Acid phosphatase

• Normal: 0-1 IU/l
• Increased: Ca of prostate, Prostate surgery, bone disease, myeloid leukemia.

ACTH Adrenocorticotropic H.

• Normal: 20-140 pg/mL @8 AM
• Increased: Addison's Disease, Oat Cell Carcinoma, Pancreatic islet cell tumors,thymic tumors,renal cell carcinoma.
• Decreased: Adrenal adenoma or carcinoma, nodular adrenal hyperplasia, pituitary insufficiency.

Alanine aminotransferase

• Normal: 5-35 IU/l
• Increase: liver disease, liver metastasis, biliary obstruction, pancreatitis, liver congestion.

  (AST > ALT in alchoholic hepatitis)
  (ALT > AST in viral hepatitis)

Albumin

• Normal Adult: 3.5-5.5 g/dL Child:>3.8
• Decreased: Malnutrition,Nephrotic Syndrome,Cystic Fibrosis, Multiple Myeloma, Hodgkin's Disease, Leukemia, Protein-losing enteropathies, chronic glomerulonephritis, alcoholic cirrhosis hyperthyroidism, Collagen-Vascular disease, Inflammatory Bowel disease.

Aldosterone

• Normal: 5-30 ng/dL early AM
• Increased: Hyperaldosteronism (primary or secondary)
• Decreased: Adrenal Insufficiency, panhypopituitarism

Alkaline phosphatase

• Normal: 20-70 U/L, Child: 20-150 U/L
• Increased: hyperparathyroidism, Paget's disease, osteoblastic bone tumors, osteomalacia, rickets, pregnancy, childhood, biliary obstruction, hyperthyroidism.
• Decreased: Malnutrition, excessive vitamin D ingestion.

  (heat-stable=Liver,heat-labile=bone)

Alpha-amylase

• Normal: 25-125 Units/L
• Increased: acute pancreatitis, pancreatic duct obstruction, EtOH ingestion, mumps, parotiditis, renaldisease, macroamylasemia, cholecystitis,peptic ulcers, intestinal obstruction,mesenteric thrombosis, post surgery.
• Decreased: pancreatitis, cystic fibrosis, hepatitis, cirrhosis

Alpha-Fetoprotein

• Normal: <25 ng/mL
• Increased: hepatoma, testicular tumor(embryonal Ca, Malignant teratoma) spina bifida(in mother's serum)
• Decreased: Down's Syndrome (in mother's serum)

ALT

• Normal: 8-20 IU/l
• Increase: liver disease, liver metastasis, biliary obstruction,pancreatitis, liver congestion.

  (AST > ALT in alchoholic hepatitis)
  (ALT > AST in viral hepatitis)

Amikacin

• Therapeutic Range: Peak 25-30; trough <10 mcg/mL

Amitriptyline

• Therapeutic Range: 100-250 ng/mL

Ammonia, serum

• Normal Adult: 11-35 uMol/L,Child:40-80
• Increased: Liver failure, Reye's syndrome.

Anion Gap

• Normal: 12-17 mmol/l (for evaluation of metabolic acidosis)
• Increased: Endogenous causes: lactic acidosis, ketoacidosis (due to diabetes, EtOH or starvation), uremia. Exogenous Causes: salicylates, methanol,paraldehyde, ethylene glycol, hyperalimentation.
• Normal: From renal causes; renal tubular acidosis, carbonic anhydrase inhibitors, post hypercapnic From gut problems; diarrhea, fistula, ileal loop.
• Calculations:
  • Anion Gap = [Na]-([Cl]+[HCO3])
  • HCO3 needed = Base Deficit x weight (Kg) / 4

  Note: give HCO3 over 8-12 hours

Antinuclear antibodies

• Normal: (negative)
• Positive: SLE, Procainamide side-effect, scleroderma, rheumatoid arthritis.

ASO Titer(antistreptolysin O)

• Normal: ≶166 Todd Units
• Increased: Streptococcal Infections (Pharyngitis, Scarlet Fever, Rheumatic Fever, Poststreptococcal Glomerulonephritis) Rheumatoid Arthritis, and other Collagen Diseases.

Aspartate aminotransferase

• Normal: 8-20 U/L
• Increased: acute MI,liver disease,Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct.
• Decreased: beriberi, diabetes w/ ketoacidosis, liver disease.

AST

• Normal: 8-20 Units/L
• Increase: acute MI,liver disease,Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct.
• Decreased: beriberi, diabetes w/ ketoacidosis, liver disease.

