Table 748.3 Abbreviations for Specimens in Table 748.

5
S Serum (C) Citrate
P Plasma (O) Oxalate
(H) Heparin W Whole blood
(LiH) Lithium heparin (NH4H) Ammonium heparinate
(E) Ethylenediaminetetraacetic acid (EDTA)

Table 748.4 Key to Comments Section of Table 748.5

30°C, 37°C Temperature of enzymatic analysis (Celsius) l Fluorometric method
a Values obtained are significantly method dependent m Fluorescence-activated cell sorting (FACS)
b Values in older males are higher than those in older n Fluorescence polarization
females
o Gas chromatography
c Values in older females are higher than those in
p High-performance liquid chromatography (HPLC)
older males
q Indirect fluorescence antibody (IFA) assay
d Atomic absorption
r Ion-selective electrode
e Borate affinity chromatography
s Nephelometry
f Cation-exchange chromatography
t Optical density
g Vitros, a proprietary analytic system of Ortho
Clinical Diagnostics u Radial immunodiffusion (RID)
i Electrophoresis v Radioimmunoassay (RIA)
j Enzymatic assay w Spectrophotometry
k Enzyme-amplified immunoassay

Table 748.5 Reference Intervals*

ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
COMPLETE BLOOD COUNT
Hematocrit (HCT, Hct) W(E) % of packed red Volume fraction (V red
cells (V red cells/V whole blood)
cells/V whole
blood cells × 100)
Calculated from mean 0-30 days 44-70% ×0.01 0.44-0.70
corpuscular volume 1-23 mo 32-42% 0.32-0.42
(MCV) and RBC 2-9 yr 33-43% 0.33-0.43
count (electronic 10-17 yr M 36-47% 0.36-0.47
displacement or laser) F 35-45% 0.35-0.45
>18-99 yr M 42-52% 0.42-0.52
F 37-47% 0.37-0.47
Hemoglobin (Hb) W(E) g/dL mmol/L
0-30 days 15.0-24.0 ×0.155 2.32-3.72 MW Hb =
1-23 mo 10.5-14.0 1.63-2.17 64,500
2-9 yr 11.5-14.5 1.78-2.25
10-17 yr M 12.5-16.1 1.93-2.50
F 12.0-15.0 1.86-2.32
>18-99 yr M 13.5-18.0 2.09-2.79
F 12.5-16.0 1.93-2.48
P(H) See Chemical Elements
Erythrocyte indices
(RBC indices)
Mean corpuscular W(E) pg/cell fmol/cell
hemoglobin (MCH) 0-30 days 33-39 ×0.0155 0.51-0.60
1-23 mo 24-30 0.37-0.46
2-9 yr 25-31 0.39-0.48
10-17 yr M 26-32 0.26-0.32
F 26-32 0.26-0.32
>18-99 yr M 27-31 0.27-0.31
F 27-31 0.27-0.31
Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Mean corpuscular W(E) % Hb/cell or g mmol Hb/L RBC
hemoglobin Hb/dL RBC
concentration (MCHC) 32-36 ×0.155 4.96-5.58
Mean corpuscular W(E) μm3 fL
volume (MCV) 0-30 days 99-115 ×1 99-115
1-23 mo 72-88 72-88
2-9 yr 76-90 76-90
10-17 yr 78-95 78-95
>18-99 yr 78-100 78-100
Leukocyte count W(E) ×1,000 cells/mm3 (μL) ×109 cells/L
(WBC count) 0-30 days 9.1-34.0 ×1 9.1-34.0
1-23 mo 6.0-14.0 6.0-14.0
2-9 yr 4.0-12.0 45.0-12.0
10-17 yr 4.0-10.5 4.0-10.5
18-99 yr 4.0-10.5 4.0-10.5
Leukocyte differential W(E) % Number fraction
Myelocytes 0% ×0.01 0
Neutrophils (“bands”) 3-5% 0.03-0.05
Neutrophils (“segs”) 54-62% 0.54-0.62
Lymphocytes 25-33% 0.25-0.33
Monocytes 3-7% 0.03-0.07
Eosinophils 1-3% 0.01-0.03
Basophils 0-0.75% 0-0.0075
Cells/mm3 (μL) ×106 cells/L
Myelocytes 0 ×1 0
Neutrophils (“bands”) 150-400 150-400
Neutrophils (“segs”) 3,000-5,800 3,000-5,800
Lymphocytes 1,500-3,000 1,500-3,000
Monocytes 285-500 285-500
Eosinophils 50-250 50-250
Basophils 15-50 15-50
Platelet count W(E) ×10 /mm (μL)
3 3
×109/L
(thrombocyte count) Newborn 84-478 (after 1 wk, same as ×106 84-478 (Buck, 1996)
adult)
Adult 150-400 150-400
Reticulocyte count W(E,H,O) Adults 0.5-1.5% of erythrocytes or ×0.01 0.005-0.015 (number
25,000-75,000/mm3 (μL) ×106 fraction) or 25,000-
75,000 × 106/L
% Number fraction
W(cap) 1 day 0.4-6.0 ×0.01 0.004-0.060
7 days <0.1-1.3 <0.001-0.013
1-4 wk <1.0-1.2 <0.001-0.012
5-6 wk <0.1-2.4 <0.001-0.024
7-8 wk 0.1-2.9 0.001-0.029
9-10 wk <0.1-2.6 <0.001-0.026
11-12 wk 0.1-1.3 0.001-0.013
Alanine transaminase S 0-7 days 6-40 U/L ×1 6-40 U/L 37°C, bgw
(aminotransferase) 8-30 days M 10-40 10-40 (Soldin,
(ALT, SGPT) F 8-32 8-32 Savwoir, Guo,
1-12 mo 12-45 12-45 1997; Lockitch
1-19 yr 5-45 5-45 Halstead,
Albersheim,
Albumin (BCG) P Premature 1 day 1.8-3.0 g/dL ×10 18-30 g/dL
1988)
Full term <6 2.5-3.4 25-34
g (Meites, 1989;
days
Soldin and
8 days-1 yr 1.9-4.9 19-49
Morse, 1998;
1-3 yr 3.4-4.2 34-42
Lockitch
4-19 yr 3.5-5.6 35-56
Halstead,
Albersheim,
1988)
Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Ammonia P 11-35 μmol/L ×1 11-35 μmol/L g
Amylase S,P 1-19 yr 30-100 U/L ×1 30-100 U/L (Lockitch
% pancreatic % pancreatic fraction Halstead,
fraction Albersheim,
1988; Gillard
et al, 1983)
Amylase isoenzymes S,P(H) Cord-8 mo 0-34% ×0.01 0-0.34%
9 mo-4 yr 5-56% 0.05-0.56%
5-19 yr 23-59% 0.23-0.59%
Anion gap (sodium P(H) 7-16 mEq/L ×1 7-16 mEq/L
− [chloride +
bicarbonate])
Antideoxyribonuclease S Age Upper limit of Upper limit of normal
B titer (anti-DNase B normal
titer) 4-6 yr 240-480 U ×1 240-480 U (Kaplan et al,
7-12 yr 480-800 U 480-800 U 1998)
Antidiuretic hormone P(E) Plasma Plasma ADH Plasma ADH ng/L
(hADH, vasopressin) osmolarity (pg/mL)
(mOsm/kg)
270-280 <1.5 ×1 <1.5
280-285 <2.5 <2.5
285-290 1-5 1-5
290-295 2-7 2-7
295-300 4-12 4-12
Antistreptolysin-O titer S Age Upper limit of Upper limit of normal
(ASO titer) normal
2-5 yr 120-160 Todd units ×1 120-160 Todd units (Kaplan et al,
6-9 yr 240 Todd units 240 Todd units 1998)
10-12 yr 320 Todd units 320 Todd units
Aspartate transaminase S U/L U/L
(aminotransferase) 0-7 days M 30-100 ×1 35-100 37°C, g (Soldin,
(AST, SGOT) F 24-95 24-95 Savwoir, Guo,
8-30 days 22-71 22-71 1997; Lockitch
1-12 mo 22-63 22-63 Halstead,
1-3 yr 20-60 20-60 Albersheim,
3-9 yr 15-50 15-50 1988)
10-15 yr 10-40 10-40
16-19 yr M 15-45 15-45
F 5-30 5-30
Base excess W(H) mmol/L mmol/L
Newborn (−10)-(−2) ×1 (−10)-(−2)
Infant (−7)-(−1) (−7)-(−1)
Child (−4)-(+2) (−4)-(+2)
Thereafter (−3)-(+3) (−3)-(−3)
Bicarbonate S,P mmol/L mmol/L
Arterial 21-28 ×1 21-28
Venous 22-29 22-29
Bilirubin, total S mg/dL μmol/L
Newborn See Bhutani ×17.1 (Bhutani et al,
nomogram 1999)
(Fig. 748.3)
1 mo-adult <1.0 <17
C-reactive protein (high S (Soldin et al,
sensitivity) M (mg/dL) F (mg/dL) M (mg/L) F (mg/L) 2004)
0-90 days 0.08-1.58 0.09-1.58 ×10 0.8-15.8 0.9-15.8
91 days-12 mo 0.08-1.12 0.05-0.79 0.8-11.2 0.5-7.9
13 mo-3 yr 0.08-1.12 0.08-0.79 0.8-11.2 0.8-7.9
4-10 yr 0.06-0.79 0.5-1.0 0.6-7.9 0.5-10.0
11-14 yr 0.08-0.76 0.06-0.81 0.8-7.6 0.6-8.1
15-18 yr 0.04-0.79 0.06-0.79 0.4-7.9 0.6-7.9
Continued
Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Calcium, ionized (Ca) S,P(H),W(H) mg/dL mmol/L
Cord blood 5.0-6.0 ×0.25 1.25-1.50
Newborn, 4.3-5.1 1.07-1.27
3-24 hr
24-48 hr 4.0-4.7 1.00-1.17
Thereafter 4.8-4.92 1.12-1.23
or 2.24-2.46 Eq/L ×0.5 1.12-1.23
Calcium, total S mg/dL mmol/L
Cord blood 9.0-11.5 ×0.25 2.25-2.88
Newborn, 9.0-10.6 2.3-2.65
3-24 hr
24-48 hr 7.0-12.0 1.75-3.00
4-7 days 9.0-10.9 2.25-2.73
Child 8.8-10.8 2.20-2.70
Thereafter 8.4-10.2 2.10-2.55
Carbon dioxide, partial W(H) mm Hg kPa
pressure (PCO2) Newborn 27-40 ×0.1333 3.6-5.3
Infant 27-41 3.6-5.5
Thereafter M 35-48 4.7-6.4
F 32-45 4.3-6.0
Carbon monoxide W(E) Nonsmoker <2% HbCO ×0.01 HbCO fraction <0.02
(carboxyhemoglobin) Smoker <10% <0.10
Lethal >50% >0.5
Chloride S,P(H) Cord blood 96-104 mmol/L ×1 96-104 mmol/L
Newborn 97-110 97-110
Thereafter 98-106 98-106
Chloride, sweat Sweat mmol/L (Farrell et al,
0-5 mo ≤29 CF unlikely 2008)
30-59 Intermediate
≥60 Indicative of
CF
≥6 mo ≤39 CF unlikely
40-60 Intermediate
≥60 Indicative of
CF
Cortisol S,P(H) μg/dL nmol/L
Newborn 1-24 ×27.59 28-662
Adults, 8 AM 5-23 138-635
4 PM 3-15 82-413
8 PM <50% of 8 AM ×0.01 Fraction of 8 AM
≤0.50
Creatine kinase S Cord blood 70-380 U/L ×1 70-380 U/L 30°C, b
5-8 hr 214-1,175 214-1,175 (Jedeikin et al,
24-33 hr 130-1,200 130-1,200 1982)
