TEST Sodium

REFERENCE 135 – 145 meq/L

 Hypernatremia: Diabetes insipidus Severe vomiting Diarrhea Aldosteronism (Sodium Retention) Hyperkalemia

CLINICAL SIGNIFICANCE

Potassium

3.8 – 5.5 meq/L

Chloride

100 – 108 meq/L

Hyperchloremia: Bicarbonate loss due to diarrhea / primary aldosteronism Hypercalcemia: Hyperparathyroidism Paget’s Bone Myeloma (fracture)

Calcium

Unionized: 8.9 – 10.1 mg/dL Ionized: 4 – 5 mg/dL

RBC

4 – 6 million/mcL

 Drugs that can increase sodium: 1. Lithium 2. Vasopressin 3. Corticosteroids 4. Methyldopa 5. Hydralazine 6. Reserpine Hypokalemia Increase K levels: 1. Repeated fist clenching before blood extraction. 2. Delaying blood flow after tourniquet. 3. Spironolactone 4. Pen G Therapy (IM) 5. Renal toxicity from amphotericin B and tetracycline. Hypochloremia: Increase of Increase chloride levels: bicarbonate 1. Ammonium chloride 2. Cholestyramine 3. Boric acid 4. Phenylbutazone 5. Oxyphenbutazone Hypocalcemia: Increase calcium levels: Hypoparathyroidism 1. Excessive ingestion of Parathyroidectomy Vitamin D Acute pancreatitis 2. Use of androgens Malabsorption of calcium 3. Calciferol (Rowachol: Activated calcium salts) 4. Estrogen 5. Thiazide diuretics Anemia and Bleeding Mixing with anticoagulants

 Hyponatremia: Sweating in diuretic treatment

INTERFERING FACTOR

 Drugs that can lower sodium levels: 1. Diuretics

Decrease K levels: 1. Insulin and glucose administration 2. Diuretics

Decrease chloride levels: 1. Thiazide diuretics 2. Furosemide 3. Bicarbonate 4. Prolong infusion of D5 W. False decrease calcium: 1. Chronic laxative use 2. Excessive transfusion of blood 3. Corticosteroids 4. Prolong tourniquet application

Leukocytosis – bacterial infection  Leukopenia  Gangrene  Tissue necrosis (due to burns)  Acute MI Mixing with anticoagulants Mixing with anticoagulants WBC 4000 – 10000 / mcL Differential count: Neutrophils 48 – 77% Lymphocytes 16 –43% Monocytes 0 – 1% Eosinophils 0 – 7% Basophils 0 – 2% Infection Platelets 140.due to iron deficiency (Thalassemia) Decrease in WBC: .” – Phil 4:13 [ .deficiency in folate Megaloblastic anemia .deficiency in Vit.Hemoglobin Hematocrit RBC Index M: 14 – 18 g/dL F: 12 – 16 g/dL M: 42 – 54% F: 38 – 47% MCV: 84 – 99 pg MCH: 26 – 32 pg MCHC: 30 – 36 g/dL Polycythemia vera Polycythemia vera MCV: Macrocytic anemia .000 per mcL Thrombocytosis . Thrombocytopenia .hemorrhage infection & cancer iron deficiency Anemia. B12 Anemia Anemia MCV & MCHC: Microcytic anemia .000 – 400.a plastic / hypoplastic bone marrow depression  Dengue “I can do all things through Christ who strengthens me.Bone marrow depression (leukopenia) due to viral infection or reaction to drugs.