Lab Values

http://evolve.elsevier.com/Lewis/medsurg/

APPENDIXBLaboratory Values

g � grammg � milligram (10�3)�g � microgram (one millionth of a gram) (10�6)ng � nanogram (one billionth of a gram) (10�9)pg � picogram (one trillionth of a gram) (10�12)

�U � microunit�l � microliterIU � international unit

mOsm � milliosmoleU � unit

mmol � millimole�mol � micromolenmol � nanomolepmol � picomole

kPa � kilopascal�kat � microkatal

1872

The tables in this appendix list some of the most commontests, their normal values, and possible etiologies of abnormalvalues. Laboratory values may vary with different techniquesor different laboratories. Possible etiologies are presented inalphabetic order. Abbreviations appearing in the tables are de-fined as follows:

� � less than� � greater thanL � liter

mEq � milliequivalentml � milliliterdl � deciliter

mm Hg � millimeter of mercuryfl � femtoliter

mm � millimeter

Laboratory Values APPENDIX B 1873

Serum, Plasma, and Whole Blood ChemistriesNORMAL VALUES POSSIBLE ETIOLOGY

CONVENTIONALTEST UNITS SI UNITS HIGHER LOWER

AcetoneQuantitativeQualitative

Albumin

Aldolase�1-Antitrypsin

�1-Fetoprotein

AmmoniaAmylase

Ascorbic acid

Bicarbonate

BilirubinTotalIndirectDirect

Blood gases*Arterial pH

Venous pH

Arterial PCO2

Venous PCO2

Arterial PO2

Venous PO2

Calcium

Calcium, ionized

Carbon dioxide (CO2 content)

Carotene

Chloride

*Because arterial blood gases are influenced by altitude, the value for PO2 decreases as altitude increases. The lower value is normal for an altitude of 1 mile.Continued

TABLE B-1

0.3-2.0 mg/dlNegative3.5-5.0 g/dl

1.0-7.5 U/L78-200 mg/dl

�15 ng/ml

30-70 �g/dl0-130 U/L (method

dependent)

0.4-1.5 mg/dl

20-30 mEq/L

0.2-1.3 mg/dl0.1-1.0 mg/dl0.1-0.3 mg/dl

7.35-7.45

7.35-7.45

35-45 mm Hg

42-52 mm Hg75-100 mm Hg30-50 mm Hg9-11 mg/dl (4.5-5.5

mEq/L)

4-4.6 mg/dl (2-2.3mEq/L

20-30 mEq/L

10-85 �g/dl

95-105 mEq/L

52-344 �mol/LNegative35-50 g/L

0.02-0.13 �kat/L0.78-2.0 g/L

�15 �g/L

17.6-41.1 �mol/L0-2.17 �kat/L

23-85 �mol/L

20-30 mmol/L

3.4-22.0 �mol/L1.7-17.0 �mol/L1.7-5.1 �mol/L

Same as conventionalunits


4.67-6.00 kPa

5.60-6.93 kPa10.0-13.33 kPa4.0-6.67 kPa2.25-2.74 mmol/L

1.0-1.15 mmol/L

20-30 mmol/L

0.19-1.58 �mol/L

95-105 mmol/L

Diabetic ketoacidosis, high-fatdiet, low-carbohydrate diet,starvation

Dehydration

Skeletal muscle diseaseAcute and chronic inflammation,

arthritis, stress syndrome

Cancer of testes and ovaries,carcinoma of liver

Severe liver diseaseAcute and chronic pancreatitis,

mumps (salivary gland dis-ease), perforated ulcers

Excessive ingestion of vitamin C

Compensated respiratory aci-dosis, metabolic alkalosis

Biliary obstruction, impairedliver function, hemolyticanemia, pernicious anemia,prolonged fasting

Alkalosis

Compensated metabolic alkalosis

Respiratory acidosisAdministration of high con-

centration of oxygenAcute osteoporosis, hyper-

parathyroidism, vitamin Dintoxication, multiplemyeloma

Same as bicarbonate

Cystic fibrosis, hypothyroidism,pancreatic insufficiency

Metabolic acidosis, respiratoryalkalosis, corticosteroidtherapy, uremia

Chronic liver disease, malab-sorption, malnutrition, ne-phrotic syndrome, pregnancy

Renal diseaseChronic lung disease (early

onset), malnutrition, ne-phrotic syndrome

Acute alcoholism, cirrhosis ofliver, extensive destructionof pancreas

Connective tissue disorders,hepatic disease, renal dis-ease, rheumatic fever, vita-min C deficiency