72-100 hr 87-725 87-725
Adult 5-130 5-130
Creatine kinase S % MB % BB
isoenzymes Cord blood 0.3-3.1 0.3-10.5
5-8 hr 1.7-7.9 3.6-13.4
24-33 hr 1.8-5.0 2.3-8.6
72-100 hr 1.4-5.4 5.1-13.3
Adult 0-2 0
Creatinine (IDMS)
Enzymatic S,P mg/dL μmol/L g
0-4 yr 0.03-0.50 ×88.4 2.65-44.2
4-7 yr 0.03-0.59 2.65-52.2
7-10 yr 0.22-0.59 19.4-52.2
10-14 yr 0.31-0.88 27.4-77.8
>14 yr 0.50-1.06 44.2-93.7
Creatinine clearance S,P,U Newborn 40-65 mL/min/1.73 m2
(endogenous) <40 yr, M 97-137
F 88-128
Decreases <6.5 mL/min/decade
Continued
Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Ferritin S ng/mL μg/L
0-6 wk 0-400 ×1 0-400
7 wk-365 days 10-95 10-95
1-9 yr 10-60 10-60
10-18 yr M 10-300 10-300
F 10-70 10-70
Folate S Newborn 7.0-32 ng/mL ×2.265 15.9-72.4 nmol/L
Thereafter 1.8-9.0 4.1-20.4
W(E) 150-450 ng/mL RBCs 340-1,020 nmol/L cells
Glucose S mg/dL mmol/L
Cord blood 45-96 ×0.0555 2.5-5.3
Premature 20-60 1.1-3.3
Neonate 30-60 1.7-3.3
Newborn
1 day 40-60 2.2-3.3
>1 day 50-90 2.8-5.0
Child 60-100 3.3-5.5
Adult 70-105 3.9-5.8
W(H) Adult 65-95 3.6-5.3
Glucose, 2 hr post S <120 <6.7
Glucose tolerance test S mg/dL mmol/L
(GTT) (Chapter 607)
Oral dose
Adult: 75 g Normal Diabetic Normal Diabetic
Child: 1.75 g/kg of Fasting 70-105 ≥126 ×0.0555 3.9-5.8 ≥7.0 (Diabetes Care,
ideal weight, up 120 min 70-120 ≥200 3.9-6.7 ≥11 2010)
to a maximum of
75 g
G6PD in erythrocytes W(E,H,C)
Bishop, modified Adult Adult
3.4-8.0 U/g Hb ×0.0645 0.22-0.52 mU/mol Hb
98.6-232 U/1012 RBCs ×10−3 0.10-0.23 nU/106 RBCs
1.16-2.72 U/mL RBC ×1 1.16-2.72 kU/L RBC
Newborn: 50% higher Newborn: 50% higher
γ-Glutamyl S U/L U/L
transpeptidase Cord blood 37-193 ×1 37-193 37°C, b (Knight
(GGT, GGTP) 0-1 mo 13-147 13-147 and Haymond,
1-2 mo 12-123 12-123 1981)
2-4 mo 8-90 8-90
4 mo-10 yr 5-32 5-32
10-15 yr 5-24 5-24
Immunoglobulin A (IgA) S mg/dL mg/L
Cord blood 1.4-3.6 ×10 14-36 s (Meites, 1989)
1-3 mo 1.3-53 13-530
4-6 mo 4.4-84 44-840
7 mo-1 yr 11-106 110-1,060
2-5 yr 14-159 140-1,590
6-10 yr 33-236 330-2,360
Adult 70-312 700-3,120
Immunoglobulin D (IgD) S Newborn: none detected None detected
Thereafter: 0-8 mg/dL ×10 0-80 mg/L
Immunoglobulin E (IgE) S M 0-230 IU/mL ×1 0-230 kIU/L
F 0-170 0-170
Immunoglobulin G (IgG) S mg/dL g/L
Cord blood 636-1,606 ×0.01 6.36-16.06 s (Meites, 1989)
1 mo 251-906 2.51-9.06
2-4 mo 176-601 1.76-6.01
5-12 mo 172-1,069 1.72-10.69
1-5 yr 345-1,236 3.45-12.36
6-10 yr 608-1,572 6.08-15.72
Adult 639-1,349 6.39-13.49
Continued
Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Immunoglobulin M S mg/dL mg/L
(IgM) Cord blood 6.3-25 ×10 63-250 s (Meites, 1989)
1-4 mo 17-105 170-1,050
5-9 mo 33-126 330-1,260
10 mo-1 yr 41-173 410-1,730
2-8 yr 43-207 430-2,070
9-10 yr 52-242 520-2,420
Adult 56-352 560-3,520
Iron P All ages 22-184 μg/dL ×0.1791 4-33 μmol/L (Lockitch
Halstead,
Iron-binding capacity, S Infant 100-400 μg/dL ×0.179 17.90-71.60 μmol/L Wadsworth,
total (TIBC) Thereafter 250-400 44.75-71.60 1988)
L-lactate (perchloric W mg/dL mmol/L
acid) 1-12 mo 10-21 ×1 1.1-2.3 (Bonnefont
1-7 yr 7-14 0.8-1.5 et al, 1990)
7-15 yr 5-8 0.6-0.9
D-lactate P(H) j (Rosenthal and
6 mo-3 yr 0.0-0.3 ×1 0.0-0.3 Pesce, 1985)
Lactate dehydrogenase S U/L U/L
(LDH) <1 yr 170-580 ×1 170-580 37°C, a (Meites,
1-9 yr 150-500 150-500 1989)
10-19 yr 120-330 120-330
Isoenzymes S % of total activity
1-6 yr 7-19 yr
LD1 20-38 20-35
LD2 27-38 31-38
LD3 16-26 19-28
LD4 5-16 7-13
LD5 3-13 5-12
Lead W(H) μg/dL mmol/L
Child <5 ×0.0483 <0.0024
Toxic ≥70 ≥3.38
Lipase P,S 1-18 yr 145-216 U/L ×1 145-216 U/L (Ghoshal and
Soldin, 2003)
Magnesium P(H) mg/dL mmol/L
0-6 days 1.2-2.6 ×0.411 0.48-1.05 gw (Meites,
7 days-2 yr 1.6-2.6 0.65-1.05 1989)
2-14 yr 1.5-2.3 0.60-0.95
0.78 ± 0.37% of total Hb ×0.01 0.0078 ± 0.0037 (mass
fraction)
Osmolality S Child, adult
275-295 mOsm/kg H2O
Phosphatase, alkaline S U/L U/L
1-9 yr 145-420 ×1 145-420 37°C, aw
10-11 yr 140-560 140-560
M F M F
12-13 yr 200-495 105-420 200-495 105-420
14-15 yr 130-525 70-230 130-525 70-230
16-19 yr 65-260 50-130 65-260 50-130
Phosphorus, inorganic S,P(H) mg/dL mmol/L
0-5 days 4.8-8.2 ×0.3229 1.55-2.65 w (Meites, 1989)
1-3 yr 3.8-6.5 1.25-2.10
4-11 yr 3.7-5.6 1.20-1.80
12-15 yr 2.9-5.4 0.95-1.75
16-19 yr 2.7-4.7 0.90-1.50
Continued
Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Potassium S mmol/L mmol/L
0-1 wk 3.2-5.5 ×1 3.3-5.5 (Greeley et al,
1 wk-1 mo 3.4-6.0 3.4-6.0 1993)
1-6 mo 3.5-5.6 3.5-5.6 Increased by
6 mo-1 yr 3.5-6.1 3.5-6.1 hemolysis;
>1 yr 3.3-4.6 3.3-4.6 serum values
systematically
higher than
plasma values
P(H) 3.5-4.5 mmol/L 3.5-4.5 mmol/L
Prealbumin S mg/dL mg/L
(transthyretin) 0-5 days 6.0-21.0 ×10 60-210 s (Lockitch,
1-5 yr 14.0-30.0 140-300 Halstead,
6-9 yr 15.0-30.0 150-300 Quigley, 1988)
10-13 yr 20.0-36.0 200-360
14-19 22.0-45.0 220-450
Protein, total S g/dL g/L
Premature 4.3-7.6 ×10 43-76 (Meites, 1989)
Newborn 4.6-7.4 46-74
1-7 yr 6.1-7.9 61-79
8-12 yr 6.4-8.1 64-81
13-19 yr 6.6-8.2 66-82
Pyruvate (perchloric W 7-17 yr 0.076 ± ×1 0.076 ± 0.026 mmol/L (Pianosi et al,
acid) 0.026 mmol/L 1995)
Sodium S,P (LiH, mmol/L mmol/L
NH4H) Newborn 133-146 ×1 133-146 g (Greeley et al,
Infant 134-144 134-144 1993)
Child 134-143 134-143
Thereafter 135-145 135-145
Thyroid-stimulating S μIU/L μIU/L
hormone (TSH) 0-3 days 1.00-20.00 ×1 1.0-20.00 g (Dugaw et al,
3-30 days 0.5-6.5 0.50-6.50 2001)
1-5 mo 0.5-6.0 0.5-6.0
6 mo-18 yr 0.5-4.5 0.5-4.5
Thyroid uptake of Activity over 2 hr <6% ×0.01 2 hr <0.06
radioactive iodine thyroid 6 hr 3-20% 6 hr 0.03-0.20
gland 24 hr 8-30% 24 hr 0.08-0.30
Thyroid uptake of Activity over After 24 hr 0.4-3.0% ×0.01 Fractional uptake
technetium-99m thyroid 0.004-0.030
gland
Thyrotropin-releasing P 5-60 pg/mL ×2.759 14-165 pmol/L
hormone (TRH)
Thyroxine-binding S mg/dL mg/L
globulin (TBG) Cord blood 1.4-9.4 ×10 14-94
1-4 wk 1.0-9.0 10-90
1-12 mo 2.0-7.6 20-76
1-5 yr 2.9-5.4 29-54
5-10 yr 2.5-5.0 25-50
10-15 yr 2.1-4.6 21-46
Adult 1.5-3.4 15-34
Thyroxine (T4), total S μg/dL nmol/L
0-3 days 8.0-20.0 ×12.9 103-258 g (Dugaw et al,
3-30 days 5.0-15.0 64-193 2001)
31-365 days 6.0-14.0 77-180
1-5 yr 4.5-11.0 58-142
6-18 yr 4.5-10.0 58-129
Thyroxine (T4), free S ng/dL pmol/L
0-3 days 2.00-5.00 ×12.9 25.7-64.3 g (Dugaw et al,
3-30 days 0.90-2.20 11.6-28.3 2001)
31 days-18 yr 0.7-2.00 9.0-25.7
Thyroxine (T4), total W Newborn screen ×12.9 80-283 nmol/L
(filter paper)
6.2-22.0 μg/dL
 Table 748.5 Reference Intervals—cont’d
ANALYTE OR CONVERSION REFERENCE VALUES
PROCEDURE SPECIMEN REFERENCE VALUES (U.S.)† FACTOR (SI)† COMMENTS
Triiodothyronine (T3), S pg/dL pmol/L
free Cord blood 20-240 ×0.01536 0.3-3.7
1-3 days 200-610 3.1-9.4
6 wk 240-560 3.7-8.6
Adult (20-50 yr) 230-660 3.5-10.0
Triiodothyronine (T3), S ng/dL nmol/L
total 0-3 days 60-300 ×0.0154 0.9-4.7
4-365 days 90-260 1.4-4.0
1-6 yr 90-240 1.4-3.7
7-11 yr 90-230 1.4-3.6
12-18 yr 100-210 1.5-3.3 g (Dugaw et al,
2001)
Urea nitrogen S,P mg/dL mmol/L
Cord blood 21-40 ×0.357 7.5-14.3
Premature 3-25 1.1-9.0
(1 wk)
Newborn 3-12 1.1-4.3
infant or child 5-18 1.8-6.4
Thereafter 7-18 2.5-6.4
Uric acid S mg/dL μmol/L
1-3 yr 1.8-5.0 ×59.48 100-300
4-6 yr 2.2-4.7 130-280
7-9 yr 2.0-5.0 120-295
10-11 yr M 2.3-5.4 135-320 (Lockitch
10-11 yr F 3.0-4.7 180-280 Halstead,
12-13 yr M 2.7-6.7 160-400 Albersheim,
14-15 yr M 2.4-7.8 140-465 1988)
12-15 yr F 3.0-5.8 180-345
16-19 yr M 4.0-8.6 235-510
16-19 yr F 3.0-5.9 180-350
*In preparing the reference range listings, a number of abbreviations, symbols, and codes were used (see Table 748.2).
†
Reference values are shown in SI units (International System of Units) and U.S. units (Traditional Units).]

