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ACTH Adrenocorticotropic H.
Normal: 20-140 pg/mL @8 AM
Increased: Addison's Disease, Oat Cell Carcinoma, Pancreatic islet cell tumors,thymic tumors,renal cell carcinoma.
Decreased: Adrenal adenoma or carcinoma, nodular adrenal hyperplasia, pituitary insufficiency.

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Alanine aminotransferase
Normal: 5-35 IU/l
Increase: liver disease, liver metastasis, biliary obstruction, pancreatitis, liver congestion.
(AST > ALT in alchoholic hepatitis)
(ALT > AST in viral hepatitis)

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Albumin
Normal Adult: 3.5-5.5 g/dL Child:>3.8
Decreased: Malnutrition,Nephrotic Syndrome,Cystic Fibrosis, Multiple Myeloma, Hodgkin's Disease, Leukemia, Protein-losing enteropathies, chronic glomerulonephritis, alcoholic cirrhosis hyperthyroidism, Collagen-Vascular disease, Inflammatory Bowel disease.

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Aldosterone
Normal: 5-30 ng/dL early AM
Increased: Hyperaldosteronism (primary or secondary)
Decreased: Adrenal Insufficiency, panhypopituitarism

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Alkaline phosphatase
Normal: 20-70 U/L, Child: 20-150 U/L
Increased: hyperparathyroidism, Paget's disease, osteoblastic bone tumors, osteomalacia, rickets, pregnancy, childhood, biliary obstruction, hyperthyroidism.
Decreased: Malnutrition, excessive vitamin D ingestion.
(heat-stable=Liver,heat-labile=bone)

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Alpha-amylase
Normal: 25-125 Units/L
Increased: acute pancreatitis, pancreatic duct obstruction, EtOH ingestion, mumps, parotiditis, renaldisease, macroamylasemia, cholecystitis,peptic ulcers, intestinal obstruction,mesenteric thrombosis, post surgery.
Decreased: pancreatitis, cystic fibrosis, hepatitis, cirrhosis

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Alpha-Fetoprotein
Normal: <25 ng/mL
Increased: hepatoma, testicular tumor(embryonal Ca, Malignant teratoma) spina bifida(in mother's serum)
Decreased: Down's Syndrome (in mother's serum)

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ALT
Normal: 8-20 IU/l
Increase: liver disease, liver metastasis, biliary obstruction,pancreatitis, liver congestion.
(AST > ALT in alchoholic hepatitis)
(ALT > AST in viral hepatitis)

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Amikacin
Therapeutic Range: Peak 25-30; trough <10 mcg/mL

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Amitriptyline
Therapeutic Range: 100-250 ng/mL

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Ammonia, serum
Normal Adult: 11-35 uMol/L,Child:40-80
Increased: Liver failure, Reye's syndrome.

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Anion Gap
Normal: 12-17 mmol/l (for evaluation of metabolic acidosis)
Increased: Endogenous causes: lactic acidosis, ketoacidosis (due to diabetes, EtOH or starvation), uremia. Exogenous Causes: salicylates, methanol,paraldehyde, ethylene glycol, hyperalimentation.
Normal: From renal causes; renal tubular acidosis, carbonic anhydrase inhibitors, post hypercapnic From gut problems; diarrhea, fistula, ileal loop.
Calculations:
Anion Gap = [Na]-([Cl]+[HCO3])
HCO3 needed = Base Deficit x weight (Kg) / 4
Note: give HCO3 over 8-12 hours

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Antinuclear antibodies
Normal: (negative)
Positive: SLE, Procainamide side-effect, scleroderma, rheumatoid arthritis.

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ASO Titer(antistreptolysin O)
Normal: &lg;166 Todd Units
Increased: Streptococcal Infections (Pharyngitis, Scarlet Fever, Rheumatic Fever, Poststreptococcal Glomerulonephritis) Rheumatoid Arthritis, and other Collagen Diseases.

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Aspartate aminotransferase
Normal: 8-20 U/L
Increased: acute MI,liver disease,Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct.
Decreased: beriberi, diabetes w/ ketoacidosis, liver disease.

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AST
Normal: 8-20 Units/L
Increase: acute MI,liver disease,Reye's syndrome, muscle trauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct.
Decreased: beriberi, diabetes w/ ketoacidosis, liver disease.

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Barbiturate, Long acting
Normal: >215=fatal micromol/l

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Barbiturate, Medium acting
Normal: >105=fatal micromol/l

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Barbiturate, Short acting
Normal: >35=fatal micromol/l

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Base Excess
Normal: -2 to +2 mmol/Litre

BE = [BB measured] - [BB normal]

[BB normal] = 48 mEq/L

BB is total buffer base including bicarb, protein, and hemoglobin

BE increased: metabolic alkalosis

BE decreased: metabolic acidosis

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Basophiles
Normal: 0-1 % ( <110 cells/ul)
Increased: chronic myeloid leukemia, Polycythemia rubra vera.
Decreased: acute rheumatic fever, lobar pneumonia, post steroid therapy, thyrotoxicosis, stress.

