BODY FLUIDS Body fluids, total volume : 50 percent (in obese) to 70 percent (lean) of body weight Intracellular : 0.

3 - 0.4 of body weight Extracellular : 0.2 - 0.3 of body weight Blood Total volume Males : 69 ml/kg body weight Females : 65 ml/kg body weight Plasma volume Males : 39 ml/kg body weight Females : 40 ml/kg body weight Red blood cell volume Males : 30 ml/kg body weight (1.15 - 1.21 L/m2 body surface area) Females : 25 ml/kg body weight (0.95 - 1.00 L/m2 body surface area) Blood acid-base Normal range Arterial Venous 7.35 - 7.45 7.32 - 7.42 35 - 45 41 - 51 0 2.5 23 - 27 26 - 30 22 - 26 24 - 28 22- 26 96 - 97 40 - 70 80 - 100 25 - 40

Actual pH PCO2 (mmHg) Base excess (mmol/L blood) Total CO2 (mmol/L plasma) Actual bicarbonate (mmol/L plasma) Standard bicarbonate(mmol/L plasma) Oxygen saturation (%) Oxygen tension PO2 (mmHg) CEREBROSPINAL FLUID Cells Chloride Glucose pH Pressure Protein, lumbar Albumin a1-globulins a2-globulins b-globulins g-globulins Protein, cisternal Protein, ventricular

< 5/mm3, all lymphocytes 600 - 700 mg/dl 45- 75 mg/dl or 60% of serum glucose 7.34 - 7.43 50-180 mm H2O 15 - 45 mg/dl 58% 9% 8% 10% 10% (5-12%) 15 - 25 mg/dl 5 - 15 mg/dl

CHEMICAL CONSITUTENTS OF BLOOD Antistreptolysin titre Acetoacetate Acid phosphatase Acid phosphatase, prostatic Aldolase 150 - 200 units/ml 0.2 - 2.0 mg/dl 0.5 - 12.0 Bodansky units/dl 2.5 - 12.0 IU/L 1.0 - 6.0 IU/L

Alkaline phosphatase Child Adult Alpha - 1 antitrypsin Ammonia 10-80 g/dl Amylase Ascorbic acid Bilirubin Adult Newborn At 3 days Carbon dioxide, total Caeruloplasmin Males Females Copper Creatinine phosphokinase, total (Duma modification of Hughes method) Creatinine phosphokinase isoenzymes MM fraction MB fraction BB fraction Creatinine Delta amino laevulinic acid Electrolytes (ISE Analyser) Potassium Sodium Chlorides Calcium (Delhi and Ellingboe) Phosphorus (Fiskee and Subbarow) Child Adult

5 - 12 Bodansky units/dl 1.4 - 4 Bodansky units/dl 200 - 500 mg/dl 3 - 10 Wohlgemuth units/dl 0.4 - 1.5 mg/dl 0.3 - 1.1 mg/dl 0.4 - 4.0 mg/dl 1.0 - 10.0 mg/dl 18 3.0 mEq/L 36.0 5.6 mg/dl 40.9 6.8 mg/dl 75 - 160 g/dl 0 - 3.4 micromoles/dl

94-95% 0-5% 0-2% 0.6 - 1.4 mg/dl 200 g/dl 3.5 - 4.5 mEq/L 135 - 140 mEq/L 98-110 mEq/L 9-10.5 mg/dl

1.1 - 1.65 mmol (2.2 - 3.3 mEq)/L 3-4.5 mg/dl 0.55 - 1.1 mmol (1.1 - 2.2 mEq)/L

Gamma glutamyl transpeptidase (Rosalki's method) Male Female Gastrin Glucose, fasting (GOD-POD method) Glucose 6-phosphate dehydrogenase G6-PD screen, qualitative Immunoglobulin, quantitative (adults) IgG IgE IgA IgM Males Females IgD (Ramsay's method) Insulin, fasting Iron 45 U/L 35 U/L 60 - 200 pg/ml 70 - 110 mg/dl 5-10 IU/g Hb Negative 570 - 1920 mg/dl < 0.025 mg/dl 70 - 400 mg/dl 30 - 250 mg/dl 30 - 300 mg/dl 0 - 40 mg/dl 6 - 25 U/ml 60 - 140 g/dl

Iron binding capacity (Ramsay's method) Lactic acid Lipidogram Cholesterol Triglycerides Phospholipids Free fatty acids Chylomicrons Beta lipoprotein Pre-beta lipoprotein Alpha lipoprotein LDH