Nomogram
Height For children of S.A. Weight
cm in M2 lb kg
normal height
for weight 180 80
90 160 70
1.30
80 2.0 140
1.20 1.9 130 60
240 70 1.10 1.8 120
90 1.7 110 50
220 85 60 1.00 1.6 100
1.5 90
200 80 1.4 40
50 .90 80
190 75 1.3
180 70 .80 1.2 70
30
170 40 1.1 60
Surface area in square meters

65 .70
160 1.0 25
150 60 50
0.9 45
140 55 30 .60 20
.55 0.8 40
Weight in pounds

130 50 .50 35 15
120 0.7
30
45 20 .45
110 0.6 25
.40
100 40 10
15 .35 0.5 20 9.0
90 35 18 8.0
16 7.0
.30 0.4
80 14
30 10 6.0
12
28 9 .25 5.0
70 10
26 8 0.3
9 4.0
24 7 8
60
22 6 .20 7 3.0
6
50 20 5 0.2 2.5
19 5
18 4 .15 2.0
17 4
40 16
15 3 1.5
3
14
13
.10 1.0
30 12 2 0.1

Alternative (Mosteller’s formula):

Surface area (m2) ! Height (cm) " Weight (kg)
3600
Fig. 748.1 Nomogram for the estimation of surface area. The surface area is indicated where a straight line that connects the height and weight
levels intersects the surface area column, or if the patient is roughly of average size, from the weight alone (enclosed area). (Nomogram modified
 PEDIATRIC PARAMETERS AND EQUIPMENT
Premie Newborn 6 mo 1 yr 2-3 yr 4-6 yr 7-10 yr 11-15 yr >16 yr
WT (kg) 2.5-3.5 3.5-4 6-8 10 13-16 20-25 25-35 40-50 >50
BAG VALVE Infant Infant Small Small Child Child Child/small Adult Adult
MASK child child adult
NASAL AIRWAY 12 12 14-16 14-16 14-18 14-18 16-20 18-22 22-36
(Fr)
ORAL AIRWAY Infant Small Small Small Small Small Med Med Med
50 mm 60 mm 60 mm 60 mm 70 mm 70-80 mm 80-90 mm 90 mm 90 mm
BLADE MIL 0 MIL 0 MIL 1 MIL 1, MIL 1, MIL 2, MIL 2, MIL 2, MIL 2,
MAC 2 MAC 2 MAC 3 MAC 3 MAC 3 MAC 3
ETT 2.5-3.0 3.0-3.5 3.5-4.0 4.0-4.5 4.5-5.0 5.0-5.5 5.5-6.0 6.0-6.5 7.0-8.0
LMA 1 1 1.5 2 2 2.5 2.5-3 3 4
GLIDESCOPE 1 1 or 2 2 2 3 3 3 3 or 4 3 or 4
IV CATH (ga) 22-24 22-24 20-24 20-24 18-22 18-22 18-22 18-20 16-20
CVL (Fr) 3 3-4 4 4-5 4-5 5 5 7 7
NGT/OGT (Fr) 5 5-8 8 10 10-12 12-14 12-14 14-18 14-18
CHEST TUBE 10-12 10-12 12-18 16-20 16-24 20-28 20-32 28-38 28-42
(Fr)
FOLEY (Fr) 6 8 8 8 8 8 8 10 12
ESTIMATED BLOOD PRESSURE BY AGE
Measurement 50th % 5th %
Systolic BP 90 + (age × 2) 60 (neonate); 70 (1 mo-1 yr)
70 + (age × 2) (for 2-10 yr)
<90 (>10 yr)
MAP 55 + (age × 1.5) 40 + (age × 1.5)
NORMAL VITAL SIGNS BY AGE
Age Heart Rate Blood Pressure Respiratory Rate
(beats/min) (mmHg) (breaths/min)
Premie 120-170 55-75/35-45 (gestational age 40-70
approximates normal MAP)
0-3 mo 110-160 65-85/45-55 30-60
3-6 mo 100-150 70-90/50-65 30-45
6-12 mo 90-130 80-100/55-65 25-40
1-3 yr 80-125 90-105/55-70 20-30
3-6 yr 70-115 95-110/60-75 20-25
6-12 yr 60-100 100-120/60-75 14-22
>12 yr 60-100 100-120/70-80 12-18
ENDOTRACHEAL TUBE FORMULAS
Uncuffed ETT size: age (years)/4 + 4; Cuffed ETT size: age (years)/4 + 3
ETT depth (from lip to mid-trachea): ETT internal diameter (size) × 3

GLASGOW COMA SCALE

Activity Score Child/Adult Score Infant
Eye opening 4 Spontaneous 4 Spontaneous
3 To speech 3 To speech/sound
2 To pain 2 To painful stimuli
1 None 1 None
Verbal 5 Oriented 5 Coos/babbles
4 Confused 4 Irritable cry
3 Inappropriate 3 Cries to pain
2 Incomprehensible 2 Moans to pain
1 None 1 None
Motor 6 Obeys commands 6 Normal spontaneous movement
5 Localizes to pain 5 Withdraws to touch
4 Withdraws to pain 4 Withdraws to pain
3 Abnormal flexion 3 Abnormal flexion (decorticate)
2 Abnormal extension 2 Abnormal extension (decerebrate)
1 None 1 None (flaccid)
 TABLE 1.9
COMA SCALES20
Grading Glasgow Coma Scale Modified Coma Scale for Infants
EYE OPENING
4 Spontaneous Spontaneous
3 To speech To speech
2 To pain To pain
1 None None
VERBAL
5 Oriented Coos or babbles
4 Confused Irritable
3 Inappropriate words Cries to pain
2 Nonspecific sounds Moans to pain
1 None None
MOTOR
6 Follows commands Normal, spontaneous movements
5 Localizes pain Withdraws to touch
4 Withdraws to pain Withdraws to pain
3 Abnormal flexion Abnormal flexion
2 Abnormal extension Abnormal extension
1 None None
Data from Shaw KN, Bachur RG. Fleisher & Ludwig’s Textbook of Pediatric Emergency Medicine. 7th ed. Philadelphia:
Lippincott Williams & Wilkins; 2016.

(4) Avoid hypercarbia, maintaining PaCO2 in normal range.

Prophylactic hyperventilation is not recommended.
b. Dextrose: Correct hypoglycemia immediately with a 5 to 10 mL/kg
bolus of 10% dextrose or 2 to 4 mL/kg of 25% dextrose. After bolus,
start a continuous infusion of dextrose-containing fluids to avoid
recurrent hypoglycemia.
c. Imaging: Request emergency head computed tomography (CT)
if patient stable for transport. Consult with neurosurgical team if
indicated.
d. Hyponatremia: Often asymptomatic unless sodium decreases rapidly
or becomes severe (i.e., <125 mmol/L).
(1) Treat symptomatic hyponatremia immediately with a 3 to 5 mL/kg
bolus of 3% hypertonic saline over 15 to 30 minutes until seizure
activity ceases or serum sodium level is >125 mmol/L.
(2) See Chapter 11 for subsequent, slow correction of asymptomatic
hyponatremia.
e. Infection: If presentation concerning for severe sepsis, treat empiri-
cally with broad-spectrum antibiotics (e.g., ceftriaxone and vanco-
mycin) within the first hour. Include antiviral therapy (e.g., acyclovir)
if viral encephalitis is suspected. Lumbar puncture should be
performed only if there is no clinical suspicion of increased ICP and
the patient is stable.
 BOX 5.1
HE2ADS3 (MODIFIED HEADSS) ASSESSMENT8
(H)OME: Household composition, family dynamics and relationships, living and
sleeping arrangements, recent changes, any periods of homelessness, running
away from home
(E)DUCATION/EMPLOYMENT, (E)ATING: School performance, attendance, sus-
pensions; attitude toward school; favorite, most difficult, best subjects; special
educational needs; goals for the future; after-school job or other work history;
body image and dieting
(A)CTIVITIES: Friendships with same or opposite sex, ages of friends, best friend,
dating, recreational activities, physical activity, sports participation, hobbies,
and interests
(D)RUGS: Personal use of tobacco, alcohol, illicit drugs, anabolic steroids; peer
substance use; family substance use and attitudes; if personal use, determine
frequency, quantity, binge, injury with use; consider use of CRAFFT question-
naire (Box 5.2)
(S)EXUALITY: Sexual orientation, gender identity, and relationship(s) should
be explored with open-ended questions. If the adolescent is sexually active,
discuss age of first sexual act, number of lifetime and current partners, ages
of partners, knowledge of contraception and sexually transmitted infection/
human immunodeficiency virus (STI/HIV) prevention, reproductive life plan,
prior testing for STI/HIV, prior pregnancies and/or abortions, and history of
nonconsensual intimate physical contact or sex. See Box EC 5.A for the “Five
Ps” of the sexual history
(S)UICIDE/DEPRESSION: Feelings about self, both positive and negative; history
of depression or other mental health problems; sleep problems (difficulty get-
ting to sleep, early waking); changes in appetite or weight; anhedonia; irritabil-
ity; anxiety; current or prior suicidal thoughts or attempts; other self-harming or
injurious behavior; screen for depression using the Patient Health Questionnaire
(PHQ-2)
(S)AFETY: Feeling unsafe at home, at school, or in the community; bullying; guns
in the home; weapon carrying, what kinds of weapons; fighting; arrests; gang
membership; seatbelt use