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Bicarbonate
Normal: 22-28 mEq/L (23-26 mmol/l)
Increased: respiratory acidosis,compensation for metabolic acidosis,emphysema, severe vomiting, primary aldosteronism, volume contraction, Bartler's syndrome.
Decreased: respiratory alkalosis, compensation for metabolic acidosis,starvation, diabetic ketoacidosis, toxins (methanol, ethylene glycol, paraldehyde), severe diarrhea, renal failure, drugs (salicylates, acetazolamide), dehydration, adrenal insufficiency.

Important tips:
Respiratory Acidosis PCO2- >45
Respiratory Alkalosis PCO2- <35
Metabolic Acidosis HCO3- <22 mmol/l
Metabolic Alkalosis HCO3- >26 mmol/l

Use pH to differentiate Primary from compensatory disorder. If Mixed Disorder, pH will never correct to normal

Calculations:

[HCO3]needed (MEq)=(Base deficit(MEq/L) x Pt.Wt.(Kg))/4

Anion Gap=[Na+]-([Cl-]+[HCO3-])

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Bilirubin
Normal: 0.1-1.0 mg/dL(T):0-0.3 (D)
Increased Total: Hepatic damage, biliary obstruction (stone or tumor), hemolysis, fasting.
Increased Direct (conjugated): biliary obstruction/cholestasis (gallstone, tumor, stricture, drugs), Dubin-Johnson or Rotor's syndrome
Increased Indirect (unconjugated): hemolytic jaundice (hemolytic anemia), transfusion reaction, sickle cell, Gilbert's disease, Crigler-Najjar syndrome, physiological jaundice of newborn.

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Bleeding time
Normal: < 6 min. (Duke,Ivy)
Increased: thrombocytopenia, DIC, Von Willibrand's disease, defective platelet function (aspirin)

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Blood Presure, classification
Normal: <120/<80 mm Hg; Recheck in 2 years.
High normal: 130-139/85-89 mm Hg; Recheck in 1 year.
Stage I hypertension (mild): 140-159/90-99 mm Hg; Reevaluate within 2 months.
Stage II hypertension (moderate): 160-179/100-109 mm Hg; Evaluate and treat within 1 month.
Stage III hypertension (severe): >180/>110 mm Hg; Evaluate and treat immediately.

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BUN
Normal: 7-18 mg/dL
Increased: renal failure, prerenal azotemia, postrenal obstruction, GI bleed, stress, aminoglycoside side-effect, CHF,Volume Depletion, shock.
Decreased: Starvation, liver failure, pregnancy, infancy, nephrotic syndrome,overhydration.

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B-12 vitamin
Normal: 140-970 micrograms/Litre
Increased: leukemia, polycythemia vera.
Decreased: pernicious anemia, pregnency, malabsorption

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Calcitonin
Normal: Male: <155ng/L, Female: <105ng/L
Increased: Medullary Carcinoma of Thyroid, Newborns, Pregnancy, Chronic renal insufficiency, Zollinger-Ellison Syndrome, Pernicious anemia

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Calcium (ionized)
Normal: 2.24-2.46 mEq/L 4.48-4.92mg/dL
Corrected Total= 0.8(Norm.Albumin - measured albumin) + Ionized Ca.
Increased: Primary hyperthyroidism, Vita D excess, PTH-secreting tumors, metastatic bone tumors, osteoporesis, Milk-Alkali syndrome, Paget's disease, chronic renal failure, infantile hypophosphatasia, multiple myeloma, sarcoidosis, thiazide drugs,
Decreased: hypoparathyroidism, Vitamin D insufficient, Ca & P ingestion (in pregnancy, osteomalacia and rickets)hypomagnesemia, renal tubular acidosis,hypoalbuminemia (due to cachexia, nephrotic syndrome & cystic fibrosis), chronic renal failure (phosphate retention) Acute pancreatitis.

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Calcium (total)
Normal: 4.2-5.3.mEq/L 8.5-10.5 mg/dL
Corrected Ca= 0.8*(normal albumin - measured albumin) + reported Ca. (norm.range 2.20-2.60)
Increased: primary hyperparathyroidism, Parathyroid-secreting tumors, VitD excess, Metastatic bone tumors, osteoporosis, immobilization, milk-alkali syndrome, Paget's disease, infantile hypophosphatasia, thiazide drugs, chronic renal failure, sarcoidosis, multiple myeloma.
Decreased: hypoparathyroidism, pseudo-H., no vita.D, calcium and phosphorus ingestion, hypomagnesemia, renal tubular acidosis, hypoalbuminemia, (cachexia,nephrotic S.,cystic fibrosis),chronic renal failure, acute pancreatitis, factitious 2nd to low protein and albumin.

