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Reference Guide

Lab Values - Reference Guides

by OneClass474155 , Fall 2015
2 Pages
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Department
Biology
Course Code
BI 361
Professor
All
Chapter
Permachart

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Lab Values
Trauma labs Type & cross • ABG • CBC • COAGS (PT/PTT) • BUN • CREAT • LYTES • ETOH • TOX SCREEN • UA • HCG Rainbow
Medication levels Acetaminophen 10–30 µg/mL • Digoxin 0.5–2.2 ng/mL • Gentamicin 5–10 µg/mL • Lithium 0.5-1.5 mEg/mL 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
pH7.35–7.45 AlkalosisAcidosis Use heparinized syringe
PaO275–100 mm Hg PolycythemiaAnemia (Note: 65–80 mm Hg over 60 yrs old > 60 mm Hg with COPDers) and put on ice;
PaCO235–45 mm Hg Respiratory acidosis = Hypoventilation/CO2retention by lungs; COPD, cardiac, CNS, pulmonary edema transport ASAP
Respiratory alkalosis = Hyperventilation; pain, anxiety, fever, pulmonary embolism
Bicarbonate (HCO3)22–26 mEq/L Metabolic alkalosis: emesis, NGT suction, diuretics; renal retention of too much bicarbonate
22–26 mmol/L Metabolic acidosis: DKA, ARF, burns, diarrhea, shock
02saturation 92–100% Arterial: 95–98 % • Venous: 60–85 % • Base exchange 0 +/- 2 mmol/L
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 hyperthermia, CK isoforms: lavender-top
Creatine phosphokinase CK–MB: 0–7% of total CPK myopathies, myocarditis, post exercise, IM injections, recent surgery, athletes with greater muscle mass CK 5 mL red, red-marbled or gold
Note: Isoenzymes normal levels: CK–MB: heart = 0–7 • CK–MM: skeletal muscle = 5–70 • CK–BB: brain = 0 QD ¥3 days, then 1 week
Erythrocyte sediment rate 0 – < 20 mm/hour Rheumatoid arthritis, infection, inflammation, all collagen connective tissue diseases (e.g., Lupus) 3 mL lavender-top
(earliest indicator of disease) M < 15, F < 20 mm/hr Congestive 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 (12–17,000) 3 mL lavender-top
Red blood cells F 3.0–5.0 million/µL Anemia, bone marrow suppression, hemorrhage, leukemias, multiple myeloma, renal failure, overhydration
WBC; Leukocytes WBC 4.500–11,000/µL Acute infection, trauma, leukemiasAIDS, bone marrow suppression, radiation 3 mL lavender-top
Neutrophils 50–75% Neutros 3000–7000/mm3Septicemia, appendicitis, bacterial infection, myelocytic leukemia, stress response, ischemic necrosis 3 mL lavender-top
(polys) Viral infection, acute lymphocytic leukemia
Lymphocytes 20–40% Lymphos 1000–4000/mm3Infections, mono, mumps, Rubella, TB, hepatitis, CMV, URI, lymphocytic leukemia 3 mL lavender-top
Renal failure, Hodgkins, HIV, AIDS (Note: >7000 or < 500, place patient in reverse isolation)
Monocytes 2–8% Monocytes 100–500/mm3TB, hepatitis, malaria, Rocky Mountain Fever, rheumatoid arthritis, Lupus, lymphomas, leukemia, multiple myeloma 3 mL lavender-top
Eosinophils 1–4% Eosinophils 50–400/mm3Asthma/drug reaction, hook & ringworms, Hodgkins, multiple myeloma, post-splenectomy 3 mL lavender-top
Stress response, shock, burns
Basophils 0.5–1% Basophils 25–100/mm3Leukemia, myelomas (Note: Contain large amounts of histamine used in hypersensitivity reactions) 3 mL lavender-top
(mast cells) ANC (Absolute Neutrophil Count): Granucyte # < 500–1000/mm3
• 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, shock 3 mL lavender-top
@ 8 or Blood transfusion F 12–16 g/dL Anemia, blood loss, immunocompromised, renal failure, acute sequestration syndrome in sickle cell anemia,
vegetarian diet, overhydration caused by excessive IV fluids
Hematocrit (Hct) M 40–50 % Polycythemia, dehydration, fever, COPD 3 mL lavender-top