BOX 5.2
CRAFFT QUESTIONNAIRE10
C—Have you ever ridden in a CAR driven by someone (or yourself) who was
“high” or had been using alcohol or drugs?
R—Do you ever use alcohol or drugs to RELAX, feel better about yourself, or fit in?
A—Do you ever use alcohol/drugs while you are ALONE?
F—Do your family or FRIENDS ever tell you that you should cut down on your
drinking or drug use?
F—Do you ever FORGET things you did while using alcohol or drugs?
T—Have you gotten into TROUBLE while you were using alcohol or drugs?
NOTE: Answering yes to two or more questions is a positive screen

From Gephart H: Rating scales, questionnaires, and behavior checklists. In ADHD Complex:
Practicing Mental Health in Primary Care. Philadelphia, Elsevier, 2019, pp 1-7.
 TABLE 5.1
TANNER STAGES OF GENITAL DEVELOPMENT (MALE)
Tanner Stage Comment (±2 Standard Deviations Around Mean Age)
1 Pre-pubertal
2 Enlargement of scrotum and testesa; skin of scrotum reddens and changes in
texture; little or no enlargement of penis; mean age 11.4 years (9.5–13.8
years)
3 Enlargement of penis, first mainly in length; further growth of testes and
scrotum; mean age 12.9 years (10.8–14.9 years)
4 Increased size of penis with growth in breadth and development of glans; further
enlargement of testes and scrotum and increased darkening of scrotal skin;
mean age 13.8 years (11.7–15.8 years)
5 Genitalia adult in size and shape; mean age 14.9 years (13–17.3 years)
aTesticular volume of greater than 4 mL or a long axis of greater than 2.5 cm is evidence that pubertal testicular growth
has begun.
Data from Joffe A. Introduction to adolescent medicine. In: McMillan JA, DeAngelis CD, Feigin RD, et al, eds. Oski’s
Pediatrics: Principles and Practice. 4th ed. Philadelphia: Lippincott Williams & Wilkins; 2006:546–557.

TABLE 5.2
TANNER STAGES OF PUBIC HAIR
Tanner Stage Appearance
1 No hair
2 Sparse, downy hair at base of symphysis pubis
3 Sparse, coarse hair across symphysis pubis
4 Adult hair quality, fills in pubic triangle, no spread to thighs
5 Adult quality and distribution including spread to medial thighs
Data from Alario AJ, Birnkrant JD. Sexual maturation and tanner staging. Practical Guide to the Care of the Pediatric
Patient. 2nd ed. St. Louis: Mosby; 2007:798–800.

5. Genitalia: For both male and female genital examinations, a chaperone

should be present, an explanation should occur before the examination,
and findings should be discussed.
a. Male15:
(1) Normal male genital development: Table 5.1.
(2) Normal pubic hair development: Table 5.2.
(3) Assess for signs of STIs (rashes, warts, ulcers, erosions,
discharge), inguinal hernias, masses, hydroceles, and varico-
celes. If there are symptoms of proctitis with history of receptive
anal intercourse (e.g., rectal pain, rectal bleeding, or tenesmus),
a digital rectal examination should be performed.
b. Female16,17:
(1) Normal pubic hair development: see Table 5.2.
(2) External examination: Assess for signs of STIs (rashes, warts,
ulcers, erosions, discharge), discharge suggestive of candidiasis
or bacterial vaginosis, and evidence of trauma.
 TABLE 9.1
DEVELOPMENTAL MILESTONES
Age Gross Motor Visual–Motor/Problem-Solving Language Social/Adaptive
1 month Raises head from prone Visually fixes, follows to midline, has Alerts to sound Regards face
position tight grasp
2 months Holds head in midline, lifts No longer clenches fists tightly, follows Smiles socially (after being stroked or talked to) Recognizes parent
chest off table object past midline
3 months Supports on forearms in prone Holds hands open at rest, follows in circu- Coos (produces long vowel sounds in musical Reaches for familiar people or
position, holds head up lar fashion, responds to visual threat fashion) objects, anticipates feeding
steadily
4 months Rolls over, supports on wrists, Reaches with arms in unison, brings Laughs, orients to voice Enjoys looking around
shifts weight hands to midline
6 months Sits unsupported, puts feet in Unilateral reach, uses raking grasp, Babbles, ah-goo, razz, lateral orientation to bell Recognizes that someone is a
mouth in supine position transfers objects stranger
9 months Pivots when sitting, crawls Uses immature pincer grasp, probes with Says “mama, dada” indiscriminately, gestures, Starts exploring environment,
well, pulls to stand, cruises forefinger, holds bottle, throws objects waves bye-bye, understands “no” plays gesture games (e.g.,
pat-a-cake)
12 months Walks alone Uses mature pincer grasp, can make a Uses two words other than “mama, dada” Imitates actions, comes when
crayon mark, releases voluntarily or proper nouns, jargoning (runs several called, cooperates with
unintelligible words together with tone or dressing
inflection), one-step command with gesture
15 months Creeps up stairs, walks back- Scribbles in imitation, builds tower of two Uses 4–6 words, follows one-step command 15–18 months: uses spoon
ward independently blocks in imitation without gesture and cup
18 months Runs, throws objects from Scribbles spontaneously, builds tower of Mature jargoning (includes intelligible words), Copies parent in tasks
standing without falling three blocks, turns two or three pages 7–10-word vocabulary, knows five body parts (sweeping, dusting), plays in
at a time company of other children

ClinicalKey.com by Elsevier on May 16, 2020. For personal use only. No other uses w
 TABLE 9.1—CONT’D
DEVELOPMENTAL MILESTONES
Age Gross Motor Visual–Motor/Problem-Solving Language Social/Adaptive
24 months Walks up and down steps Imitates stroke with pencil, builds tower Uses pronouns (I, you, me) inappropriately, Parallel play
without help of seven blocks, turns pages one at a follows two-step commands, 50-word
time, removes shoes, pants, etc. vocabulary, uses two-word sentences
3 years Can alternate feet going up Copies a circle, undresses completely, Uses minimum of 250 words, three-word Group play, shares toys, takes
steps, pedals tricycle dresses partially, dries hands if sentences, uses plurals, knows all pronouns, turns, plays well with others,
reminded, unbuttons repeats two digits knows full name, age, gender
4 years Hops, skips, alternates feet Copies a square, buttons clothing, Knows colors, says song or poem from memory, Tells “tall tales,” plays coopera-
going down steps dresses self completely, catches ball asks questions tively with a group of children
5 years Skips alternating feet, jumps Copies triangle, ties shoes, spreads Prints first name, asks what a word means Plays competitive games, abides
over low obstacles with knife by rules, likes to help in
household tasks
From Capute AJ, Biehl RF. Functional developmental evaluation: prerequisite to habilitation. Pediatr Clin North Am. 1973;20:3; Capute AJ, Accardo PJ. Linguistic and auditory milestones during the first two years of life: a
language inventory for the practitioner. Clin Pediatr. 1978;17:847; and Capute AJ, Shapiro BK, Wachtel RC, et al. The Clinical Linguistic and Auditory Milestone Scale (CLAMS): identification of cognitive defects in motor
delayed children. Am J Dis Child. 1986;140:694. Rounded norms from Capute AJ, Palmer FB, Shapiro BK, et al. Clinical Linguistic and Auditory Milestone Scale: prediction of cognition in infancy. Dev Med Child Neurol.
1986;28:762.

ClinicalKey.com by Elsevier on May 16, 2020. For personal use only. No other uses w
 TABLE 10.5
AGE-BASED NORMAL VALUES FOR ROUTINE THYROID FUNCTION TESTS
Test Age Normal Range
TSH (mIU/L) Birth–6 days 0.70–15.2
1 week–3 months 0.72–11.0
3 months–12 months 0.73–8.35
1–5 years 0.70–5.97
6–10 years 0.60–4.84
>10 years 0.45–4.50
Free T4 (ng/dL) Birth–3 days 0.66–2.71
4–30 days 0.83–3.09
31 days–12 months 0.48–2.34
13 months–5 years 0.85–1.75
6–10 years 0.90–1.67
11–19 years 0.93–1.60
>19 years 0.82–1.77
Total T4 (mCg/dL) Male Female
< 1 months 4.5–17.2 4.5–17.2
1–23 months 5.9–13.9 5.9–13.9
2–12 years 5.7–11.6 5.7–11.6
13–20 years 5.1–10.3 5.3–11.7
>20 years 4.9–10.5 5.1–11.9
T4, Thyroxine; TSH, thyroid-stimulating hormone.
NOTE: If age-specific reference ranges are provided by the laboratory that is running the assay, please refer to those
ranges.
TSH and Free T4 reference ranges from Labcorp; Total T4 reference range from Quest Diagnostics.