Barbiturate, Long acting

• Normal: >215=fatal micromol/l

Barbiturate, Medium acting

• Normal: >105=fatal micromol/l

Barbiturate, Short acting

• Normal: >35=fatal micromol/l

Base Excess

• Normal: -2 to +2 mmol/Litre
  BE = [BB measured] - [BB normal]

• [BB normal] = 48 mEq/L
  
• BB is total buffer base including bicarb, protein, and hemoglobin
  
• BE increased: metabolic alkalosis
  
• BE decreased: metabolic acidosis

Basophiles

• Normal: 0-1 % ( <110 cells/ul)
• Increased: chronic myeloid leukemia, Polycythemia rubra vera.
• Decreased: acute rheumatic fever, lobar pneumonia, post steroid therapy, thyrotoxicosis, stress.

Bicarbonate

• Normal: 22-28 mEq/L (23-26 mmol/l)
• Increased: respiratory acidosis,compensation for metabolic acidosis,emphysema, severe vomiting, primary aldosteronism, volume contraction, Bartler's syndrome.
• Decreased: respiratory alkalosis, compensation for metabolic acidosis,starvation, diabetic ketoacidosis, toxins (methanol, ethylene glycol, paraldehyde), severe diarrhea, renal failure, drugs (salicylates, acetazolamide), dehydration, adrenal insufficiency.

• Important tips:
  Respiratory Acidosis PCO2- >45
  Respiratory Alkalosis PCO2- <35
  Metabolic Acidosis HCO3- <22 mmol/l
  Metabolic Alkalosis HCO3- >26 mmol/l
  

  Use pH to differentiate Primary from compensatory disorder. If Mixed Disorder, pH will never correct to normal

• Calculations:
  • [HCO3]needed (MEq)=(Base deficit(MEq/L) x Pt.Wt.(Kg))/4

  • Anion Gap=[Na+]-([Cl-]+[HCO3-])

Bilirubin

• Normal: 0.1-1.0 mg/dL(T):0-0.3 (D)
• Increased Total: Hepatic damage, biliary obstruction (stone or tumor), hemolysis, fasting.
• Increased Direct (conjugated): biliary obstruction/cholestasis (gallstone, tumor, stricture, drugs), Dubin-Johnson or Rotor's syndrome
• Increased Indirect (unconjugated): hemolytic jaundice (hemolytic anemia), transfusion reaction, sickle cell, Gilbert's disease, Crigler-Najjar syndrome, physiological jaundice of newborn.

Bleeding time

• Normal: < 6 min. (Duke,Ivy)
• Increased: thrombocytopenia, DIC, Von Willibrand's disease, defective platelet function (aspirin)

Blood Presure, classification

• Normal: <120/<80 mm Hg; Recheck in 2 years.
• High normal: 130-139/85-89 mm Hg; Recheck in 1 year.
• Stage I hypertension (mild): 140-159/90-99 mm Hg; Reevaluate within 2 months.
• Stage II hypertension (moderate): 160-179/100-109 mm Hg; Evaluate and treat within 1 month.
• Stage III hypertension (severe): >180/>110 mm Hg; Evaluate and treat immediately.

BUN

• Normal: 7-18 mg/dL
• Increased: renal failure, prerenal azotemia, postrenal obstruction, GI bleed, stress, aminoglycoside side-effect, CHF,Volume Depletion, shock.
• Decreased: Starvation, liver failure, pregnancy, infancy, nephrotic syndrome,overhydration.

B-12 vitamin

• Normal: 140-970 micrograms/Litre
• Increased: leukemia, polycythemia vera.
• Decreased: pernicious anemia, pregnency, malabsorption

Calcitonin

• Normal: Male: <155ng/L, Female: <105ng/L
• Increased: Medullary Carcinoma of Thyroid, Newborns, Pregnancy, Chronic renal insufficiency, Zollinger-Ellison Syndrome, Pernicious anemia

Calcium (ionized)

• Normal: 2.24-2.46 mEq/L 4.48-4.92mg/dL
• Corrected Total= 0.8(Norm.Albumin - measured albumin) + Ionized Ca.
• Increased: Primary hyperthyroidism, Vita D excess, PTH-secreting tumors, metastatic bone tumors, osteoporesis, Milk-Alkali syndrome, Paget's disease, chronic renal failure, infantile hypophosphatasia, multiple myeloma, sarcoidosis, thiazide drugs,
• Decreased: hypoparathyroidism, Vitamin D insufficient, Ca & P ingestion (in pregnancy, osteomalacia and rickets)hypomagnesemia, renal tubular acidosis,hypoalbuminemia (due to cachexia, nephrotic syndrome & cystic fibrosis), chronic renal failure (phosphate retention) Acute pancreatitis.

Calcium (total)

• Normal: 4.2-5.3.mEq/L 8.5-10.5 mg/dL
• Corrected Ca= 0.8*(normal albumin - measured albumin) + reported Ca. (norm.range 2.20-2.60)
• Increased: primary hyperparathyroidism, Parathyroid-secreting tumors, VitD excess, Metastatic bone tumors, osteoporosis, immobilization, milk-alkali syndrome, Paget's disease, infantile hypophosphatasia, thiazide drugs, chronic renal failure, sarcoidosis, multiple myeloma.
• Decreased: hypoparathyroidism, pseudo-H., no vita.D, calcium and phosphorus ingestion, hypomagnesemia, renal tubular acidosis, hypoalbuminemia, (cachexia,nephrotic S.,cystic fibrosis),chronic renal failure, acute pancreatitis, factitious 2nd to low protein and albumin.

