

0.3 – 1 mg/dL

Indirect (or unconjugated) bilirubin. This form of bilirubin does not dissolve in water (it is insoluble). Indirect bilirubin travels through the bloodstream to the liver, where the liver converts it into a soluble form (direct or conjugated).

Direct (or conjugated) bilirubin. Direct bilirubin dissolves in water (it is soluble) and is made by the liver from indirect bilirubin.

Total bilirubin and direct bilirubin levels are measured directly in the blood, whereas indirect bilirubin levels are derived from the total and direct bilirubin measurements.

High Bilirubin

The skin and whites of the eyes may appear yellow (jaundice). Jaundice may be caused by liver disease (hepatitis), blood disorders (hemolytic anemia), or blockage of the tubes (bile ducts) that allow bile to pass from the liver to the small intestine.