Important Information on the Release of PSAP-VII

Book 11 Gastroenterology and Nutrition

To be eligible to earn up to 15.5 hours of BCPS recertification credit for PSAP-VII
Book 11, you must complete and submit the online posttest by 11:59 PM (Central
Time) on October 15, 2012. Please note that test modules must be completed in
their entirety; partial recertification credit is not available for incomplete tests.

Posttest Information
All posttests for PSAP-VII are Web based. Access the posttest at www.accp.com/ce using your
e-mail address and password. Technical support is available from 8 AM to 5 PM (Central
Time) weekdays by calling (913) 492-3311.

PSAP-VII series errata are online at: www.accp.com/docs/psap/psap7-errata.pdf.

This book is divided into two modules—Gastroenterology and Nutrition I and Gastro-
enterology and Nutrition II. You may complete one or both modules. You may also save or
print your test responses before submission.

Posttest answers and explanations for the PSAP-VII Gastroenterology and Nutrition book will be
posted online October 19, 2012.

• If you submitted a posttest: After October 19, 2012, log on at www.accp.com/ce and return to the
posttest page. You will see a link to the explained answers.
• If you waived a posttest: After October 19, 2012, log on at www.accp.com/ce and return to the
posttest page. You will see a link to the explained answers.

Tests submitted for BCPS recertification credit will be processed and statements of con-
tinuing pharmacy education (CPE) credit for posttests will be available within 60 days
after the close of the BCPS testing period. Log on at www.accp.com/ce to see a link to
print CPE statements of credit.

Submitting the online test for BCPS recertification attests that you have completed
the test as an individual effort and not in collaboration with any other individual or
group. Failure to complete this test as an individual effort may jeopardize your ability
to use PSAP for BCPS recertification.
Director of Professional Development: Nancy M. Perrin, M.A., CAE
Associate Director of Professional Development: Wafa Y. Dahdal, Pharm.D., BCPS (AQ Cardiology)
Recertification Project Manager: Edward Alderman, B.S., B.A.
Graphic Designer/Desktop Publisher: Jen DeYoe, B.F.A.
Medical Editor: Kimma Sheldon, Ph.D., M.A.
Information Technology Project Manager: Brent Paloutzian, A.A.S.

For order information or questions, write or call:

Pharmacotherapy Self-Assessment Program
American College of Clinical Pharmacy
13000 W. 87th St. Parkway
Lenexa, KS 66215-4530
Telephone: (913) 492-3311
Fax: (913) 492-4922
E-mail: accp@accp.com

Notes
• The editors and publisher of PSAP recognize that the development of this volume of material offers many opportu-
nities for error. Despite our best efforts, some errors may persist into print. Drug dosage schedules are, we believe,
accurate and in accordance with current standards. Readers are advised, however, to check package inserts to
be certain that the recommended dosages and contraindications are in agreement with the recommendations of
PSAP. This is especially important for new, infrequently used, and highly toxic drugs.
• To facilitate further learning and research, this publication incorporates print and live hyperlinks to Web sites
administered by other organizations. The URLs provided are those of third parties not affiliated in any way with
ACCP. ACCP assumes no liability for material downloaded from or accessed on these Web sites.

Library of Congress Control Number: 2009942010

ISBN-13: 978-1-932658-44-6 (11-Volume Set)
Library of Congress Control Number: 2012936294
ISBN-13: 9781932658248 (BOOK 11, Gastroenterology and Nutrition)

Copyright © 2012 by the American College of Clinical Pharmacy. All rights reserved. This book is protected by
copyright. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form
or by any means, electronic or mechanical, including photocopy, without prior written permission of the American
College of Clinical Pharmacy.

Printed in the United States of America.

To cite PSAP properly:

Authors. Chapter name. In: Richardson M, Chant C, Chessman KH, Finks SW, Hemstreet BA, Hume AL, et al, eds.
Pharmacotherapy Self-Assessment Program, 7th ed. Book Title. Lenexa, KS: American College of Clinical Pharmacy,
year:page range.
Table of Contents
Illustrations in This Book iv
PSAP-VII Editorial Board v
Welcome vi
Faculty Potential COI Disclosure vii
Role of ACCP vii
Role of BPS vii
CPE and Program Instructions viii
Posttest Instructions viii
Gastroenterology and Nutrition I 1
Gastroenterology and Nutrition I Panel 3
Gastroenterology and Nutrition I Subscriber Evaluation 5
Management and Prevention
of Upper GI Bleeding
By Jiwon Kim, Pharm.D., BCPS, FCSHP
Learning Objectives 7
Introduction 7
Pathophysiology 7
Peptic Ulcer Disease 7
Baseline Review Resources 7
Abbreviations in This Chapter 8
Esophageal Varices 8
Stress-Related Mucosal Damage 8
Other Uncommon Causes of UGIB 9
Clinical Evaluation and Diagnosis 9
Endoscopy 9
Prognostic Assessment 10
Management of UGIB 11
Hemodynamic Resuscitation and
Preendoscopy Management 11
Endoscopic Management 11
Pharmacologic Management 12
Nonpharmacologic Management 15
Prevention of UGIB
Peptic Ulcer–Induced UGIB 15
H. pylori Eradication 16
Prevention of Variceal Bleeding 16
Prevention of SRMD 17
Role of the Pharmacist 17
Conclusion 19
Annotated Bibliography 19
Self-Assessment Questions 23
Inflammatory Bowel Disease
By Sheila M. Wilhelm, Pharm.D., BCPS; and
Pramodini Kale-Pradhan, Pharm.D.
Learning Objectives 27
Introduction 27
Etiology 27
PSAP-VII • Gastroenterology and Nutrition
Baseline Review Resources 27
Abbreviations in This Chapter 28
Diagnosis 28
Clinical Signs and Symptoms 28
Endoscopy and Imaging 29
Genetic Testing 29
Determining Disease Activity 29
Location 29
Severity 29
Disease Classification 29
Treatment Goals 31
Induction and Maintenance of Remission 31
Mucosal Healing 31
Treatment 32
Pharmacotherapy 32
Immunomodulators 32
Biologic Therapies 36
Antibiotics 37
Adjunctive Therapy 37
Top-down vs. Step-up Treatment Approaches 37
Surgery 38
Health Maintenance 38
Cancer Surveillance and Prevention 38
Osteoporosis Screening and Prevention 38
Vaccinations 39
Venous Thromboembolism Prophylaxis 39
Role of the Pharmacist 39
Adherence 39
Patient Education 39
Conclusion 39
Annotated Bibliography 39
Self-Assessment Questions 45
Irritable Bowel Syndrome
By Lisa Smith, Pharm.D., BCPS
Learning Objectives 49
Introduction 49
Risk Factors 49
Baseline Review Resources 49
Abbreviations in This Chapter 50
Symptoms 50
Rome Criteria and Diagnostic Testing 50
End Points in Clinical Trials 50
Placebo Effect in IBS Studies 52
Pathophysiology 52
Brain-Gut Axis 52
Inflammation and Immune System Activation 52
GI Microbiota 53
Genetic Polymorphisms 53
Psychological Stress and Psychiatric Illness 53
Nonpharmacologic Therapy 53
Diet 53
Exercise 54
Psychological Therapy 54
Pharmacologic Therapy 54
i Front Matter
 Selective C-2 Chloride Channel Activators 57
Serotonin-3 and Serotonin-4 Receptor Agonists 57
Antidepressants 58
Antibiotics 59
Probiotics 59
Complementary and Alternative Medicines 60
Emerging Treatments 60
Role of the Pharmacist 60
Conclusion 60
Annotated Bibliography 62
Self-Assessment Questions 65
Management of Constipation
and Postoperative Ileus
By Erik D. Maki, Pharm.D., BCPS; and
Geoffrey C. Wall, Pharm.D., FCCP, BCPS, CGP
Learning Objectives 69
Introduction 69
Baseline Review Resources 69
Abbreviations in This Chapter 70
Treatment of Chronic Constipation 70
Treatment of Opioid-Induced Constipation 71
Conclusion 73
Treatment of POI 74
Postoperative Ileus 74
Conclusion 76
Role of the Pharmacist 76
Annotated Bibliography 76
Self-Assessment Questions 81
Gastroenterology and Nutrition II 85
Gastroenterology and Nutrition II Panel 87
Gastroenterology and Nutrition II Subscriber Evaluation 89
Complications of Chronic
Liver Disease
By Rima A. Mohammad, Pharm.D., BCPS
Learning Objectives 91
Introduction 91
Baseline Review Resources 91
Abbreviations in This Chapter 92
Hepatic Encephalopathy 92
Therapy Goals and Treatment Options 92
Nutrition 95
Role of the Pharmacist 95
Ascites and Complications of Ascites 95
Therapy Goals and Treatment Options 96
Role of the Pharmacist 98
Portal Hypertension and Variceal Bleeding Prevention 99
Therapy Goals and Treatment Options 99
Role of the Pharmacist 100
Conclusion 100
Annotated Bibliography 101
Self-Assessment Questions 105
Front Matter
GERD in Adults
By Sharon See, Pharm.D., FCCP, BCPS; and
Regina Ginzburg, Pharm.D.
Learning Objectives 109
Introduction 109
Pathophysiology 109
Baseline Review Resources 109
Abbreviations in This Chapter 110
Diagnosis 110
Self-Care 111
Lifestyle Modifications 111
Over-the-counter Treatment 111
Primary Care 113
Symptomatic Treatment 113
Maintenance Therapy 114
Treatment of Extraesophageal Manifestations 114
Pregnancy 114
Secondary Care 115
Endoscopy 115
Secondary Agents 115
Surgery 115
Complications of PPIs 115
Clopidogrel and PPIs 116
Recommendations 117
Fractures 117
Hypomagnesemia 118
Clostridium difficile Infection 118
Pneumonia 118
Vitamin B12 Deficiency 119
Rebound Hypersecretion 119
Summary of Safety Data 119
Conclusion 119
Annotated Bibliography 120
Self-Assessment Questions 123
Infant Formulas
By Katherine Hammond Chessman, Pharm.D.,
FCCP, BCPS, BCNSP
Learning Objectives 127
Introduction 127
Baseline Review Resources 127
Abbreviations in This Chapter 128
Macronutrients in Infant Formulas 128
Carbohydrates 128
Proteins 128
Fats 131
Formula Types 131
Term Infant Formulas 131
Preterm Infant Formulas 132
Specialty Infant Formulas 135
Iron Fortification of Infant Formulas 136
Nutritional Supplements in Infant Formulas 136
Probiotics 136
Prebiotics 137
Formula Selection for Specific Conditions 137
Gastroesophageal Reflux 137
ii PSAP-VII • Gastroenterology and Nutrition
 Cow’s Milk-Protein Allergy 138
Chylous Effusions 138
Kidney Disease 138
Inborn Errors of Metabolism 139
Formula Choice for Disease Prevention 139
Atopic Disease 139
Type 1 Diabetes Mellitus 139
Role of the Pharmacist 140
Conclusion 140
Annotated Bibliography 140
Self-Assessment Questions 149

Sports Nutrition
By Mark A. Newnham, Pharm.D., BCPS, BCNSP
Learning Objectives 153
Introduction 153
Baseline Review Resources 153
Abbreviations in This Chapter 154
Study Design and Definitions for Sports Nutrition 154
Hydration 154
Heat-Related Illness and the Athlete 154
Dehydration and the Active Adult 155
Hydration Guidelines for the Athlete 155
Hydration and Electrolytes 155
Clinical Hyponatremia and the Athlete 155
Macronutrients and Exercise 156
Physical Activity as a Metabolic Stressor 156
Physical Exercise Capacity: Depletion of CHOs 157
Macronutrients and Performance 157
Nutrient Timing 157
Creatine 161
Ergogenic Supplements 162
Public Health Guidelines 163
Role of the Pharmacist 164
Conclusion 164
Annotated Bibliography 164
Self-Assessment Questions 171
Reference Values for Common Laboratory Tests a 184

PSAP-VII • Gastroenterology and Nutrition iii Front Matter

Illustrations in This Book
Algorithm for the management of patients with
nonvariceal upper GI bleeding 13

Treatment algorithm for the patient with Crohn disease 34

Algorithm for the management of the patient

with ulcerative colitis 35

Algorithm for the management of GERD 112

Energy expenditure in a trained athlete as

exercise intensity increases 156

Energy contribution by macronutrients

over time when exercising unfed at 65% to 70% of
maximal oxygen capacity (VO2max) 157