250 - 450 g/dl 5-15 mg/dl 140 - 220 mg/dl 10 - 160 mg/dl 150 - 350 mg/dl < 18 mg/dl Absent 60 - 75% 8 - 20% 13 - 24% 70 - 240 IU/L

LDH isoenzymes (Colorimetric method of King) LDH1 LDH2 LDH3 LDH4 LDH5 Lipase Magnesium Osmolality Phenosulphonphthalein Phenylalanine Protein, total Albumin Globulin Protein electrophoresis Alpha - 1 Alpha - 2 Beta Gamma SGOT (AST) SGPT (ALT) Sulphate Urea Urea nitrogen Uric acid Viscosity (Serum compared to H2O) Vitamin A Vitamin B12 FUNCTION TESTS Circulation Arteriovenus oxygen difference: 30-50 ml/L Cardiac output (Fick) : 2.5-3.6 L/m2 body surface area per min Contractility indexes Maximum left ventricular dp/dt: 1650 300 mmHg/s Maximum (dp/dt)/p : 44 + 8.4s-1 (dp/dt)/DP at DP = 40 mmHg : 37.6 12.2s-1 (DP = diastolic pressure) Mean normalised systolic ejection rate (angiography) : 3.32 0.84 end-diastolic volumes per second Mean velocity of circumferential fibre shortening (angiography) : 1.66 0.42 circumferences per second Ejection fraction, stroke volume/end-diastolic volume (SV/EDV): Normal range : 0.55-0.78; average : 0.67 20 - 34% 28 - 41% 15 - 25% 8-16% 6-15% 0-160 U/L 1.7 - 2.6 mg/dl 278 - 305 Osm/kg serum water 25% excreted within 15 min after injection of 1 ml dye 3 mg/dl 6.3 - 7.9 g/dl 3.5 - 5.3 g/dl 1.8 - 3.6 g/dl 0.2 - 0.4 g/dl 0.5 - 0.9 g/dl 0.6 - 1.2 g/dl 0.7 - 1.7 g/dl 8 - 40 Karmen units/dl 0 - 40 Karmen units/dl 0.5 - 1.5 mg/dl 15 - 45 mg/dl 7 - 21 mg/dl 2.5 - 7.0 mg/dl 1.4 - 1.8 mg/dl 0.15 - 0.60 g/dl 200 - 850 g/dl

End-diastolic volume : 75 15 ml/m2 End-systolic volume : 25 8 ml/m2 Left ventricular work Stroke work index : 30-110 (g.m)/m2 Left ventricular minute work index : 1.8-6.6 (kg.m)/m2/min Oxygen consumption index : 110-150 ml Pressures, intracardiac and intraarterial Pulmonary vascular resistance : 2-12 (kPa.s)/L (20-120 (dyn.s/cm2) Systemic vascular resistance : 77-150 (kPa.s)/L (770-1500 dyn.s)/cm2) Gastrointestinal Absorption tests D-xylose absorption test : After an overnight fast, 25 g xylose is given in aqueous solution by mouth. Urine collected for the following 5 h should contain 33-53 mmol (5-8 g) (or > 20 percent of ingested dose). Serum xylose should be 1.7-2.7 mmol/L l h after the oral dose (25-40 mg per 100 ml). Vitamin A absorption test : A fasting blood specimen is obtained and 200,000 units of vitamin A in oil is given by mouth. Serum vitamin A levels should rise to twice fasting level in 3-5 h. Bentiromide test (pancreatic function): 500 mg bentiromide (Chymex) orally; p-aminobenzoic acid (PABA) measured in plasma and/or urine. Plasma : 3.6 ( 1.1) mg/L at 90 min Urine : 50 percent recovered in 6 h Gastric juice Volume 24 h : 2-3 L Nocturnal : 600-700 ml Basal fasting : 30-70 ml/h Conversion factor for SI Reaction pH : 1.6-1.8 Titratable acidity of fasting juice : 4.9 mol/s (15-35 mEq/h) Acid output Basal Females (mean 1 SD) : 0.6 0.5 mol/s (2.0 1.8 mEq/h) Maximal (after subcutaneous histamine acid phosphate 0.004 mg/kg body weight and preceded by 50 mg promethazine or after betazole 1.7 mg/kg body weight or pentagastrin 6 g/kg body weight): Females (mean 1 SD) : 4.4 1.4 mol/s (16 5 mEq/h) Males (mean 1 SD) : 6.4 1.4 mol/s (23 5 mEq/h) Basal acid output/maximal acid output ratio : 0.6 or less Gastrin, serum : 40-200 ng/L (40-200 pg/ml) Secretin test (pancreatic exocrine function ) : 1 unit per kg body weight, intravenously Volume (pancreatic juice): 2.0 ml/kg in 80 min Bicarbonate concentration : 80 mmol/L (80 mEq/L) Bicarbonate output : 10 mmol in 30 min (10 mEq in 30 min) Haematology