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Carbamazepine
Therapeutic Range: 4-10 mcg/mL

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Cardiac Injury, serum markers
Creatine kinase:

Normal Value: <130 IU per L
Raise after AMI: 4 to 8 hours
Peak Values: 12 to 24 hours
Return to Normal: 4 to 5 days

CK-MB fraction:
Normal Value: <13 IU per L
Raise after AMI: 3 to 12 hours
Peak Values: 10 to 18 hours
Return to Normal: 2 to 3 days

Lactic dehydrogenase:
Normal Value: >250 IU per L
Raise after AMI: 24 to 48 hours
Peak Values: 3 to 6 days
Return to Normal: 7 to 14 days

Myoglobin:
Normal Value: <55 ng per mL
Raise after AMI: 1 to 4 hours
Peak Values: 6 to 9 hours
Return to Normal: 18 to 24 hours

C-Tnl:
Normal Value: Undetectable
Raise after AMI: 3 to 12 hours
Peak Values: 24 hours
Return to Normal: 5 to 10 days

C-TnT:
Normal: Undetectable
Raise after AMI: 3 to 12 hours
Peak Values: 12 to 24 hours and 2 to 3 days
Retur to Normal: 5 to 14 days

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Cardiac Index
Normal: >2.5 L/Min/Sq.Metre
Decreased: Cardiac failure. Consider Inotrope like dobutamine. if less than 2.5

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CEA Carcinoembryonic Antigen
Normal Nonsmoke: <3.0mg/mL, Smoker:<5.0
Increased:carcinoma (colon, pancreas, lung, stomach), smokers, liver disease, Crohn's disease, and ulcerative colitis.

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Chloramphenicol
Therapeutic Range: Peak 10-15; trough <5 mcg/mL

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Chloride
Normal: 95-105 mEq/L
Increased: diarrhea, renal tubular acidosis, mineralocorticoid deficiency, hyperalimentation, acetazolamide, ammonium chloride.
Decreased: vomiting, diabetes w/ ketoacidosis, mineralocorticoid excess, renal disease w/ sodium loss.

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Cholesterol
Normal: 140-250 mg/dL
Increased: idiopathic, biliary obstruction, nephrosis, hypothyroidism, pancreatic disease (diabetes), pregnancy, hyperlipoproteinemia (types IIb,III,V)
Decreased: liver disease (hepatitis), hyperthyroidism, malnutrition (cancer,starvation), chronic anemias, steroid therapy, lipoproteinemias.

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CO2
Normal: 22-28 mEq/L (See bicarbonate, also called: Total CO2 )
Increased: respiratory acidosis, compensation for metabolic acidosis, emphysema, severe vomiting, primary aldosteronism, volume contraction, Bartler's syndrome.

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Cold Agglutinins
Normal: <1:32
Increased: Atypical pneumonia (mycoplasma), viral infections (mononucleosis, measles, mumps) cirrhosis, some parasites.

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Complement C3
Normal: 80-160 mg/dL
Increased: Rheumatoid arthritis, rheumatic fever, neoplasms (GI, Prostate, others)
Decreased: Systemic Lupus, glomerulonephritis (Poststreptococcal and membranoproliferative) sepsis, subacute bacterial endocarditis, chronic active hepatitis.

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Complement C4
Normal: 20-50 mg/dL
Increased: Rheumatoid arthritis (juvenile), neoplasms (gastrointestinal, lung, others)
Decreased: Systemic Lupus, Chronic active hepatitis, cirrhosis, glomerulonephritis, hereditary angioedema.

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Complement CH50 (total)
Normal: 33-61 mg/mL
Test for complement deficiency in classical pathway.
Increased: Acute phase reactants (tissue injury, infections, etc.)
Decreased: hereditary complement deficiencies.

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Coomb's Test, direct
Normal: Negative (no antibody on Pt's RBC).
Positive: Autoimmune hemolytic anemia (leukemia, lymphoma, collagen vascular Diseases), hemolytic transfusion reaction, drug sensitizations (methyldopa, levodopa, cephalothin), Erythroblastosis fetalis (hemolytic disease of the newborn)

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Coomb's Test, indirect
Normal: Negative (no antibody in Pts serum).
Positive: Isoimmunization from previous trasfusion, incompatible blood due to improper cross-matching.

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Copper
Normal: 12-26 micromol/l
Increased: Wilson's disease, oral contraceptives.

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Cortisol
Normal: 8AM:5.0-23.0 ug/dL 4PM:3.0-15.
Increased: Adrenal adenoma, adrenal Carcinoma, Cushing's disease, ACTH-producing tumor, steroid therapy, oral contraceptives.
Decreased: Addison's disease, Congenital adrenal hyperplasia, Waterhouse-Friderichsen syndrome, pituitary insufficiency.