@ 25 or Blood transfusion F 37–47% Anemia, 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/mm3Polycythemia, cancer, post-splenectomy, rheumatoid arthritis, infections, TB, hemorrhage, living at high altitude 3 mL lavender-top or
@ 20 or Platelet transfusion (Kids: 100,000–300,000) Aplastic anemia, pneumonia, HIV, thrombocytopenia, DIC, acute leukemias, bone marrow cancer, chemotherapy 2.7 mL light blue
Prothrombin (PT) 10–15 seconds Liver disease, Vitamin K deficiency, alcohol abuse, anabolic steroids, salicylates, DIC (Coumadin Tx. OK at 1.5–2¥norm) 2.7 mL light blue
(11–16 seconds) Clotting disorders, antihistamines, diuretics
Partial thromboplastin time 30–45 seconds Vitamin K deficiency, liver disease, DIC, hemophilia, leukemia (heparin Tx. OK at 1.5–2.5¥normal) 2.7 mL light blue
(PTT); activated PTT (25–35 seconds aPTT) Extensive cancer, hemorrhage, thrombocytopenia, multiple myeloma
International Normalized 2.0–3.0, 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
BLOOD CHEMISTRY “lytes 8.6–10.0 mg/dL Cancer, renal failure, oliguric phase, parathyroid gland tumor, Vitamin D toxicity (Note: 2.1–2.75 mmol/L) 4 mL + red-marble or gold
Calcium (Ca++)4.5–5.5 mEq/L Osteoporosis, 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
98–110 mEq/L Diarrhea, vomiting, fever, ulcerative colitis, pyelonephritis, Addison’s Disease, NGT, overhydration
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 Diarrhea, vomiting, malabsorption, starvation, prolonged diuretics or corticosteroid use
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 Renal failure: polyuric, diaphoresis, diarrhea, vomiting, Addison’s, SIADH, overhydration, NGT, CHF
Carbon dioxide (CO2)22–32 mEq/L Metabolic alkalosis (due to excessive vomiting or gastric suctioning), respiratory acidosis (due to hypoventilation) 4 mL + red-marble or gold or
23–29 mmol/L Metabolic acidosis (due to severe diarrhea), respiratory alkalosis (due to hyperventilation) Green 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 Alcohol abuse, DM, hyperaldosteronism (Note: 0.7–1.2 mmol/L)
Phosphorous (PO4
--)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) Malnutrition, malabsorption, hyperparathyroidism (Note: 0.87–1.45 mmol/L)
Iron (Fe) M 50–160 µg/L Polycythemia Vera, hemolytic anemias, hepatic necrosis, BCPs 4 mL + red-marble or gold
F 40–150 µg/L Pernicious anemia, neoplasia, chronic infections, hepatic disease, rheumatoid arthritis, vegetarian diet
Osmolality (a) 280–300 mOsmol/L Dehydration, excess ADH, DM, DI, hypercalcemia, cerebral lesions, head injury 4 mL + red-marble or gold
Calculated osmolality (b) 295–315 mOsmol/L Fluid overload, deficient ADH, 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, AMI, trauma 4 mL + red-marble, gold or grey
(8–14 hr fasting) (70–110/80–120) Too 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/dL can lead to permanent brain damage postprandial
Lactic acid & pyruvic acid Lactic: 0.5–2.2 mEq/L or Myocardial infarction, pulmonary embolism, congestive heart failure, shock, hemorrhage, septicemia, 4 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
WBC > Hgb
Hct Plt<
Memory tip: Notes: Lab values may vary • Refer to your institutions guidelines
Na | Cl | BUN
K|CO |Cr Glucose
2
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Memory tip:
Lab Values for a Non-Pregnant Adult
Lab Test Normal Values Applications Sample Collection
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Description
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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