0.261

0.2778

0.2778 0.2778

Haemogram Total erythrocyte count Males Females Haemoglobin Males Females Packed cell volume Males Females Mean corpuscular volume Mean corpuscular haemoglobin Mean corpuscular haemoglobin concentration 30-35% Total leucocyte count Differential count Neutrophils Eosinophils Lymphocytes Monocytes Platelets Reticulocyte count Erythrocyte sedimentation rate (Westergen) Male Female Blood volume Average plasma volume

4.5 - 5.5 millions/cmm 4.1 - 4.8 millions/cmm 14.5 - 16.5 g/dL 12.0 - 14.5 g/dL 38 - 50% 34 - 43% 78 - 94 c 24 - 33 g

4000 - 11000/cmm 60 - 70% 1 - 7% 20 - 30% 1- 6% 150, 000 - 450,000/cmm 0.5 - 2% of erythrocytes

0 - 15 mm at end of 1 h 0 - 20 mm end of 1 h 45 5 ml/kg body weight 1487 112 ml/sq meter body surface Lysis of RBCs seen with over 0.5% of sodium chloride; haemolysis incomplete in 0.3% sodium chloride 1.7 min 4 - 8 min Control 1 sec 40 - 65% 120 - 240 min 10 g/dl 200 - 400 mg/dl 24 - 35 sec 9 - 10 sec (control + 3 sec) < 24 hours

Erythrocyte osmotic fragility test Increased fragility

Coagulation studies Bleeding time (Ivys method) Coagulation time (Lee and White) One-stage prothrombin time (Quick) Clot retraction Euglobulin lysis time Fibrin degradation products Fibrinogen Activated partial thromboplastin Time (PTT) Thrombin time Whole blood clot lysis time Bone marrow study Normal percentage (range) WBC reticulum cells Blasts Promyelocytes Myel-neutro Myel-eosino Myel-baso Metamyelocytes Stab forms PMN neutrophils

0.2 (0.1 - 2.0) 2.0 (0.3 - 5.0) 5.0 (1.0 - 8.0) 12.0 (5.0 - 21.0) 1.5 (0.5 - 3.0) 0.3 (0.0 - 0.5) 11.0 (6.0 - 17.0) 11.0 (7.0 - 15.0) 20.0 (7.0 - 15.0)

PMN eosinophils 20.0 (0.5 - 4.0) PMN basophils 0.2 (0.0 - 0.7) Lymphocytes 10.0 (3.0 - 17.0) Plasma cells 0.4 (0.0 - 2.0) Monocytes 2.0 (0.5 - 5.0) Megakaryocytes 0.4 (0.03 - 3.0) RBC : Pronormoblasts 4.0 (1.0 - 8.0) Normoblasts Basophilic 1.4 (0.5 - 2.4) Polychromatophilic 18.0 (7.0 - 32.0) Orthochromatic 2.0 (0.4 - 4.6) Unclassified cells 0.3 (0.0 - 0.9) M : E ratio 3.5 : 1 Haemoglobin studies (normal and abnormal) Haemoglobin A1 0.5% of total Hb Haemoglobin A1C Up to 6% of total Hb Haemoglobin A2 1.5 - 3.5% of total Hb Haemoglobin, foetal 0-2% of total Hb Haemoglobin, plasma 0-5% of total Hb Haemoglobin, serum 2-3 mg/dl Methaemoglobin < 1.8% Haptoglobin, serum 100 - 300 mg/dl Haemochromogens, plasma 3-5 mg/dl Haemolysis test Acid haemolysis test (Ham) No haemolysis Cold haemolysis test (Donath - Landsteiner) No haemolysis Erythrocyte life-span Normal 120 days 51 Cr - labeled half-life 28 days Iron turnover rate (plasma) 29 - 42 mg/24 h Osmotic fragility Haemolysis begins 0.45 - 0.38 NaCl Haemolysis completed 0.33 - 0.30 NaCl Corrected rate Reticulocyte index = 2 Reticulocyte index correction factor Corrected Observed rate x patients haematocrit rate = Normal haematocrit (45) Haematocrit Correction factor 45 1.00 40 0.71 35 0.52 30 0.38 25 0.28 20 0.20 15 0.13 Note : Reticulocyte index = percent reticulocytes x correction factor haematocrit and early bone marrow release Schilling test : 7-40% of orally administered radiolabelled vitamin B12 excreted in urine after flushing with intramuscular injection of B12 Hormones and metabolites Adrenocorticortropin (ACTH), serum Aldosterone, serum 210 mEq/day sodium diet Supine 15 - 70 pg/ml