Front Matter iv PSAP-VII • Gastroenterology and Nutrition

Pharmacotherapy Self-Assessment Program
Seventh Edition
Editorial Board
Anne L. Hume, Pharm.D., FCCP, BCPS
Michelle M. Richardson, Pharm.D., FCCP, BCPS (Chair) Professor of Pharmacy
Special and Scientific Staff Department of Pharmacy Practice
William B. Schwartz Division of Nephrology University of Rhode Island
Tufts Medical Center Kingston, Rhode Island
Assistant Professor of Medicine Adjunct Professor of Family Medicine
Tufts University School of Medicine Alpert School of Medicine at Brown University
Boston, Massachusetts Providence, Rhode Island
Katherine Hammond Chessman, Pharm.D., Lisa C. Hutchison, Pharm.D., MPH, FCCP, BCPS
FCCP, BCPS, BCNSP (Vice Chair) Professor
Professor Pharmacy Practice
Department of Clinical Pharmacy and Outcome Sciences University of Arkansas for Medical Sciences
Pediatric Pharmacy Practice Residency Program Director Little Rock, Arkansas
South Carolina College of Pharmacy
Medical University of South Carolina Campus Emilie L. Karpiuk, Pharm.D., BCPS, BCOP
Clinical Pharmacy Specialist Oncology Pharmacist
Pediatrics/Pediatric Surgery Department of Pharmacy
MUSC Children’s Hospital Froedtert Hospital
Charleston, South Carolina Milwaukee, Wisconsin
Clarence Chant, Pharm.D., FCSHP, FCCP, BCPS Marianne McCollum, Ph.D., BSPharm, BCPS
Clinical Pharmacy Specialist/Leader, Critical Care/Research Interim Dean
Associate Scientist, Keenan Research Centre School of Pharmacy
of the Li Ka Shing Knowledge Institute Rueckert-Hartman College for Health Professions
St. Michael’s Hospital Regis University
Toronto, Ontario, Canada Denver, Colorado
Shannon W. Finks, Pharm.D., FCCP, BCPS (AQ Cardiology) Marisel Segarra-Newnham, Pharm.D., MPH, FCCP, BCPS
Associate Professor Clinical Pharmacy Specialist, Infectious Diseases
Department of Clinical Pharmacy Pharmacy Service
University of Tennessee College of Pharmacy Veterans Affairs Medical Center
Clinical Pharmacy Specialist, Cardiology West Palm Beach, Florida
Department of Pharmacy Clinical Assistant Professor of Pharmacy Practice
VA Medical Center University of Florida College of Pharmacy
Memphis, Tennessee Gainesville, Florida
Brian A. Hemstreet, Pharm.D., BCPS Jeffrey T. Sherer, Pharm.D., MPH, BCPS
Associate Professor Clinical Associate Professor
Director, Pharmaceutical Care Learning Center Department of Clinical Sciences and Administration
Department of Clinical Pharmacy University of Houston College of Pharmacy
University of Colorado Skaggs School of Houston, Texas
Pharmacy and Pharmaceutical Sciences
Aurora, Colorado

