Lab Values - Alberta Health Services

AMNSP Day #2
Haemoglobin
o Normal –Female 120‐160
o Normal –Male 137‐180
o When do you get concerned?
Haemoglobin
Conditions to expect lower than normal value:
o Anaemia (various types)
o Erythropoietin deficiency (from kidney disease)
o Red blood cell destruction or bleeding
o Lead poisoning
o Malnutrition
o Nutritional deficiencies of iron, folate, vitamin B‐
12, vitamin B‐6
o Over hydration
I have a result…Now so what?
o Questions to ask yourself:
• Is it a known/expected value?
• Will the current course of treatment correct the
issue?
• Is the critical value consistent with the disease
process going on in the patient?
o If the answer is YES:
• Don’t get excited, remain calm
• Follow the trends
Haemoglobin
o What else should you consider:
CBC
• Hematocrit (Hct)
• Normal 0.40‐0.54 L/L
• The volume of RBCs packed in a 100 mL of
blood as a percentage
• Platelets
• Normal 150‐400 x 10E9/L
• Low count =
• High count =
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White Blood Cells
High numbers of WBC’s (leukocytosis) may
indicate:
• Infectious disease
• Inflammatory disease
• Leukemia
• Severe emotional or physical stress
WBCs
• WBCs:
Normal: 4.0‐11.0 x10 E9/L
ASA, heparin, epinephrine, digitalis, and lithium can increase WBCs
• Neutrophils:
Normal: 2.0‐8.0 10 E9/L
First responders
• Lymphocytes:
Normal: 0.7‐3.5 10 E9/L
Increase in viral infections
• Monocytes:
normal: 0.0‐1.0 10 E9/L
Second responders
Blood Cultures
o When should blood cultures be drawn?
o Is there anything different to be aware of?
o Do these need to be reported immediately or can
it wait?
o What if the patient is already on antibiotics?
White Blood Cells
Low numbers of WBC’s (leukopenia) may
indicate:
• Bone Marrow Failure
• PPresence of f cytotoxic t t i substance bt
• Disease of the liver or spleen
• Radiation
• Eosinophils:
normal: 0.0‐0.7 10 E9/L
Increase in an allergic reaction
• Basophils:
normal: 0.0‐0.2 10 E9/L
Increase during healing
• Bands:
WBCs
Electrolytes
• Sodium (Na+):
Normal 135‐145 mmol/L
It has a water retaining effect helping maintain
body fluids
Also responsible for neuromuscular impulses
via the sodium channel pump
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Hyponatremia: Na < 135mEq/L
Symptoms include:
• Dysphagia
• Facial weakness
• Muscle weakness (pronounced)
• CComa
Risk Factors:
• Alcoholism
• General illness
• Malnutrition
• Significantly sodium restricted diets
Potassium
• Potassium
• Normal 3.5‐5.0 mmol/L
• Influenced by:
• insulin –stimulates cellular uptake of K+
• Epinephrine – stimulates cellular uptake of K+
• Plays many different roles in the body including affecting
cardiac muscle contractility and transmission of nerve
impulses
• Death can occur if levels are 7.0 mmol/L
• The body does not conserve K+ it excretes approx.
40mEq/L/day
Hypokalemia: K+ < 3.5
• Treatment:
• Replacement –oral or IV
• IV rate should h ldbbe lless than h 10 mEq/hr /h unless l via i
central line with cardiac monitoring
Hyponatremia: Na < 135mEq/L
Treatment:
• Fluid restriction
• Diuretics
• Hypertonic infusions ex: 3% Saline
• Only actively replaced in symptomatic patients
• Do not replace faster than 2 mEq/l/hr due to
risk of Central Pontine Myelinolyis
Hypokalemia: K+ < 3.5
• Can be caused by:
• Dietary deficiency
• Excessive potassium loss because of a gastrointestinal
disorder
• Vomiting
• Diuretic use
• Renal artery stenosis
• Hyperaldosteronism
Hyperkalemia: K+ > 5.5
Hyperkalemia can KILL!!!
