Compiled Lab Values

7/29/2019 Compiled Lab Values

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LAB NORMALVALUE

PURPOSE ABNORMAL

SERUMAMYLASE

25 TO 151SOMOGYIUNITS =

53 TO 123

PANCREASFXN

HIGH

HGB FEMALE 12 TO 15 O2 CARRYING LOW

HGB MALE 14 to 18 INCRESAED are dehydrationand polycythemia,

DECREASED overhydrationand anemia.

HEMATOCRIT FE 36 TO 48 INCRESAED are dehydrationand polycythemia,

DECREASED overhydrationand anemia.

HEMATOCRITMA

42 TO 52 VALUES DEPEND ON SOURCE

PLATELETS 150,000 TO400,000

SODIUM 135 TO 145

POTASSIUM 3.5 TO 5 Notify physician if level greater than 5.5 mEq/L, and prepare totreat hyperkalemia.

CALCIUM 8.6 TO 10MAGNESIUM 1.6 TO 2.6

PHOSPHORUS 2.7 TO 4.5

CREATININEMALECREATININEFEMALE

0.6 TO 1.3

0.5 TO 1.0;

0.7 to 1.4

RENALFUNCTION,betterdeterminant ofkidney functionbecause it doesnot vary withprotein intake

and metabolicstate

Serum creatinine increases withdecreased kidney function.

BUN 10 TO 20 End product of metabolism ofproteins frommuscles anddietary intake

BUN level varies with urineoutput.

Increased BUN decreasedrenal function, GI bleeding,dehydration, increased proteinintake, fever, sepsis


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Decreased BUN END stageliver failure, low protein diet,starvation, pregnancy

URINE SPECIFIC

GRAVITY

1.016 TO

1.022

KIDNEYS

ABILITY TOREGULATEFLUIDBALANCEINDIRECTMEASURE OFTHE AMOUNTOF PROTEIN INTHE URINE

ELEVEATED

PROTEIN IN URINE

BUN/CREATININE

RATIO

10/1 TO15/1

RENALDISEASE

KIDNEYFUNCTION

< 10/1 LOW UREACONCENTRATION

>15/1 KIDNEY DYSFUNCTION

SERUMAMMONIA

10 TO 80 LIVERFUNCTION

SERUM

PROTEIN NOTALBUMIN

6 TO 8

SERUM LIPASE 10 TO 140

NORMALRANDOMFASTING

GLUCOSE

70 TO 110

ORAL GLUCOSETOLERANCETEST

NORMALVALUES

120 MIN


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DrugsPregnancy

or prehypertension

BNP < 100 Heart damagedue to stretchingof myocardium

Determinant ofCHF

100 to 300 mild CHF300 to 600 moderate CHF> 600 severe CHF

TOTALCHOLESTEROL

> HIGH CAD

10% decrease in total cholesterolresults in 30% decrease for risk of

CAD

LDLs


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HDLS > 40 MEN> 50WOMEN

When it comesto HDLcholesterol goodcholesterol

the higher thenumber, thelower your risk.

60 and above High;

Optimal cardioprotective +

associated with lower risk

Goal

Men > 45; Women > 55

Less than 40 in men and less

than 50 in women Low;

considered a risk factor for

heart disease

Weight reduction and exercise

can increase HDLsTRIGLYCERIDES 100

1. Abdominal obesityMen 40 inches or more

Women 35 inches or more

2. hypertriglyceridemia

3. low HDLs

4. High blood pressure

5. high fasting blood

glucose

6. elevated CRPGLUCOSE

FASTING


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6 Greater than 200=

HGB A1C < 5.0 6.5%

Diabetes

HEMOGLOBINA1C > 8INDICATESVERYPOOR/NOCONROL OVERTHEIR BLOODGLUCOSE &DIABETES

PREDIABETES= VALUES 5.7TO 6.4

Criteria for DiagnosisSymptomatic patient with one

Fasting plasma glucose >= 7.0

mmol/LFasting plasma glucose >= 7.0mmol/LRandom plasma glucose >=

11.1 mmol/LIf there are no symptoms then

you need two separatereadings on different days

CRP < 1 > 3 high risk

1.0 to 3.0moderate risk

High CRP is associated with heartdisease, systemic inflammationassociated with atheriosclerosis

WBCS 4500 TO11,000

CARBAMAZEPINE CANDEPRESS WBC COUNTS

NEUTROPHILS 1800 TO

7800AST LIVER

FUNCTIONVIRAL HEPATITIS LOWERED

VANCOMYCINTITERS 30 TO 40

MCG/ML

PEAK SERUMMEASURED 1.5HOURS TO 2.5HOURS AFTERTHECOMPLETED IVINFUSION

NEPHROTOXICITY ANDOTOTOXICITY

DILANTIN

THERAPUETICSERUM

10 TO 20

MCG/ML

< 10 RISK FOR SEIZURE

> 20 TOXICITY

THEOPHYLLINETHERAPUETIC

10 TO 20MCG/ML

< 10 EXCERBATERESPIRATORY DISORDER

DIGOXINTHERAPUETIC

0.5 TO 2.0

BLOOD pH 7.35 to 7.45


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paCO2 35 to 45 ELEVATED CO2 LEVELS

