Lab Values Podcast by NURSING.com (Nursing Podcast, normal lab values for nurses for NCLEX®) by NURSING.com (NRSNG)

Normal <150 mg/dL Indications Evaluate for: Elevated triglycerides Risk for atherosclerotic heart disease and stroke Description Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue. What would cause increased levels? Myocardial Infarction (MI) Alcoholism Alcoholic cirrhosis High carbohydrate diet Anorexia nervosa Cirrhosis Hypertension (HTN) Nephrotic Syndrome Obesity Renal failure Pancreatitis Stress What would cause decreased levels? Chronic Obstructive Pulmonary Disease (COPD) Liver disease Hyperthyroidism Malnutrition Malabsorption

Normal 135-145 mEq/L Indications Monitor: Extracellular osmolality Electrolyte imbalance Description Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt. What would cause increased levels? Cushing Syndrome Hyperaldosteronism Dehydration Burn injury Azotemia (elevated nitrogen) Lactic acidosis (LA) Fever/excessive sweating Excessive IV fluids containing sodium Diabetes Insipidus Osmotic diuresis What would cause decreased levels? Congestive Heart Failure (CHF) Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Cystic Fibrosis Diuretic use Metabolic acidosis Addison’s Disease Nephrotic Syndrome Vomiting Diarrhea Ascites Excessive Antidiuretic Hormone(ADH) Liver failure

Normal 3.5 - 5.0 mEq/L Indications Evaluate: Electrolyte imbalances Cardiac arrhythmias Monitor patients who are: Acidotic Receiving diuretic therapy Description Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will cause a 0.5 increase in K+. What would cause increased levels? Renal failure Hypoaldosteronism Addison’s disease Injury to tissues Diabetes Mellitus (DM) Ketoacidosis Hyperventilation Acidosis Infection Dehydration Burns What would cause decreased levels? Hyperaldosteronism Excess insulin Alkalosis Diarrhea Vomiting Cystic Fibrosis Cushing Syndrome

Normal 25 - 35 seconds Indications Detection of coagulation disorders Evaluate response to Heparin (PT for Coumadin) Preoperative assessment Description Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Clotting Factor Deficiencies: Hypofibrinogenemia Von Willebrand Disease Hemophilia Liver disease: Cirrhosis Vitamin K deficiency Polycythemia Dialysis What would cause decreased levels? N/A

Normal 95 - 100% Indications Determine respiratory status Part of Arterial Blood Gas (ABG) testing Description Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg. What would cause increased levels? Polycythemia Increased inspired O2 Hyperventilation What would cause decreased levels? Anemia’s Hypoventilation Bronchospasm Mucus plugs Atelectasis Pneumothorax Pulmonary edema Adult respiratory distress syndrome

Normal 261 – 280 mOsm/kg Indications Monitor: Electrolyte balance Acid-Base balance Hydration Evaluate function of antidiuretic hormone.   Description Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality   What would cause increased levels? Dehydration Azotemia Hypercalcemia Hyperglycemic Hyperosmolar Nonketotic State (HHNS) Hypernatremia Diabetes Insipidus Hyperglycemia Mannitol therapy Uremia Severe pyelonephritis Shock Ketosis   What would cause decreased levels? Hyponatremia Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Overhydration

Normal 1.6 – 2.6 mg/dL Indications Monitor: Renal failure Chronic alcoholism Cardiac arrhythmias Description Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.   What would cause increased levels? Renal insufficiency Uncontrolled Diabetes Mellitus (DM) Addison Disease Dehydration Hypothyroidism Overuse of antacids Tissue trauma   What would cause decreased levels? Alcoholism Diabetic acidosis Renal failure: Glomerulonephritis Hypercalcemia Malnutrition Malabsorption Hypoparathyroidism Diarrhea

Normal <70 mg/dL Indications Useful in determining risk of cardiovascular disease. Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, and very low-density lipoprotein (VLDL). LDL cholesterol is considered bad cholesterol because as it travels through the blood, it deposits cholesterol into the lining of blood vessels, causing atherosclerosis and an increase in cardiovascular disease. What would cause increased levels? Diet high in saturated fats Nephrotic Syndrome Alcoholism Chronic liver disease: Hepatitis Cirrhosis Hypothyroidism Cushing’s Syndrome What would cause decreased levels? Regular physical activity Hyperthyroidism Hypoproteinemia: Malabsorption Severe burns Malnutrition

Normal 0.3 -2.6 mmol/L Indications Determine cause of acidosis Evaluate tissue oxygenation Description Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid. What would cause increased levels? Shock Sepsis Tissue ischemia Carbon monoxide poisoning Lactic acidosis Diabetes Mellitus (DM) Heart failure Pulmonary edema Strenuous exercise What would cause decreased levels? N/A

Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5 Indications Evaluate therapeutic doses of Warfarin Identify patients at higher risk for bleeding Identify cause of: Bleeding Deficiencies Description International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Liver disease Vitamin K deficiency Warfarin What would cause decreased levels? Too much vitamin K Estrogen containing medications such as birth control