48 29 pg/dl

Upright (2 h) 65 23 pg/dl 110 mEq/day sodium diet Supine 107 45 pg/dl Upright (2 h) 532 228 pg/dl Urine 5 - 19 g/24 h Calcitonin, serum None detectable Catecholamines, free urinary 110 ug/24 h Cortisol, serum 8 AM 5 - 25 g/dl 8 PM 5 - 25 ug/dl Cosyntropin stimulation (30-90 min after 0.25 mg cosyntropin intramuscularly or 10 g/dL rise over intravenously) baseline Overnight suppression (8 AM) (serum cortisol after 1 mg 5 g/dl dexamethasone orally at 11 pm) Urine 20 - 70 g/24 h 11-deoxycortisol, serum, basal < 0 - 1.4 g/dl Metyrapone stimulation (30 mg/dl orally 8 h prior) > 1.5 g/dl Oestrogens, urine (increased during pregnancy, decreased after menopause) Males 4 - 25 g/24 h 1 - 11 g/24 h 0 - 6 g/24 h 3 - 8 g/ 24 h Females 5 - 100 g/24 h 0 - 65 g/24 h 0 - 14 g/24 h 4 - 31 g/24 h 1.2 g/24 h

Total Oestriol Oestradiol Oestrone Oestriocholanolone, serum Follicle-stimulating hormone, serum Males Females Follicular phase Peak midcycle Luteal phase Postmenopausal Free thyroxine index, serum Adult, fasting Glucose load (100 g orally)

6 - 18 U/dl 5 - 20 U/dl 12 - 30 U/dl 5 - 15 U/dl 50 U/dl

5 ng/dl < 5 ng/dl

Levodopa stimulation (500 mg orally in a fasting state) baseline within 2 h 17-hydroxycorticosteroids, urine Males Females 2 - 12 mg/24 h 2 - 8 mg/24 h

5-hydroxyindoleacetic acid (5-HIAA), urine Insulin, plasma Fasting Hypoglycaemia 17-ketogenic steroids, urine Under 8 years Adolescent Adult males 2- 9 mg/24 h 6 - 126 U/ml < 5 U/ml 0-2 mg/24 h 0-18 mg/24 h 8-18 mg/24 h

females Metanephrine, urine Norepinephrine, urine Parathyroid hormone, serum

Radioactive iodine 131I uptake (RAIU) Renin activity, plasma Normal diet Supine Upright Low-sodium diet Supine Upright Diuretics and lowsodium diet Testosterone Total plasma bound Adolescent males Adult males Females Unbound Adult males Females 0.09 - 1.30 mg/dl Thyroid-stimulating hormone, serum Thyroxine (T4), serum Total Free Thyroxine-binding globulin capacity, serum Thyroxine index, free Tri-iodothyronine (T3), serum T3 resin uptake Vanillyl mandelic acid (VMA), urine Renal function tests

5-15 mg/24 h 1.3 mg/24 h 100 mg/24 h 150-300 pg/ml (varies with serum calcium) 5-25% at 24 h (varies with iodine intake)

1.1 0.8 mg/dl 1.9 1.7 mg/dl 2.7 1.8 mg/dl 6.6 2.5 mg/dl 10.0 3.7 mg/dl

100 mg/dl 300 - 100 mg/dl 25 - 90mg/dl 3 - 24 mg/dl

< 10 U/ml

4.5 - 11.5 g/dl 0.8 - 2.4 /dl 15 - 25 g T4/dl 1-4 mg/dl 70-190 mg/dl 25 - 45% 1-8 g/24 h

Anion gap Na+ - (HCO-3 + Cl-) 10 2 mEq/dL Osmolality Osmolality (serum) = 2 Na+ (mEq/L) + BUN (mg/dl) Glucose (mg/dl) + 2.8 18 Bicarbonate deficit HCO-3 deficit = body weight (kg) x 0.4 (desired HCO-3 - observed HCO-3) Ucr x V Creatinine clearance Pcr = 130 20 ml/min in males = 120 15 ml/min in females where Ucr = Urine creatinine (mg/dl) Pcr = Plasma creatinine (mg/dl) V = Urine volume/(ml) 24 h Renal plasma flow RPF = Upah X V