Carbamazepine

• Therapeutic Range: 4-10 mcg/mL

Cardiac Injury, serum markers

• Creatine kinase:
  
  Normal Value: <130 IU per L
  Raise after AMI: 4 to 8 hours
  Peak Values: 12 to 24 hours
  Return to Normal: 4 to 5 days

• CK-MB fraction:
  Normal Value: <13 IU per L
  Raise after AMI: 3 to 12 hours
  Peak Values: 10 to 18 hours
  Return to Normal: 2 to 3 days

• Lactic dehydrogenase:
  Normal Value: >250 IU per L
  Raise after AMI: 24 to 48 hours
  Peak Values: 3 to 6 days
  Return to Normal: 7 to 14 days

• Myoglobin:
  Normal Value: <55 ng per mL
  Raise after AMI: 1 to 4 hours
  Peak Values: 6 to 9 hours
  Return to Normal: 18 to 24 hours

• C-Tnl:
  Normal Value: Undetectable
  Raise after AMI: 3 to 12 hours
  Peak Values: 24 hours
  Return to Normal: 5 to 10 days

• C-TnT:
  Normal: Undetectable
  Raise after AMI: 3 to 12 hours
  Peak Values: 12 to 24 hours and 2 to 3 days
  Retur to Normal: 5 to 14 days

Cardiac Index

• Normal: >2.5 L/Min/Sq.Metre
• Decreased: Cardiac failure. Consider Inotrope like dobutamine. if less than 2.5

CEA Carcinoembryonic Antigen

• Normal Nonsmoke: <3.0mg/mL, Smoker:<5.0
• Increased:carcinoma (colon, pancreas, lung, stomach), smokers, liver disease, Crohn's disease, and ulcerative colitis.

Chloramphenicol

• Therapeutic Range: Peak 10-15; trough <5 mcg/mL

Chloride

• Normal: 95-105 mEq/L
• Increased: diarrhea, renal tubular acidosis, mineralocorticoid deficiency, hyperalimentation, acetazolamide, ammonium chloride.
• Decreased: vomiting, diabetes w/ ketoacidosis, mineralocorticoid excess, renal disease w/ sodium loss.

Cholesterol

• Normal: 140-250 mg/dL
• Increased: idiopathic, biliary obstruction, nephrosis, hypothyroidism, pancreatic disease (diabetes), pregnancy, hyperlipoproteinemia (types IIb,III,V)
• Decreased: liver disease (hepatitis), hyperthyroidism, malnutrition (cancer,starvation), chronic anemias, steroid therapy, lipoproteinemias.

CO2

• Normal: 22-28 mEq/L (See bicarbonate, also called: Total CO2 )
• Increased: respiratory acidosis, compensation for metabolic acidosis, emphysema, severe vomiting, primary aldosteronism, volume contraction, Bartler's syndrome.

Cold Agglutinins

• Normal: <1:32
• Increased: Atypical pneumonia (mycoplasma), viral infections (mononucleosis, measles, mumps) cirrhosis, some parasites.

Complement C3

• Normal: 80-160 mg/dL
• Increased: Rheumatoid arthritis, rheumatic fever, neoplasms (GI, Prostate, others)
• Decreased: Systemic Lupus, glomerulonephritis (Poststreptococcal and membranoproliferative) sepsis, subacute bacterial endocarditis, chronic active hepatitis.

Complement C4

• Normal: 20-50 mg/dL
• Increased: Rheumatoid arthritis (juvenile), neoplasms (gastrointestinal, lung, others)
• Decreased: Systemic Lupus, Chronic active hepatitis, cirrhosis, glomerulonephritis, hereditary angioedema.

Complement CH50 (total)

• Normal: 33-61 mg/mL
• Test for complement deficiency in classical pathway.
• Increased: Acute phase reactants (tissue injury, infections, etc.)
• Decreased: hereditary complement deficiencies.

Coomb's Test, direct

• Normal: Negative (no antibody on Pt's RBC).
• Positive: Autoimmune hemolytic anemia (leukemia, lymphoma, collagen vascular Diseases), hemolytic transfusion reaction, drug sensitizations (methyldopa, levodopa, cephalothin), Erythroblastosis fetalis (hemolytic disease of the newborn)

Coomb's Test, indirect

• Normal: Negative (no antibody in Pts serum).
• Positive: Isoimmunization from previous trasfusion, incompatible blood due to improper cross-matching.