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Creatine phosphokinase 1
Normal: M:25-90 F:10-70 Units/L
Increased: any muscle damage, acute MI, myocarditis, muscular dystrophy, post-surgical, brain infartion, defibrillation, cardiac catheterization,rhabdomyolysis, polymyositis, hypothyroidism.
Isoenzymes:

-MB;heart muscle <6%
-MM;skeletal muscle 94-100%
-BB:brain & CNS %lt;1%

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Creatinine
Normal: 0.6-1.3 mg/dL
Increased: renal failure( pre-renal, renal, or postrenal obstruction), gigantism, acromegaly, ingestion of roasted meat, aminoglycosides or other drugs, false positives with ketones (DKA)
Decreased: pregnancy, loss of muscle mass.

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Creatine kinase:
Normal Value: <130 IU per L

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CK-MB fraction:
Normal Value: <13 IU per L

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C-Peptide
Fasting <4.0ng/ml ,>60y/o:<5.5
Decreased: Diabetes (decreased endogenous insulin), factitious insulin administration.

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Desipramine
Therapeutic Range: 150-300 ng/mL

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Dexamethasone Suppression Test
Normal: <5 ug/dL Cortisol at 8AM
Overnight Test: (for Cushing's Disease).Give 1mg PO Dexamethasone at 11PM; measure fasting serum cortisol at 8AM
<5 ug/dL = Normal
>5 ug/dL = Cushing's syndrome
(false positives with obesity, alcoholism, depression)

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Dexamethasone Suppression Test - High dose
Normal: 17-OH Cort.Steroids drop 50%
High Dose Test: Adrenal Hyperplasia vs. Tumor
Dexamethasone,2mg PO q6h X 8 doses. Measure urinary 17-OH Corticsteroid before and after drug

Bilteral Adrenal Hyperplasia: drop in urinary 17-OH corticosteroids to 50% of baseline.
Adrenal Tumors or Ectopic ACTH Production: No drop in levels.

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Digitoxin
Therapeutic Range: 10-30 ng/mL

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Digoxin
Therapeutic Range: 0.8-2.0 ng/mL

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Disopyramide
Therapeutic Range: 2-5 mcg/mL

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Doxepin
Therapeutic Range: 75-200 ng/mL

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Eosinophiles
Normal: 1-6 % ( <400 cells/ul)
Increased: allergy, parasites, skin diseases, collagen-vascular diseases (NAACP= neoplasm,allergy,addison's, collagen-vascular, parasites), pulmonary diseases(loffler's syndrome & PIE)
Decreased: after steroids, ACTH, after stress, Cushing's syndrome.

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Estrogen Receptors
see Note
Fresh Surgical Specimens, if Positive then better survivability and cure rate for Breast Carcinoma with better response to endocrine therapy.

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Ethosuximide
Therapeutic Range: 40-100 mcg/mL

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Ferritin
Normal: 15-200(M),12-150(F) ng/mL
Decreased: iron deficiency anemia (even before RBC morphology changes) a measure of bone marrow Iron stores

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Fibrin Degradation(Split)Products
Normal: <10 micrograms/mL
Increased: any thromboembolic condition(deep vein thrombosis, MI, pulmonary embolus), DIC (disseminated intravascular coagulation).

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Fibrinogen
Normal: 150-450 mg/dL
Decreased: Congenital, disseminated intravascular coagulation (sepsis, amnionic fluid embolism, abruptio placentae), surgery (prostate, open heart) neoplastic and haematological conditions, acute severe bleeding, burns, snake bite.

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Flecainide
Therapeutic Range: 0.2-1.0 mcg/mL

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Folate (Folic Acid)
Normal: 2.0-21 ng/mL
Increased: folic acid administration.
Decreased: malnutrition, carcinoma, hemolytic anemia, megaloblastic anemia, malabsorption.

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FTA-ABS (Flourescent Treponemal Antibody- Absorbed)
Normal: nonreactive
Positive: Syphilis (test of choice to confirm diagnosis),other treponemal infections.

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Fungal Serologies
Normal: Negative <1:8
A Complement-fixation fungal antibody screen usually detects antibodies to Histoplasma, Blastomyces, Aspergillus, and Coccidioides.

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Gastrin
Normal: Male:<100 pg/mL Female:<75
Increased: Zollinger-Ellison Syndrome, pyloric stenosis, pernicious anemia, atrophic gastritis, ulcerative colitis, renal insufficiency, steroid and calcium administration.

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Gentamicin
Therapeutic Range: Peak 6.0-8.0; trough <2.0 mcg/mL

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GGT (Gamma Glutamyl Transpeptidase)
Normal: Male:9-50 IU/L,Female:8-40 IU/L
Note: parallels changes in serum alkaline phosphatase and 5'nucleotidase in liver disease.
Increased: liver disease (hepatitis, cirrhosis, obstructive jaundice), pancreatitis.

