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Reference Guide

Lab Values - Reference Guides

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Course Code
BI 361

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permacharts TM L a bV a lu e s Lab Values for a Non-Pregnant Adult Lab Test Normal Values Applications Sample Collection Trauma labs – •Type & cross •ABG • CBC • COAGS(PT/PTT) • BUN • CREAT • LYTES • ETOH •TOXSCREEN • UA• HCG Rainbow Medication levels – •Acetaminophen 10–30 µg/mL • Digoxin 0.5–2.2 ng/mL • Gentamicin 5–10 µg/mL • Lithium 0.5-1.7 mL red-top •Phenobarbital 10–40 µg/mL • Pheytoin 10–20 µg/mL •Tegretol 4–12 µg.mL •Theophylline 10–20 µg/mL ARTERIAL BLOOD GASES pH 7.35–7.45 ›Alkalosis • flAcidosis Use heparinized syringe PaO2 75–100 mm Hg ›Polycythemia • flAnemia (Note: 65–80 mm Hg over 60 yrs old > 60 mm Hg with COPDers) and put on ice; PaCO2 35–45 mm Hg ›Respiratory acidosis = Hypoventi2ation/CO retention by lungs; COPD,cardiac,CNS,pulmonary etransportASAP flRespiratory alkalosis = Hyperventilation; pain,anxiety,fever,pulmonary embolism Bicarbonate (H3O 22–26 mEq/L ›Metabolic alkalosis:emesis,NGT suction,diuretics; renal retention of too much bicarbonate 22–26 mmol/L flMetabolic acidosis:DKA,ARF,burns,diarrhea,shock 0 saturation 92–100% Arterial:95–98 % •Venous:60–85 % • Base exchange 0 +/- 2 mmol/L 2 CARDIAC ENZYMES (CPK) M 20-170,F 10-135 IU/L ›AMI (Initial Rise–3-4hrs,Peak–18-24hrs,Normal– 72hrs),unstable angina,shock,malignant hypeCK isoforms:lavender-top Creatine phosphokinase CK–MB:0–7% of total CPK myopathies,myocarditis,post exercise,IMinjections,recent surgery,athletes with greater musCK5 mL red,red-marbled or gold Note: Isoenzymes normal levels:CK–MB:heart = 0–7 • CK–MM:skeletal muscle = 5–70 • CK–BB:braQD ¥ 3 days,then 1 week Erythrocyte sediment rat0 – < 20 mm/hour ›Rheumatoid arthritis,infection,inflammation,all collagen connective tissue diseases (e.g.,3 mL lavender-top (arliest indicator of diM < 15,F < 20 mm/hr flCongestive heart failure,sickle cell anemia (Note: Rates increase with age) Lactate dehydrogenase 105–150 units/L ›Cardiac,renal,skeletal muscle,brain,liver,lung disorders 5 mL+ red, red-marbled or gold LDH 1 > LDH 2 = MI (45–100 units/L) Slight increase:hepatitis,cirrhosis,jaundice due to obstruction Record time on lab sheet Troponin I. 0–0.4 µg/L •A regulatory protein released when cardiac muscle cell necrosis occurs 5 mL+ red, red-marbled or gold Troponin T. 0.0-0.1 µg/L •Appears 1–3 hrs after an MI and remains elevated for 10–14 days Record time on lab sheet COMPLETE BLOOD COUNT M 4.0–6.0 million/µL ›Polycythemia,COPD,dehydration,hemoconcentration,high altitude,sickle cell anemia (12–17,003 mL lavender-top Red blood cells F 3.0–5.0 million/µL flAnemia,bone marrow suppression,hemorrhage,leukemias,multiple myeloma,renal failure,overhydration WBC; Leukocytes WBC 4.500–11,000/µL ›Acute infection,trauma,leukemias • flAIDS,bone marrow suppression,radiation 3 mL lavender-top 3 Neutrophils 50–75% Neutros 3000–7000/mm ›Septicemia,appendicitis,bacterial infection,myelocytic