Compensated respiratory alka-losis, metabolic acidosis

Acidosis

Compensated metabolic acidosis

Respiratory alkalosisChronic lung disease, de-

creased cardiac outputAcute pancreatitis, hypopara-

thyroidism, liver disease, mal-absorption syndrome, renalfailure, vitamin D deficiency

Dietary deficiency, malabsorp-tion disorders

Addison’s disease, diarrhea,metabolic alkalosis, respira-tory acidosis, vomiting

POSSIBLE ETIOLOGY

1874 APPENDIX B Laboratory Values

Serum, Plasma, and Whole Blood Chemistries—cont’dNORMAL VALUES POSSIBLE ETIOLOGY


Cholesterol

HDL (high-density lipoproteins)MaleFemale

LDL (low-densitylipoproteins)

Cholinesterase (RBC)

Pseudocholinesterase (plasma)

Copper

Cortisol

Creatine

Creatine kinase (CK)MaleFemale

CK-MB (CK-2)CreatinineFerritin (serum)

MaleFemale

Folic acid (folate)

Gamma-glutamyl transpeptidase (GGT)

Glucose, fasting

Glucose tolerance (GTT)Fasting30 min

60 min

120 min

180 min

RBC, Red blood cell.

TABLE B-1

140-200 mg/dl(age dependent)

�45 mg/dl�55 mg/dl�130 mg/dl

0.65-1.00 pH

5-12 U/ml

80-150 �g/dl

8 AM: 5-25 �g/dl8 PM: �10 �g/dl0.2-1.0 mg/dl

15-105 U/L10-80 U/L

0-9 U/L0.5-1.5 mg/dl

20-300 ng/ml10-120 ng/ml3-25 ng/ml

0-30 U/L

70-120 mg/dl

70-120 mg/dl30-60 mg/dl above

fasting20-50 mg/dl above

fasting5-15 mg/dl above

fastingFasting level or

lower

3.6-5.2 mmol/L

�1.2 mmol/L�1.4 mmol/L�3.4 mmol/L



12.6-23.6 �mol/L

0.14-0.69 �mol/L�0.28 �mol/L15.3-76.3 �mol/L

0.26-1.79 �kat/L0.17-1.36 �kat/L

�0.1 �kat/L44-133 �mol/L

20-300 �g/L10-120 �g/L7-57 nmol/L

0-0.5 �kat/L

3.89-6.66 mmol/L

3.89-6.66 mmol/L1.67-3.33 mmol/L

1.11-2.78 mmol/L

0.28-0.83 mmol/L

Fasting level or lower

Biliary obstruction, hypothy-roidism, idiopathic hypercho-lesterolemia, renal disease,uncontrolled diabetes

Exercise

Cirrhosis, female on contraceptives

Cushing syndrome, pancreati-tis, stress

Active rheumatoid arthritis,biliary obstruction, hyper-thyroidism, renal disorders,severe muscle disease

Musculoskeletal injury or dis-ease, myocardial infarction,severe myocarditis, exercise,numerous intramuscular in-jections, brain damage

Acute myocardial infarctionSevere renal diseaseSideroblastic anemia, anemia

of chronic disease (infection,inflammation, liver disease)

Hypothyroidism

Acute stress, cerebral lesions,Cushing’s disease, diabetesmellitus, hyperthyroidism,pancreatic insufficiency

Diabetes mellitus

Extensive liver disease, hyper-thyroidism, malnutrition,corticosteroid therapy

Acute infections, insecticide intoxication, liver disease,muscular dystrophy

Wilson’s disease

Adrenal insufficiency,panhypopituitary states

Diabetes mellitus

Iron-deficiency anemia

Alcoholism, hemolytic anemia,inadequate diet, malabsorp-tion syndrome, megaloblas-tic anemia

Liver disease, infectiousmononucleosis

Addison’s disease, hepaticdisease, hypothyroidism,insulin overdosage, pancre-atic tumor, pituitary hypo-function, postgastrectomydumping syndrome

Hyperinsulinism

POSSIBLE ETIOLOGY




Haptoglobin

Insulin

Iron, total

Iron-binding capacity

Lactic acid

Lactic dehydroge-nase (LDH)

