normal values & lab tests

8/3/2019 Normal Values & Lab Tests

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I & O Conversions

1 cup = 240 ml

1 tsp = 5 ml

1 tbs = 15 ml (3 tsp)

1 oz = 30 ml

1 gr = 60 ml

1 kg = 2.2 lbs

1 inch = 2.54 cm

Serum Electrolyte Normal Values

Magnesium 1.5 - 2.5

Phosphate 2.5 - 4.5

Potassium 3.5 - 5.0

Calcium 4.5-5.5 (ionized)

Calcium 8.5 10.5 (total)

Chloride 95 108

Sodium 135 - 154

Normal Blood Gases

pH 7.35 7.45

pCO2 35 45

HCO3 22 26

PO2 80 - 100

Osmolarity

270 320

320 = hypertonic (exits cells)

Normal Adult

Vital Signs

BP: 110-120/ 60-80 (140/90 = hypertension)

HR: 60 -100

RR: 12 20

Temp:

(axillary): 97.6

(oral): 98.6

(rectal): 99.6


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Normal Newborn

Vital Signs

BP: 65/41

HR: 120 160 (180 when crying)

RR: 30 - 60

Normal 1-4 Years

Vital Signs

BP: 90-100/ 60-65

HR: 80 140

RR: 20 - 40

Normal 5-12 Years

Vital Signs

BP: 100-110/ 55-60

HR: 70 115

RR: 15 - 25

Fluid Volume Excess

Symptoms: BP, HR (bounding pulse), Resp,

CVP, confusion, muscle weakness, distended neck

veins, peripheral edema, lung crackles, DECREASED

values, low specific gravity.

Causes: CHF, renal failure, burns, excessive Na+, live

cirrhosis.

Implementation: Diuretics, fluid restriction, ambulat

high flowlers, breath sounds


3/17

Fluid Volume Deficit

Symptoms: BP (orthostatic hypotension), CVP,

rapid/weak pulse, Resp, HA, confusion, tachycard

dizziness, weakness, oliguria, poor turgor (cool &

moist), flat neck veins in dependent position,

INCREASED lab values, high specific gravity.

Causes: V/D, suctioning, diuretics, diabetes insipidus

diabetic ketoacidosis, third spacing, hemorrhage.

Implementation: Isotonic solution

*The higher the hematocrit and specific gravity, the

dryer they are high and dry.

SODIUM

*Main extracellular ion that regulates fluid balance.

Hypernatremia

*similar to fluid balance deficit

Symptoms: Hypotension, tachycardia, deep tendo

reflex, twitching, edema, oliguria, dillusions.

Causes: Fluid loss, increase Na+, renal failure,hypertonic fluids, diabetes insipidus, burns, fever,

Cushings syndrome (increased secretion of

aldosterone, which increases Na+ reabsorption).

Implementation:Hypotonic solution to shift Na+ int

cells, decrease sodium in diet.

Hyponatremia

Symptoms: BP, HR (thread pulse), deep tend

reflex, twitching, headache (ICP), confusion, musc

weakness.

Causes: V/D, tap enemas, excessive admin of dextroand water IVs, excessive water intake, NG suction,

diuretics, burns, renal disease, Addisons (decrease

secretion of aldosterone, which decreases Na+

reabsorption).

Implementation:Oral admin, water restriction. If

combined with fluid volume deficit, IV sodium chorid

is administered. If combined with fluid volume exces

osmotic diuretics given to excrete water rather than


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sodium.

*precipitates LITHIUM toxicity!!!

Diabetes Insipidus

(Decrease in ADH posterior pituitary)

Symptoms: Excessive UOP (inability to concentrate

urine, so it stays in blood), chronic severe dehydratio

excessive thirst, weakness, constipation, wt. loss.

Causes: head trauma, brain tumor, meningitis,

encephalitis (tumors that hypersecrete), high serum

sodium, low specific gravity and plasma osmolality

(water is not being reabsorbed into the plasma getting lost in urine).

Implementation: Administer Vasopressin (Pitressin)

causes venous constriction to preserve H2O loss.

Syndrome of Inappropriate Antidiuretic Hormone

Secretion (SIADH)

(Increase in ADH posterior pituitary)

Acts like hyponatremia: Onconologic Emergency (br

oncology patients suffer from this)

Symptoms: N/V, anorexia, tachycardia, HA, lethargy

change in LOC, in DTR, blood volume, UOP,

edema not seen (all water reabsorbed into plasmabloodstream)

Causes: tumors that hypersecrete (small cell carcino

of lung, brain tumors), head trauma, stroke,

meningitis, encephalitis, pneumonia, positive pressu

ventilation, plasma osmolality (concentration),

specific gravity (H2O not lost in urine, all being

reabsorbed), serum sodium (115-120).