Copper

• Normal: 12-26 micromol/l
• Increased: Wilson's disease, oral contraceptives.

Cortisol

• Normal: 8AM:5.0-23.0 ug/dL 4PM:3.0-15.
• Increased: Adrenal adenoma, adrenal Carcinoma, Cushing's disease, ACTH-producing tumor, steroid therapy, oral contraceptives.
• Decreased: Addison's disease, Congenital adrenal hyperplasia, Waterhouse-Friderichsen syndrome, pituitary insufficiency.

Creatine phosphokinase 1

• Normal: M:25-90 F:10-70 Units/L
• Increased: any muscle damage, acute MI, myocarditis, muscular dystrophy, post-surgical, brain infartion, defibrillation, cardiac catheterization,rhabdomyolysis, polymyositis, hypothyroidism.
• Isoenzymes:
  
  -MB;heart muscle <6%
  -MM;skeletal muscle 94-100%
  -BB:brain & CNS %lt;1%
  

Creatinine

• Normal: 0.6-1.3 mg/dL
• Increased: renal failure( pre-renal, renal, or postrenal obstruction), gigantism, acromegaly, ingestion of roasted meat, aminoglycosides or other drugs, false positives with ketones (DKA)
• Decreased: pregnancy, loss of muscle mass.

Creatine kinase:

• Normal Value: <130 IU per L

CK-MB fraction:

• Normal Value: <13 IU per L

C-Peptide

• Fasting <4.0ng/ml ,>60y/o:<5.5
• Decreased: Diabetes (decreased endogenous insulin), factitious insulin administration.

Desipramine

• Therapeutic Range: 150-300 ng/mL

Dexamethasone Suppression Test

• Normal: <5 ug/dL Cortisol at 8AM
• Overnight Test: (for Cushing's Disease).Give 1mg PO Dexamethasone at 11PM; measure fasting serum cortisol at 8AM

  <5 ug/dL = Normal
  >5 ug/dL = Cushing's syndrome
  (false positives with obesity, alcoholism, depression)

Dexamethasone Suppression Test - High dose

• Normal: 17-OH Cort.Steroids drop 50%
• High Dose Test: Adrenal Hyperplasia vs. Tumor

  Dexamethasone,2mg PO q6h X 8 doses. Measure urinary 17-OH Corticsteroid before and after drug

• Bilteral Adrenal Hyperplasia: drop in urinary 17-OH corticosteroids to 50% of baseline.
• Adrenal Tumors or Ectopic ACTH Production: No drop in levels.

Digitoxin

• Therapeutic Range: 10-30 ng/mL

Digoxin

• Therapeutic Range: 0.8-2.0 ng/mL

Disopyramide

• Therapeutic Range: 2-5 mcg/mL

Doxepin

• Therapeutic Range: 75-200 ng/mL

Eosinophiles

• Normal: 1-6 % ( <400 cells/ul)
• Increased: allergy, parasites, skin diseases, collagen-vascular diseases (NAACP= neoplasm,allergy,addison's, collagen-vascular, parasites), pulmonary diseases(loffler's syndrome & PIE)
• Decreased: after steroids, ACTH, after stress, Cushing's syndrome.

Estrogen Receptors

• see Note
• Fresh Surgical Specimens, if Positive then better survivability and cure rate for Breast Carcinoma with better response to endocrine therapy.

Ethosuximide

• Therapeutic Range: 40-100 mcg/mL

Ferritin

• Normal: 15-200(M),12-150(F) ng/mL
• Decreased: iron deficiency anemia (even before RBC morphology changes) a measure of bone marrow Iron stores

Fibrin Degradation(Split)Products

• Normal: <10 micrograms/mL
• Increased: any thromboembolic condition(deep vein thrombosis, MI, pulmonary embolus), DIC (disseminated intravascular coagulation).

Fibrinogen

• Normal: 150-450 mg/dL
• Decreased: Congenital, disseminated intravascular coagulation (sepsis, amnionic fluid embolism, abruptio placentae), surgery (prostate, open heart) neoplastic and haematological conditions, acute severe bleeding, burns, snake bite.

Flecainide

• Therapeutic Range: 0.2-1.0 mcg/mL

Folate (Folic Acid)

• Normal: 2.0-21 ng/mL
• Increased: folic acid administration.
• Decreased: malnutrition, carcinoma, hemolytic anemia, megaloblastic anemia, malabsorption.

FTA-ABS (Flourescent Treponemal Antibody- Absorbed)

• Normal: nonreactive
• Positive: Syphilis (test of choice to confirm diagnosis),other treponemal infections.

Fungal Serologies

• Normal: Negative <1:8
• A Complement-fixation fungal antibody screen usually detects antibodies to Histoplasma, Blastomyces, Aspergillus, and Coccidioides.