(3) Electrolytes: Potassium, phosphate, and magnesium deficits

greater than in DKA; monitor every 2 to 4 hours. Start potassium
replacement with 40 mEq/L once K <5 mEq/L.␣

II. THYROID GLAND14-16

A. Thyroid Tests15,17,18
1. Normal thyroid function values: See reference values for age (Table 10.5).
Preterm infants have different ranges (Table 10.6).
2. Interpretation of abnormal thyroid function values: See Table 10.7.
3. Imaging studies:
a. Thyroid ultrasound: Most useful in assessing thyroid nodules for
features suspicious for malignancy.
b. Thyroid uptake scan: Measures uptake of Technetium (99mTc)
pertechnetate or radioactive iodine by metabolically active thyroid
tissue, helping to identify etiology of hyperthyroidism.␣
B. Hypothyroidism
1. Types of hypothyroidism: Can be either congenital or acquired and
either primary or central. See Table 10.8 for details on identification and
management.
 TABLE 14.1
AGE-SPECIFIC BLOOD CELL INDICES
Age Hb (g/dL)a HCT (%)a MCV (fL)a MCHC (g/dL RBC)a Reticulocytes WBCs (×103/mL)b Platelets (103/mL)b
26–30 weeks gestationc 13.4 (11) 41.5 (34.9) 118.2 (106.7) 37.9 (30.6) — 4.4 (2.7) 254 (180–327)
28 weeks 14.5 45 120 31.0 (5–10) — 275
32 weeks 15.0 47 118 32.0 (3–10) — 290
Termd (cord) 16.5 (13.5) 51 (42) 108 (98) 33.0 (30.0) (3–7) 18.1 (9–30)e 290
1–3 days 18.5 (14.5) 56 (45) 108 (95) 33.0 (29.0) (1.8–4.6) 18.9 (9.4–34) 192
2 weeks 16.6 (13.4) 53 (41) 105 (88) 31.4 (28.1) — 11.4 (5–20) 252
1 month 13.9 (10.7) 44 (33) 101 (91) 31.8 (28.1) (0.1–1.7) 10.8 (4–19.5) —
2 months 11.2 (9.4) 35 (28) 95 (84) 31.8 (28.3) — — —
6 months 12.6 (11.1) 36 (31) 76 (68) 35.0 (32.7) (0.7–2.3) 11.9 (6–17.5) —
6 months–2 years 12.0 (10.5) 36 (33) 78 (70) 33.0 (30.0) — 10.6 (6–17) (150–350)
2–6 years 12.5 (11.5) 37 (34) 81 (75) 34.0 (31.0) (0.5–1.0) 8.5 (5–15.5) (150–350)
6–12 years 13.5 (11.5) 40 (35) 86 (77) 34.0 (31.0) (0.5–1.0) 8.1 (4.5–13.5) (150–350)
12–18 YEARS
Male 14.5 (13) 43 (36) 88 (78) 34.0 (31.0) (0.5–1.0) 7.8 (4.5–13.5) (150–350)
Female 14.0 (12) 41 (37) 90 (78) 34.0 (31.0) (0.5–1.0) 7.8 (4.5–13.5) (150–350)
ADULT
Male 15.5 (13.5) 47 (41) 90 (80) 34.0 (31.0) (0.8–2.5) 7.4 (4.5–11) (150–350)
Female 14.0 (12) 41 (36) 90 (80) 34.0 (31.0) (0.8–4.1) 7.4 (4.5–11) (150–350)
aData are mean (−2 SD).
bData are mean (±2 SD).
cValues are from fetal samplings.
d1 month, capillary hemoglobin exceeds venous: 1 hour: 3.6-g difference; 5 day: 2.2-g difference; 3 weeks: 1.1-g difference.
eMean (95% confidence limits).

Hb, Hemoglobin; HCT, hematocrit; MCHC, mean cell hemoglobin concentration; MCV, mean corpuscular volume; RBC, red blood cell; WBC, white blood cell.

ClinicalKey.com by Elsevier on May 16, 2020. For personal use only. No other uses w
Data from Forestier F, Dattos F, Galacteros F, et al. Hematologic values of 163 normal fetuses between 18 and 30 weeks of gestation. Pediatr Res. 1986;20:342; Oski FA, Naiman JL. Hematological Problems in the Newborn
 TABLE 14.7
AGE-SPECIFIC LEUKOCYTE DIFFERENTIAL
Total
Leukocytesa Neutrophilsb Lymphocytes Monocytes Eosinophils
Age Mean (Range) Mean (Range) % Mean (Range) % Mean % Mean %
Birth 18.1 (9–30) 11 (6–26) 61 5.5 (2–11) 31 1.1 6 0.4 2

12 hr 22.8 (13–38) 15.5 (6–28) 68 5.5 (2–11) 24 1.2 5 0.5 2

24 hr 18.9 (9.4–34) 11.5 (5–21) 61 5.8 (2–11.5) 31 1.1 6 0.5 2

1 week 12.2 (5–21) 5.5 (1.5–10) 45 5.0 (2–17) 41 1.1 9 0.5 4

2 weeks 11.4 (5–20) 4.5 (1–9.5) 40 5.5 (2–17) 48 1.0 9 0.4 3

1 month 10.8 (5–19.5) 3.8 (1–8.5) 35 6.0 (2.5–16.5) 56 0.7 7 0.3 3

6 months 11.9 (6–17.5) 3.8 (1–8.5) 32 7.3 (4–13.5) 61 0.6 5 0.3 3

1 year 11.4 (6–17.5) 3.5 (1.5–8.5) 31 7.0 (4–10.5) 61 0.6 5 0.3 3

2 years 10.6 (6–17) 3.5 (1.5–8.5) 33 6.3 (3–9.5) 59 0.5 5 0.3 3

4 years 9.1 (5.5–15.5) 3.8 (1.5–8.5) 42 4.5 (2–8) 50 0.5 5 0.3 3

6 years 8.5 (5–14.5) 4.3 (1.5–8) 51 3.5 (1.5–7) 42 0.4 5 0.2 3

8 years 8.3 (4.5–13.5) 4.4 (1.5–8) 53 3.3 (1.5–6.8) 39 0.4 4 0.2 2

10 years 8.1 (4.5–13.5) 4.4 (1.5–8.5) 54 3.1 (1.5–6.5) 38 0.4 4 0.2 2

16 years 7.8 (4.5–13.0) 4.4 (1.8–8) 57 2.8 (1.2–5.2) 35 0.4 5 0.2 3

21 years 7.4 (4.5–11.0) 4.4 (1.8–7.7) 59 2.5 (1–4.8) 34 0.3 4 0.2 3

aNumbers of leukocytes are ×103/µL; ranges are estimates of 95% confidence limits; percentages refer to differential
counts.
bNeutrophils include band cells at all ages and a small number of metamyelocytes and myelocytes in the first few days

of life.
Adapted from Cairo MS, Brauho F. Blood and blood-forming tissues. In: Randolph AM, ed. Pediatrics. 21st ed. New York:
McGraw-Hill; 2003.
 TABLE 14.11
AGE-SPECIFIC COAGULATION VALUES
Preterm Infant
(30–36 Weeks), Term Infant, Day
Coagulation Test Day of Life 1a of Life 1 Day of Life 3 1 Month–1 Year 1–5 Years 6–10 Years 11–16 Years Adult
PT (s) 13.0 (10.6–16.2) 15.6 (14.4–16.4) 14.9 (13.5–16.4) 13.1 (11.5–15.3) 13.3 (12.1–14.5) 13.4 (11.7–15.1) 13.8 (12.7–16.1) 13.0
(11.5–14.5)
INR 1.26 (1.15–1.35) 1.20 (1.05–1.35) 1.00 (0.86–1.22) 1.03 (0.92–1.14) 1.04 (0.87–1.20) 1.08 (0.97–1.30) 1.00
(0.80–1.20)
aPTT (s)b 53.6 (27.5–79.4) 38.7 (34.3–44.8) 36.3 (29.5–42.2) 39.3 (35.1–46.3) 37.7 (33.6–43.8) 37.3 (31.8–43.7) 39.5 (33.9–46.1) 33.2
(28.6–38.2)
Fibrinogen (g/L) 2.43 (1.50–3.73) 2.80 (1.92–3.74) 3.30 (2.83–4.01) 2.42 (0.82–3.83) 2.82 (1.62–4.01) 3.04 (1.99–4.09) 3.15 (2.12–4.33) 3.1 (1.9–4.3)
Bleeding time 6 (2.5–10) 7 (2.5–13) 5 (3–8) 4 (1–7)
(min)a
Thrombin time (s) 14 (11–17) 12 (10–16)a 17.1 (16.3–17.6) 17.5 (16.5–18.2) 17.1 (16.1–18.5) 16.9 (16.2–17.6) 16.6
(16.2–17.2)
Factor II (U/mL) 0.45 (0.20–0.77) 0.54 (0.41–0.69) 0.62 (0.50–0.73) 0.90 (0.62–1.03) 0.89 (0.70–1.09) 0.89 (0.67–1.10) 0.90 (0.61–1.07) 1.10
(0.78–1.38)
Factor V (U/mL) 0.88 (0.41–1.44) 0.81 (0.64–1.03) 1.22 (0.92–1.54) 1.13 (0.94–1.41) 0.97 (0.67–1.27) 0.99 (0.56–1.41) 0.89 (0.67–1.41) 1.18
(0.78–1.52)
Factor VII (U/mL) 0.67 (0.21–1.13) 0.70 (0.52–0.88) 0.86 (0.67–1.07) 1.28 (0.83–1.60) 1.11 (0.72–1.50) 1.13 (0.70–1.56) 1.18 (0.69–2.00) 1.29
(0.61–1.99)
Factor VIII (U/mL) 1.11 (0.50–2.13) 1.82 (1.05–3.29) 1.59 (0.83–2.74) 0.94 (0.54–1.45) 1.10 (0.36–1.85) 1.17 (0.52–1.82) 1.20 (0.59–2.00) 1.60
(0.52–2.90)
vWF (U/mL)a 1.36 (0.78–2.10) 1.53 (0.50–2.87) 0.82 (0.47–1.04) 0.95 (0.44–1.44) 1.00 (0.46–1.53) 0.92 (0.5–1.58)
Factor IX (U/mL) 0.35 (0.19–0.65) 0.48 (0.35–0.56) 0.72 (0.44–0.97) 0.71 (0.43–1.21) 0.85 (0.44–1.27) 0.96 (0.48–1.45) 1.11 (0.64–2.16) 1.30

ClinicalKey.com by Elsevier on May 16, 2020. For personal use only. No other uses w
 TABLE 14.11
AGE-SPECIFIC COAGULATION VALUES—Cont’d.
Factor X (U/mL) 0.41 (0.11–0.71) 0.55 (0.46–0.67) 0.60 (0.46–0.75) 0.95 (0.77–1.22) 0.98 (0.72–1.25) 0.97 (0.68–1.25) 0.91 (0.53–1.22) 1.24
(0.96–1.71)
Factor XI (U/mL) 0.30 (0.08–0.52) 0.30 (0.07–0.41) 0.57 (0.24–0.79) 0.89 (0.62–1.25) 1.13 (0.65–1.62) 1.13 (0.65–1.62) 1.11 (0.65–1.39) 1.12
(0.67–1.96)
Factor XII (U/mL) 0.38 (0.10–0.66) 0.58 (0.43–0.80) 0.53 (0.14–0.80) 0.79 (0.20–1.35) 0.85 (0.36–1.35) 0.81 (0.26–1.37) 0.75 (0.14–1.17) 1.15
(0.35–2.07)
PK (U/mL)a 0.33 (0.09–0.57) 0.37 (0.18–0.69) 0.95 (0.65–1.30) 0.99 (0.66–1.31) 0.99 (0.53–1.45) 1.12
(0.62–1.62)
HMWK (U/mL)a 0.49 (0.09–0.89) 0.54 (0.06–1.02) 0.98 (0.64–1.32) 0.93 (0.60–1.30) 0.91 (0.63–1.19) 0.92
(0.50–1.36)
Factor XIIIa (U/ 0.70 (0.32–1.08) 0.79 (0.27–1.31) 1.08 (0.72–1.43) 1.09 (0.65–1.51) 0.99 (0.57–1.40) 1.05
mL)a (0.55–1.55)
Factor XIIIs (U/ 0.81 (0.35–1.27) 0.76 (0.30–1.22) 1.13 (0.69–1.56) 1.16 (0.77–1.54) 1.02 (0.60–1.43) 0.97
mL)a (0.57–1.37)
D-dimer 1.47 (0.41–2.47) 1.34 (0.58–2.74) 0.22 (0.11–0.42) 0.25 (0.09–0.53) 0.26 (0.10–0.56) 0.27 (0.16–0.39) 0.18
(0.05–0.42)
FDPsa Borderline titer
= 1:25–1:50
Positive titer
<1:50
Continued