Implementation: FIRST restrict H2O intake

(500ml/24hr), hypertonic saline (pull fluid out of celladminister demeclycline (Declomycin) side effect i

to induce diabetes insipidus


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POTASSIUM

Main intracellular ion. Involved in cardiac rhythm an

nerve transmission.

Hyperkalemia

Symptoms: BP, HR (weak, irregular), resp.

depression, twitches, weakness, parathesias, diarrhe

increased GI motility.

Causes: Renal failure, cellular destruction (burns,

trauma) diabetic ketoacidosis, hyperglycemia,

Addisons.

Implementation: Administer loop diuretics, Kayexala(diarrhea inducer), dialysis. In emergency: Calcium

gluconate, sodium bicarbonate, regular insulin &

dextrose (shifts K+ into cells).

ECG: Tall, peaked T waves; Flat P waves; widened QR

prolonged PR interval.

Hypokalemia

Symptoms: BP, HR (thready, irregular), shallow

respirations (failure), muscle weakness, confusion,

polyuria, GI mobility, dysrhythmias, DT hyporeflex

Causes: D/V, NG suction, diuretics or corticosteroids

diaphoresis, wounds, metabolic alkalosis, Cushings.

Implementation: Increase dietary intake, supplemen

IV (cant give >40mEq/L into periph IV or without

cardiac monitor)

ECG: ST depression, inverted/flat T wave, prominent

wave.

*Hypokalemia may precipitate Digitalis toxicity.


6/17

Potassium Administration

Oral K+- (can cause nausea or vomiting, shouldnt be

taken on empty stomach).

IV K+ - infusion must be controlled. Liquid form K+ h

unpleasant taste.

Points about administering K+: Never given by IV pu

or IM or SQ route. Dilution of no more than 1 mEq/L

K+ to 10 ml of IV solution is recommended.

Recommended infusion rate = 5-10 mEq/Hr. ShouldNEVER exceed >20 mEq/Hr.

K+ infusion can cause phlebitis. Assess site frequent

CALCIUM

*Functions in bone formation, blood clotting, nerve

impulse transmission and contraction of myocardial

and skeletal muscle.

*Regulated by the parathyroid hormone (parathyroi

gland) & Vitamin D (also activated by the PTH).

*When serum phosphorus levels decrease, serum

calcium levels increase and vice versa. So

hypocalcemia acts like hyperphosphatemia.

Hypercalcemia

*Sedative effect on NS

Symptoms: Confusion, Muscle weakness, lack of

coordination, Depressed deep tendon reflexes,

Constipation, ECG Changes dysrhythmias, GI

Motility.

Causes: Hyperparathyroidism, Malignant neoplastic

disease, Immobility, Excessive intake of calciumcarbonate antacids.

Implementation: Foods low in calcium, high in

phosphorus. Fluids, Lasix, Calcitonin (to decrease Ca

level), Mobilize patient, Maintain acidic urine

ECG: Shortened ST segment, Widened T wave.

Hypocalcemia

*NS becomes excitable

Symptoms: BP, HR, Confusion, Tetany,

dysrhythmias, Seizures, Positive Trousseau andChvostek signs, Parathesia (tingling, numbness),

hyperactive DTR, anxiety, irritable, GI motility.

Causes: Hypoparathyroidism, Pancreatitis, Renal

Failure, Steroids & Loop diuretics, Post-thyroid surge

Malabsorption (Crohns), Immobility

Implementation: Foods high in calcium and low in

phosphorus. Calcium gluconate or calcium chloride


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(administer with OJ to maximize absorption). USE

CAUSIOUSLY with digitalis patients (b/c both are

cardiac depressants). Administer phosphate-binding

antacids = calcitrol, Vitamin D.

ECG: Prolonged ST and QT intervals.

MAGNESIUM

*Used as an index to determine metabolic activity a

renal function.

*Needed in blood clotting, regulates neuromuscular

activity, effects metabolism of calcium.

*Magnesium acts as a depressant. Think Deep Tend

Reflexes. It is a smooth muscle relaxant (diaphragmbladder)

Hypermagnesemia

Symptoms: Depresses the CNS, hypotension,

depresses cardiac impulse transmission, shallow

respirations, muscle weakness, absent DTR,

drowsiness, lethargy.