Gastrin

• Normal: Male:<100 pg/mL Female:<75
• Increased: Zollinger-Ellison Syndrome, pyloric stenosis, pernicious anemia, atrophic gastritis, ulcerative colitis, renal insufficiency, steroid and calcium administration.

Gentamicin

• Therapeutic Range: Peak 6.0-8.0; trough <2.0 mcg/mL

GGT (Gamma Glutamyl Transpeptidase)

• Normal: Male:9-50 IU/L,Female:8-40 IU/L
  Note: parallels changes in serum alkaline phosphatase and 5'nucleotidase in liver disease.
• Increased: liver disease (hepatitis, cirrhosis, obstructive jaundice), pancreatitis.

Glucose (fasting)

• Normal: 70-110 mg/dL
• Increased: diabetes mellitus, Cushing's syndrome, acromegaly, epinephrine (inj., pheochromocytoma, stress, burns), acute pancreatitis, ACTH administration, elderly patients, pancreatic gluagonoma.
• Decreased: pancreatic disorders (pancreatitis, islet-cell tumors), extrapancreatic tumors (carcinoma of the adrenals, stomach), hepatic disease (hepatitis, cirrhosis, tumors), endocrine disorders (early diabetes, hypothyroidism, hypopituitarism), post-gastrectomy, prematurity, infant of a diabetic mother, ketotic hypoglycemia, exogenous insulin, oral hypoglycemics, malnutrition, sepsis.

GlycoHemoglobin

• Normal: 4.6-7.1%
• also called Hemoglobin A-1c
• Increased: Diabetes mellitus (uncontrolled; reflects levels over preceding 3-4 months)
• Decreased: Chronic renal failure
• Mean Glucose=10x(HgbA1C + 4)

Haptoglobin

• Normal: 26-185 mg/mL
• Increased: Obstructive liver disease, any cause if combined with increased ESR (erythrocyte sedimentation rate).
• Decreased: Any type of hemolysis (transfusion reaction, etc.), liver disease.

Hb (blood)

• Normal: M:13.5-17.5 F:12.0-16.

Hb (plasma)

• Normal: 1-4 mg/dL

HbA1c

• Normal: 4.6-7.1 %
• Also called glycohemoglobin
• Increased: Diabetes Mellitus (uncontrolled; reflects levels over preceding 3-4 months)
• Decreased: Chronic renal failure.
• Mean Glucose=10x(HgbA1C + 4)

HDL

• Fasting 45 (+/-12) mg/dL
• HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk
• Increased: estrogen (females)
• Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease.
• HDL-C = High Density Lipoprotein Cholesterol

HDL-C

• Fasting 45 (+/-12) mg/dL
• HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females).
• Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease.
• HDL-C = High Density Lipoprotein Cholesterol

Hematocrit

• Normal: male:40-54% female:37-47%
• Increased: Primary polycythemia, polycythemia vera, secondary polycythemia (decr.fluid intake, incr. fluid loss), heart disease, high altitude, heavy smokers, renal cell carcinoma, hepatoma, renal cysts.
• Decreased: megaloblastic anemia (due to folate or B-12 deficiency), Iron deficiency anemia, sickle cell anemia, acute or chronic blood loss, hemolysis, alcohol, drugs.

Hemoglobin A-1c

• Normal: 4.6-7.1 %
• AKA: glycohemoglobin
• Increased: Diabetes Mellitus (uncontrolled; reflects mean glucose levels over preceding 4-6 weeks)
• Decreased: Chronic renal failure.
• Mean Glucose=10x(HgbA1C + 4)

High Density Lipoprotein

• Fasting 45 (+/-12) mg/dL
• HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females)
• Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease.
• HDL-C = High Density Lipoprotein Cholesterol

Imipramine

• Therapeutic Range: 150-300 ng/mL

Iron

• Normal: 50-170 micrograms/dL
• Increased: hemochromatosis, hemosiderosis (caused by excessive iron intake), excess destruction of RBC's, decreased production of RBC's, liver necrosis, oral contraceptives.
• Decreased: Iron deficiency anemia, hepatitis, nephrosis (loss of iron binding proteins), normochromic anemia of chronic disease and infections.

Iron Binding Capacity

• Normal: 250-450 ug/dL
• The normal iron/TIBC ratio is 20-50%, <15% is diagnostic of Iron Deficiency Anemia.
• Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives.
• Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis.

Lactate

• Normal: 0.5-2.2 mMol/L
• Increased: Lactic Acidosis due to Hypoxia, hemmorhage, Shock, sepsis, cirrhosis, exercise.

Lactic Acid

• Normal: 0.5-2.2 mMol/L
• Increased: Lactic Acidosis due to Hypoxia, hemmorhage, Shock, sepsis, cirrhosis, exercise.

LDH (lactate dehydrogenase)

• Normal: 45-90 U/L
• Increased:acute MI, cardic surgery, prosthetic valves, hepatitis, pernicious anemia, malignant tumors, pulmonary embolus, hemolysis (anemiasor factitious, renal infarction, muscle injury.