PSAP-VII • Gastroenterology and Nutrition v Front Matter

Welcome from the Editorial Board
On behalf of the Editorial Board, welcome to the
seventh edition of the Pharmacotherapy Self-Assessment
Program (PSAP-VII). For almost 2 decades, PSAP has
been the premier home study tool for pharmacists,
and we are pleased that you have chosen this edition
as a resource for continuing pharmacy education and/
or pharmacotherapy specialist recertification. As with
our predecessors, the PSAP-VII Editorial Board is
committed to providing readers with a high-quality
educational series to enhance their skills as pharmacists
and, ultimately, improve patient care.
Planning for each edition begins long before the first book
is released, and we are very excited about the changes
to PSAP-VII. Returning subscribers will immediately
notice a new typeface, new table formatting, and a new
baseline resources box intended to enhance the learning
experience. We have also improved the format of the self-
assessment questions, and we now include the original
question and response options with each explained
answer; this will enhance the author’s explanation and
make it easier for readers to continue learning after
taking the test. With respect to book content, topics
related to BPS Domain 2 (i.e., retrieval, generation,
interpretation, and dissemination of knowledge in
pharmacotherapy) and Domain 3 (i.e., health system–
related pharmacotherapy) are integrated throughout
all the PSAP-VII books. The Editorial Board feels this
more closely reflects actual practice and will better relate
Domain 2 and 3 topics to the clinical focus of each book.
Acknowledgments
ACCP and the PSAP-VII Editorial Board wish to express
our appreciation to the many authors and reviewers
who have contributed to this edition. The success of this
unique pharmacotherapy self-assessment program is the
direct result of the commitment of these outstanding
clinical pharmacotherapy specialists.
Front Matter
The Editorial Board and publications staff are deeply
indebted to the dedicated authors and reviewers who
make PSAP possible. The series is well known for its
timeliness: with books released every 3 months over a
3-year period, it takes a major effort from many dedicated
individuals to achieve the series’ mission. We gratefully
acknowledge the contribution of these individuals to
the publication and, ultimately, the education of our
pharmacist readers.
PSAP is a continuous work in progress, and the Editorial
Board welcomes constructive feedback from subscribers.
In fact, many of the changes in this edition are based
on suggestions from readers such as you. Because we
routinely evaluate and discuss reader commentary
in an effort to continually improve the usefulness of
PSAP, your opinions are very important. Constructive
comments can be shared through the online evaluations
or by contacting the PSAP publications staff at ACCP, or
any member of the Editorial Board.
Thank you again for choosing PSAP. It is our sincere
hope that this edition meets your educational needs and
is a great addition to your professional library.
Michelle M. Richardson, Pharm.D., FCCP, BCPS
Chair, PSAP-VII Editorial Board
vi PSAP-VII • Gastroenterology and Nutrition
Disclosure of Potential
Conflicts of Interest
Consultancies: Clarence Chant (Sunovion Canada); Catherine
M. Crill (Board of Pharmacy Specialties); Shannon W. Finks
(Novartis Pharmaceuticals); Randolph V. Fugit (Takeda Phar-
maceuticals, North American Center for Continuing Medi-
cal Education, Novartis Pharmaceuticals); Regina Ginzburg
(Institute for Family Health); Brian A. Hemstreet (Conexus
Health); Lisa C. Hutchison (Arkansas Medicaid, Arkansas
Foundation for Medical Care); Erik D. Maki (Iowa Pharmacy
Association); Michelle Richardson (Amgen, QualityMet-
ric); Marisel Segarra-Newnham (Tibotec Therapeutics, USP,
Annals of Pharmacotherapy); Jeffrey T. Sherer (Sturge-Weber
Foundation); Geoffrey C. Wall (Takeda Pharmaceuticals);
Stock Ownership: Katherine H. Chessman (Procter & Gamble
[spouse or significant other]); Lisa C. Hutchison (Cardi-
nal Health); Erik D. Maki (Walgreens [spouse or significant
other]);
Royalties: Lisa C. Hutchison (ASHP); Mark A. Newnham
(ACCP [spouse or significant other]);
Grants: Regina Ginzburg (Institute for Family Health); Brian
A. Hemstreet (AstraZeneca); Anne L. Hume (AHRQ [two
grants], HRSA); Lisa C. Hutchison (Boehringer Ingelheim,
National Institutes of Health); Erik D. Maki (Drake Univer-
sity); J. Mark Ruscin (Memorial Medical Foundation); Julie
M. Sease (Blue Cross Blue Shield of South Carolina Founda-
tion); Sharon See (HRSA Bureau or Primary Care); Geoffrey
C. Wall (Takeda Pharmaceuticals);
ROLE OF ACCP: ACCP developed the petition seek-
ing recognition of Pharmacotherapy as a specialty of
pharmacy and presented it to the Board of Pharmacy
Specialties (BPS). As part of its mission to provide leader-
ship, education, advocacy, and resources enabling clinical
pharmacists to achieve excellence in practice and research,
ACCP also helps pharmacotherapy specialists maintain
their certification through PSAP. ACCP reports success-
ful completion of PSAP examinations to BPS for recertifi-
cation credit. Neither ACCP nor its agents, including the
PSAP Editorial Board, authors, reviewers, or other staff,
has knowledge of specific examination content, areas of
emphasis, or any other information that would compro-
mise the integrity of the examination process.
PSAP-VII • Gastroenterology and Nutrition
Honoraria: Clarence Chant (Hospira Canada and Drug Intel-
ligence Inc.); Randolph V. Fugit (Takeda Pharmaceuticals,
North American Center for Continuing Medial Education);
Lisa C. Hutchison (American College of Clinical Pharmacy,
American Society of Health-System Pharmacists); Erik D.
Maki (The Collaborative Education Institute); Michelle Rich-
ardson (Amgen); Geoffrey C. Wall (Merck, Sanofi-Aventis,
Takeda Pharmaceuticals, ALK-Abello);
Other:
Nothing to Disclose: Kelly S. Bobo; Paulina Deming; Pramodini B.
Kale-Pradhan; Emilie Karpiuk; Jiwon Kim; Marianne McCol-
lum; Rima A. Mohammad; Steven Pass; Bhavik M. Shah; Lisa
S. Smith; Sheila M. Wilhelm; Joseph V. Ybarra; Nancy Yunker
ROLE OF BPS: The Board of Pharmacy Specialties (BPS)
is an autonomous division of the American Pharmacists
Association (APhA). BPS is totally separate and distinct from
ACCP. The Board, through its specialty councils, is responsible
for specialty examination content, administration, scoring,
and all other aspects of its certification programs. PSAP
has been approved by BPS for use in BCPS recertification.
Information about the BPS recertification process is available
at www.bpsweb.org/recertification/general.cfm.
Other questions regarding recertification should be directed to:
Board of Pharmacy Specialties
2215 Constitution Avenue NW
Washington, DC 20037
(202) 429-7591
www.bpsweb.org
vii Front Matter
Continuing Pharmacy Education
and Program Instructions
Continuing Pharmacy Education Credit:
The American College of Clinical Phar-
macy is accredited by the Accreditation
Council for Pharmacy Education as a
provider of continuing pharmacy edu-
cation. Subscribers to the Pharmaco-
therapy Self-Assessment Program, sev-
enth edition (PSAP-VII), can earn 15.5 contact hours of con-
tinuing pharmacy education credit for successfully completing
the Gastroenterology and Nutrition book. The universal activ-
ity numbers are: Gastroenterology and Nutrition I – 0217-
0000-12-007-H01-P, 7.5 contact hours; and Gastroenterology
and Nutrition II – 0217-0000-12-008-H01-P, 8.0 contact hours.
To receive BCPS recertification continuing pharmacy educa-
tion (CPE) credit for a PSAP-VII module, a posttest module
must be submitted during the 3-month period after the book’s
release. The first page of each print and online book lists the
deadline for BCPS subscribers to submit online tests in order
for CPE credit to apply toward recertification.
Answers are made available online to participants who com-
plete a posttest. Starting 3 days after the close of the BCPS test-
ing period, the CE Center page will show a link to view the sub-
mitted test with the correct and incorrect answers identified.
You will also see a link to a PDF file with the correct answers,
explained rationale, and reference citations supporting the
answer for each question.
To receive ACPE continuing pharmacy education (CPE) credit
for a PSAP-VII module, an online posttest must be submitted
for scoring. The appropriate CPE credit will be awarded for test
scores of 50% and greater. Answers are available online to par-
ticipants who complete a posttest starting 3 days after the close
of the BCPS testing period. After this date, the CE Center page
will show a link to view the answers to a submitted test. Your
test will be displayed with correct and incorrect answers identi-
fied. You will also see a hyperlink to a PDF file with the correct
answers and explanations for that test. Statements of CPE credit
are also available online starting 6 weeks after the close of the
BCPS testing period.

Tests submitted for BCPS recertification credit will be pro-
cessed and the results will be posted online within 6 weeks of
the published test deadline. Only completed tests are eligible
for credit; no partial or incomplete tests will be processed. The
passing point for BCPS recertification is based on a statistical
analysis of the examinations and answers submitted for each of
the modules. If you receive a passing score, that information will
be forwarded to the Board of Pharmacy Specialties (BPS), and a
printable online statement of continuing pharmacy education/
BCPS recertification credit will be made immediately available
to you. Questions regarding the number of hours required for
BCPS recertification should be directed to BPS at (202) 429-
7591 or www.bpsweb.org.
To receive electronic access to the explained answers to the
PSAP-VII questions without submitting a posttest, enter the
ACCP online CE Center and click on the PSAP product you
have purchased. You will see a link to the online waiver form. By
completing the waiver form for a module, you waive the oppor-
tunity to receive CPE credit for that module. After you submit a
waiver for a posttest, you will see a link to the PDF file that con-
tains the answers for the module you waived. Answers are avail-
able starting 3 days after the close of BCPS testing.