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Glucose (fasting)
Normal: 70-110 mg/dL
Increased: diabetes mellitus, Cushing's syndrome, acromegaly, epinephrine (inj., pheochromocytoma, stress, burns), acute pancreatitis, ACTH administration, elderly patients, pancreatic gluagonoma.
Decreased: pancreatic disorders (pancreatitis, islet-cell tumors), extrapancreatic tumors (carcinoma of the adrenals, stomach), hepatic disease (hepatitis, cirrhosis, tumors), endocrine disorders (early diabetes, hypothyroidism, hypopituitarism), post-gastrectomy, prematurity, infant of a diabetic mother, ketotic hypoglycemia, exogenous insulin, oral hypoglycemics, malnutrition, sepsis.

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GlycoHemoglobin
Normal: 4.6-7.1%
also called Hemoglobin A-1c
Increased: Diabetes mellitus (uncontrolled; reflects levels over preceding 3-4 months)
Decreased: Chronic renal failure
Mean Glucose=10x(HgbA1C + 4)

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Haptoglobin
Normal: 26-185 mg/mL
Increased: Obstructive liver disease, any cause if combined with increased ESR (erythrocyte sedimentation rate).
Decreased: Any type of hemolysis (transfusion reaction, etc.), liver disease.

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Hb (blood)
Normal: M:13.5-17.5 F:12.0-16.

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Hb (plasma)
Normal: 1-4 mg/dL

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HbA1c
Normal: 4.6-7.1 %
Also called glycohemoglobin
Increased: Diabetes Mellitus (uncontrolled; reflects levels over preceding 3-4 months)
Decreased: Chronic renal failure.
Mean Glucose=10x(HgbA1C + 4)

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HDL
Fasting 45 (+/-12) mg/dL
HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk
Increased: estrogen (females)
Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease.
HDL-C = High Density Lipoprotein Cholesterol

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HDL-C
Fasting 45 (+/-12) mg/dL
HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females).
Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease.
HDL-C = High Density Lipoprotein Cholesterol

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Hematocrit
Normal: male:40-54% female:37-47%
Increased: Primary polycythemia, polycythemia vera, secondary polycythemia (decr.fluid intake, incr. fluid loss), heart disease, high altitude, heavy smokers, renal cell carcinoma, hepatoma, renal cysts.
Decreased: megaloblastic anemia (due to folate or B-12 deficiency), Iron deficiency anemia, sickle cell anemia, acute or chronic blood loss, hemolysis, alcohol, drugs.

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Hemoglobin A-1c
Normal: 4.6-7.1 %
AKA: glycohemoglobin
Increased: Diabetes Mellitus (uncontrolled; reflects mean glucose levels over preceding 4-6 weeks)
Decreased: Chronic renal failure.
Mean Glucose=10x(HgbA1C + 4)

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High Density Lipoprotein
Fasting 45 (+/-12) mg/dL
HDL-C has best correlation w/ development of coronary artery Disease. A decreased level->increased risk Increased: estrogen (females)
Decreased: Males, Uremia, Obesity, diabetes, Liver Disease, Tangier's Disease.
HDL-C = High Density Lipoprotein Cholesterol

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Imipramine
Therapeutic Range: 150-300 ng/mL

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Iron
Normal: 50-170 micrograms/dL
Increased: hemochromatosis, hemosiderosis (caused by excessive iron intake), excess destruction of RBC's, decreased production of RBC's, liver necrosis, oral contraceptives.
Decreased: Iron deficiency anemia, hepatitis, nephrosis (loss of iron binding proteins), normochromic anemia of chronic disease and infections.

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Iron Binding Capacity
Normal: 250-450 ug/dL
The normal iron/TIBC ratio is 20-50%, <15% is diagnostic of Iron Deficiency Anemia.
Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives.
Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis.

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Lactate
Normal: 0.5-2.2 mMol/L
Increased: Lactic Acidosis due to Hypoxia, hemmorhage, Shock, sepsis, cirrhosis, exercise.

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Lactic Acid
Normal: 0.5-2.2 mMol/L
Increased: Lactic Acidosis due to Hypoxia, hemmorhage, Shock, sepsis, cirrhosis, exercise.

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LDH (lactate dehydrogenase)
Normal: 45-90 U/L
Increased:acute MI, cardic surgery, prosthetic valves, hepatitis, pernicious anemia, malignant tumors, pulmonary embolus, hemolysis (anemiasor factitious, renal infarction, muscle injury.

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LDH Isoenzymes
Normal LDH1/LDH2 Ratio: <0.6 - 0.7
If LDH1/LDH2 > 1.0 : Then Poss. Acute MI
If LDH5 > LDH4 : Suspect liver Disease
With Acute MI: Levels start to rise 12-24 Hrs post MI and Peak 3-6 Days then return to normal in 8-14 Days.