o Hyperkalemia can cause:
Fl id l i th i
• Flaccid paralysis, paresthesias
• Irritability
• Abdominal distention and diarrhoea
• Potentially lethal cardiac dysrhythmias
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Hyperkalemia: K+ > 5.5
• Acute treatment:
• Calcium – stabilizes the cardiac membranes,
improves ECG but does not affect K+ levels
• Glucose and insulin
• Sodium bicarbonate
• Diuretics
• Calcium exchange resins
• Chloride:
Electrolytes
Normal 98‐111 mmol/L
Plays an important role in water balance, osmolarity of
fluids, and acid base balance
Levels coincide with sodium and bicarbonate
• Carbon Dioxide
Normal 21‐31 mmol/L
Used to determine acid base balance
Can be used instead of bicarbonate level (HCO3) to
determine acid base balance
Creatinine Considerations:
• Drugs that can increase creatinine measurements
include:
• Aminoglycosides (Gentamycin)
• Bactrim
• Cimetidine
• Heavy metal chemotherapeutic agents (Cisplatin)
• Nephotoxic drugs –such as cephalosporins
• Monitor trending
• Consider patients meds and condition
Hyperkalemia: K+ > 5.5
Chronic Treatment:
• Aldosterone : It increases the re‐absorption of
sodium and water along with the excretion of
potassium p
• Diuretics
• Calcium exchange resins
• Dialysis
Creatinine
Higher than normal levels may indicate:
o Acute renal failure
o Chronic renal failure
o Dehydration
o Shock
o Congestive heart failure (reduced renal flow)
o Rhabdomyolysis
• Normal 2.10‐2.55
Calcium Ca+
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Hypocalcaemia: Ca+ < 2.0
Symptoms include:
• Latent tetany‐muscle fatigue, weakness, numbness
• Overt tetany – twitching and cramping of muscles,
carpupedal spasms and seizures
Treatment:
• IV Calcium –gluconate or chloride
• Consider medications –steroids increase calcium
loss
Hypercalcemia > 3
Symptoms:
• Renal – hypercalciuria, urinary calculi
• Skeletal –bone pain, fractures, demineralization
• GI – anorexia anorexia, weight loss loss, constipation, constipation pancreatitis
• Neurological –emotional changes, abnormal mentation,
obtundation, coma, fatigue, muscle weakness
Magnesium: Mg
• Normal: Mg 0.7‐1.2 mmol/L
• Part of the production and transport of energy
• Important in the contraction and relaxation of
muscles
• Synthesis of protein
• Assists in the functioning of certain enzymes
Hypercalcemia > 3
Causes:
• Bone mets
• Hyperthyroidism
• Thi Thiazide id diuretics di ti
• Immobilization
• Vitamin D intoxication
Hypercalcemia > 3
Treatment:
• Emergent treatment –hydration, sodium diuresis
• Phosphate
• Calcitonin
• Glucocorticoids
• Increased fluid intake
• Estrogen
Hypomagnesium >0.7mmol/L
o Symptoms include:
• Irritability
• Anorexia
• Fatigue
• Insomnia
• Muscle Twitching
o Rapid heartbeat and other arrhythmias can
occur with moderate deficiencies
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Hypomagnesium >0.7mmol/L
o Treatment:
• Assess for signs and symptoms of weakness,
irritability, tetany, ECG changes, delirium
• Patients will be given Magnesium Sulphate IVPB,
• Mild hypomagnesium patients will be given PO
replacement
References
www.nlm.nih.gov/medlineplus
www.emedicine.com
www.calgarylabservices.com
Eikenberry, L. Critical Labs: What’s Important to
Know
Ficaccio, S.; Tuinenga, S. (2004). Common Surgical
Lab Values.
• ALT:
• AST:
• Bilirubin:
• ALP:
• GGT:
Liver Function Tests
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