BOOK 11 Posttest Directions

Self-assessment questions are located at the end of each chapter. Each self-assessment question has four multiple-choice answer
options. Please read each question carefully and select the one best answer for each question.

For psychometric analysis, the chapters in each book are grouped into two or more test modules. To submit your answers for the
posttest module, go to www.accp.com and click on CE Center. Log in and select the PSAP-VII book (e.g., Gastroenterology and Nutrition)
that contains the posttest you wish to submit. You will be asked to select the appropriate credit type (BCPS or ACPE). You may save
your responses to the posttest and return to them later before submitting the test. The status of the test (e.g., saved, submitted) will
appear next to the module on the CE Center page. To be eligible for BCPS credit, completed posttests must be submitted by the
deadline listed on the first page of each print and online book.

Front Matter viii PSAP-VII • Gastroenterology and Nutrition

 Gastroenterology and Nutrition I Panel
Editorial Board Liaison Wayne State University
Clinical Pharmacy Specialist in Internal Medicine
Harper University Hospital
Brian A. Hemstreet, Pharm.D., BCPS Detroit, Michigan
Associate Professor
Director, Pharmaceutical Care Learning Center Pramodini Kale-Pradhan, Pharm.D.
Department of Clinical Pharmacy Professor (Clinical)
University of Colorado Skaggs School of Department of Pharmacy Practice
Pharmacy and Pharmaceutical Sciences Wayne State University
Aurora, Colorado Clinical Pharmacy Specialist in Infectious Diseases
St. John Hospital and Medical Center
Management and Prevention Detroit, Michigan
of GI Bleeding
Reviewers
Author
Nancy S. Yunker, Pharm.D., BCPS
Jiwon Kim, Pharm.D., BCPS, FCSHP Assistant Professor
Assistant Professor of Clinical Pharmacy Department of Pharmacotherapy and Outcomes Science
Titus Family Department of Clinical Pharmacy Virginia Commonwealth University School of Pharmacy
and Pharmaceutical Economics and Policy Clinical Pharmacy Specialist, Adult Internal Medicine
University of Southern California School of Pharmacy Virginia Commonwealth University Health System
Clinical Pharmacist Richmond, Virginia
Department of Pharmacy
Keck Medical Center of USC Anne L. Hume, Pharm.D., FCCP, BCPS
Los Angeles, California Professor of Pharmacy
Department of Pharmacy Practice
Reviewers University of Rhode Island
Kingston, Rhode Island
Clarence Chant, Pharm.D., FCSHP, FCCP, BCPS Adjunct Professor of Family Medicine
Clinical Pharmacy Specialist/Leader, Alpert School of Medicine at Brown University
Critical Care/Research Providence, Rhode Island
Associate Scientist, Keenan Research Centre of
the Li Ka Shing Knowledge Institute
St. Michael’s Hospital
Toronto, Ontario, Canada Irritable Bowel Syndrome

Steven E. Pass, Pharm.D., FCCP, FCCM, BCPS Author

Associate Professor and Vice Chair for Residency Programs
Department of Pharmacy Practice Lisa Smith, Pharm.D., BCPS
Texas Tech University Health Sciences Assistant Dean for Faculty Development
Center School of Pharmacy Associate Professor of Pharmacy
Dallas, Texas Wingate University School of Pharmacy
Wingate, North Carolina
Inflammatory Bowel Disease
Reviewers
Authors Julie M. Sease, Pharm.D., BCPS, BCACP, CDE
Associate Professor
Sheila M. Wilhelm, Pharm.D., BCPS Department of Pharmacy Practice
Clinical Assistant Professor Presbyterian College School of Pharmacy
Department of Pharmacy Practice Clinton, South Carolina

PSAP-VII • Gastroenterology and Nutrition 3 Gastroenterology and Nutrition I


Brian A. Hemstreet, Pharm.D., BCPS
Associate Professor
Director, Pharmaceutical Care Learning Center
Department of Clinical Pharmacy
University of Colorado Skaggs School of
Pharmacy and Pharmaceutical Sciences
Aurora, Colorado
The American College of Clinical Pharmacy and the authors
thank the following individuals for their careful review of
the Book 11, Gastroenterology and Nutrition I chapters:
H. Gwen Bartlett, Pharm.D., BCPS
Clinical Pharmacist III
Department of Pharmacy
St. Francis Health Center
Topeka, Kansas

Nicola G. Dahl, Pharm.D.

Management of Constipation Medical Writer
and Postoperative Ileus Kanab, Utah

Authors Julia Elenbaas, Pharm.D.

Anthem, Arizona
Erik D. Maki, Pharm.D., BCPS
Associate Professor
Department of Clinical Sciences
Drake University College of Pharmacy
and Health Sciences
Des Moines, Iowa

Geoffrey C. Wall, Pharm.D., FCCP, BCPS, CGP

Professor of Clinical Sciences
Drake University College of Pharmacy
and Health Sciences
Clinical Pharmacist
Iowa Inflammatory Bowel Disease Center
Des Moines, Iowa

Reviewers

Bhavik M. Shah, Pharm.D., BCPS

Assistant Professor
Department of Pharmacy Practice
Jefferson School of Pharmacy
Thomas Jefferson University
Philadelphia, Pennsylvania

Jeffrey T. Sherer, Pharm.D., MPH, BCPS

Clinical Associate Professor
Department of Clinical Sciences and Administration
University of Houston College of Pharmacy
Houston, Texas

Joseph V. Ybarra, Pharm.D., BCNSP

Nutrition Support Clinical Specialist
Vanderbilt Center for Human Nutrition
Department of Pharmaceutical Services
Vanderbilt University Medical Center
Nashville, Tennessee