Normal >60 optimal mg/dL Indications Monitor risks of heart disease Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver. What would cause increased levels? Familial HDL Lipoproteinemia Exercise Unsaturated fats: Mono- Poly- Hypothyroid What would cause decreased levels? Metabolic Syndrome Hepatocellular disease: Hepatitis Cirrhosis Hypoproteinemia: Nephrotic Syndrome Malnutrition Smoking High saturated and trans fat diets Excess body weight Hyperthyroid

Normal 5.6-7.5 % of total Hgb Indications Assess control of blood sugars over a several month time frame Diagnose Diabetes Mellitus (DM) Description Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months. What would cause increased levels? Poorly controlled Diabetes Mellitus(DM) Non-Diabetic Hyperglycemia: Stress Cushing Syndrome Pheochromocytoma Corticosteroid Therapy What would cause decreased levels? Renal failure Blood loss Hemolytic anemia Sickle cell anemia

Normal 2 - 20 ng/mL Indications Diagnose megaloblastic anemia Monitor effects of long-term Total Parenteral Nutrition (TPN) Identify Folate Deficiency Description Folic acid is an essential water soluble B vitamin. It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division. What would cause increased levels? Excess folate intake What would cause decreased levels? Vitamin B12 deficiency Pernicious anemia Hemolytic anemia Celiac Disease or Crohn Disease Inflammatory Bowel Disease (IBS) Alcoholism Malnutrition

Normal 20-300 ng/mL Indications Diagnosing: Iron-deficiency anemiaH emochromatosis Monitor: Iron levels Description Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron. What would cause increased levels? Inflammation Alcoholic liver disease Multiple blood transfusions Hemochromatosis What would cause decreased levels? Long term Gastrointestinal(GI) bleeding Iron-deficiency anemia Heavy menstrual bleeding

Normal 96-108 mEq/L Indications Identify Acid-Base Imbalance Description Chloride (Cl-), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body. Chloride is inversely related to bicarbonate levels in the blood. Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food. When red blood cells (RBCs) take up CO2 they take up chloride as well. The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained. Extra chloride is excreted into the urine by the kidneys. What would cause increased levels? Dehydration Acute Renal Failure Cushing Disease Metabolic Acidosis Respiratory Alkalosis. What would cause decreased levels? Congestive Heart Failure (CHF) Water intoxication Burns Metabolic Alkalosis Respiratory Acidosis Addison Disease Salt-losing Nephritis Excessive sweating Diarrhea Vomiting

Normal 8.4-10.2 mg/dL Indications Identify problems with: Parathyroid Neuromuscular functions Diseases that affect bone Effectiveness of treatments. Description Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion. The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional. What would cause increased levels? Cancers: Breast, lung, and multiple myeloma are the most common Hyperparathyroidism Acidosis Renal transplant Sarcoidosis Vitamin D toxicity Dehydration What would cause decreased levels? Malnutrition Cirrhosis Chronic Renal Failure Hypoparathyroidism Alkalosis Hypomagnesemia Hypoalbuminemia Hyperphosphatemia Malabsorption Alcoholism Osteomalacia Vitamin D deficiency

Normal 12-37 U/L Indications Monitor progression of: Liver disease Response to treatments. Monitor liver toxic medications Description Aspartate Aminotransferase (AST) is an enzyme primarily found in liver and heart cells, and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain. Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood. What would cause increased levels? Liver disease Liver cancer Shock Congestive Heart Failure (CHF) Pericarditis Biliary tract obstruction Dermatomyositis Pancreatitis Muscular Dystrophy CVA Hemolytic anemia Delirium Tremens (DT) What would cause decreased levels? N/A

Normal 0-130 U/L Indications Diagnosing: Pancreatitis Pancreatic Duct Obstruction Macroamylasemia Trauma to Pancreas Description Amylase is made in the pancreas. It is an enzyme that breaks down carbohydrates to allow our body to absorb it. Monitoring amylase levels can help identify problems with the pancreas. What would cause increased levels? Pancreatitis Pancreatic Cancer Pancreatic Cyst DKA Peritonitis Abdominal Trauma Duodenal Obstruction Mumps Alcohol use What would cause decreased levels? Pancreatic Insufficiency Pancreatectomy Toxemia of Pregnancy Cystic Fibrosis Liver Disease

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Normal 30-40 seconds Indications Identifying congenital deficiencies in clotting Monitoring heparin therapeutic levels (PT for warfarin) Monitoring effects of: Liver Disease Protein Deficiency Fat malabsorption on clotting Description Activated Partial Thromboplastin Time (aPTT) is a test that measures the amount of time it takes for a fibrin clot to form after reagents have been added to the specimen. It is useful in diagnosing clotting disorders. In conjunction with PT it can be used to differentiate the specific factor that may be missing. What would cause increased (Prolonged) levels? Vitamin K Deficiency Disseminated Intravascular Coagulation (DIC) Hemodialysis Patients Afibrinogenemia Polycythemia Liver disease Von Willebrand Disease. What would cause decreased levels? N/A