Serum, Plasma, and Whole Blood Chemistries Normal Adult Reference Range Determination Acetone Conventional Units 0.3-2.

0 mg/dL SI Units 51.6-344.0/umol/L Clinical Significance Increased Diabetic ketoacidosis Toxemia of Pregrnancy Carbohydrate-free diet High-fat Decreased

Acid, total phosphatase

Males: 2-12UL Females: 0.3-9.2UL

Males: 2-12UL Females: 0.39.2UL 2.5-3.37 ug/L

Acid, phosphatase, prostatic—RIA Alkaline phosphatase

2.5-3.37 ng/mL

Carcinoma of prostate Advance Paget’s disease Hyperparathyroidism Gaucher’s disease Carcinoma of prostrate Carcinoma of prostate

Adults:50-120 UL

50-120 UL

Conditions reflecting increased osteoblastic activity of bone Rickets Hyperparathyroidism Hepatic disease Bone disease Pituitary-dependent Cushing’s syndrome Adrenocortical tumor Adrenal insufficiency

Adrenocorticotropic hormone (ACTH)

Hepatic:>25% Combined:10%-25%

(plasma) – RIA Aldosterone (plasma) – RIA Alpha-1-fetoprotein

Skeletal: <10% <50 pg/ml Supine: 3-10 ng/dL Upright: 5-30 ng/dL Adrenal vein: 200800 ng/dL <15ng/mL

<50 ng/L 0.08-0.30nmol/L 0.14-0.90nmol/L 5.54-22.16nmol/L 15 ug/L

Ectopic ACTH syndrome Primary adrenal atrophy Primary aldosteronism Secondary aldosteronism Hepatocarcinoma Metastatic carcinoma of liver Germinal cell carcinoma of the testicle or ovary Fetal neural tube defects— elevation in maternal serum Severe liver disease Hepatic decompensation Acute pancreatitis Mumps Duodenal ulcer Carcinoma of head of pancreas Prolonged elevation with pseudocyst of pancreas Increased by medications that constrict pancreatic duct sphincters: morphine, codeine, cohlinergics Same conditions as AST (SGOT), butincrease is more marked in liver disease that AST (SGOT) Myocardial infarction

secondary to hypopituitarism Addison’s disease

Ammonia (plasma) Amylase

15-45 ug/dL (varies with method) 60-10 Somogyi U/dl

11-32/umol/L 111-296U/L

Chronic pancreatitis Pancreatic fibrosis and atrophy Cirrhosis of liver Pregnancy (2nd and 3rd trimesters)

ALT (alanine aminotransferase), formerly SGPT AST (aspartate

Males: 10-40 U/mL Females: 8-35 U/mL Males: 10-40 U/L

Males: 0.170.68ukat/L Females: 0.140.60ukat/L Males: ).34-0.68

aminotransferase), formerly SGOT Biluribin

Females: 15-30 U/L Total: 0.3-1.0 mg/dL Direct: 0.1-0.4 mg/dL Indirect: 0.1-0.4 mg/dL 85-95 mm Hg

ukat/L Females0.25-0.51 ukat/L 5-17umol/L 1.7-3.7 umol/L 3.4-11.2 umol/L

Skeletal muscle disease Liver disease Hemolytic anemia (indirect) Biliary obstruction and disease Hepatocellular damage (hepatitis) Pernicious anemia Hemolytic disease of newborn Polycythemia Anemia Cardiac or pulmonary disease Cardiac decompensation Chronic obstructive lung disease Respiratory acidosis Metabolic alkalosis Vomiting Hyperventilation Fever Intestinal Obstruction Tumor or hyperplasia of parathyroid Hypervitaminosis D Multiple myeloma Nepritis with Uremia Malignant tumors Respiratory alkalosis Metabolic acidosis Uremia Diabetic acidosis Hemorrhage Nephritis Hypoparathyroidism Diarrhea Celiac disease Vitamin D deficiency Acute pancreatitis Nephrosis

Blood gases Oxygen, arterial (whole blood): Partial pressure (PaO2) Saturation (SaO2)

10.64-12.64 kPa

95%-99%

Volume fraction: 0.95-0.99 4.66-5.99 kPa 7.35-7.45

Carbon dioxide, arterial (whole blood) partial pressure (PaCO2) pH (whole blood, arterial)