Gastroenterology and Nutrition I 4 PSAP-VII • Gastroenterology and Nutrition

 Subscriber Evaluation—
Gastroenterology and Nutrition I
As you take the posttest for this module, also com-
plete the accompanying evaluation of the material’s
quality and usefulness and the achievement of learn-
ing objectives. Rate each item using this 5-point scale:
• Strongly agree
• Agree
• Neutral
• Disagree
• Strongly disagree presented were appropriate for a pharmacotherapy
Questions 1––11 apply to the Management and
Prevention of GI Bleeding chapter.
Use the 5-point scale to indicate your agreement with the
following statements:
1. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
2. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
3. The material presented was relevant and applicable
to my practice.
4. The content of the module was objective and
balanced.
5. The instructional materials were constructive for
helping me learn and retain the information.
6. The learning objectives were adequately assessed
by the self-assessment questions.
7. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter pre-
pared you to accomplish the following learning objectives:
8. Apply an understanding of the pathophysiology
and risk factors for upper gastrointestinal (GI)
bleeding to patient care.
9. Evaluate the most recent guidelines for manage-
ment and prevention of upper GI bleeding.
10. Devise a plan to effectively manage acute GI
bleeding and optimize treatment responses in the
individual patient.
11. Design plans for the prevention of upper GI bleed-
ing caused by commonly associated risk factors.
PSAP-VII • Gastroenterology and Nutrition
Questions 12–25 apply to the Inflammatory Bowel
Disease chapter.
Use the 5-point scale to indicate your agreement with the
following statements:
12. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
13. The scope, depth, and relevance of the material
specialist.
14. The material presented was relevant and applicable
to my practice.
15. The content of the module was objective and
balanced.
16. The instructional materials were constructive for
helping me learn and retain the information.
17. The learning objectives were adequately assessed
by the self-assessment questions.
18. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter pre-
pared you to accomplish the following learning objectives:
19. Classify the severity of Crohn disease (CD) and
ulcerative colitis (UC) on the basis of clinical fea-
tures and endoscopic and biopsy findings.
20. For an individual patient, design an optimal phar-
macotherapy plan for CD or UC.
21. Analyze risk factors for the development of adverse
effects related to the treatment of CD or UC and
develop a plan to avoid these effects.
22. Develop a pharmacotherapy plan for the treatment
of complications of CD or UC.
23. Evaluate the role of adjunctive agents in the treat-
ment of inflammatory bowel disease (IBD).
24. For an individual patient, design a health main-
tenance plan including appropriate surveillance,
prophylaxis, and treatment of potential complica-
tions of IBD.
25. Apply evidence from the primary literature on
adherence issues during induction versus mainte-
nance of remission of CD or UC.
Questions 26–37 apply to the Irritable Bowel
Syndrome chapter.
5 Gastroenterology and Nutrition I
Use the 5-point scale to indicate your agreement with the
following statements:
26. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
27. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
28. The material presented was relevant and applicable
to my practice.
29. The content of the module was objective and
balanced.
30. The instructional materials were constructive for
helping me learn and retain the information.
31. The learning objectives were adequately assessed
by the self-assessment questions.
32. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter pre-
pared you to accomplish the following learning objectives:
33. Assess methods used to diagnose irritable bowel
syndrome (IBS) and its associated common
comorbidities.
34. Distinguish which aspect of its multifactorial
pathophysiology might prompt the development of
IBS in a given patient.
35. Analyze the role of nonpharmacologic modalities
in the treatment of IBS.
36. Distinguish advantages and disadvantages of dif-
ferent methods for measuring outcomes in trials of
IBS treatment.
37. Construct a nonpharmacologic and pharmacologic
treatment plan for the patient with IBS.
43. The learning objectives were adequately assessed
by the self-assessment questions.
44. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter pre-
pared you to accomplish the following learning objectives:
45. Using patient characteristics including age and
etiology of constipation, apply available evidence
to achieve optimal outcomes in the treatment of
constipation.
46. Develop a pharmacotherapy plan that uses recently
approved drugs to treat acute constipation, includ-
ing opioid-induced constipation and postoperative
ileus (POI).
47. Assess the potential risks of lubiprostone, methyl
naltrexone, and alvimopan and how these risks
affect a patient’s treatment plan.
48. Identify the risks and benefits of newer treatment
options for POI, including gum chewing and alvi-
mopan, and apply that information to a specific
patient case.
Questions 49–51 apply to the entire learning
module.
49. How long (in total hours) did it take you to read
all the chapters (learning objectives, text, tables/
figures, and annotated bibliographies) for this
module?
50. How long (in total hours) did it take you to answer
all the questions for this module?
51. Do you have any comments on this module?

Questions 38–48 apply to the Management of

Constipation and Postoperative Ileus chapter.

Use the 5-point scale to indicate your agreement with the

following statements:
38. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
39. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
40. The material presented was relevant and applicable
to my practice.
41. The content of the module was objective and
balanced.
42. The instructional materials were constructive for
helping me learn and retain the information.

Gastroenterology and Nutrition I 6 PSAP-VII • Gastroenterology and Nutrition

 Gastroenterology and Nutrition II Panel
Editorial Board Liaison GERD in Adults

Brian A. Hemstreet, Pharm.D., BCPS Authors

Associate Professor
Director, Pharmaceutical Care Learning Center Sharon See, Pharm.D., FCCP, BCPS
Department of Clinical Pharmacy Associate Clinical Professor
University of Colorado Skaggs School of Department of Clinical Pharmacy Practice
Pharmacy and Pharmaceutical Sciences St. John’s University College of
Aurora, Colorado Pharmacy and Health Sciences
Queens, New York
Clinical Pharmacy Faculty
Complications of Chronic Beth Israel Residency in Urban Family Practice
Liver Disease New York, New York

Regina Ginzburg, Pharm.D.

Author Associate Clinical Professor
Department of Clinical Pharmacy Practice
Rima A. Mohammad, Pharm.D., BCPS St. John’s University College of
Assistant Professor Pharmacy and Health Sciences
Department of Pharmacy and Therapeutics Queens, New York
University of Pittsburgh School of Pharmacy Clinical Pharmacy Faculty
Pittsburgh, Pennsylvania Beth Israel Residency in Urban Family Practice
New York, New York
Reviewers
Reviewers
Kelly S. Bobo, Pharm.D., BCPS
Clinical Pharmacy Manager Shannon W. Finks, Pharm.D., FCCP,
Director, PGY1 and PGY2 Residency Programs BCPS (AQ Cardiology)
Department of Pharmacy Associate Professor
Le Bonheur Children’s Hospital Department of Clinical Pharmacy
Assistant Professor University of Tennessee College of Pharmacy
Department of Clinical Pharmacy Clinical Pharmacy Specialist, Cardiology
University of Tennessee College of Pharmacy Department of Pharmacy
Memphis, Tennessee VA Medical Center
Memphis, Tennessee
Paulina Deming, Pharm.D.
Clinical Assistant Professor Randolph V. Fugit, Pharm.D., BCPS
Department of Pharmacy Practice Clinical Pharmacy Specialist, Internal Medicine
University of New Mexico College of Pharmacy Department of Pharmacy
Pharmacist Clinician Veterans Affairs Medical Center, Eastern
Project ECHO Colorado Health System
University of New Mexico Health Sciences Center Denver, Colorado
Albuquerque, New Mexico Clinical Assistant Professor
Department of Clinical Pharmacy
Marisel Segarra-Newnham, Pharm.D., MPH, FCCP, BCPS University of Colorado Skaggs School of
Clinical Pharmacy Specialist, Infectious Diseases Pharmacy and Pharmaceutical Sciences
Pharmacy Service Aurora, Colorado
Veterans Affairs Medical Center
West Palm Beach, Florida
Clinical Assistant Professor of Pharmacy Practice
University of Florida College of Pharmacy
Gainesville, Florida