ClinicalKey.com by Elsevier on May 16, 2020. For personal use only. No other uses w
 TABLE 14.11
AGE-SPECIFIC COAGULATION VALUES—cont’d.
Preterm Infant
(30–36 Weeks), Term Infant, Day
Coagulation Test Day of Life 1a of Life 1 Day of Life 3 1 Month–1 Year 1–5 Years 6–10 Years 11–16 Years Adult
COAGULATION INHIBITORS
ATIII (U/mL)a 0.38 (0.14–0.62) 0.63 (0.39–0.97) 1.11 (0.82–1.39) 1.11 (0.90–1.31) 1.05 (0.77–1.32) 1.0 (0.74–1.26)
α2-M (U/mL)a 1.10 (0.56–1.82) 1.39 (0.95–1.83) 1.69 (1.14–2.23) 1.69 (1.28–2.09) 1.56 (0.98–2.12) 0.86
(0.52–1.20)
C1-Inh (U/mL)a 0.65 (0.31–0.99) 0.72 (0.36–1.08) 1.35 (0.85–1.83) 1.14 (0.88–1.54) 1.03 (0.68–1.50) 1.0 (0.71–1.31)
α2-AT (U/mL)a 0.90 (0.36–1.44) 0.93 (0.49–1.37) 0.93 (0.39–1.47) 1.00 (0.69–1.30) 1.01 (0.65–1.37) 0.93
(0.55–1.30)
Protein C (U/mL) 0.28 (0.12–0.44) 0.32 (0.24–0.40) 0.33 (0.24–0.51) 0.77 (0.28–1.24) 0.94 (0.50–1.34) 0.94 (0.64–1.25) 0.88 (0.59–1.12) 1.03
(0.54–1.66)
Protein S (U/mL) 0.26 (0.14–0.38) 0.36 (0.28–0.47) 0.49 (0.33–0.67) 1.02 (0.29–1.62) 1.01 (0.67–1.36) 1.09 (0.64–1.54) 1.03 (0.65–1.40) 0.75
(0.54–1.03)
FIBRINOLYTIC SYSTEMa
Plasminogen (U/ 1.70 (1.12–2.48) 1.95 (1.60–2.30) 0.98 (0.78–1.18) 0.92 (0.75–1.08) 0.86 (0.68–1.03) 0.99 (0.7–1.22)
mL)
TPA (ng/mL) 2.15 (1.0–4.5) 2.42 (1.0–5.0) 2.16 (1.0–4.0) 4.90
(1.40–8.40)
α2-AP (U/mL) 0.78 (0.4–1.16) 0.85 (0.70–1.0) 1.05 (0.93–1.17) 0.99 (0.89–1.10) 0.98 (0.78–1.18) 1.02
(0.68–1.36)
PAI (U/mL) 5.42 (1.0–10.0) 6.79 (2.0–12.0) 6.07 (2.0–10.0) 3.60 (0–11.0)
aData from Andrew M, Paes B, Milner R, et al. Development of the human anticoagulant system in the healthy premature infant. Blood. 1987;70:165–172; Andrew M, Paes B, Milner R, et al. Development of the human
anticoagulant system in the healthy premature infant. Blood. 1988;72(5):1651–1657; and Andrew M, Vegh P, Johnston M, et al. Maturation of the hemostatic system during childhood. Blood. 1992;8:1998–2005.
baPTT values may vary depending on reagent.

ClinicalKey.com by Elsevier on May 16, 2020. For personal use only. No other uses w
 TABLE 28.1
REFERENCE VALUES
Conventional Units SI Units
ALANINE AMINOTRANSFERASE (ALT)a,1
0 to <1 year 5–33 U/L 5–33 U/L
1 to <13 years 9–25 U/L 9–25 U/L
13–19 years (male) 9–24 U/L 9–24 U/L
13 to <19 years (female) 8–22 U/L 8–22 U/L
ALBUMINb,1
0–14 days 3.3–4.5 g/dL 33–45 g/L
15 days to <1 year 2.8–4.7 g/dL 28–47 g/L
1 to <8 years 3.8–4.7 g/dL 38–47 g/L
8 to <15 years 4.1–4.8 g/dL 41–48 g/L
15 to <19 years (male) 4.1–5.1 g/dL 41–51 g/L
15 to <19 years (female) 4.0–4.9 g/dL 40–49 g/L
ALKALINE PHOSPHATASE1
0–14 days 90–273 U/L 90–273 U/L
15 days to <1 year 134–518 U/L 134–518 U/L
1 to <10 years 156–369 U/L 156–369 U/L
10 to <13 years 141–460 U/L 141–460 U/L
13 to <15 years (male) 127–517 U/L 127–517 U/L
13 to <15 years (female) 62–280 U/L 62–280 U/L
15 to <17 years (male) 89–365 U/L 89–365 U/L
15 to <17 years (female) 54–128 U/L 54–128 U/L
17 to <19 years (male) 59–164 U/L 59–164 U/L
17 to <19 years (female) 48–95 U/L 48–95 U/L
AMMONIA5
0–14 days 35.8–161.8 mCg/dL 21–95 mcmol/L
15 days to 6 years 27.2–115.8 mCg/dL 16–68 mcmol/L
>6 years 30.7–122.6 mCg/dL 18–72 mcmol/L
AMYLASE1
0–14 days 3–10 U/L 3–10 U/L
15 days to <13 weeks 2–22 U/L 2–22 U/L
13 weeks to <1 year 3–50 U/L 3–50 U/L
1 year to <19 years 25–101 U/L 25–101 U/L
ANTISTREPTOLYSIN O TITER1
0 to <6 months 0 IU/mL 0 IU/mL
6 months to <1 year 0–30 IU/mL 0–30 IU/mL
1 to <6 years 0–104 IU/mL 0–104 IU/mL
6 to <19 years 0–331 IU/mL 0–331 IU/mL
ASPARTATE AMINOTRANSFERASE (AST)c,1
0–14 days 32–162 U/L 32–162 U/L
15 days to <1 year 20–67 U/L 20–67 U/L
1 to <7 years 21–44 U/L 21–44 U/L
7 to <12 years 18–36 U/L 18–36 U/L
12 to <19 years (male) 14–35 U/L 14–35 U/L
12 to <19 years (female) 13–26 U/L 13–26 U/L
BICARBONATE1
0–14 days 5–20 mEq/L 5–20 mmol/L
15 days to <1 year 10–24 mEq/L 10–24 mmol/L
TABLE 28.1—CONT’D
Conventional Units SI Units
1 to <5 years 14–24 mEq/L 14–24 mmol/L
5 to <15 years 17–26 mEq/L 17–26 mmol/L
Male 15 to <19 years 18–28 mEq/L 18–28 mmol/L
Female 15 to <19 years 17–26 mEq/L 17–26 mmol/L
BILIRUBIN (TOTAL)1
See Chapter 18 for more complete information about neonatal hyperbilirubinemia.
0–14 days 0.19–16.60 mg/dL 3.25–283.92 mcmol/L
15 days to <1 year 0.05–0.68 mg/dL 0.86–11.63 mcmol/L
1 to <9 years 0.05–0.40 mg/dL 0.86–6.84 mcmol/L
9 to <12 years 0.05–0.55 mg/dL 0.86–9.41 mcmol/L
12 to <15 years 0.10–0.70 mg/dL 1.71–11.97 mcmol/L
15 to <19 years 0.10–0.84 mg/dL 1.71–14.37 mcmol/L
BILIRUBIN (CONJUGATED)1
0–14 days 0.33–0.71 mg/dL 5.64–12.14 mcmol/L
15 days to <1 year 0.05–0.30 mg/dL 0.86–5.13 mcmol/L
1 to <9 years 0.05–0.20 mg/dL 0.86–3.42 mcmol/L
9 to <13 years 0.05–0.29 mg/dL 0.86–4.96 mcmol/L
13 to <19 years (female) 0.10–0.39 mg/dL 1.71–6.67 mcmol/L
13 to <19 years (male) 0.11–0.42 mg/dL 1.88–7.18 mcmol/L
BLOOD GAS, ARTERIAL (BREATHING ROOM AIR)6

pH PaO2 (mmHg) PaCO2 (mmHg) HCO3− (mEq/L)

