Monday, November 30, 2009

All the lab values RTs need to know

The best RTs I've ever met study patient charts at the beginning of every shift, and make recommendations as needed. You never know when the doctor or nurse might be missing something.

As an RT I love to know what high and low lab values indicate. I also like to know what they indicate from my own perspective. You never know when your mother-in-law is going to call you for some medical advice pertaining so some lab result.

Therefore, I like to keep the following information close by just in case:

Lab tests & possible reasons for abnormal results:
(Critical values in parenthesis.)
  1. CK: greater than 200 (greater than 351-2000 critical) = Muscle damage (nonspecific)
  2. CKMB: greater than 2.5-3.0 (greater than 5.5) = Heart muscle damage
  3. Troponin: greater than 0.1 (greater than 0.4) = Heart muscle damage (most specific)
  4. ALK: greater than 136 = Liver or bone damage
  5. ALP: greater than 150 = Liver or bone damage
  6. AST: greater than 37 (greater than 200 critical) = Liver tissue damage (nonspecific)
  7. ALT: greater than 65 = Liver tissue damage (Specific for Hepatitis)
  8. Biliruben: greater than 1.0 = Liver cell damage (best indicator of liver function)
  9. Albumin: greater than 5.0 = Dehydration (best indicator of liver function)
    less than 3.5 (less than 1.5) = Liver disease, shock, malnutrition
  10. Gamma-Gt: greater than 51 = CHF, liver damage
  11. BNP: greater than 100 = CHF = heart failure (300=mild, 600=mod, 900 severe)
    OK = 125-450, less than 75 YO = 125, less than 75 YO = 450
  12. Glucose: greater than 120 (greater than 350) = Diabetes (greater than 150 = insulin protocol) less than 90 (less than 40)= Liver failure if not on Insulin (sepsis?)
  13. GFR: less than 60 (less than 29 critical) less than 15=Kidney failure
  14. BUN: greater than 18 (greater than 45 critical) = Kidney problems, CHF, shock, stress MI, dehydration, GI bleed less than 07 = Severe liver disease, malnutrition, over-hydrated
  15. Creatinin: greater than 1.7 (3.0 critical) = Kidney probs, dehydration, CHF, shock
  16. Sodium: greater than 145 (greater than 160 critical) = Dehydration
    less than 136 (less than 120) Kidney disease, over-hydrated (edema), not
    eating well, CHF, effects of Lasix, diarrhea, vomiting
    sweating. (less than 126=critical, confusion, lethargy, seizures)
  17. Potassium: greater than 5.1 (greater than 6 critical) Kidney failure, massive tissue trauma, (post op), metabolic acidosis (diabetes), dehydration. less than 3.5 (less than 2.8) = Not enough in diet, gastro-intestinal disorder, vomiting. Due to Insulen, Lasix, dig, steroids?
  18. Magnesium: greater than 2.4(greater than 2.7) = Kidney failure, dehydration, diabetic acidosis less than 1.3 (less than1.0 critical) Malnourished (low intake), elderly, alcoholism, long-term diuretic use, diarrhea.
  19. Chloride: greater than107 = Dehydration, met acidosis, hypoventilation (alkalosis)
    less than 98) = When Sodium low
  20. Calcium: greater than 10.1 (greater than 13) = Bone breaks, prolonged bed rest, etc.
    less than 8.5 (less than 6) = Bone disease, malnutrition, alcoholism
  21. PTT/ PT: greater than 33/ greater than 12.7(greater than 60/greater than 40) = transfusion, therapeutic, DIC. PTT is one of the best measures of liver function. less than 24/less than 10 = Impaired clotting ability
  22. INR: greater than 1.2 (greater than 6) = Acute bleed, DIC or therapeutic.
  23. Fibrinogen: greater than 450 = Risk for heart disease (checked often) less than 160 (less than 70) = Acute bleed, liver disease, malnutrition, DIC
  24. D-Dimer: greater than 500 = DVT, PE, DIC, acute bleed, surgery, trauma
  25. Platelets: less than 80,000 = bleeding problems, Heparin, DIC alcoholic, leukemia (Vitamin K increases clotting)
  26. Phosphorus: greater than 4.1 (greater than 8) = Liver disease, Kidney failure, bone mets. less than 3.0 (less than 1.1) = Diabetic Keto-acidosis
  27. Uric Acid: greater than 7.0 = Acidosis, alcoholism, diabetes, Kidney failure
  28. Folic Acid: less than 2.0 = Malnutrition
  29. Lactic Acid: greater than 19.8 = Hypoxia, O2 deprivation, shock, CHF, tissue death increases when organs failing/dying (sepsis?)
  30. LDH (Lactate Dehydrogenase): greater than 136 (greater than 350 critical) = Nonspecific Tissue damage or death
  31. Osmology greater than 300 = Dehydration
  32. Hematocrit: greater than 47 = Dehydration
  33. Keytones: Positive test = Diabetes, starvation, vomiting, increased metabolism (fever, severe illness).
  34. Neutrophils: greater than 48-73% = increased levels of bacterial infection (acute)
    a. Segs greater than 60 if new infection
    b. Bands greater than 2% = worsening infection
  35. Eisinophils: greater than 2% with allergic reaction (associated with asthma).
  36. Lymphocytes: greater than 18-48% = may indicate viral infection (mono, measles, pox)
  37. Basophils: greater than 2% = allergic reaction
For a printable cheat sheet with this information and more, click here.

1 comment:

Chelsea said...

I just saw a blurb, probably on medscape that said that uric acid can be signal in dyspnea, at least with chronic heart failure.