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Reference Guide

Permachart - Marketing Reference Guide: Acute Lymphoblastic Leukemia, Tumor Lysis Syndrome, Acute Kidney Injury

2 pages92 viewsFall 2015

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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