Lactic dehydroge-nase isoenzymesLDH1

LDH2

LDH3

LDH4

LDH5

Lipase

Magnesium

Osmolality

Oxygen saturation (arterial)

pHPhenylalaninePhosphatase, acid

Phosphatase, alkaline

Phosphorus, inorganic

Continued

TABLE B-1

26-185 mg/dl

4-24 �U/ml

50-150 �g/dl

250-410 �g/dl

5-20 �g/dl

50-150 U/L

20%-35%

30%-40%

15%-25%

0%-10%

4%-12%

0-160 U/L

1.5-2.5 mEq/L

285-295 mOsm/kg

95%-98%

See blood gases0-2 mg/dl0-0.6 U/L

30-120 U/L

2.8-4.5 mg/dl

260-1850 mg/L

29-172 pmol/L

9.0-26.9 �mol/L

45-73 �mol/L

0.56-2.2 mmol/L

0.83-2.5 �kat/L

0.20-0.35

0.30-0.40

0.15-0.25

0-0.10

0.04-0.12

0-2.66 �kat/L

0.62-1.03 mmol/L

285-295 mmol/kg

0.95-0.98 saturated

0-121 �mol/L0-90 �kat/L

0.5-2.0 �kat/L

0.90-1.45 mmol/L

Infectious and inflammatoryprocesses, malignant neoplasms

Acromegaly, adenoma of isletcells, untreated mild case oftype 2 diabetes

Excessive RBC destruction

Iron-deficient state, oral con-traceptive use, polycythemia

Acidosis, congestive heartfailure, shock

Congestive heart failure,hemolytic disorders, hepati-tis, metastatic cancer of liver,myocardial infarction, perni-cious anemia, pulmonaryembolus, skeletal muscledamage

Myocardial infarction, perni-cious anemia

Pulmonary embolus, sickle cellcrisis

Malignant lymphoma, pulmo-nary embolus

Lupus erythematosus, pulmo-nary infarction

Congestive heart failure, hepa-titis, pulmonary embolusand infarction, skeletalmuscle damage

Acute pancreatitis, hepatic dis-orders, perforated pepticulcer

Addison’s disease, hypothy-roidism, renal failure

Chronic renal disease, diabetesmellitus

Polycythemia

PhenylketonuriaAdvanced Paget’s disease,

cancer of prostate, hyper-parathyroidism

Bone diseases, marked hyper-parathyroidism, obstructionof biliary system, rickets

Healing fractures, hypopara-thyroidism, renal disease,vitamin D intoxication

Hemolytic anemia, mononu-cleosis, toxoplasmosis,chronic liver disease

Diabetes mellitus, obesity

Iron-deficiency anemia,anemia of chronic disease

Cancer, chronic infections, per-nicious anemia, uremia

Chronic alcoholism, hyperpara-thyroidism, hyperthyroidism,hypoparathyroidism, severemalabsorption

Addison’s disease, diuretictherapy

Anemia, cardiac decompensa-tion, respiratory disorders

Excessive vitamin D ingestion,hypothyroidism, milk-alkalisyndrome

Diabetes mellitus, hyperparathy-roidism, vitamin D deficiency

POSSIBLE ETIOLOGY




Potassium

Prostate-specific antigen (PSA)

ProteinsTotalAlbuminGlobulinAlbumin/globulin

ratio

ReninSupine positionUpright position

Sodium

TestosteroneMaleFemale

T4 (thyroxine), total

T4 (thyroxine), freeT3 uptake

T3 (triiodothyronine)Thyroid-stimulating

hormone (TSH)Transaminases

Serum glutamicoxaloacetic (SGOT) or aspartate aminotrans-ferase (AST)

Serum glutamate pyruvate (SGPT) or alanine aminotrans-ferase (ALT)

Triglycerides

Urea nitrogen (BUN)

TABLE B-1

3.5-5.5 mEq/L

�4 ng/mL

6.0-8.0 g/dl3.5-5.0 g/dl2.0-3.5 g/dl1.5:1-2.5:1

1.4-2.9 ng/ml/hr0.4-4.5 ng/ml/hr135-145 mEq/L

300-1200 ng/dl25-90 ng/dl

5-12 �g/dl

0.8-2.3 ng/dl25%-35%

110-230 ng/dl0.3-5.4 �U/ml

7-40 U/L

5-36 U/L

40-150 mg/dl

10-30 mg/dl

3.5-5.5 mmol/L

�4 �g/L

60-80 g/L35-50 g/L20-35 g/LSame as conventional

units

0.39-0.81 ng/L·sec0.11-1.25 ng/L·sec135-145 mmol/L

10.4-41.6 nmol/L0.87-3.1 nmol/L

64-154 nmol/L

10-30 pmol/L0.25-0.35

1.7-3.5 nmol/L0.3-5.4 mU/L

0.12-0.67 �kat/L

0.08-0.6 �kat/L

0.45-1.69 mmol/L

1.8-7.1 mmol/L

Addison’s disease, diabeticketosis, massive tissue de-struction, renal failure

Prostate cancer

Burns, cirrhosis (globulin frac-tion), dehydration

Multiple myeloma (globulinfraction), shock, vomiting

Renal hypertension, volumedecrease (e.g., hemorrhage)