PSAP-VII • Gastroenterology and Nutrition 87 Gastroenterology and Nutrition II

Infant Formulas Southern Illinois University Edwardsville,
School of Pharmacy
Edwardsville, Illinois
Author
Katherine Hammond Chessman,
The American College of Clinical Pharmacy and the authors
Pharm.D., FCCP, BCPS, BCNSP
thank the following individuals for their careful review of
Professor
the Book 11, Gastroenterology and Nutrition II chapters:
Department of Clinical Pharmacy
and Outcome Sciences
Nicola G. Dahl, Pharm.D.
Pediatric Pharmacy Practice Residency Program Director
Medical Writer
South Carolina College of Pharmacy
Kanab, Utah
Medical University of South Carolina Campus
Clinical Pharmacy Specialist
Julia Elenbaas, Pharm.D.
Pediatrics/Pediatric Surgery
Anthem, Arizona
MUSC Children’s Hospital
Charleston, South Carolina
Mary Lee, Pharm.D., FCCP, BCPS
Vice President and Chief Academic Officer
Reviewers
Pharmacy and Health Sciences Education
Midwestern University
Catherine M. Crill, Pharm.D., FCCP, BCPS, BCNSP
Professor of Pharmacy Practice
Associate Professor
Midwestern University
Departments of Clinical Pharmacy and Pediatrics
Chicago College of Pharmacy
University of Tennessee Health Science Center
Downers Grove, Illinois
Director, Parenteral Nutrition Service
Clinical Pharmacy Specialist
Le Bonheur Children’s Medical Center
Memphis, Tennessee

Lisa C. Hutchison, Pharm.D., MPH, FCCP, BCPS

Professor
Pharmacy Practice
University of Arkansas for Medical Sciences
Little Rock, Arkansas

Sports Nutrition

Author

Mark A. Newnham, Pharm.D., BCPS, BCNSP

Clinical Coordinator, Pharmacy Services
Lawnwood Regional Medical Center and Heart Institute
Fort Pierce, Florida

Reviewers

Emilie L. Karpiuk, Pharm.D., BCPS, BCOP

Oncology Pharmacist
Department of Pharmacy
Froedtert Hospital
Milwaukee, Wisconsin