35-45 mm Hg 7.35-7.45

Calcium

8.6-10.2 mg/dL

2.15-2.55 mmol/L

CO2 venous

Adults: 24-32 mEq/L 24-32 mmol/L Infants: 18-24 18-24 mmol/L mEq/L 97-107 mEq/L 97/107mmol/L

Sarcoidosis Hyperthyroidism Skeletal immobilization Excess calcium intake: milk alkali syndrome Tetany Respiratory disease Intestinal obstruction Vomiting Nephrosis Nephritis Urinary obstruction Cardiac decompensation Anemia

After parathyroidectomy

Chloride

Cholesterol

150-200mg/dL

3.9-5.2 mmol/L

Lipemia Obstructive jaundice Diabetes Hypothyroidism Myocardial infarction Skeletal muscle diseases Intramuscular injections Crush syndrome Hypothyroidism Alcoholic myopathy Cerebrovascular disease

Acidosis Nephritis Eclampsia Diarrhea Anesthesia Diabetes mellitus Diarrhea Vomiting Pneumonia Heavy metal poisoning Cushing’s syndrome Intestinal obstruction Febrile conditions Pernicious anemia Hemolytic anemia Hyperthyroidism Severe infection Terminal states of debilitating disease

Creatine phospokinase (CPK)

Males: 50-325 mU/mL Females: 50-250 mU/mL

50-325 U/L 50-250 U/L

Creatine phosphokinase isoenzymes Creatinine Creatinine clearance

MM band present (skeletal muscle)MB band absent (heart muscle) 0.7-1.4 mg/dL Males: 85125mL/min Females: 75115mL/min Fasting: 60-110 mg/dL Postprandial (2h): 65-140 mg/dL

MB band increased in myocardial infarction, ischemia 62-124 umol/L 1.42-2.08 mL/s 1.25-1.92 mL/s 3.3-6.05 mmol/L 3.58-7.7 mmol/L Diabetes mellitus Nephritis Hyperthyroidism Early hyperpituitarism Cerebral lesions Infections Pregnancy Uremia Two-hour value > 200 mg/dL (11.1 mmol/L) is diagnostic for diabetes mellitus Hyperinsulinism Hypothyroidism Late hyperpituitarism Pernicious vomiting Addison’s disease Extensive hepatic damage Decreased 2 and 3 hour values may occur with hypoglycemia mellitus Nephritis Chronic renal disease Kidney diseases

Glucose

Glucose tolerance (oral)

Features of a normal response: 1. Normal fasting between 60/110mg/dL 2. No sugar in urine 3. Upper limits of normal: Fasting = 125 1 hour = 190 2 hours = 140

3.3-6.05 mmol/L

6.88 mmol/L 10.45 mmol/L 7.70 mmol/L

3 hours = 125 Glycohemoglobin (GHB, hemoglobin A1c, hemoglobin A1) High-density lipoprotein cholesterol(HDL cholesterol) Immunoglobulin A

6.88 mmol/L Suboptimal glucose control HDL cholesterol is lower in patient with increased risk for coronary heart disease Ataxia tenagiectasis Agammaglobulinemia Hypogammaglobulinemia, transient Dysgammaglobulinemia Protein-losing enteropathies

Nondiabetics and diabetics with good control: 4.4 % - 6.4% Males: 35-70 mg/dL 0.91-1.81 mmol/L Females: 350.91-2.20 mmol/L 85mg/dL Adults: 85-385 mg/dL (in children the normals are lower and vary with age) 0-14 mg/dL 100-700 ng/mL Adults: 565-1765 mg/dL 0.85-3.85g/L

Gamma A myeloma Wiskott-Aldrich syndrome Autoimmune disease Hepatic cirrhosis

Immunoglobulin D Immunoglobulin E Immunoglobulin G

0.140mg/L 100-700ug/L 6.35-14 g/L

IgD multiple myeloma Some patients with chronic infectious diseases Allergic patients and those with parasitic infections IgG myeloma Following hyperimmunization Autoimmune disease states Chronic infections Waldenström’s macroglobulinemia Parasitic infections Hepatitis

Immunoglobulin M

Adults: 55375mg/dL

0.4-2.8 g/L

Congenital and acquired hypogammaglobulinemia Some malabsorption syndromes Extensive protein loss Agammaglobulinemia Some IgG and IgA myeloma Chronic lymphatic

leukemia Lactic dehydrogenase (LDH) Lead (whole blood) Lipase 90-176 mU/mL 90-176 U/L Untreated pernicious anemia Myocardial infarction Pulmonary infarction Liver disease Lead poisoning Acute and chronic pancreatitis Biliary obstruction Cirrhosis Hepatitis Peptic ulcer LDL cholesterol is highe in patients with increased risk for coronary heart disease