Dehydration, impaired renalfunction, primary aldoster-onism, corticosteroid therapy

Polycystic ovary, virilizingtumors

Hyperthyroidism, thyroiditis

Hyperthyroidism, metastaticneoplasms

HyperthyroidismMyxedema, primary hypothy-

roidism, Graves’ disease

Liver disease, myocardial in-farction, pulmonary infarc-tion, acute hepatitis

Liver disease, shock

Diabetes mellitus, hyperlipid-emia, hypothyroidism, liverdisease

Increase in protein catabolism(fever, stress), renal disease,urinary tract infection

Cushing syndrome, diarrhea(severe), diuretic therapy,gastrointestinal fistula,pyloric obstruction, starva-tion, vomiting

Congenital agammaglobulin-emia, liver disease, malab-sorption

Malnutrition, nephrotic syn-drome, proteinuria, renaldisease, severe burns

Increased salt intake, primaryaldosteronism

Addison’s disease, diabetic ke-toacidosis, diuretic therapy,excessive loss from gastro-intestinal tract, excessive per-spiration, water intoxication

Hypofunction of testes

Cretinism, hypothyroidism,myxedema

Hypothyroidism, pregnancy

HypothyroidismSecondary hypothyroidism

Malnutrition

Malnutrition, severe liverdamage

POSSIBLE ETIOLOGY




Uric acidMaleFemale

Vitamin A

Vitamin B12

Zinc

TABLE B-1

4.5-6.5 mg/dl2.5-5.5 mg/dl

15-60 �g/dl

200-1000 pg/ml

50-150 �g/dl

149-327 �mol/L268-387 �mol/L

0.52-2.09 �mol/L

148-738 pmol/L

7.6-22.9 �mol/L

Gout, gross tissue destruction,high-protein weight reduc-tion diet, leukemia, renalfailure, eclampsia

Excess ingestion of vitamin A

Chronic myeloid leukemia

Administration of uricosuricdrugs

Vitamin A deficiency

Strict vegetarianism, malab-sorption syndrome, perni-cious anemia, total or partialgastrectomy

Alcoholic cirrhosis

HematologyNORMAL VALUES POSSIBLE ETIOLOGY


Bleeding time (Simplate)

Activated partial thromboplastin time (APTT)

Prothrombin time (Protime, PT)

Fibrinogen

Fibrin split (degra-dation) products

D-Dimer

Erythrocyte count†

(altitude dependent)MaleFemale

Mean corpuscular volume (MCV)

Mean corpuscular hemoglobin (MCH)

Mean corpuscular hemoglobin con-centration (MCHC)

*Values depend on reagent and instrumentation used.†Components of complete blood count (CBC).COPD, Chronic obstructive pulmonary disease; DIC, disseminated intravascular coagulation; WBC, white blood cell. Continued

TABLE B-2

3.0-9.5 min

24-36 sec*

10-14 sec*

200-400 mg/dl

�10 �g/ml

Negative

4.5-6.0 � 106/�L4.0-5.0 � 106/�L82-98 fl

27-33 pg

32%-36%

180-570 sec



2.0-4.0 g/L


Negative

4.5-6.0 � 1012/L4.0-5.0 � 1012/LSame as conventional

unitsSame as conventional

units0.32-0.36

Defective platelet function,thrombocytopenia, vonWillebrand’s disease, aspiriningestion, vascular disease

Deficiency of factors I, II, V, VIII,IX and X, XI, XII; hemophilia;liver disease; heparin therapy

Warfarin therapy; deficiency offactors I, II, V, VII, and X; vita-min K deficiency; liver disease

Burns (after first 36 hr), inflam-matory disease

Acute DIC, massive hemor-rhage, primary fibrinolysis

DIC, myocardial infarction,deep vein thrombosis, un-stable angina

Dehydration, high altitudes,polycythemia vera, severediarrhea

Macrocytic anemia

Macrocytic anemia

Spherocytosis

Burns (during first 36 hr), DIC,severe liver disease

Anemia, leukemia, posthemorrhage

Microcytic anemia

Microcytic anemia

Hypochromic anemia

POSSIBLE ETIOLOGY

POSSIBLE ETIOLOGY


Hematology—cont’dNORMAL VALUES POSSIBLE ETIOLOGY


Erythrocyte sedimen-tation rate (ESR), WestergrenMale �50 yr

�50 yrFemale �50 yr

�50 yrHematocrit (altitude

dependent)†

MaleFemale

Hemoglobin (altitude dependent)†

MaleFemale

Hemoglobin, glycosylated

Red cell distribution width (RDW)