J. Mark Ruscin, Pharm.D., BCPS

Professor
Department of Pharmacy Practice

Gastroenterology and Nutrition II 88 PSAP-VII • Gastroenterology and Nutrition

 Subscriber Evaluation—
Gastroenterology and Nutrition II
As you take the posttest for this module, also com-
plete the accompanying evaluation of the material’s
quality and usefulness and the achievement of learn-
ing objectives. Rate each item using this 5-point scale:
• Strongly agree
• Agree
• Neutral
• Disagree
• Strongly disagree following statements:
Questions 1–11 apply to the Complications of
Chronic Liver Disease chapter.
Use the 5-point scale to indicate your agreement with the
following statements:
1. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
2. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
3. The material presented was relevant and applicable
to my practice.
4. The content of the module was objective and
balanced.
5. The instructional materials were constructive for
helping me learn and retain the information.
6. The learning objectives were adequately assessed by
the self-assessment questions.
7. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter
prepared you to accomplish the following learning objectives:
8. Apply results from clinical studies and guidelines to
the management of hepatic encephalopathy.
9. Design evidence-based treatment and prevention
regimens for patients with ascites or complications
of ascites such as spontaneous bacterial peritonitis
and hepatorenal syndrome.
10. Given recent guidelines on the management of
portal hypertension, justify the need for primary
and secondary prophylaxis of variceal bleeding in
patients with cirrhosis.
PSAP-VII • Gastroenterology and Nutrition
11. Assess and apply the role of the pharmacist in pro-
viding appropriate treatment recommendations to
health care providers and drug education to patients
regarding the management of complications caused
by chronic liver disease.
Questions 12–23 apply to the GERD in Adults
chapter.
Use the 5-point scale to indicate your agreement with the
12. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
13. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
14. The material presented was relevant and applicable
to my practice.
15. The content of the module was objective and
balanced.
16. The instructional materials were constructive for
helping me learn and retain the information.
17. The learning objectives were adequately assessed by
the self-assessment questions.
18. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter
prepared you to accomplish the following learning objectives:
19. Develop a comprehensive therapeutic plan for
a patient with gastroesophageal reflux disease
(GERD) using patient-specific information.
20. Analyze clinical evidence for the treatment of
GERD.
21. Determine the clinical impact of complications
from proton pump inhibitor (PPI) use for a patient
on the basis of the medical history.
22. Evaluate the safety and efficacy of concomitant use
of PPI and clopidogrel therapy for the patient with
GERD who requires antiplatelet therapy.
23. Distinguish patients with GERD who are appropri-
ate candidates for referral to a gastroenterologist.
89 Gastroenterology and Nutrition II
Questions 24–35 apply to the Infant Formulas
chapter.
Use the 5-point scale to indicate your agreement with the
following statements:
24. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
25. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
26. The material presented was relevant and applicable
to my practice.
27. The content of the module was objective and
balanced.
28. The instructional materials were constructive for
helping me learn and retain the information.
29. The learning objectives were adequately assessed by
the self-assessment questions.
30. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter
prepared you to accomplish the following learning objectives:
31. Assess the appropriate role of altered macronutrient
sources in infant nutrition.
32. Judge the appropriateness of the addition of various
nutrition supplements to infant formulas.
33. Distinguish specialty infant formulas on the basis of
their macronutrient composition.
34. Choose an appropriate formula for an infant with
a disease or condition requiring a specialty infant
formula.
35. Apply knowledge of the role of altered protein
sources in the prevention of disease, such as atopic
dermatitis and diabetes mellitus.
Questions 36–48 apply to the Sports Nutrition
chapter.
Use the 5-point scale to indicate your agreement with the
following statements:
36. The educational content of the material presented
was appropriate for a pharmacotherapy specialist.
37. The scope, depth, and relevance of the material
presented were appropriate for a pharmacotherapy
specialist.
38. The material presented was relevant and applicable
to my practice.
Gastroenterology and Nutrition II
39. The content of the module was objective and
balanced.
40. The instructional materials were constructive for
helping me learn and retain the information.
41. The learning objectives were adequately assessed by
the self-assessment questions.
42. The self-assessment questions were written clearly.
Use the 5-point scale to indicate whether this chapter
prepared you to accomplish the following learning objectives:
ss43. Evaluate the relative effects of carbohydrates
(CHOs) and fatty acids on aerobic athletic
performance.
44. Develop a recommendation to prevent dehydration
for an athlete during training and competition.
45. Evaluate the data supporting the addition of protein
to a CHO- and electrolyte-containing sports drink
for its effect on endurance exercise duration and
muscle glycogen recovery after exercise.
46. Develop a therapeutic plan for hydration and nutri-
ent timing for an athletic event of sufficient duration
to develop muscle glycogen depletion.
47. Develop a therapeutic plan for the application of
dietary protein guidelines for a resistance-training
athlete interested in gaining muscle mass.
48. Develop a pharmacotherapeutic recommendation
for an athlete who wishes to use a natural substance
as an ergogenic performance enhancer.
Questions 49–51 apply to the entire learning module.
49. How long (in total hours) did it take you to read
all the chapters (learning objectives, text, tables/
figures, and annotated bibliographies) for this
module?
50. How long (in total hours) did it take you to answer
all the questions for this module?
51. Do you have any comments on this module?
90 PSAP-VII • Gastroenterology and Nutrition
 Reference Values for Common Laboratory Tests a
Serum Chemistries Reference Range Hematology/Coagulation Reference Range
Albumin 3.5–5 g/dL (adults) Hematocrit 42% to 50% (males)
3.4–4.2 g/dL (young children) 36% to 45% (females)
Ammonia 30–70 mcg/dL
Hemoglobin 14–18 g/dL (males)
Amylase 60–180 units/L 12–16 g/dL (females)
Alanine aminotransferase (ALT) 0–35 international units/L International normalized ratio (INR) 0.9–1.1
Alkaline phosphatase (ALK) Varies with age: Mean corpuscular hemoglobin (MCH) 27–33 pg/cell
30–120 international units/L (adults)
150–420 international units/L (children) Mean corpuscular hemoglobin concentration (MCHC) 33–36 g/dL
Aspartate aminotransferase (AST) 8–42 international units/L Mean corpuscular volume (MCV) 80–96 f L
Bicarbonate (carbon dioxide content) 24–30 mEq/L Partial thromboplastin time (PTT) 21–45 seconds
Bilirubin, direct 0.1–0.3 mg/dL
Platelet count 150,000–450,000/mm3
Bilirubin, total 0.3–1.0 mg/dL
Prothrombin time (PT) 10–13 seconds
Blood urea nitrogen (BUN) 8–20 mg/dL (adults)
Lower in children Red blood cell count 4.5–5.9 × 106 cells/microliter (males)
4.1–5.1 × 106 cells/microliter (females)
Calcium, ionized 1.12–1.23 mmol/L
Reticulocyte count 0.5% to 2.5%
Calcium, total serum 8.5–10.8 mg/dL
White blood cell count 4.4–11.3 × 103 cells/mm3
Chloride 96–106 mEq/L
C-reactive protein < 0.8 mg/dL
Creatinine, serum 0.7–1.5 mg/dL (adults) Serum Lipids Reference Range
0.2–0.7 mg/dL (children)
Cholesterol, total < 200 mg/dL
Creatinine kinase 25–90 international units/L (male)
10–70 international units/L (female) HDL cholesterol > 40 mg/dL
Ferritin 22–322 ng/mL LDL cholesterol < 130 mg/dL
Gamma glutamyl transpeptidase 0–30 international units Triglycerides < 150 mg/dL
Glucose, serum 70–110 mg/dL Blood Gases Arterial Venous
Hemoglobin A1C 4% to 6% Partial pressure of carbon dioxide (Pco2) 35–45 mm Hg 42–55 mm Hg
Lactate dehydrogenase (LDH) 100–210 international units/L Partial pressure of oxygen (Po2) > 70 (80–100 mm Hg) 30–50 mm Hg
Lipase < 160 units/L
Oxygen saturation (Sao2) > 90% 60% to 85%
Magnesium 1.5–2.2 mEq/L
Serum bicarbonate 24–30 mEq/L 24–28 mEq/L
Osmolality, serum 280–295 mOsm/kg
Phosphorus 2.6–4.5 mg/dL (adults) Urinalysis
3.8–6.5 mg/dL (children) Leukocyte esterase, nitrite, protein, blood, ketones, bilirubin, glucose Negative
Potassium 3.5–5.0 mEq/L pH 4.5–8.0
Prealbumin 20–36 mg/dL Specific gravity 1.010–1.025
Sodium 135–145 mEq/L
Uric acid, serum 3.4–7 mg/dL (males)
2.4–6 mg/dL (females)

a
Values given in this table are commonly accepted reference ranges compiled from many sources. Patient-specific goals may differ depending on age, sex, clinical condition, and the laboratory methodology
used to perform the assay.
Information from: Ayers P, Warrington L. Diagnosis and treatment of simple acid-base disorders. Nutr Clin Pract 2008;23:122–7;
DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy: A Pathophysiologic Approach, 7th ed. New York: McGraw-Hill Medical, 2008;
Lee M. Basic Skills in Interpreting Laboratory Data, 4th ed. Bethesda, MD: American Society of Health-System Pharmacists, 2009; and
MUSC Health, Laboratory Services. Test Directory and Specimen Collection Handbook. Charleston, SC: MUSC Pathology and Laboratory Services, 2008–2009.