OCCURS WITH LOWER pHrespiratory acidosis

HCO3 22 TO 26 ELEVATED HCO3 OCCURSWITH HIGHER pH metabolic

alkalosisLOW HCO3 Metabolic acidosis

FIBRINOGENFEMALES

190 TO 420 TENDENCY TO BLEED, DIC

FIBRINOGENMALES

180 TO 340 TENDENCY TO BLEED, DIC

SCHILLING TEST DETERMINEPERNICIOUS

ANEMIA

INCREASED

RBC COUNT

DECREASED

CARDIACOUTPUTIMPAIREDPULMONARYGASEXCHANGECORTICOSTEROID THERAPYPOLYCYTHEMI

A VERA,SEVERE

DIARRHEA,DEHYDRATION

INCREASEDPLATELET

AGGREGATION

NORMAL

LESSTHAN 5MINUTES

INCREASEDPLATELET

AGGREGATIONOCCURS

AFTERSURGERY,

ACUTEILLNESS,VENOUS

THROMBOSIS DVT,PULMONARYEMBOLISM

ESRERYTHROCYTESEDIMENTATION RATE

< 30NORMAL30 TO 40MILD

AUTOIMMUNE

DISEASEDEGREE OFINFLAMMATIO


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INFLAMM40 TO 70MODERATE INFLAMM70 TO 150

SEVEREINFLAMM

N,CONNECTIVETISSUEINFLAMM;RHEUMATOID

ARTHRITIS

PTPROTHROMBINTIME

FEM 9.5 TO11.3MALE 9.6TO 11.8

ASPIRINTHERAPYBLEED TIME

DECREASED PT VALUEARTERIAL OCCLUSION,DVT, EDEMA, MI, PERIPHERALVASCULAR DISEASE,PULMONARY EMBOLISM

Right Sided HFback up in SVCand IVC

COPD,emphysema

Liver and kidneyfailure

dependent edema

jugular distension

englarged liver

anorexia/nausea

distended abdomen, ascites portal hypertension

abdominal pulsesmeasureable

swollen arms,hands

nocturia, polyuria

weight gain

high or low blood pressure

elevated BUN and creatinine

kidney failure

ATRIAL FIBRILLATIONLeft Sided HF

Ejection fraction


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obtained andrecorded. A 1-kgweight gain isequal to 1000 mLof retained fluid.

risk Orthnopia trifold position

Paroxysmal nocturnal dyspnea(PND)

ATRIAL FIBRILLATION

Ventricular tachycardia

Angina Decreased LOC

Respiratory acidosis

JC core measuresfor pneumonia

Dropletprecautions

Gown, mask,eye shield,gloves

Communityacquired < 48hours afteradmission

Hospitalacquired/ventilator aquired > 48hours afteradmission

Bacterial moreserious than

viral

Get ABGs inaddition to O2

saturation more accurate

2. blood culture before antibiotic3. antibiotic within 4-6 hrs4. documentation of smoking

cessation teaching to patient5. patient given pneumococcal

vaccine + influenza vaccine6. arranged appointment for

follow up

Admission:

Fever > 100.4

Altered LOC, esp 70 yrs orolder

New onset or worseningcough

Prurulent sputum, change insputum

Dyspnea or tachypnea

Rales or bronchial breathsounds

02 sat


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day for at least6 months, or 3to 6 monthsafter negativesputum

True diagnostic for TB QFTgold blood test results within 2 hrs

airborne isolation n95

exposed ppl prophylaxis ofINH for 6 months

abnormal Xray orimmunosuppressed/HIV prophylaxis of INH for 12months

COPD ChronicBronchitis

If perfusion 3months

Eventual lungchanges result

in brochectasisand emphysema

Hypoxia, hypercapnia, respiratoryacidosis, digital clubbing,

cardiomeagly, cor pulmonaleright sided heart failure LATE indisease , increased risk forrespiratory infectionBLUE BLOATER

COPDEmphysema

If perfusion


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absorbed when taken with food.Other statins such as Prvacholand Zocor can be taken withoutregard to food intake. However,all the statin drugs can cause

adverse GI effects such ascramps, diarrhea, constipation,flatus and heartburn, andgenerally taken with evening mealor bedtime.