ppah = 700 100 ml/min in males = 600 100 ml/min in females where Upah = Urine para-aminohippuric acid V = Urine volume/24 h ppah = Plasma para-aminohippuric acid Summary of values useful in pulmonary physiology Pulmonary mechanics Spirometry : volume-time curves Forced vital capacity Forced expiratory volume 3.0 litres in 1 s FEV1/FVC Maximal midexpiratory flow Maximal expiratory flow rate Spirometry: flow-volume curves Maximal expiratory flow 5.5 litres per second at 50% of expired vital capacity Maximal expiratory flow 3.0 litres per second at 75% of expired vital capacity Resistance to airflow Pulmonary resistance Airway resistance Specific conductance Pulmonary compliance Static recoil pressure 25 5 cm H2O at total lung capacity Compliance of lungs (static) Compliance of lungs 0.1 L/cm H2O and thorax Dynamic compliance of 0.25 0.05 litres 20 breaths per minute Maximal static respiratory pressures Maximal inspiratory pressure Maximal expiratory pressure Lung volumes Total lung capacity Functional residual capacity Residual volume Inspiratory capacity Expiratory reserve volume Vital capacity Gas exchange (sea level) Arterial O2 tension Arterial CO2 tension Arterial O2 saturation Arterial blood pH Arterial bicarbonate Base excess Diffusing capacity for 25 ml co/min/mmHg 95 5 mmHg 40 2 mmHg 97 2% 7.40 0.02 24 2 mmol/L 0 2 mmol/L 6-7 litres 2-3 litres 1-2 litres 4.5 litres 3.2 litres 4-5 litres Normal values 4.0 litres

75% 4.0 litres per second 8.0 litres per second

< 3.0 cm H2O/s per litre < 2.5 cm H2O/s per litre > 0.13 cm H2O/s

0.2 L/cm H2O

per cm H2O > 90 cm H2O > 150 cm H3O

carbon monoxide (single breath) Dead space volume Physiologic dead space : dead spacetidal volume ratio (rest) (exercise) Alveolar-arterial difference for O2 Semen Liquefaction Morphology Motility pH Spermatocrit Spermatocyte count Volume Stool Bulk Wet weight Dry weight Coproporphyrin Fat (on a diet containing 30 g fat/day) Nitrogen Urobilinogen Water Synovial fluid Cells Polymorphonuclear cells Crystals Fibrin clot Glucose Hyaluronic acid pH Protein Albumin a1-globulins a2-globulins b-globulins g-globulins Relative viscosity Uric acid Urine Acidity, titrable Ammonia Amylase Bence-Jones protein Bilirubin Calcium : Normal diet Low-calcium diet Chloride

50 25 ml 35% VT 20% VT 20 mmHg

Complete in 15 min 60% normal forms 75% motile forms 7.2 - 8.0 10% 50 million/dl 2.0 - 6.6 ml

< 197 g/24 h < 66.4 g/24 h 12 - 832 mg/24 h < 7.2 g/24 h or 30% dry weight < 2.2 g/24 h 40 - 280 mg/24 h Approximately 65%

200 cells/mm3 25% None None Same as serum 2.45 - 3.97 g/L 7.32 - 7.64 2.5 g/dL 63% 7% 7% 9% 14% 300 Same as serum

20-40 mEq/24 h 20 - 50 mEq/24 h 25 - 260 Somogyi unit/h None detected None detected 0.05 - 0.31 mEq/kg body weight/24 h 150 mg/24 h 120 - 240 mEq/24 h (varies with dietary intake)

Copper Creatinine Adults Children Creatinine

0-32 g/24 h 0 - 200 mg in 24 h 7 - 11 mg in 24 h 1.0 - 1.6 g/24 h or 15-25 mg/kg body weight/24 h None detected 16-300 mg/24 h None detected None detected 40 - 140 g/24 h 0 - 120 g/24 h None detected 50 - 1200 mOsm/L 4.6 - 8.0 None detected 0.8 - 2.0 g/24 h None detected 0-2.4 mg/24 h 50 - 250 g/24 h 10 - 30 g/24 h 25 - 100 mEq/24 h Non detected 10 - 150 mg/24 h 10 - 150 mEq/24 h (varies with dietary sodium intake) 1.003 - 1.030 600 - 700 mg/24 h 1.0 Enrich units/24 h

Glucose Qualitative Quantitative Haemoglobin Homogentisic acid Iron Lead Myoglobin Osmolality pH Phenylpyruvic acid, quantitative Phosphorus Porphobilinogen Qualitative Quantitative Porphyrin Coproporphyrin Uroporphyrin Potassium Protein Qualitative Quantitative Sodium Specific gravity Uric acid Urobilinogen