Cord blood 7.28 ± 0.05 18.0 ± 6.2 49.2 ± 8.4 14–22
Newborn (birth) 7.11–7.36 8–24 27–40 13–22
5–10 min 7.09–7.30 33–75 27–40 13–22
30 min 7.21–7.38 31–85 27–40 13–22
60 min 7.26–7.49 55–80 27–40 13–22
1 day 7.29–7.45 54–95 27–40 13–22
Child/adult 7.35–7.45 83–108 32–48 20–28
NOTE: Venous blood gases can be used to assess acid-base status, not oxygenation. PvCO2 averages
6–8 mmHg higher than PaCO2, and pH is slightly lower. Peripheral venous samples are strongly
affected by the local circulatory and metabolic environment. Capillary blood gases correlate best
with arterial pH and moderately well with PaCO2.
C-REACTIVE PROTEIN (HIGH SENSITIVITY)1
0–14 days 0.3–6.1 mg/L 0.3–6.1 mg/L
15 days to <15 years 0.1–1.0 mg/L 0.1–1.0 mg/L
15 to <19 years 0.1–1.7 mg/L 0.1–1.7 mg/L
CALCIUM (IONIZED)7
0–1 month 3.9–6.0 mg/dL 1.0–1.5 mmol/L
1–6 months 3.7–5.9 mg/dL 0.95–1.5 mmol/L
1–19 years 4.9–5.5 mg/dL 1.22–1.37 mmol/L
CALCIUM (TOTAL)1
0 to <1 year 8.5–11.0 mg/dL 2.1–2.7 mmol/L
1 year to <19 years 9.2–10.5 mg/dL 2.3–2.6 mmol/L
CARBON MONOXIDE (CARBOXYHEMOGLOBIN)6
Nonsmoker 0–2% of total hemoglobin
Smoker 0–9% of total hemoglobin
Continued
TABLE 28.1—CONT’D
Conventional Units SI Units
CHLORIDE (SERUM)8
3–5 years 100–107 mEq/L 100–107 mmol/L
6–11 year 101–107 mEq/L 101–107 mmol/L
12–29 years (male) 101–106 mEq/L 101–106 mmol/L
12–29 years (female) 100–107 mEq/L 100–107 mmol/L
CHOLESTEROL
(See LIPIDS, further on)
COPPER9
6 months to 2 years 72–178 mCg/dL 11.3–28.0 mcmol/L
3–4 years 80–160 mCg/dL 12.6–25.2 mcmol/L
5–6 years 76–167 mCg/dL 12.0–26.3 mcmol/L
7–8 years 79–147 mCg/dL 12.4–23.1 mcmol/L
9–10 years 84–154 mCg/dL 13.2–24.2 mcmol/L
11–12 years 73–149 mCg/dL 11.5–23.4 mcmol/L
13–14 years 66–137 mCg/dL 10.4–21.6 mcmol/L
15–16 years 60–132 mCg/dL 9.4–20.8 mcmol/L
17–18 years 59–146 mCg/dL 9.3–23.0 mcmol/L
CREATINE KINASE10
6 months to 2 years (male) 50–292 U/L 50–292 U/L
6 months to 2 years (female) 38–260 U/L 38–260 U/L
3–5 years (male) 59–296 U/L 59–296 U/L
3–5 years (female) 42–227 U/L 42–227 U/L
6–8 years (male) 54–275 U/L 54–275 U/L
6–8 years (female) 50–231 U/L 50–231 U/L
9–11 years (male) 55–324 U/L 55–324 U/L
9–11 years (female) 52–256 U/L 52–256 U/L
12–14 years (male) 63–407 U/L 63–407 U/L
12–14 years (female) 45–257 U/L 45–257 U/L
15–17 years (male) 68–914 U/L 68–914 U/L
15–17 years (female) 45–458 U/L 45–458 U/L
CREATININE (SERUM) (ENZYMATIC)1
0–14 days 0.32–0.92 mg/dL 28.29–81.33 mcmol/L
15 days to <2 years 0.10–0.36 mg/dL 8.84–31.82 mcmol/L
2 to <5 years 0.20–0.43 mg/dL 17.68–38.01 mcmol/L
5 to <12 years 0.31–0.61 mg/dL 27.40–53.93 mcmol/L
12 to <15 years 0.45–0.81 mg/dL 39.78–71.61 mcmol/L
15 to <19 years (male) 0.62–1.08 mg/dL 54.81–95.47 mcmol/L
15 to <19 years (female) 0.49–0.84 mg/dL 43.32–74.26 mcmol/L
ERYTHROCYTE SEDIMENTATION RATE (ESR)6
Child 0–10 mm/hr
Adult male 0–15 mm/hr
Adult female 0–20 mm/hr
FERRITIN1
4 to <15 days 100–717 ng/mL 224–1611 pmol/L
15 days to <6 months 14–647 ng/mL 31–1454 pmol/L
6 months to <1 year 8–182 ng/mL 19–409 pmol/L
TABLE 28.1—CONT’D
Conventional Units SI Units
1 to <5 years 5–100 ng/mL 12–224 pmol/L
5 to <14 years 14–79 ng/mL 31–177 pmol/L
14 to <19 years (female) 6–67 ng/mL 12–152 pmol/L
14 to <16 years (male) 13–83 ng/mL 28–186 pmol/L
16 to <19 years (male) 11–172 ng/mL 25–386 pmol/L
FOLATE (RBC)5
Deficient ≤3.9 ng/mL ≤8.7 nmol/L
Indeterminate 4.0–5.8 ng/mL 9.1–13.1 nmol/L
Normal ≥5.9 ng/mL ≥13.4 nmol/L
FOLATE (SERUM)5 ≥366 ng/mL ≥831 nmol/L
GAMMA-GLUTAMYL TRANSFERASE (GGT)d,1
0–14 days 23–219 U/L 23–219 U/L
15 days to <1 year 8–127 U/L 8–127 U/L
1 to <11 years 6–16 U/L 6–16 U/L
11 to <19 years 7–21 U/L 7–21 U/L
GLUCOSE
See Chapter 10.
HAPTOGLOBIN1
0–14 days 0–10 mg/dL 0–0.10 g/L
15 days to <1 year 7–221 mg/dL 0.07–2.21 g/L
1 to <12 years 7–163 mg/dL 0.07–1.63 g/L
12 to <19 years 7–179 mg/dL 0.07–1.79 g/L
HEMOGLOBIN A1C
See Chapter 10.
HEMOGLOBIN F, % TOTAL HEMOGLOBIN5
0–1 month 45.8–91.7
2 months 32.7–85.2
3 months 14.5–73.7
4 months 4.2–56.9
5 months 1.0–38.1
6–8 months 0.9–19.4
9–12 months 0.6–11.6
13–23 months 0.0–8.5
2 years and older 0.0–2.1
IRON1
0 to <14 years 16–128 mCg/dL 2.8–22.9 mcmol/L
14–19 years (male) 31–168 mCg/dL 5.5–40.0 mcmol/L
14–19 years (female) 20–162 mCg/dL 3.5–29.0 mcmol/L
LACTATE7
0–90 days 9–32 mg/dL 1.0–3.5 mmol/L
3–24 months 9–30 mg/dL 1.0–3.3 mmol/L
2–18 years 9–22 mg/dL 1.0–2.4 mmol/L
LACTATE DEHYDROGENASE1
0–14 days 309–1222 U/L 309–1222 U/L
15 days to <1 year 163–452 U/L 163–452 U/L
1 to <10 years 192–321 U/L 192–321 U/L
Continued
TABLE 28.1—CONT’D
Conventional Units SI Units
10 to <15 years (male) 170–283 U/L 170–283 U/L
10 to <15 years (female) 157–272 U/L 157–272 U/L
15 to <19 years 130–250 U/L 130–250 U/L
LEAD
See Chapter 3.
LIPASE1
0 to <19 years 4.0–39.0 U/L 4.0–39.0 U/L
LIPIDS11

Desirable Borderline Highe

Total cholesterol <170 mg/dL (4.4 170–199 mg/dL ≥200 mg/dL (5.2
mmol/L) (4.4–5.2 mmol/L) mmol/L)
LDL <110 mg/dL (2.8 110–129 mg/dL ≥130 mg/dL (3.4
mmol/L) (2.8–3.3 mmol/L) mmol/L)
Non-HDL <120 mg/dL (3.1 120–144 mg/dL ≥145 mg/dL (3.8
mmol/L) (3.1–3.7 mmol/L) mmol/L)
HDL >45 mg/dL (1.2 40–45 mg/dL (1.0–1.2 ≤40 mg/dL (1.0
mmol/L) mmol/L) mmol/L)
Triglycerides (0–9 <75 mg/dL (0.8 75–99 mg/dL (0.8–1.1 ≥100 mg/dL (1.1
years) mmol/L) mmol/L) mmol/L)
Triglycerides (10–19 <90 mg/dL (1.0 90–129 mg/dL (1.0–1.5 ≥130 mg/dL (1.5
years) mmol/L) mmol/L) mmol/L)

Conventional Units SI Units

MAGNESIUM1
0–14 days 1.99–3.94 mg/dL 0.82–1.62 mmol/L
15 days to <1 year 1.97–3.09 mg/dL 0.81–1.27 mmol/L
1 to <19 years 2.09–2.84 mg/dL 0.86–1.17 mmol/L
OSMOLALITY5
0–16 years 271–296 mOsm/kg 271–296 mmol/kg
17 years and older 280–303 mOsm/kg 280–303 mmol/kg
PHOSPHORUS1
0–14 days 5.6–10.5 mg/dL 1.8–3.4 mmol/L
15 days to <1 year 4.8–8.4 mg/dL 1.5–2.7 mmol/L
1 to <5 years 4.3–6.8 mg/dL 1.4–2.2 mmol/L
5 to <13 years 4.1–5.9 mg/dL 1.3–1.9 mmol/L
13 to <16 years (male) 3.5–6.2 mg/dL 1.1–2.0 mmol/L
13 to <16 years (female) 3.2–5.5 mg/dL 1.0–1.8 mmol/L
16 to <19 years 2.9–5.0 mg/dL 0.9–1.6 mmol/L
PORCELAIN12
Male 5.28–20.15 mg/dL 6.15–20.13 mmol/L
Female 7.20–19.21 mg/dL 7.01–20.15 mmol/L
POTASSIUM6
Preterm 3.0–6.0 mEq/L 3.0–6.0 mmol/L
Newborn 3.7–5.9 mEq/L 3.7–5.9 mmol/L
Infant 4.1–5.3 mEq/L 4.1–5.3 mmol/L
TABLE 28.1—CONT’D
Conventional Units SI Units
Child 3.4–4.7 mEq/L 3.4–4.7 mmol/L
Thereafter 3.5–5.1 mEq/L 3.5–5.1 mmol/L
PREALBUMIN1
0–14 days 2–12 mg/dL 0.02–0.12 g/L
15 days to <1 year 5–24 mg/dL 0.05–0.24 g/L
1 to <5 years 12–23 mg/dL 0.12–0.23 g/L
5 to <13 years 14–26 mg/dL 0.14–0.26 g/L
13 to <16 years 18–31 mg/dL 0.18–0.31 g/L
16 to <19 years (male) 20–35 mg/dL 0.20–0.35 g/L
16 to <19 years (female) 17–33 mg/dL 0.17–0.33 g/L
RHEUMATOID FACTOR1
0–14 days 9.0–17.1 IU/mL 9.0–17.1 IU/mL
15 days to <19 years 0–9.0 IU/mL 0–9.0 IU/mL
SODIUM8
3–5 years 135–142 mEq/L 135–142 mmol/L
6–15 years 136–143 mEq/L 136–143 mmol/L
16–49 years (male) 137–143 mEq/L 137–143 mmol/L
16–49 years (female) 137–142 mEq/L 137–142 mmol/L
TOTAL IRON-BINDING CAPACITY (TIBC)5
0–2 months 59–175 mCg/dL 11–31 mcmol/L
3 months to 17 years 250–400 mCg/dL 45–72 mcmol/L
18 years and older 240–450 mCg/dL 43–81 mcmol/L
TOTAL PROTEIN1
0–14 days 5.3–8.3 g/dL 53–83 g/L
15 days to <1 year 4.4–7.1 g/dL 44–71 g/L
1 to <6 years 6.1–7.5 g/dL 61–75 g/L
6 to <9 years 6.4–7.7 g/dL 64–77 g/L
9 to <19 years 6.5–8.1 g/dL 65–81 g/L
TRANSFERRIN1
0 to <9 weeks 104–224 mg/dL 1.04–2.24 g/L
9 weeks <1 year 107–324 mg/dL 1.07–3.24 g/L
1 to <19 years 220–337 mg/dL 2.2–3.37 g/L
TRIGLYCERIDES
(See LIPIDS, earlier)
UREA NITROGEN1
0 to <14 days 2.8–23.0 mg/dL 1.0–8.2 mmol/L
15 days to <1 year 3.4–16.8 mg/dL 1.2–6.0 mmol/L
1 to <10 years 9.0–22.1 mg/dL 3.2–7.9 mmol/L
Male 10 to <19 years 7.3–21 mg/dL 2.6–7.5 mmol/L
Female 10 to <19 years 7.3–19 mg/dL 2.6–6.8 mmol/L
URIC ACID1
0–14 days 2.8–12.7 mg/dL 0.2–0.8 mmol/L
15 days to <1 year 1.6–6.3 mg/dL 0.1–0.4 mmol/L
1 to <12 years 1.8–4.9 mg/dL 0.1–0.3 mmol/L
Continued
 TABLE 28.1—CONT’D
Conventional Units SI Units
Male 12 to <19 years 2.6–7.6 mg/dL 0.2–0.5 mmol/L
Female 12 to <19 years 2.6–5.9 mg/dL 0.2–0.4 mmol/L
VITAMIN A (RETINOL)1
0 to <1 year 8.0–53.6 mg/dL 0–2 mcmol/L
1 to <11 years 27.5–44.4 mg/dL 1–2 mcmol/L
11 to <16 years 24.9–55.0 mg/dL 1–2 mcmol/L
16 to <19 years 28.7–75.1 mg/dL 1–3 mcmol/L
VITAMIN B1 (THIAMINE) RBC6 4.5–10.3 mCg/dL 106–242 nmol/L
VITAMIN B2 (RIBOFLAVIN)6 4–24 mCg/dL 106–638 nmol/L
VITAMIN B12 (COBALAMIN)1
5 days to <1 year 259–1576 pg/mL 191–1163 pmol/L
1 to <9 years 283–1613 pg/mL 209–1190 pmol/L
9 to <14 years 252–1125 pg/mL 186–830 pmol/L
14 to <17 years 244–888 pg/mL 180–655 pmol/L
17 to <19 years 203–811 pg/mL 150–599 pmol/L
VITAMIN C (ASCORBIC ACID)6 0.4–2.0 mg/dL 23–114 mcmol/L
VITAMIN D (1,25-DIHYDROXY-VITAMIN D)13
0 to <1 year 32.1–196.2 pg/mL 77–471 pmol/L
1 to <3 years 47.1–151.2 pg/mL 113–363 pmol/L
3 to <19 years 45.0–102.5 pg/mL 108–246 pmol/L
VITAMIN D (25-HYDROXY-VITAMIN D)14,15
Deficient <12 ng/mL <30 nmol/L
Insufficient 12–20 ng/mL 30–50 nmol/L
Sufficientf ≥20 ng/mL ≥50 nmol/L
Excess >50–60 ng/mL >125–150 nmol/L
VITAMIN E (α-TOCOPHEROL)1
0 to <1 year 0.2–2.1 mg/dL 5.0–50.0 mcmol/L
1 to <19 years 0.6–1.4 mg/dL 14.5–33.0 mcmol/L
ZINC9
6 months to 2 years 56–125 mCg/dL 8.6–19.1 mcmol/L
3–4 years 60–120 mCg/dL 9.2–18.4 mcmol/L
5–6 years 64–117 mCg/dL 9.8–17.9 mcmol/L
7–8 years 65–125 mCg/dL 9.9–19.1 mcmol/L
9–10 years 66–125 mCg/dL 10.1–19.1 mcmol/L
11–12 years 66–127 mCg/dL 10.1–19.4 mcmol/L
13–14 years 69–124 mCg/dL 10.6–19.0 mcmol/L
15–16 years 62–123 mCg/dL 9.5–18.8 mcmol/L
17–18 years 62–133 mCg/dL 9.5–20.3 mcmol/L
a
These reference ranges are similar to data from the SAFETY study,2 which examined 12- to 17-year-old NHANES partici-
pants and identified the 95th percentile of ALT in boys to be 25.8 U/L and in girls to be 22.1 U/L. In all age groups, similar
yet slightly higher ALT cutoffs were published in Bussler et al.3 (LIFE Child cohort) and in Zierk et al.4
bAssay with bromocresol green.
cIn all age groups, similar, yet slightly higher AST cutoffs were published in Bussler et al.3 (LIFE Child cohort) and in Zierk