Liver damage check LFTs

Muscle pain/damageRhabdomyolysis can causesevere muscle pain, liver damage,kidney failure and death

24 HOUR URINE COLLECTION SPECIMEN PLACE IN THE REFRIDGERATOROR THE BACTERIA AND WBCS IN THE URINE WILL DECOMPOSE AND UNABLETO MEASURE, PRESERVES THE ELEMENTS OF THE URINE, IF LEFTUNREFRIDGERATED THE URINE BREAKS DOWN TO AMMONIA AND BECOMESMORE ALKALINE

24 HOUR URINE COLLECTION IS TIMED, QUANTITATIVE MEASUREESSENTIOAL TO START TEST WITH AN EMPTY BLADDER

AT START TIME ASK PATIENT TO VOID, DISCARD THE SPECIMEN = BLADDER

NOW EMPTY, AND NOTE THE START TIME. COLLECTION STARTS AFTER THISVOID AND TIME. IN BETWEEN COLLECTIONS PLACE THE URINE SPECIMEN ONICE OR REFRIDGERATE IT, AND AT THE END OF COLLECTION (24 HOURS) HAVEPATIENT VOID ADDING THIS TO THE COLLECTION.FIFTEEM MINUTES BEFORE THE END OF COLLECTION TIME THE PATIENTSHOULD BE ASKED TO VOID AND ADD THIS SPECIMENT TO THE COLLECTION

CLEAN CATCH SPECIMEN HAVE PATIENT CLEANSE LABIA/PENIS USINGTOWELS THEN HAVE THEM VOID INTO THE STERILE SPECIMENT CONTAINER

GROSS HEMATURIA AND PROTEINURIA CLASSIC SIGNS OF

GLOMERULONEPHRITIS

THROAT CULTURE MUST BE REFRIDGERATED IF CANNOT BE ANALYZEDWITHIN 1 HOUR

CHRONIC CARRIER STATE OF HEPATITIS POSITIVE FOR HEPATITIS B

SURFACE ANTIGEN (HBsAG) CHRONIC CARRIERS


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Anti-HBs ANTIBODY TO SURFACE ANTIGEN MARKER FOR RESPONSE TOTHE VACCINE AND INDICATES IMMUNITY TO HEPATITIS B

Labs for bleeding and clotting timesLets look at the three tests used to determine bleeding or clotting times:

1. Prothrombin Time (PT) this blood test measures how long ittakes blood to clot and can be used to check for bleeding problems.

An abnormal PT/INR can be caused by liver disease; injury; lack of

vitamin K; or treatment with blood thinners.QUIZ YOURSELF: Which blood thinner are we talking about here?(answer below).

2. International Normalized Ratio (INR) is a standardized wayto report results of bleeding time. It is used in place of PT; in fact, some

labs will only report INR.

3. Activated Partial Thromboplastin Time (APTT)* this blood

test also measure the time it takes your blood to clot and to helpdiagnose bleeding problems.

An abnormal APTT can be caused by bleeding disorders (such as

hemophila); liver or kidney disease; or treatment with bloodthinners.QUIZ YOURSELF: Which blood thinner are we talking about here?(answer below)

Therapeutic Lab ValuesLets look at these same lab tests once again.

PT & INR If you answered warfarin (Coumadin) to the first question

above, you were correct! How much warfarin the person is prescribeddepends on the prothrombin time (or INR). The therapeutic value ofPT is about 1.5 to 2.5 times the normal value; the therapeutic valueof INR is 2 to 3 times the normal value.

Test Normal lab value Therapeutic lab value

Prothrombin time (PT) 11 13 seconds 15.5 35 seconds

International normalized ratio

(INR)

0.8 1.1 2 3

APTT If you answered heparin for this test, you were correct! As

with the PT/INR test, the heparin dose is changed so that the APTT

result is about 1.5 to 2.5 times the normal value.How can you remember if APTT is used for heparin or warfarin? I always

remember APTT has 2 sticks (the Ts), and there are 2 sticks in the H in

HEPARIN its stuck with me all these years.

Test Normal lab value Therapeutic labvalue

Activated Partial thromboplastin 30 40 seconds 45 100 seconds


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time (aPTT)

Applying this informationSo, lets say you are caring for a client taking warfarin (for example,

following total hip replacement surgery). This means that when you look at

the labs for this client, you want to see longer bleeding times or, essentially

abnormal values. The idea here is to prevent blood clots from forming.

For heparin therapy, you are caring for a client who is on IV heparin

(admission diagnosis is deep vein thrombosis). When you look at the labs for

this client, you also want to see longer bleeding times.

Keep in mind that if the number is too high for either client, you should start

watching for signs of spontaneous bleeding and the dosage should be

decreased. Another key point to remember, these tests should be done atthe same time of day every day while the client is hospitalized.QUIZ YOURSELF: What are the antidotes for reversing the effects ofheparin? And for warfarin?(Watch for the answer below.)**

Now its your turnAre there any other topics you would like me to discuss in an upcoming blog?

*Are you wondering if it's PTT or APTT? PTT was first used in the early 1950s

and was replaced by APTT in the 1970s.

** The antidote for reversing the effects of heparin is... protamine

sulfate. The antidote for reversing the effects of warfarin is... vitamin K. Did

you come up with the correct response without looking?The risk of bleeding increases significantly when the INR is 3or greater.

DASH dietLow saturated fats, low cholesterol, low total fat, LOW SODIUM

Stage 1 HTN < 2400 mg of sodium

Stage 2 HTN < 1500 mg sodiumCan increase K+ in diet though

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Compiled Lab Values