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Lead
Normal: 0.3-1.8 micromol/l

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Lidocaine
Therapeutic Range: 2-5 mcg/mL

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Lithium
Normal: theraputic 0.5-1.5 (toxic >2.0) mmol/l
Increased: treatment for manic phase of manic-depressive disorder.

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Lymphocytes
Normal: 20-45 %
Increased: measles, German measles, mumps, whooping cough, smallpox, influenza, hepatitis, infectious monucleosis, acute infectious lymphocytosis, any viral infection, and chronic lymphocytic leukemias.
Decreased: post-stress, uremia, some viral infections, normal in 22% of Pop.

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Magnesium
Normal: 1.6-2.6 mg/dL
Increased: renal failure, hypothyroidism, Mg-containing antacids, Addison's disease, diabetic coma, severe dehydration, lithium intoxication.
Decreased: malabsorption, steatorrhea, alcoholism, cirrhosis, hyperthyroidism, aldosteronism, diuretics, acute pancreatitis, hyperPTHism, hyperalimentation, nasogastric suctioning, chronic dialysis, renal tubular acidosis, drugs(cis-platinum, amphotericin B, aminoglycosides), hungry bone syndrome, hypophospatemia, intracellular shifts with respiratory or metabolic acidosis.

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MCH (mean cellular hemoglobin)
Normal: 27-32 pg
= hemoglobin(g/l) / RBC (million/microlitre)
Increased: macrocytosis (megaloblastic anemias, high reticulocyte count)
Decreased: microcytosis (Fe-deficiency, sideroblastic anemias, thalassemia)

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MCHC (mean cellular hemoglobin concentration)
Normal: 30-36 g/dl
=hemoglobin (gm/dL) / hematocrit
Increased: severe & prolonged dehydration, spherocytosis.
Decreased: iron-deficiency anemia, overhydration, thalassemia, sideroblastianemia.

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MCV (mean cell volume)
Normal: 76-96 fl
MCV=HCT x 1000/ RBC (millions/microlitre)
Increased: megaloblastic anemia(B-12 or folate deficiency), macrocytic (normoblastic) anemia, reticulocytosis, Down's syndrome, chronic liverdisease.
Decreased: Iron deficiency, thalassemia, lead poisoning.

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Myoglobin
Normal Value: <55 ng per mL

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Monocytes
Normal: 2-10 % ( <800 cells/ul)
Increased: bacterial infections(TB, subacute bacterial endocarditis, brucellosis, typhoid fever, recovery from acute infection), protozoal infections, infectious mononucleosis, leukemia, Hodgkin's disease, ulcerative colitis, regional enteritis.

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Neutrophiles
Normal: 40-75 % (2K-9K cells/ul)
(Polymorphonuclear Neutrophils)
Increased:
-Normal: severe exercise, last months of pregnancy, labor, surgery, newborns.
-Pathological Increase: bacterial infections, tissue damage( MI, pulmonary infarction, crush injury, burn injury), metabolic disorders (eclampsia, diabetic ketoacidosis, uremia, acute gout), leukemias.

Decreased: pancytopenia, aplastic anemia, PMN depression (mild = neutopenia, severe = agranulocytosis), marrow damage( due to x-rays, benzene poisoning or antitumor drugs), disseminated TB, septicemia, acute malaria, severe osteomyelitis, infectious mononucleosis, atypical pneumonias, viral infections, marrow obliteration (osteosclerosis, myelosclerosis, myelofibrosis, malignant infiltrate), over 70 different drugs (chloramphenicol, phenylbutazone ,chlorpromazine, quinine), B-12 and folate deficiencies, hypoadrenalism, hypopitutarism,dialysis.

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Nortriptyline
Therapeutic Range: 50-150 ng/mL

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Osmolality, plasma
Normal: 278-305 mosm/kg
Osm = (2(sodium)+ BUN/2.8 +Glucose/18)
Increased: hyperglycemia, alcohol ingestion, water loss (diabetes, hypercalcemia, diuresis), ethylene glycol ingestion, mannitol.
Decreased: low serum sodium,diuretics,Addison's disease, inappropriate ADH (SIADH is seen in bronchogenic carcinoma & hypothyroidism), iatrogenic(poor water balance).

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PaCO2
Normal: 4.4 - 5.9 kPa (33-44 mmHg)
Respiratory Acidosis PCO2- >45
Respiratory Alkalosis PCO2- <35
Metabolic Acidosis HCO3- <22 mmol/l
Metabolic Alkalosis HCO3- >26 mmol/l

Use pH to differentiate Primary from compensatory disorder. If Mixed Disorder, pH will never correct to normal.