LDH Isoenzymes

• Normal LDH1/LDH2 Ratio: <0.6 - 0.7
• If LDH1/LDH2 > 1.0 : Then Poss. Acute MI
  If LDH5 > LDH4 : Suspect liver Disease
  With Acute MI: Levels start to rise 12-24 Hrs post MI and Peak 3-6 Days then return to normal in 8-14 Days.

Lead

• Normal: 0.3-1.8 micromol/l

Lidocaine

• Therapeutic Range: 2-5 mcg/mL

Lithium

• Normal: theraputic 0.5-1.5 (toxic >2.0) mmol/l
• Increased: treatment for manic phase of manic-depressive disorder.

Lymphocytes

• Normal: 20-45 %
• Increased: measles, German measles, mumps, whooping cough, smallpox, influenza, hepatitis, infectious monucleosis, acute infectious lymphocytosis, any viral infection, and chronic lymphocytic leukemias.
• Decreased: post-stress, uremia, some viral infections, normal in 22% of Pop.

Magnesium

• Normal: 1.6-2.6 mg/dL
• Increased: renal failure, hypothyroidism, Mg-containing antacids, Addison's disease, diabetic coma, severe dehydration, lithium intoxication.
• Decreased: malabsorption, steatorrhea, alcoholism, cirrhosis, hyperthyroidism, aldosteronism, diuretics, acute pancreatitis, hyperPTHism, hyperalimentation, nasogastric suctioning, chronic dialysis, renal tubular acidosis, drugs(cis-platinum, amphotericin B, aminoglycosides), hungry bone syndrome, hypophospatemia, intracellular shifts with respiratory or metabolic acidosis.

MCH (mean cellular hemoglobin)

• Normal: 27-32 pg
• = hemoglobin(g/l) / RBC (million/microlitre)
• Increased: macrocytosis (megaloblastic anemias, high reticulocyte count)
• Decreased: microcytosis (Fe-deficiency, sideroblastic anemias, thalassemia)

MCHC (mean cellular hemoglobin concentration)

• Normal: 30-36 g/dl
• =hemoglobin (gm/dL) / hematocrit
• Increased: severe & prolonged dehydration, spherocytosis.
• Decreased: iron-deficiency anemia, overhydration, thalassemia, sideroblastianemia.

MCV (mean cell volume)

• Normal: 76-96 fl
• MCV=HCT x 1000/ RBC (millions/microlitre)
• Increased: megaloblastic anemia(B-12 or folate deficiency), macrocytic (normoblastic) anemia, reticulocytosis, Down's syndrome, chronic liverdisease.
• Decreased: Iron deficiency, thalassemia, lead poisoning.

Myoglobin

• Normal Value: <55 ng per mL

Monocytes

• Normal: 2-10 % ( <800 cells/ul)
• Increased: bacterial infections(TB, subacute bacterial endocarditis, brucellosis, typhoid fever, recovery from acute infection), protozoal infections, infectious mononucleosis, leukemia, Hodgkin's disease, ulcerative colitis, regional enteritis.

Neutrophiles

• Normal: 40-75 % (2K-9K cells/ul)
• (Polymorphonuclear Neutrophils)
• Increased:
  -Normal: severe exercise, last months of pregnancy, labor, surgery, newborns.
  -Pathological Increase: bacterial infections, tissue damage( MI, pulmonary infarction, crush injury, burn injury), metabolic disorders (eclampsia, diabetic ketoacidosis, uremia, acute gout), leukemias.
  
• Decreased: pancytopenia, aplastic anemia, PMN depression (mild = neutopenia, severe = agranulocytosis), marrow damage( due to x-rays, benzene poisoning or antitumor drugs), disseminated TB, septicemia, acute malaria, severe osteomyelitis, infectious mononucleosis, atypical pneumonias, viral infections, marrow obliteration (osteosclerosis, myelosclerosis, myelofibrosis, malignant infiltrate), over 70 different drugs (chloramphenicol, phenylbutazone ,chlorpromazine, quinine), B-12 and folate deficiencies, hypoadrenalism, hypopitutarism,dialysis.

Nortriptyline

• Therapeutic Range: 50-150 ng/mL

Osmolality, plasma

• Normal: 278-305 mosm/kg
• Osm = (2(sodium)+ BUN/2.8 +Glucose/18)
• Increased: hyperglycemia, alcohol ingestion, water loss (diabetes, hypercalcemia, diuresis), ethylene glycol ingestion, mannitol.
• Decreased: low serum sodium,diuretics,Addison's disease, inappropriate ADH (SIADH is seen in bronchogenic carcinoma & hypothyroidism), iatrogenic(poor water balance).