Causes: Renal failure, antacids or cathartics

(excellerates defication mag citrate, mag sulfate,

maalox).

Implementation: Administer calcium gluconate

ECG: Prolonged PR, widened QRS.

Hypomagnesemia

Symptoms: Tremors, tetany, (positive trousseaus an

chvostek) seizures, dysthythmias, confusion,

dysphagia, irritable, confusion.

Causes: V/D, alcoholism, GI suction, abuse of laxativ

Implementation: Dietary, IV mag sulfate

ECG: Tall T waves, depressed ST

*Low mag potentiates Digitalis toxicity.


8/17

Addisons Disease

(Adrenal insufficiency = hyposecretion of adrenal

hormones (mineralcorticods: Aldosterone -regulates

the amounts of Na+ absorbed by the kidneys;

glucocorticoids, androgens)

SKINNY (hypoglycemic) = add hormones

Hyperkalemia, Hyponatremia

Symptoms: BP, wt. loss, weakness, orthostatic

hypotension, hyperpigmentation, alopecia.

Diagnosis: Na+ = dehydration, Blood volume =

shock, blood sugar = insulin shock, K+ = metaboacidosis & arrhythmias.

Implementation:High protein, carb, sodium and low

potassium diet. Hormone replacement.

Addisoninan Crisis

Symptoms: N/V, fever, abdominal pain, muscular

weakness, fatigue, severe hypoglycemia, hyperkalem

and dehydration. BP drops, leading to shock and

coma.

Interventions: Administer Hydrocortisone

Isotonic fluids, IV glucose, Kayexalate.

Cushings Disease

(Adrenal insufficiency (hypersecretion) =

Aldosterone (regulates the amounts of Na+

absorbed by the kidneys)

FAT (hyperglycemic)

Hypokalemia, Hypernatremia

Symptoms: BP, muscle wasting, cramps, edema,

purple skin striations, hirtuism, moon face, buffalo

hump, retain Na+ and fluid, immunosuppressed,

obesity (trunk), thin extremities with bruising, moodswings, female masculinization.

Diagnosis: Na+, blood volume (BP), blood

sugar = ketoacidosis, K+ = metabolic alkalosis.

Implementation: Hypophysectomy (removal of the

pituitary gland), adrenalectomy (removal of the

adrenal gland). High protein, potassium and Low

sodium diet. Low calaries, fluid restriction. Administ

aminoglutethimide and metyrapone to decrease

cortisol production.


9/17

Red Blood Cells

Male: 4.5 6.2 million/mm3

Female: 4.0 5.5 million/ mm3

Child: 3.2 5.2 million/mm3

Platelets

Normal: 150,000 400,000

Low = thrombocytopenia (bleeding precautions)

WBC

Normal: 4,500 11,0000

Low = immune compromised

High = infection

Hemoglobin

Male: 14 18 g/dL

Female: 12 16 g/dL

Child: 11 12.5 g/dL

*Vehicle for transporting O2 and CO2. Determines

anemias.

Hematocrit

Male: 42 52%

Female: 35 47%

Child: 35 45%

*Represents RBC mass, identifies anemia or

polycythemia.


10/17

Clotting Time

Normal: 8 15 minutes

Bleeding TimeNormal: 1.5 9.5 minutes

Prothrombin Time (PT)

Used to monitor response to Warfarin (Coumadin)

Control: 9.5 12 seconds

Warfarin should maintain the PT at 1.5 2 times the

control (14 24).

*If PT time > 30 seconds, initiate bleeding precautio

*Diets high in green leafy veggies can increase Vitam

K, which shortens the PT.

International Normalized Ratio (INR)

Used to monitor response to Warfarin (Coumadin)

Control: 1-3 for standard Warfarin therapy

2.54 for high-dose therapy (heart valves

Warfarin should maintain the PT at 1.5 2 times the

control (2 - 4).


11/17

Partial Thromboplastin Time (PTT)

Used to monitor response to Heparin therapy

Lower Limit: 20 25 seconds

Upper Limit: 32- 40 seconds

Heparin should maintain the PTT 1.5 2.5 times the

control (30 90).

*If PTT> 90 seconds, initiate bleeding precautions.

Erythrocyte Sedimentation Rate

(ESR)

Male = < 15 mm /hr

Female < 50 yrs = < 25 mm/hr

Female > 50 yrs = < 30 mm/hr

*Tests acut/chronic infection, inflammation, neplasm

tissue necrosis, infarction.