et al.4
dSimilar data can also be referenced for all age groups in Bussler et al.3 (LIFE Child cohort) and Zierk et al.4
eIt is important to note that these values have not been validated to demonstrate increased risk of atherosclerosis or

cardiovascular events.
fControversy exists regarding optimal 25-hydroxyvitamin D level. Some experts recommend a level ≥30 ng/mL as

sufficient.16
 TABLE 28.2
EVALUATION OF CEREBROSPINAL FLUID
WBC
Age Count/mcL (median) 95th Percentile
0–28 days17 0–12a (4) 16
29–60 days17 0–8a (2) 11
Child18 0–7
GLUCOSE
Age Median 5th Percentile
0–28 days17 45 mg/dL 35 mg/dL
29–60 days17 47 mg/dL 37 mg/dL
Conventional Units SI Units
Infant, child6 60–80 mg/dL 3.3–4.4 mmol/L
Adult6 40–70 mg/dL 2.2–3.9 mmol/L
PROTEIN
Age Median 95th Percentile
0–28 days17 66 mg/dL 118 mg/dL
29–60 days17 49 mg/dL 91 mg/dL
Conventional Units SI Units
6 months to 2 years19 6–25 mg/dL 60–250 mg/L
2–6 years19 5–25 mg/dL 50–250 mg/L
6–12 years19 5–28 mg/dL 50–280 mg/L
12–18 years19 6–34 mg/dL 60–340 mg/L
OPENING PRESSURE (LATERAL RECUMBENT POSITION18,20)
Newborn 8–11 cm H2O
1–18 years 11.5–28 cm H2Oa
Respiratory variations 0.5–1 cm H2O
a
Up to 90th percentile.
WBC, White blood cell
 TABLE 28.3
EVALUATION OF URINE
Urine Analyte Normal Range
ALBUMIN18,21
Random <30 mg urine albumin/g creatinine (on first morn-
ing urine)
24-hr collection
4–16 years (male) 3.35–13.15 mg/1.73 m2/day
4–16 years (female) 3.75–18.34 mg/1.73 m2/day
CALCIUM21
Random
0–6 months <0.8 mg/mg creatinine
7–12 months <0.6 mg/mg creatinine
≥2 years <0.21 mg/mg creatinine
24-hr collection <4 mg/kg/day
CHLORIDE6
Random
Male 25–253 mEq/g creatinine
Female 39–348 mEq/g creatinine
24-hr collection
Infant 2–10 mEq/day
Child <6 years 15–40 mEq/day
6–10 years (male) 36–110 mEq/day
6–10 years (female) 18–74 mEq/day
10–14 years (male) 64–176 mEq/day
10–14 years (female) 36–173 mEq/day
Adult 110–250 mEq/day
CREATININE6
Random
Male <40 years 24–392 mg/dL
Female <40 years 16–327 mg/dL
24-hr collection
Infant 8–20 mg/kg/day
Child 8–22 mg/kg/day
Adolescent 8–30 mg/kg/day
Adult (male) 14–26 mg/kg/day
Adult (female) 11–20 mg/kg/day
POTASSIUM6
Random
Male 13–116 mEq/g creatinine
Female 8–129 mEq/g creatinine
24-hr collection
6–10 years (male) 17–54 mEq/day
6–10 years (female) 8–37 mEq/day
10–14 years (male) 22–57 mEq/day
10–14 years (female) 18–58 mEq/day
Adult 25–125 mEq/day
TABLE 28.3—CONT’D
PROTEIN18,21
Random
6 months to 24 months <0.5 mg protein/mg creatinine
>2 years <0.2 mg protein/mg creatinine
24-hr collection
At rest 50–80 mg/day
After intense exercise <250 mg/day
SODIUM6
Random
Male 23–229 mEq/g creatinine
Female 26–297 mEq/g creatinine
24-hr collection
Full-term, 7–14 days ∼20% that of adults
6–10 years (male) 41–115 mEq/day
6–10 years (female) 20–69 mEq/day
10–14 years (male) 63–177 mEq/day
10–14 years (female) 48–168 mEq/day
Adult 40–220 mEq/day
UREA NITROGEN6
Random
Male 2,864–9,851 mg/g creatinine
Female 3,129–11,639 mg/g creatinine
24-hr collection 12–20 g/day
URINE OSMOLALITY6
Random 50–1,200 mOsm/kg H2O, depending on fluid intake
On average fluid intake 300–900 mOsm/kg H2O
After 12 hr fluid restriction >850 mOsm/kg H2O
24-hr collection ∼300–900 mOsm/kg H2O
 TABLE EC 28.A
EVALUATION OF TRANSUDATE VERSUS EXUDATE (PLEURAL, PERICARDIAL, OR
PERITONEAL FLUID)
Measurementa Transudate Exudateb
Protein (g/dL) <3.0 >3.0
Fluid/serum protein ratio <0.5 ≥0.5
LDH (IU/L) <200 ≥200
Fluid/serum LDH ratio <0.6 ≥0.6
WBCs (mm3)c <10,000 (PMN) >10,000 (PMN)
RBCs (mm3) <5,000 >5,000
Glucose (mg/dL) >40 <40
pHd >7.2 <7.2
aAlways obtain serum for glucose, LDH, protein, amylase, etc. for comparison.
bAll of the following criteria do not have to be met for consideration as an exudate.
cIn peritoneal fluid, WBC count >800/mcL suggests peritonitis.
dCollect anaerobically in a heparinized syringe.

Amylase >5000 U/mL or pleural fluid/serum ratio >1 suggests pancreatitis.

LDH, Lactate dehydrogenase; RBCs, red blood cells; WBCs, white blood cells
Data from Nichols DG, Ackerman AD, Carcillo JA, et al. Rogers Textbook of Pediatric Intensive Care. 4th ed. Baltimore:
Williams & Wilkins; 2008.
 TABLE EC 28.B
CHARACTERISTICS OF SYNOVIAL FLUID
Miscellaneous
Group Condition Synovial Complement Color/Clarity Viscosity Mucin Clot WBC Count PMN (%) Findings
Noninflammatory Normal N Yellow ↑↑ G <200 <25
Clear
Traumatic arthritis N Xanthochromic ↑ F–G <2,000 <25 Debris
Turbid
Osteoarthritis N Yellow ↑ F–G 1,000 <25
Clear
Inflammatory Systemic lupus ↓ Yellow N N 5,000 10 Lupus cells
erythematosus Clear
Rheumatic fever N–↑ Yellow ↓ F 5,000 10–50
Cloudy
Juvenile rheumatoid N–↓ Yellow ↓ Poor 15,000–20,000 75
arthritis Cloudy
Reactive arthritis ↑ Yellow ↓ Poor 20,000 80
Opaque
Pyogenic Tuberculous arthritis N–↑ Yellow-white ↓ Poor 25,000 50–60 Acid-fast
Cloudy bacteria
Septic arthritis ↑ Serosanguineous ↓ Poor 50,000–300,000 >75 Low glucose,
Turbid bacteria
F, Fair; G, good; H, high; N, normal; PMN, polymorphonuclear leukocyte; WBC, white blood cell; ↓, decreased; ↑, increased
From Cassidy JT, Petty RE. Textbook of Pediatric Rheumatology. 5th ed. Philadelphia: WB Saunders; 2005.