PaCO2

• Normal: 4.4 - 5.9 kPa (33-44 mmHg)
• Respiratory Acidosis PCO2- >45
• Respiratory Alkalosis PCO2- <35
• Metabolic Acidosis HCO3- <22 mmol/l
• Metabolic Alkalosis HCO3- >26 mmol/l

PaO2

• Normal: >10.6 kPa (75-105 mmHg)

PCV (hematocrit)

• Normal: M:0.4-0.54 F:0.37-0.47 (to one
• Decreased: megaloblastic anemia (due to folate or B-12 deficiency), Iron deficiency anemia, sickle cell anemia, acute or chronic blood loss, hemolysis, alcohol, drugs.
• Increased: Primary polycythemia, polycythemia vera, secondary polycythemia (decr.fluid intake, incr. fluid loss), heart disease, high altitude, heavy smokers, renal cell carcinoma, hepatoma, renal cysts.

pH Arterial Blood

• Normal: 7.36 - 7.44
• pH = 6.1 + LOG ([HCO3]/ 0.03 x pCO2)

Phenobarbital

• Therapeutic Range: 10-30 mEq/mL

Phenytoin

• Therapeutic Range: 8-20 mcg/mL

Phenylalanine, infants

• Normal: 42-73 micromol/l
• For screening infants for PKU

Phosphate (inorganic)

• Normal: 3.0-4.5 mg/dL
• Increased: hypoparathyroidism, excess vitamin-D, secondary hyperparathyroidism, renal failure, bone disease, healing fractures, Addison's disease, childhood, factitious from specimen hemolysis.
• Decreased: hyperparathyroidism,alcoholism, diabetes, hyperalimentation,acidosis, alkalosis, gout, salicylate poisoning, IV steroid, glucose or insulin injection, hypokalemia, hypomagnesemia, diuretics, Vitamin D deficiency, posphate-binding antacids

Platelets

• Normal: 150-400 x10^9/l, abnormalities of platelet function are measured by bleeding time.
• Increased: sudden exercise, after trauma bone fracture, after asphyxia,after surgery, acute hemmorrhage, polycythemia vera, primary thrombocythemia, leukemias, carcinoma, post-childbirth.
• Decreased: disseminated intravascular coagulation (DIC), idiopathic thrombocytopenic purpura, congenital disease, bone marrow suppressants (chemotherapy, thiazide diuretics, alcohol, estrogens, x-rays), burns, snake and insect bites, leukemias, aplastic anemia, hypersplenism, infectious mononucleosis, viral infections, cirrhosis, massive transfusions, eclampsia, preeclampsia, over 30 different drugs.

PMN's

• Normal: 40-75 %(Polymorphonuclear Neutrophils)
• Increased: -Normal: severe exercise, last months of pregnancy, labor, surgery, newborns.
  -Pathological Increase: bacterial infections, tissue damage( MI, pulmonary infarction, crush injury, burn injury), metabolic disorders (eclampsia, diabetic ketoacidosis, uremia, acute gout), leukemias.
• Decreased: pancytopenia, aplastic anemia, PMN depression (mild = neutopenia, severe = agranulocytosis), marrow damage( due to x-rays, benzene poisoning or antitumor drugs), disseminated TB, septicemia, acute malaria, severe osteomyelitis, infectious mononucleosis, atypical pneumonias, viral infections, marrow obliteration (osteosclerosis, myelosclerosis, myelofibrosis, malignant infiltrate), over 70 different drugs (chloramphenicol, phenylbutazone ,chlorpromazine, quinine), B-12 and folate deficiencies, hypoadrenalism, hypopitutarism,dialysis.

Potassium

• Normal: 3.5-5.0 mEq/L (same in mmol/L)
• Increased: factitious( hemolysis of specimen, thrombocytosis), renal failure, Addison's disease, acidosis, spironolactone, triamterene, dehydration, hemolysis, massive tissue damage, excess intake, acidosis.
• Decreased: diuretics, decreased intake, vomiting, nasogastric suction, villous adenoma, diarrhea, Zollinger-Ellison syndrome, chronic pyelonephritis, renal tubular acidosis, metabolic alkalosis (primary aldoseronism, Cushing's syndrome)

Procainamide

• Therapeutic Range: 4.0-8.0 mcg/mL.

Protein(total Plasma)

• Normal: 6.0-7.8 g/dL
• Increased: Multiple myeloma, macroglobulinemia, hypergammaglobulinemia, sarcoidosis.
• Decreased: malnutrition, inflammatory bowel disease, Hodgkin's disease, leukemias, decreased albumin from any cause.

PT (prothrombin time)

• Normal: 11.5-13.5 seconds
• Prolonged: Drugs(Warfarin), Vitamin K deficiency, fat malabsorption,liver disease, disseminated intravascular coagulation (DIC), Factitious due to prolonged use of tourniquet before drawing sample.