Platelet count (thrombocytes)

Reticulocyte count (manual)

White blood cell count†

WBC differentialSegmented

neutrophilsBand neutrophilsLymphocytes

Monocytes

Eosinophils

Basophils

Sickle cell solubility test

TABLE B-2

�15 mm/hr�20 mm/hr�20 mm/hr�30 mm/hr

40%-54%38%-47%

13.5-18.0 g/dl12.0-16.0 g/dl4.0%-6.0%

10.2%-14.5%

150-400 � 103/�l

0.5%-1.5% of RBC

4.0-11.0 � 103/�l

50%-70%

0%-8%20%-40%

4%-8%

0%-4%

0%-2%

Negative



0.40-0.540.38-0.47

135-180 g/L120-160 g/LSame as conventional


therapy150-400 � 109/L

Same

4.0-11.0 � 109/L

0.50-0.70

0-0.080.20-0.40

0.04-0.08

0-0.04

0-0.02

Negative

Moderate increase: acute hep-atitis, myocardial infarction;rheumatoid arthritis

Marked increase: acute andsevere bacterial infections,malignancies, pelvic inflam-matory disease

Dehydration, high altitudes,polycythemia

COPD, high altitudes, polycythemia

Poorly controlled diabetesmellitus

Acute infections, chronic gran-ulocytic leukemia, chronicpancreatitis, cirrhosis, colla-gen disorders, polycythemia,postsplenectomy

Hemolytic anemia, poly-cythemia vera

Inflammatory and infectiousprocesses, leukemia

Bacterial infections, collagendiseases, Hodgkin’s disease

Acute infectionsChronic infections, lympho-

cytic leukemia, mononucleo-sis, viral infections

Chronic inflammatory disor-ders, malaria, monocyticleukemia, acute infections,Hodgkin’s disease

Allergic reactions, eosinophilicand chronic granulocyticleukemia, parasitic disorders,Hodgkin’s disease

Hypothyroidism, ulcerativecolitis, myeloproliferativediseases

Sickle cell anemia

Malaria, severe liver disease,sickle cell anemia

Anemia, hemorrhage, overhydration

Anemia, hemorrhage

Sickle cell anemia, chronicrenal failure, pregnancy

Anisocytosis, macrocyticanemia, microcytic anemia

Acute leukemia, DIC, thrombo-cytopenic purpura

Hypoproliferative anemia,macrocytic anemia, micro-cytic anemia

Aplastic anemia, side effects ofchemotherapy and irradiation

Aplastic anemia, viral infections

Corticosteroid therapy, wholebody irradiation

Corticosteroid therapy

Hyperthyroidism, stress

POSSIBLE ETIOLOGY


Serology-ImmunologyNORMAL VALUES POSSIBLE ETIOLOGY


Antinuclear antibody (ANA)

Anti-DNA antibody

Anti-RNP

Anti-Sm (Smith)Antistreptolysin-O

(ASO)

C-reactive protein (CRP)

Carcinoembryonic antigen (CEA)

Complement componentsC1qC3C4

Direct antihuman globulin test (DAT) or direct Coombs

Fluorescent trepone-mal antibody ab-sorption (FTAAbs)

Hepatitis A antibodyHepatitis B surface

antigen (HBsAg)Hepatitis C antibodyImmunoglobulins

IgA

IgD

IgE

IgG

IgM

Continued

TABLE B-3

Negative or titer�1:10

Negative or titer�1:10 or �20%binding

Negative

Negative166 Todd units

or 1:85

Negative or 1.2mg/dl

2.5 ng/ml

11-21 mg/dl80-180 mg/dl15-50 mg/dlNegative

Nonreactive

NegativeNegative

Negative

90-400 mg/dl

0.5-12.0 mg/dl

�1.0 mg/dl

650-1800 mg/dl

55-300 mg/dl



Negative

NegativeSame as conventional

units


2.5 �g/L

0.11-0.21 g/L0.8-1.8 g/L0.15-0.5 g/LNegative

Negative

NegativeNegative

Negative

0.9-4.0 g/L

5-120 mg/L

�10 mg/L

6.5-18.0 g/L

0.5-3.0 g/L

Chronic hepatitis, rheumatoidarthritis, scleroderma, sys-temic lupus erythematosus