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PaO2
Normal: >10.6 kPa (75-105 mmHg)

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PCV (hematocrit)
Normal: M:0.4-0.54 F:0.37-0.47 (to one
Decreased: megaloblastic anemia (due to folate or B-12 deficiency), Iron deficiency anemia, sickle cell anemia, acute or chronic blood loss, hemolysis, alcohol, drugs.
Increased: Primary polycythemia, polycythemia vera, secondary polycythemia (decr.fluid intake, incr. fluid loss), heart disease, high altitude, heavy smokers, renal cell carcinoma, hepatoma, renal cysts.

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pH Arterial Blood
Normal: 7.36 - 7.44
pH = 6.1 + LOG ([HCO3]/ 0.03 x pCO2)

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Phenobarbital
Therapeutic Range: 10-30 mEq/mL

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Phenytoin
Therapeutic Range: 8-20 mcg/mL

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Phenylalanine, infants
Normal: 42-73 micromol/l
For screening infants for PKU

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Phosphate (inorganic)
Normal: 3.0-4.5 mg/dL
Increased: hypoparathyroidism, excess vitamin-D, secondary hyperparathyroidism, renal failure, bone disease, healing fractures, Addison's disease, childhood, factitious from specimen hemolysis.
Decreased: hyperparathyroidism,alcoholism, diabetes, hyperalimentation,acidosis, alkalosis, gout, salicylate poisoning, IV steroid, glucose or insulin injection, hypokalemia, hypomagnesemia, diuretics, Vitamin D deficiency, posphate-binding antacids

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Platelets
Normal: 150-400 x10^9/l, abnormalities of platelet function are measured by bleeding time.
Increased: sudden exercise, after trauma bone fracture, after asphyxia,after surgery, acute hemmorrhage, polycythemia vera, primary thrombocythemia, leukemias, carcinoma, post-childbirth.
Decreased: disseminated intravascular coagulation (DIC), idiopathic thrombocytopenic purpura, congenital disease, bone marrow suppressants (chemotherapy, thiazide diuretics, alcohol, estrogens, x-rays), burns, snake and insect bites, leukemias, aplastic anemia, hypersplenism, infectious mononucleosis, viral infections, cirrhosis, massive transfusions, eclampsia, preeclampsia, over 30 different drugs.

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PMN's
Normal: 40-75 %(Polymorphonuclear Neutrophils)
Increased: -Normal: severe exercise, last months of pregnancy, labor, surgery, newborns.
-Pathological Increase: bacterial infections, tissue damage( MI, pulmonary infarction, crush injury, burn injury), metabolic disorders (eclampsia, diabetic ketoacidosis, uremia, acute gout), leukemias.
Decreased: pancytopenia, aplastic anemia, PMN depression (mild = neutopenia, severe = agranulocytosis), marrow damage( due to x-rays, benzene poisoning or antitumor drugs), disseminated TB, septicemia, acute malaria, severe osteomyelitis, infectious mononucleosis, atypical pneumonias, viral infections, marrow obliteration (osteosclerosis, myelosclerosis, myelofibrosis, malignant infiltrate), over 70 different drugs (chloramphenicol, phenylbutazone ,chlorpromazine, quinine), B-12 and folate deficiencies, hypoadrenalism, hypopitutarism,dialysis.

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Potassium
Normal: 3.5-5.0 mEq/L (same in mmol/L)
Increased: factitious( hemolysis of specimen, thrombocytosis), renal failure, Addison's disease, acidosis, spironolactone, triamterene, dehydration, hemolysis, massive tissue damage, excess intake, acidosis.
Decreased: diuretics, decreased intake, vomiting, nasogastric suction, villous adenoma, diarrhea, Zollinger-Ellison syndrome, chronic pyelonephritis, renal tubular acidosis, metabolic alkalosis (primary aldoseronism, Cushing's syndrome)

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Procainamide
Therapeutic Range: 4.0-8.0 mcg/mL.

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Protein(total Plasma)
Normal: 6.0-7.8 g/dL
Increased: Multiple myeloma, macroglobulinemia, hypergammaglobulinemia, sarcoidosis.
Decreased: malnutrition, inflammatory bowel disease, Hodgkin's disease, leukemias, decreased albumin from any cause.

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PT (prothrombin time)
Normal: 11.5-13.5 seconds
Prolonged: Drugs(Warfarin), Vitamin K deficiency, fat malabsorption,liver disease, disseminated intravascular coagulation (DIC), Factitious due to prolonged use of tourniquet before drawing sample.

NOTE: PT measures activity of factors I,II,V,VII,IX,X and fibrinogen. (extrinsic clotting mechanism)

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PTT (Partial Thromboplastin Time)
Normal: 35-45 Secs.
Prolonged: Hemophilia A and B, Heparin administration, Factitious from Tourniquet on too long.

Note: PTT measures Defects in clotting factors I,II,V,VIII,IX,X,XI,and XII

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Quinidine
Therapeutic Range: 2.5-5.0 mcg/mL

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RBC
Normal: M:4.3-5.9 F:3.5-5.5 x10^12/L

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RDW (red cell distribution width)
Normal: 11.5-14.5%, a measure of variation in cell size.
Increased: in many anemias; esp. Iron Deficiency Anemia (normal in Anemia of Chronic Disease) in setting of a microcitic(or normocytic) hypochromic anemia.