PTT (Partial Thromboplastin Time)

• Normal: 35-45 Secs.
• Prolonged: Hemophilia A and B, Heparin administration, Factitious from Tourniquet on too long.

Quinidine

• Therapeutic Range: 2.5-5.0 mcg/mL

RBC

• Normal: M:4.3-5.9 F:3.5-5.5 x10^12/L

RDW (red cell distribution width)

• Normal: 11.5-14.5%, a measure of variation in cell size.
• Increased: in many anemias; esp. Iron Deficiency Anemia (normal in Anemia of Chronic Disease) in setting of a microcitic(or normocytic) hypochromic anemia.

Salicylate

• Therapeutic Range: 15-25 mg/dL

SGOT

• Normal: 5-35 IU/l
• Increase: acute MI,liver disease, Reye's syndrome, muscletrauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct.
• Decreased:beriberi, diabetes w/ ketoacidosis, liver disease.

SGPT

• Normal: 5-35 IU/l
• Increase: liver disease, liver metastasis, biliary obstruction, pancreatitis, liver congestion.

  (SGOT > SGPT in alchoholic hepatitis)
  (SGPT > SGOT in viral hepatitis)

Sodium

• Normal: 135-145 mEq/L
• Increased:
  -low total body sodium: (gycosuria, mannitol, urea, sweating)
  -normal body Na: (diabetes insipidus; central and nephrogenic, respiratory losses, sweating)
  -increased total body Na: (hypertonic H2CO3, Cushing's syndrome, hyperaldosteronism).
  
• Decreased:
  -excess total Na and H2O: (nephrotic syndrome, congestive heart failure, cirrhosis, renal failure)
  -excess H20 only: (SIADH, hypothyroidism, adrenal insufficiency)
  -with decreased Na and H2O: ( diuretics, renal tubular acidosis, mannitol, urea, mineralocorticoid deficiency, vomiting,diarrhea, pancreatitis)
  -with pseudohyponatremia (hyperlipidemia, hyperglycemia, multiple myeloma).

• Total Body Water calc for rehydration:
  • Current TBW = 0.6 X Current Weight(Kg.)

  • Desired TBW = (Serum Na+(mEq/L.) X Current TBW)/(Normal Serum Na+(mEq/L.))

  • Body Water Deficit = Desired TBW - Current TBW

  Note: Correct SLOWLY; 1/2 BWD over first 24 Hrs. Then the rest over 1-2 days. Repeat calc. daily to reach steady-state.

Streptomycin

• Therapeutic Range: Peak 10-20; trough <5 mcg/mL

Theophylline

• Therapeutic Range: 8-20 mcg/mL

TIBC

• Normal: 250-450 ug/dL(54-75 uMol/l)
• The normal iron/TIBC ratio is 20-50%, <15% is diagnostic of Iron Deficiency Anemia. Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives
• Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis.

Total Iron Binding Capacity

• Normal: 250-450 ug/dL
• The normal iron/TIBC ratio is 20-50%, <15% is diagnostic of Iron Deficiency Anemia
• Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives
• Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis.

Tocainide

• Therapeutic Range: 4-10 mcg/mL

Triglycerides:

• Normal: 115-190 ng/dL
• Increased: hyperlipoproteinemias (types I,IIb,III,IV,V), hypothyroidism,liver diseases, alcoholism, pancreatitis, acute MI,nephrotic syndrome, familial increase.
• Decreased: malnutrition, congenital abetalipoproteinemia.

Urea

• Normal: 3.0-8.2 mg/dL

Urea nitrogen

• Normal: 7-18 mg/dL
• Increased: renal failure, prerenal azotemia, postrenal obstruction, GI bleed, stress, aminoglycoside side-effect.
• Decreased: Starvation, liver failure, pregnancy, infancy, nephrotic syndrome, overhydration.

Uric acid

• Normal: M:210-480 F:150-390 micromol/l
• Increased: gout,renal failure,leukemia, anemia, chemotherapy,toxemia of pregnancy, diuretics, lactic acidosis, hypothyroidism,polycystic kidney disease, parathyroid diseases.
• Decreased: uricosuric drugs (salicylatesprobenecid, allopurinol), Wilson's disease, Fanconi's syndrome.

Valproic acid

• Therapeutic Range: 50-100 mcg/mL

Vancomycin

• Therapeutic Range: Peak 30-40; trough <10 mcg/mL

Viscosity, plasma

• Normal: 1.4-1.8 Cp
• Increased: macroglobulinemia, multiple myeloma,Plasma cell myeloma,

WBC

• Normal: 4-11 x10^9/l
• Increased: In many inflammatory and bacterial infective processes. Look at individual leukocyte subpopulations for some indication of the exact infective process involved.

Wedge Pressure

• Normal: <15 mmHg
• If >15, increased:give Dobutamine or other inotrope. Means left atrial pressure is too high.