Up to 40 ug/dL <200 U/mL

Up to umol/L <200 U/L

Low-density lipoprotein cholesterol (LDL cholesterol)

Magnesium

mg/dL desirable levels: <160 if no coronary artery disease (CAD) and <2 risk factors <100 if CAD present 1.3-2.3 mg/dL

0.62-0.95 mmol/L

Excess ingestin of magnesiumcontaining antacids Phenylketonuria

Phenylalanine

Phosphorus, inorganic Potassium

1.2-3.5 mg/dL 1st week 0.7-3.5 mg/dL thereafter 20-90IU/L 2.5-4.5 mg/dL 3.5-5mEq/L

0.07-0.21mmol/L 0.04-0.21 mmol/L

Chronic alcoholism Severe renal disease Diarrhea Defective growth Chronic renal failure

0.8-1.45 mmol/L 3.5-5mmol/L

Chronic nephritis Hypoparathyroidism Renal Failure

Hyperparathyroidism

Prostrate-specific antigen Protein, total Protein, Albumin Protein, Globulin Sodium T3 (triodothyronine) uptake

<4 ng/mL 6-8 gm/dL 4-5.5 g/dL 1.7-3.3 g/dL 135-145 mEq/L 24%-34% 60-80 g/L 40-55 g/L 17-33 g/L 135-145 mmol/L Relative uptake fraction: 0.24-0.34

Acidosis Cell lysis Tissue breakdown or hemolysis Prostatic cancer, benign prostatic hyperplasia, prostatitis Hemoconcentration Shock Globulin fraction increased in multiple myeloma, chronic infection, liver disease Hemoconcentration Nephritis Pyloric obstruction Hyperhyroidism Thyroxine-binding globulin (TBG) deficiency Androgens and anabolic steroids Hyperthyroidism Thyroiditis Elevated thyroxine-binding proteins caused by oral contraceptives Pregnancy

Vitamin D deficiency GI losses Diuretic administration Malnutrition Hemorrhage Loss of plasma from burns Proteinuria Alkali deficit Addison’s disease Myxedema Hypothyroidism Pregnancy TBG excess Estrogens and antiovulatory drugs Primary and pituitary hypothyroidism Idiopathic involvement Cases of diminished thyroxine-binding proteins caused by androgenic and anabolic steroids Hypoproteinemia Nephritic syndrome Trytophan-specific malabsorption syndrome Severe hepatic failure

T4 (thyroxine) – RIA

5-11 ug/dL

65-138nmol/L

Triglycerides Urea nitrogen (BUN)

100-200 mg/dL 10-20 mg/dL

1.13-3.8mmol/L 3.6-7.2 mmol/L Acute gomerulonephritis

Uric acid

2.5-8mg/dL

0.15-0mmol/L

Obstructive uropathy Mercury poisoning Nephritic syndrome Gouty arthritis Acute leukemia Lymphomas treated by chemotherapy Toxemia of pregnancy Clinical Significance

Pregnancy Defective tubular reabsorption

Immunodiagnostic Test Determination Anti ds-DNA antibody Antinuclear antibody Anti-Smith antibody C reactive protein Hepatitis A virus antibodies, IgM (HAVAb/Igm) Hepatitis B surface antigen (HBsAg) Hepatitis B surface antibody (HBsAb) Rheumatoid factor

Normal Value <70 U by enzyme-linked immunosorbent assay (ELISA) <1:20 by indirect fluorescence Negative, <1:40 Negative <0.8 mg/dL Negative Negative Negative Negative or less than 40 IU/mL

Valuable in supporting diagnosis or monitoring disease activity and prognosis of systemic lupus erythematosus (SLE) Increased in SLE, chronic hepatitis, scleroderma, leukemia, and mononucleosis Highly diagnostic of SLE Increase indicates active inflammation Positive in acute-stage hepatitis A: develops early in disease Positive in acute-stage hepatitis B Positive if previous exposure and immunity to hepatitis B Elevated in rheumatoid arthritis, lupus endocarditis, tuberculosis, syphilis, sarcoidosis, cancer

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