leukemia,stress response,ischemic n3 mLlavender-top (polys) flViral infection,acute lymphocytic leukemia Lymphocytes 20–40% Lymphos 1000–4000/mm3 ›Infections,mono,mumps,Rubella,TB,hepatitis,CMV,URI,lymphocytic leukemia 3 mLlavender-top flRenal failure,Hodgkin’s,HIV,AIDS (Note: >7000 or < 500,place patient in reverse isolation) Monocytes 2–8% Monocytes 100–500/mm3 ›TB,hepatitis,malaria,Rocky Mountain Fever,rheumatoid arthritis,Lupus,lymphomas,leukemia,mu3 mL lavender-top 3 Eosinophils 1–4% Eosinophils 50–400/mm ›Asthma/drug reaction,hook & ringworms,Hodgkin’s,multiple myeloma,post-splenectomy 3 mL lavender-top flStress response,shock,burns Basophils 0.5–1% Basophils 25–100/mm ›Leukemia,myelomas (Note: Contain large amounts of histamine used in hypersensitivity react3 mL lavender-top (mast cells) ANC (Absolute Neutrophil Count):Granucyte # < 500–1000/mm • Place patient in Neutropenic precautions (i.e.,no fresh fruits,flowers in room) Hemoglobin (Hgb) M 14–18 g/dL ›Polycythemia,chronic pulmonary disease,CHF,people living at high altitudes,dehydration,sho3 mL lavender-top @ 8 or flBlood transfusioF 12–16 g/dL flAnemia,blood loss,immunocompromised,renal failure,acute sequestration syndrome in sickle cell anemia, m vegetarian diet,overhydration caused by excessive IV fluids o Hematocrit (Hct) M 40–50 % ›Polycythemia,dehydration,fever,COPD 3 mL lavender-top c @ 25 or flBlood transfusiF 37–47% flAnemia,cirrhosis of the liver,immunocompromised,renal failure,overhydration,pregnancy,prolonged hemorrhage, vegetarian diet,IVFs of crystalloid or colloid solutions instead of blood . COAGULATION: platelets 100,000–450,000/mm3 ›Polycythemia,cancer,post-splenectomy,rheumatoid arthritis,infections,TB,hemorrhage,living 3 mL lavender-top or s @ 20 or flPlatelet transfusion (Kids:100,000–300flAplastic anemia,pneumonia,HIV,thrombocytopenia,DIC,acute leukemias,bone marrow cancer,chem2.7 mL light blue t Prothrombin (PT) 10–15 seconds ›Liver disease,Vitamin Kdeficiency,alcohol abuse,anabolic steroids,salicylates,DIC(CoumadinTx.OKat 1.5–2¥norm) 2.7 mL light blue r (11–16 seconds) flClotting disorders,antihistamines,diuretics Partial thromboplastin time 30–45 seconds ›Vitamin K deficiency,liver disease,DIC,hemophilia,leukemia (heparinTx.OK at 1.5–2.5¥ norma2.7 mL light blue a (PTT); activated PTT (25–35 seconds aPTT) flExtensive cancer,hemorrhage,thrombocytopenia,multiple myeloma h International Normalized2.0–3.0,2.5–3.5 •Anticoagulant therapy guidelines •Therapeutic @ 2.0–3.0 to prevent DVT,AMI,PAD,A Fib 2.7 mL light blue Ratio (INR) •Therapeutic @ 2.5–3.5 for mechanical valves c BLOOD CHEM++TRY“lytes” 8.6–10.0 mg/dL ›Cancer,renal failure,oliguric phase,parathyroid gland tumor,Vitamin D toxicity (Note: 2.1–4 mL + red-marble or gold a Calcium (Ca ) 4.5–5.5 mEq/L flOsteoporosis,acute pancreatitis,malabsorption,hypoparathyroidism,Vitamin D deficiency Chloride (Cl ) 98–108 mmol/L (96–112) ›Dehydration,anemia,congestive heart failure,IVF with chloride 4 mL + red-top,red-marble m 98–110 mEq/L flDiarrhea,vomiting,fever,ulcerative colitis,pyelonephritis,Addison’s