Systemic lupus erythematosus

Mixed connective-tissue disease, rheumatoid arthritis, systemiclupus erythematosus, Sjögrensyndrome, scleroderma

Systemic lupus erythematosusAcute glomerulonephritis,

rheumatic fever, streptococ-cal infection

Acute infections, any inflam-matory condition, wide-spread malignancy

Carcinoma of colon, liver, pan-creas; chronic cigarettesmoking; inflammatorybowel disease; other cancers

Acquired hemolytic anemia,hemolytic disease of thenewborn, drug reactions,transfusion reactions

Syphilis

Hepatitis AHepatitis B

Hepatitis C

IgA myeloma, chronic liverdisease, chronic infection,rheumatoid arthritis, auto-immune disorders

Chronic infection, connectivetissue disease

Anaphylactic shock, atopicdisease (allergies), parasiteinfections

Infections—acute and chronic,hepatitis, IgG monoclonalgammopathy, systemiclupus erythematosus

Acute infections, rheumatoidarthritis, liver disease

Acute glomerulonephritis, sys-temic lupus erythematosus,rheumatoid arthritis, sub-acute bacterial endocarditis,serum sickness

Burns, hereditary telangiectasia,malabsorption syndromes

Congenital deficiencies, ac-quired deficiencies, nephro-tic syndromes, burns,immunosuppression

Congenital and acquired anti-body deficiencies, lympho-cytic leukemia, protein-losingenteropathies

POSSIBLE ETIOLOGY


Serology-Immunology—cont’dNORMAL VALUES POSSIBLE ETIOLOGY


Monospot or monotest

Rheumatoid factor (RA factor)

RPR

VDRL

Thyroid antibodies

CSF, Colony-stimulating factor; RNP, ribonuclear protein; RPR, rapid plasma reagin test; VDRL, Venereal Disease Research Laboratory test.

TABLE B-3

Negative

Negative or titer�1:20

Nonreactive

Nonreactive

1:10 titer

Negative





Infectious mononucleosis

Rheumatoid arthritis, Sjögrensyndrome, systemic lupuserythematosus

Syphilis, systemic lupus erythem-atosus, rheumatoid arthri-tis, leprosy, malaria, febrilediseases, IV drug abuse

Syphilis

Hashimoto’s thyroiditis, thyroidcarcinoma, early hypo-thyroidism, perniciousanemia, systemic lupus ery-thematosus, Graves’ disease

Urine ChemistryNORMAL VALUES POSSIBLE ETIOLOGY

CONVENTIONALTEST SPECIMEN UNITS SI UNITS HIGHER LOWER

Acetone

Aldosterone

Amylase

Bence Jones protein

BilirubinCalcium

CatecholaminesEpinephrineNorepinephrine

Chloride

Copper

TABLE B-4

Negative

1-80 �g/day (de-pends on urinarysodium)

1-17 U/hr

Negative

Negative100-250 mg/day

�20 �g/day�100 �g/day110-250 mEq/day

�30 �g/day

Random

24 hr

24 hr

Random

Random24 hr

24 hr

24 hr

24 hr

Negative

2.7-222 nmol/day


Negative

Negative2.5-6.3 mmol/day

�118 nmol/day�591 nmol/day110-250 mmol/day

�0.5 �mol/day

Diabetes mellitus, high-fat and low-carbohydrate diets,starvation states

Primary aldosteronism:adrenocortical tumors

Secondary aldosteronism:cardiac failure, cirrho-sis, large dose ofACTH, salt depletion

Acute pancreatitis

Multiple myeloma, biliaryduct obstruction

HepatitisBone tumor, hyperpara-

thyroidism, milk-alkalisyndrome

Pheochromocytoma,progressive musculardystrophy, heart failure

Addison’s disease

Cirrhosis, Wilson’sdisease

ACTH deficiency,Addison’s disease,corticosteroid therapy

Hypoparathyroidism,malabsorption ofcalcium and vitamin D

Burns, excess perspira-tion, vomiting, diar-rhea, menstruation

POSSIBLE ETIOLOGY

POSSIBLE ETIOLOGY


Urine Chemistry—cont’dNORMAL VALUES POSSIBLE ETIOLOGY


Coproporphyrin

Creatine

Creatinine

Creatinine clearance

EstrogensFemale

Ovulation peak

Luteal peakPregnancy

MenopauseMale

Glucose

Hemoglobin

5-Hydroxyindole-acetic acid (5-HIAA)