Iron

Male: 65 175 mg/L

Female: 50 170 mg/L

*Iron found in Hg, acts as a carrier of O2 from lungs

tissue.

Total Cholesterol

< 160 mg/dL (No CAD, less than 2 risk factors)

< 130 mg/dL (No CAD, greater than 2 risk factors)

< 100 mg/dL (CAD present)


12/17

Triglycerides

Normal: 100 200 mg/dL

Low Density Lipoproteins

(LDL)

Optimal 160

*you want to be LOW

High Density Lipoproteins

(HDL)

Males: 35 70 mg/dL

Females: 35 85 mg/dL

*you want your HDL to be HIGH

Glucose Tolerance Test

(GTT)

Fasting = 60-110 mg/dL

1 hr = 190

2 hr = 140

3 hr = 125

*140 200 = impaired

*>200 = diagnostic of diabetes

Glycosylated Hemoglobin (HbA1c)

*A reflection of how well BG levels have been

controlled for the past 3-4 months.

Poor control of diabetes = >8%


13/17

Creatinine Kinase (CK)

Males: 50 235 U/L

Females: 50 250

Child: 0 - 70

*used to diagnose acute MI, can detect in 3 5 hour

Myoglobin

When > 90 = Diagnostic of an MI

Tropinin

Troponin I if > 1.5 = Diagnostic of an MI

Troponin T if > 0.2 = Diagnostic of an MI

Lactase Dehydrogenase

(LDH)

When LDH 1 > LDH 2 = diagnostic of an MI

Serum Creatinine

Adult: 0.7 1.4

Child: 0.4 1.2

Infant: 0.3 0.6


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Creatinine Clearance

24 hour collection

Normal: 1.67 2.5 ml/s

*tests how well creatinine is removed from your blo

by your kidneys.*Decreases with nephrotoxicity

Blood Urea Nitrogen

(BUN)

Normal = 8-20 mg/dL

*Tests renal function. Is affected by protein intake,

tissue breakdown and change in fluid volume.

*BUN/Creatinine ratio = 10:1 or 20:1

Specific GravityNormal: 1.010 1.030

*Increased levels indicate slowing of GFR.

Protein

Normal: 6-8 g/dL

*Regulates osmotic pressure and is major building

material for blood, skin, hair, nails and organs.

*Increased in Addisons, chronic infection, crohns

disease.

*Decreased in liver disease, burns, edema.

Albumin

Normal: 3.5 5.5 g/dL

*detects protein malnutrition

*presence in urine = abnormal renal fucntion


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Alkaline Phosphatase

Normal: 50 150 U/L

*level rises during periods of bone growth, liver

disease, and bile duct abstruction.

Serum Ammonia

Normal 10 40 mcg/dL

Elevated = liver dysfunction

Alanine Aminotransferase (ALT)

Normal: 4 6

Liver function test

Asparatate Aminotransferase (AST)Normal: 5 35

Liver function test

Amylase

Normal: 25 160 U/dL

*Diagnostic of pancreatitis and acute cholecystitis


16/17


17/17

Gastric AspirateNormal is < 4.0

Hypothyroidism

(Myxedema puffy face)

TSH, T3,T4, basal metabolic rate.

FAT, COLD, DRY, SLOW

Symptoms: Decreased activity and HR, cold

intolerance, wt gain, constipation, alopecia, dry (

sweating), slowed physical and mental function,

sensitivity to narcotics (risk for resp depression).

Causes: inflammation of thyroid, thyroidectomy,pituitary deficiencies, iodine deficiency.

Implementation: Hormone replacement (Synthroid,

Levothyroid). Low calorie, high protein, high fiber di

*Myexedema coma causes: acute illness, surgery,

chemo, DC of meds

*Destruction of thyroid can be caused from

Hashimotos Disease where cells of immune system

attack T-cells and destroy tissue.

Hyperthyroidism

(Graves Disease)

TSH, T3,T4, basal metabolic rate.

SKINNY, HOT, HYPER

Symptoms: Heat intolerance, tachycardia, wt loss,

diarrhea, bulging eye, accelerated physical and ment

functions (hyperactive, diff. sleeping), fine/soft hair.

Implementation: antithyroid drugs (SSKI methimazo

proplthiouracil), surgery, irradiation.

*Thyroid Storm (post thyroidectomy): increased tem

and pulse, hypertension, abdominal pain, seizures.

Treatment = hypothermia blanket, O2, PTU (slows

down body).

normal values & lab tests

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