Disease,NGT,overhydration r Potassium (K+) 3.5–5.0 mmol/L ›Acute renal failure,extensive tissue damage,Addison’s Disease,hemolysis,Diabetes Mellitus,tumor lysis syndrome 4 mL + red-marble or gold 3.5–5.0 mEq/L flDiarrhea,vomiting,malabsorption,starvation,prolonged diuretics or corticosteroid use e + p Sodium (Na ) 135–145 mmol/L ›Renal failure:oliguric,Cushing’s,prolonged corticosteroid therapy,dehydration,IVF with Na 4 mL + red-marble or gold 135–145 mEq/L flRenal failure:polyuric,diaphoresis,diarrhea,vomiting,Addison’s,SIADH,overhydration,NGT,CHF Carbon dioxide (2O ) 22–32 mEq/L ›Metabolic alkalosis (due to excessive vomiting or gastric suctioning),respiratory acidosis4 mL + red-marble or gold or 23–29 mmol/L flMetabolic acidosis (due to severe diarrhea),respiratory alkalosis (due to hyperventilationGreen heparinized Magnesium (Mg ) 1.5–3.0 mg/dL ›Renal failure (Note: High levels have neurological side effect of seizures; know Mg drugs (antacids),find alternates) 4 mL + red-marble or gold 1.5–2.5 mEq/L flAlcohol abuse,DM,hyperaldosteronism (Note: 0.7–1.2 mmol/L) -- Phosphorous (P4 ) 1.8–2.6 mEq/L ›Renal failure,hypoparathyroidism,healing fractures,diabetic acidosis,high intestinal obstruction,tumor lysis syndrome 4 mL + red-marble or gold (serum) 3.0–4.5 mg/dL (atomic) flMalnutrition,malabsorption,hyperparathyroidism (Note: 0.87–1.45 mmol/L) Iron (Fe) M 50–160 µg/L ›PolycythemiaVera,hemolytic anemias,hepatic necrosis,BCPs 4 mL + red-marble or gold F 40–150 µg/L flPernicious anemia,neoplasia,chronic infections,hepatic disease,rheumatoid arthritis,vegetarian diet Osmolality (a) 280–300 mOsmol/L ›Dehydration,excessADH,DM,DI,hypercalcemia,cerebral lesions,head injury 4 mL + red-marble or gold Calculated osmolality (b295–315 mOsmol/L flFluid overload,deficientADH,hypermagnesmia,hyponatremia,SIADH Osmolal gap if b-a>10 Best indicator of cellular hydration:2(Na) + BUN/5 + Glucose/20 = 275–295 or 2¥ sodium level (or 2¥ Na level) CARBO.TESTS: Glucose 70–120 mg/dL ›Diabetes,hyperglycemia,pancreatitis,Cushing’s,prolonged corticosteroid use,stress,burns,AM4 mL + red-marble,gold or grey (8–14 hr fasting) (70–110/80–120) flToo much insulin/oral antihyperglycemics,too little food,alcoholics,hepatic disease 5 mL gray-top tested with 3.9–6.5 mmol/L Note: < 30 mg/dLcan lead to permanent brain damage postprandial Lactic acid & pyruvic acLactic:0.5–2.2 mEq/L or›Myocardial infarction,pulmonary embolism,congestive heart failure,shock,hemorrhage,septice4 mL + gray on ice Venous (fast usually required) 4.5–19.8 mg/dL 4 mL + gray,lavender or green (fast usually required) Pyruvic:0.5–1.5 mg/dL post-strenuous exercise (Collection: PT should rest 1 hr before test; to prevent higher levels,tell PT not to clench fist) heparinized on ice Memory tip: WBC > Hgb 100 mg/dL = serious flLiver disease/damage/failure (hepatitis,drugs,poisoning),SIADH,malnutrition/impaired absorption (celiac disease), impairment of renal function) overhydration,anabolic steroid use,pregnancy (physiologic hydremia) C reati
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