Ketone bodiesLeadMetanephrineMyoglobin

pH

Phenylpyruvic acid

Phosphorus, inorganic

Continued

TABLE B-4

50-200 �g/day

�100 mg/day

0.8-2.0 g/day

85-135 ml/min

28-100 �g/day

22-80 �g/dayUp to 45,000

�g/day1.4-19.6 �g/day5-18 �g/dayNegative

Negative

2-9 mg/day

20-50 mg/day�100 �g/day�1.3 mg/dayNegative

4.0-8.0

Negative

0.9-1.3 g/day

76-305 nmol/day

�763 �mol/day

7.1-17.7 mmol/day

1.42-2.25 ml/sec

104-370 nmol/day

81-296 nmol/dayUp to 166,455

nmol/day5.2-72.5 nmol/day18-67 nmol/dayNegative

Negative

10.5-47.1 �mol/day

0.34-0.86 mmol/day�0.48 �mol/day�7.1 �mol/dayNegative


Negative

29-42 mmol/day

Lead poisoning, oralcontraceptive use, poliomyelitis

Carcinoma of liver, hy-perthyroidism, dia-betes, Addison’sdisease, infections,burns, muscular dys-trophy, skeletalmuscle atrophy

Anemia, leukemia, muscular atrophy, salmonellae

Gonadal or adrenaltumor

Diabetes mellitus, lowrenal threshold forglucose resorption,physiologic stress, pi-tuitary disorders

Extensive burns, glomer-ulonephritis, hemolyticanemias, hemolytictransfusion reaction

Malignant carcinoidsyndrome

Marked ketonuriaLead poisoningPheochromocytomaCrushing injuries, electric

injuries, extreme phys-ical exertion

Chronic renal failure,compensatory phaseof alkalosis, salicylateintoxication, vege-tarian diet

Phenylketonuria

Fever, hypoparathy-roidism, nervous ex-haustion, rickets,tuberculosis

Hypothyroidism

Renal disease

Renal disease

Agenesis of ovaries, en-docrine disturbance,ovarian dysfunction,menopause

Compensatory phase ofacidosis, dehydration,emphysema

Acute infections, nephritis

24 hr

24 hr

24 hr

24 hr

24 hr

Random

Random

24 hr

24 hr24 hr24 hrRandom

Random

Random

24 hr

POSSIBLE ETIOLOGY


Urine Chemistry—cont’dNORMAL VALUES POSSIBLE ETIOLOGY


Porphobilinogen

Protein (dipstick)

Protein (quantitative)

SodiumSpecific gravity

Titratable acidity

Uric acidUrobilinogen

Uroporphyrins

Vanillylmandelic acid

ACTH, Adrenocorticotropic hormone; EU, Ehrlich unit.

TABLE B-4

Negative�2.0 mg/dayNegative

�150 mg/day

40-250 mEq/day1.003-1.030

20-50 mEq/day

250-750 mg/day0.5-4.0 EU/day

�1.0 Erhlich unit

Random

1-8 mg/day1.5-7.0 �g/mg

creatine

Negative�9 �mol/dayNegative

�0.15 g/day

40-250 mmol/daySame as conventional


units1.5-4.5 mmol/daySame as conventional



units5-40 �mol/day

Acute intermittent por-phyria, liver disorders

Congestive heart failure,nephritis, nephrosis,physiologic stress

Cardiac failure, inflam-matory processes ofurinary tract, nephritis,nephrosis, toxemia ofpregnancy

Acute tubular necrosisAlbuminuria, dehydra-

tion, glycosuriaMetabolic acidosis

Gout, leukemiaHemolytic disease, he-

patic parenchymal celldamage, liver disease

Porphyria

Pheochromocytoma

HyponatremiaDiabetes insipidus

Metabolic alkalosis

NephritisComplete obstruction of

bile duct

Random24 hrRandom

24 hr

24 hrRandom

24 hr

24 hr24 hr

Random

Random

24 hr

Gastric AnalysisNORMAL VALUES


BasalFree hydrochloric acidTotal acidity

PoststimulationFree hydrochloric acidTotal acidity

TABLE B-5

0.30 mEq/L15-45 mEq/L

10-130 mEq/L20-150 mEq/L

Same as conventional unitsSame as conventional units

Same as conventional unitsSame as conventional units

Hypermotility of stomachGastric and duodenal ulcers,

Zollinger-Ellison syndrome

Pernicious anemiaGastric carcinoma, severe

gastritis

POSSIBLE ETIOLOGY

POSSIBLE ETIOLOGY


Fecal AnalysisNORMAL VALUES POSSIBLE ETIOLOGY


Fecal fat

Urobilinogen

MucusPus

Blood*

ColorBrownClay

Tarry

RedBlack

*Ingestion of meat may produce false-positive results. Patient may be placed on a meat-free diet for 3 days before the test.