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Salicylate
Therapeutic Range: 15-25 mg/dL

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SGOT
Normal: 5-35 IU/l
Increase: acute MI,liver disease, Reye's syndrome, muscletrauma, pancreatitis, intestinal trauma, erythromycin tx, opiate tx, burns cardiac cath., brain damage, renal infarct.
Decreased:beriberi, diabetes w/ ketoacidosis, liver disease.

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SGPT
Normal: 5-35 IU/l
Increase: liver disease, liver metastasis, biliary obstruction, pancreatitis, liver congestion.
(SGOT > SGPT in alchoholic hepatitis)
(SGPT > SGOT in viral hepatitis)

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Sodium
Normal: 135-145 mEq/L
Increased:
-low total body sodium: (gycosuria, mannitol, urea, sweating)
-normal body Na: (diabetes insipidus; central and nephrogenic, respiratory losses, sweating)
-increased total body Na: (hypertonic H2CO3, Cushing's syndrome, hyperaldosteronism).

Decreased:
-excess total Na and H2O: (nephrotic syndrome, congestive heart failure, cirrhosis, renal failure)
-excess H20 only: (SIADH, hypothyroidism, adrenal insufficiency)
-with decreased Na and H2O: ( diuretics, renal tubular acidosis, mannitol, urea, mineralocorticoid deficiency, vomiting,diarrhea, pancreatitis)
-with pseudohyponatremia (hyperlipidemia, hyperglycemia, multiple myeloma).

Total Body Water calc for rehydration:

Current TBW = 0.6 X Current Weight(Kg.)

Desired TBW = (Serum Na+(mEq/L.) X Current TBW)/(Normal Serum Na+(mEq/L.))

Body Water Deficit = Desired TBW - Current TBW

Note: Correct SLOWLY; 1/2 BWD over first 24 Hrs. Then the rest over 1-2 days. Repeat calc. daily to reach steady-state.

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Streptomycin
Therapeutic Range: Peak 10-20; trough <5 mcg/mL

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Theophylline
Therapeutic Range: 8-20 mcg/mL

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TIBC
Normal: 250-450 ug/dL(54-75 uMol/l)
The normal iron/TIBC ratio is 20-50%, <15% is diagnostic of Iron Deficiency Anemia. Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives
Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis.

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Total Iron Binding Capacity
Normal: 250-450 ug/dL
The normal iron/TIBC ratio is 20-50%, <15% is diagnostic of Iron Deficiency Anemia
Increased:Acute&Chronic Blood loss, Iron deficiency Anemia, Hepatitis, Oral Contraceptives
Decreased:Anemia of Infection or Chronic Disease, cirrhosis, Nephrosis, Hemochromatosis.

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Tocainide
Therapeutic Range: 4-10 mcg/mL

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Triglycerides:
Normal: 115-190 ng/dL
Increased: hyperlipoproteinemias (types I,IIb,III,IV,V), hypothyroidism,liver diseases, alcoholism, pancreatitis, acute MI,nephrotic syndrome, familial increase.
Decreased: malnutrition, congenital abetalipoproteinemia.

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Urea
Normal: 3.0-8.2 mg/dL

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Urea nitrogen
Normal: 7-18 mg/dL
Increased: renal failure, prerenal azotemia, postrenal obstruction, GI bleed, stress, aminoglycoside side-effect.
Decreased: Starvation, liver failure, pregnancy, infancy, nephrotic syndrome, overhydration.

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Uric acid
Normal: M:210-480 F:150-390 micromol/l
Increased: gout,renal failure,leukemia, anemia, chemotherapy,toxemia of pregnancy, diuretics, lactic acidosis, hypothyroidism,polycystic kidney disease, parathyroid diseases.
Decreased: uricosuric drugs (salicylatesprobenecid, allopurinol), Wilson's disease, Fanconi's syndrome.

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Valproic acid
Therapeutic Range: 50-100 mcg/mL

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Vancomycin
Therapeutic Range: Peak 30-40; trough <10 mcg/mL

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Viscosity, plasma
Normal: 1.4-1.8 Cp
Increased: macroglobulinemia, multiple myeloma,Plasma cell myeloma,

Note: usually >4 Cp before symptoms of fundal hemmorrhage, epistaxis, drowsiness, and confusion are seen. The units are in centipoises.

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WBC
Normal: 4-11 x10^9/l
Increased: In many inflammatory and bacterial infective processes. Look at individual leukocyte subpopulations for some indication of the exact infective process involved.

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Wedge Pressure
Normal: <15 mmHg
If >15, increased:give Dobutamine or other inotrope. Means left atrial pressure is too high.

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