common lab valuea

[code][b][color=darkred]Electrolyte Values:-




· SODIUM - Sodium is the most abundant cation in the blood and its chief base. It functions in the body to maintain osmotic pressure, acid-base balance and to transmit nerve impulses. Very Low value: seizure and Neurologic Sx.


Normal Adult Range: 135-146 mEq/L

Optimal Adult Reading: 140.5







· POTASSIUM - Potassium is the major intracellular cation. Very low value: Cardiac arythemia.


Normal Range: 3.5 - 5.5 mEq/L

Optimal Adult Reading: 4.5








CHLORIDE - Elevated levels are related to acidosis as wellas too much water crossing the cell membrane


Decreased levels with decreased serum albumin may indicate water deficiencycrossing thecell membrane (edema). - Diabetes


Normal Adult Range: 95-112 mEq/L

Optimal Adult Reading: 103 mEq/L




Discussion



Chloride contributes to the body’s acid/base balance. Along with Sodium, Potassium and Carbon Dioxide, it is important in evaluating acid/base relationships, state of hydration, adrenal and renal functions. Its level varies inversely with Carbon Dioxide. Chloride elevation indicates acidosis, decrease indicate alkalosis.





· CO2 (Carbon Dioxide) - The CO2 level is related tothe respiratory exchange of carbon dioxide in the lungs and is part of the bodies buffering system. Generally when used with the other electrolytes, it is a good indicator of acidosis and alkalinity.


Normal Adult Range: 22-32 mEq/L

Optimal Adult Reading: 27

Normal Children's Range - 20 - 28 mEq/L
Optimal Children's Reading: 24






· CALCIUM - involved in bone metabolism, protein absorption, fat transfer muscular contraction, transmission of nerve impulses, blood clotting and cardiac function. Regulated by parathyroid.


Normal Adult Range: 8.5-10.3 mEq/dl

Optimal Adult Reading: 9.4




Discussion


Serum calcium is not at all reflective of total body stores of calcium but rather reflects the metabolic and hormonal state of the individual. Ionic or free calcium is not only the biologically active form of calcium but reflects the amount of albumin and the blood pH.



Serum calcium can not be properly interpreted without serum albumin level. Use the formula Adjusted Calcium = Serum calcium - serum albumin + 4. By far the most common causes of hypocalcaemia are primary hyperparathyroidism, malignancy, and drug-induced. A PTH, calcium, albumin and phosphorus level drawn simultaneously helps classify the etiology into main groups. Watch for signs of calcium deposition and kidney stones




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MAGNESIUM


Optimal Range: 2-3 mg/DL


Discussion


The serum magnesium is not reflective of total magnesium stores. Unfortunately there is not a good test for magnesium, but a red cell Mg level is preferable to serum magnesium. Approximately 2/3 to ¾ of magnesium in blood is not attached to protein.




· PHOSPHORUS - Generally inverse with Calcium.


Normal Adult Range: 2.5 - 4.5 mEq/dl

Optimal Adult Reading: 3.5

Normal Children's Range: 3 - 6 mEq/dl
Optimal Children's Range: 4.5





· ANION GAP (Sodium + Potassium - CO2 + Chloride) - An increased measurement is associated with metabolic acidosis due to the overproduction of acids (a state of alkalinity is in effect). Decreased levels may indicate metabolic alkalosis due to the overproduction of alkaloids (a state of acidosis is in effect).


Normal Adult Range: 4 - 14 (calculated)

Optimal Adult Reading: 9







· CALCIUM / PHOSPHORUS Ratio


Normal Adult Range: 2.3 - 3.3 (calculated)

Optimal Adult Reading: 2.8

Normal Children’s range: 1.3 - 3.3 (calculated)
Optimal Children’s Reading: 2.3






· SODIUM / POTASSIUM


Normal Adult Range: 26 - 38 (calculated)

Optimal Adult Readi[/center]ng: 32[/code]
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Lipids:-




CHOLESTEROL - High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in arthrosclerosis, diabetes, hypothyroidism, pancreatic dysfunction and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia, Hyperthyroidism and infection.