TABLE B-6

�6 g/24 hr

30-220 mg/100 gof stool

NegativeNegative

Negative


51-372 �mol/100 g ofstool

NegativeNegative

Negative

Chronic pancreatic disease, obstruction of common bile duct, malabsorptionsyndrome

Hemolytic anemias

Mucous colitis, spastic constipationChronic bacillary dysentery, chronic ulcer-

ative colitis, localized abscessesAnal fissures, hemorrhoids, malignant

tumor, peptic ulcer, inflammatory boweldisease

Various color depending on dietBiliary obstruction or presence of barium

sulfateMore than 100 ml of blood in gastrointes-

tinal tractBlood in large intestineBlood in upper gastrointestinal tract or

iron medication

Complete biliary obstruction

Cerebrospinal Fluid AnalysisNORMAL VALUES POSSIBLE ETIOLOGY


Pressure

BloodCell count (age

dependent)WBCRBC

Chloride

Glucose

ProteinLumbar

CisternalVentricular

CNS, Central nervous system.

TABLE B-7

60-150 mm H2O

Negative

0-5 cells/�l0100-130 mEq/L

40-75 mg/dl

15-45 mg/dl

15-25 mg/dl5-15 mg/dl


Negative

0.5 � 106/L0 � 106/L100-130 mmol/L

2.5-4.2 mmol/L

0.15-0.45 g/L

0.15-0.25 g/L0.05-0.15 g/L

Hemorrhage, intracranial tumor, meningitis

Intracranial hemorrhage

Inflammation or infections of CNS

Uremia

Diabetes mellitus, viral infections of CNS

Guillain-Barré syndrome, poliomyelitis,traumatic tap

Syphilis of CNSAcute meningitis, brain tumor, chronic

CNS infections, multiple sclerosis

Head injury, spinal tumor,subdural hematoma

Bacterial infections of CNS(meningitis, encephalitis)

Bacterial infections and tuber-culosis of CNS

POSSIBLE ETIOLOGY

POSSIBLE ETIOLOGY


Toxicology of Common DrugsTHERAPEUTIC LEVEL TOXIC LEVEL

DRUG CONVENTIONAL UNITS SI UNITS CONVENTIONAL UNITS SI UNITS

acetaminophen (Tylenol)

BarbituratesShort acting

Intermediate acting

Long actingCarbon monoxide

(carboxyhemo-globin)Normal values

Urban nonsmokers

Rural nonsmokersSmokersHeavy smokers

chlordiazepoxide (Librium)

chlorpromazine (Thorazine)

diazepam (Valium)

Digitalis preparationsdigoxindigitoxin

Dilantingentamicin

(Garamycin)PeakTrough

propranolol (Inderal)

SalicylatesAlcohol (ethanol)*

*See Table 10-10.

TABLE B-8

0.2-0.6 mg/dl

1-2 mg/dl

1-5 mg/dl

15-35 mg/dl

�5% saturation of hemoglobin

�5% saturation of hemoglobin

0.5%-2.0% saturation of hemoglobin5%-9% saturation of hemoglobin�9% saturation of hemoglobin0.05-5.0 mg/L

0.5 �g/ml

0.10-0.25 mg/L

0.8-2.4 ng/ml14-30 ng/ml10-20 mg/L

4-10 mg/L�2 mg/L50-100 ng/ml

10-20 mg/dl

13-40 �mol/L

Dependent on com-position of mixture

�0.05

�0.05

0.005-0.020.05-0.09�0.092-17 �mol/L

1.6 �mol/L

0.35-0.88 �mol/L

1.0-3.1 nmol/L18-39 nmol/L40-80 �mol/L

9-22 �mol/L�4 mmol/L192-386 nmol/L

0.724-1.45 mmol/L

�5 mg/dl

�5 mg/dl

�10 mg/dl

�40 mg/dl

Symptoms with �20% saturation

�10 mg/L

�2.0 �g/ml

�1.0 mg/L2.0 mg/L (lethal)

�2.5 ng/ml�30 ng/ml�30 mg/L

�10 mg/L�2 mg/L�200 ng/ml

�20 mg/dl�60 mg/dl (lethal)

�330 �mol/L

�0.20

�33 �mol/L

�6.3 �mol/L

�3.5 �mol/L

�2.6 nmol/L�39 nmol/L�120 �mol/L

�22 �mol/L�4 �mol/L�771 nmol/L

�1.45 mmol/L�4.34 mmol/L

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Lab Values