Normal Adult Range: 120 - 240 mg/dl

Optimal Range: 185-200 mg/d




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Discussion



Cholesterol is an important part of our diet. It is essential to the proper function and structure of cell membranes. Bile acids are derived from cholesterol. The liver, adrenals, sex glands, intestines, and even the placenta, manufacture cholesterol. Cholesterol is best used as an indicator of other metabolic dysfunction. Should not be considered a disease by itself unless extreme, which indicates familial cause. Check triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypo function. Low levels are not necessarily desirable as it is associated with increased incidence of malignancy and mental illness
LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial arthrosclerosis
Normal Adult Range: 62 - 130 mg/dl

Optimal Adult Reading: 81 mg/dl


HDL (High Density Lipoprotein) - A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.
Normal Adult Range: 35 - 135 mg/dl

Optimal Adult Reading: +85 mg/dl




Discussion



HDL is comprised of phospholipids and one or two apolipoproteins. It plays a role in the metabolism of other lipoproteins and in the transport of cholesterol to the liver. The HDL is a class of lipoproteins produced by the liver and intestines.A combination of increased triglyceride, cholesterol, and LDL with reduced HDL is indicative of atherogenic tendencies. A diet high in sugar may decrease HDL while increasing total serum cholesterol.
TRIGLYCERIDES - Increased levels may be present in atherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl

Optimal Adult Reading: 100


CHOLESTEROL / LDL RATIO:-
Normal Adult Range: 1 - 6

Optimal Adult Reading: 3.5








Thyroid:-
THYROXINE (T4)- Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
Normal Adult Range: 4 - 12 ng/dl

Optimal Adult Reading: 8 ng/dl






Free THYROXINE (T4)- A low level may indicate a diseased thyroid gland or may indicate a non-functioning pituitary gland which is not stimulating the thyroid to produce T4 . If T4 is low and TSH is normal , that is more likely to indicate a problem with the pituitary .


Normal Adult Range: 8-2 ng/dl
Free Triiodothyronine (T3) - Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal level of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function.
Normal Adult Range1.4-4.4 pg/ml



THYROID-STIMULATING HORMONE (TSH) - produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSHsecretion increases. Mid–rangenormal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have an effect on fertility.
Normal Adult Range: .0.4-4.0 mlU/l





Cardiac:-
Creatine phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI, peaking at 16 to 30 hours and returning to baseline within 4 days
25-200 U/L
32-150 U/L
CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI, peaks in 24 hours, and remains elevated for up to 72 hours.
< 12 IU/L if total CK is <400 IU/L
<3.5% of total CK if total CK is >400 IU/L
(LDH) Lactate dehydrogenase - Total (LDH) will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.
140-280 U/L
SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours
10-42 U/L



GLUCOSE






Optimal Range: 85-100 mg/DL


Causes of Increased


· Diabetes mellitus and insulin resistance syndromes


· Thiamine (B<sub>1) insufficiency


· Stress


· Acute and chronic pancreatitis


· Drugs (anabolic and glucocorticoids, epinephrine, , diuretics,)


Causes of Decreased
Excess insulin (insulinoma, over dosage)
Impaired glucose tolerance (post-prandial)
Late/large malignancies
Endocrine hypo function (thyroid, adrenal cortex, anterior pituitary)
Protein malnutrition
Sometimes in pregnancy
Liver dysfunction
After gastric surgeries (altered gastric emptying)
IRON
Optimal Range: 75-150 mg/ml


Causes of Increased
Ineffective erythropoiesis (thalassemias, sideroblastic)
Intra-vascular hemolysis
Liver disease (alcohol, portocaval shunts)
Excessive iron intake
Causes of Decreased
Iron deficiency (low ferritin level; nutritional, blood loss, , small bowel disease, increased demand)
Chronic disease (liver dysfunction, renal dysfunction, etc.)
Discussion

Iron is known for its relationship to hemoglobin, which transports oxygen. Confirm true iron deficiency before supplementing iron. Never give Iron to someone who has an inflamed liver because this can be toxic. With B<sub>12 or Iron deficiencies, give special consideration to increased occurrence in the elderly. The most important test for iron is the serum ferritin.

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