Normal

Normal 135-145 mEq/L

Indications

• Monitor:
• Extracellular osmolality
• Electrolyte imbalance

Description Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt.

What would cause increased levels?

• Cushing Syndrome
• Hyperaldosteronism
• Dehydration
• Burn injury
• Azotemia (elevated nitrogen)
• Lactic acidosis (LA)
• Fever/excessive sweating
• Excessive IV fluids containing sodium
• Diabetes Insipidus
• Osmotic diuresis

What would cause decreased levels?

• Congestive Heart Failure (CHF)
• Syndrome of Inappropriate
• Antidiuretic Hormone (SIADH)
• Cystic Fibrosis
• Diuretic use
• Metabolic acidosis
• Addison’s Disease
• Nephrotic Syndrome
• Vomiting
• Diarrhea
• Ascites
• Excessive Antidiuretic
• Hormone(ADH)
• Liver failure

Normal 3.5 - 5.0 mEq/L

Indications

• Evaluate:
  • Electrolyte imbalances
  • Cardiac arrhythmias
• Monitor patients who are:
  • Acidotic
  • Receiving diuretic therapy

Description

Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will cause a 0.5 increase in K+.

What would cause increased levels?

• Renal failure
• Hypoaldosteronism
• Addison’s disease
• Injury to tissues
• Diabetes Mellitus (DM)
• Ketoacidosis
• Hyperventilation
• Acidosis
• Infection
• Dehydration
• Burns

What would cause decreased levels?

• Hyperaldosteronism
• Excess insulin
• Alkalosis
• Diarrhea
• Vomiting
• Cystic Fibrosis
• Cushing Syndrome

Normal 25 - 35 seconds

Indications

• Detection of coagulation disorders
• Evaluate response to Heparin (PT for Coumadin)
• Preoperative assessment

Description

Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin.

What would cause increased levels?

• Disseminated Intravascular Coagulation (DIC)
• Clotting Factor Deficiencies:
  • Hypofibrinogenemia
  • Von Willebrand Disease
  • Hemophilia
• Liver disease:
  • Cirrhosis
• Vitamin K deficiency
• Polycythemia
• Dialysis

What would cause decreased levels?

• N/A

Normal 95 - 100%

Indications

• Determine respiratory status
• Part of Arterial Blood Gas (ABG) testing

Description Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg.

What would cause increased levels?

• Polycythemia
• Increased inspired O2
• Hyperventilation

What would cause decreased levels?

• Anemia’s
• Hypoventilation
• Bronchospasm
• Mucus plugs
• Atelectasis
• Pneumothorax
• Pulmonary edema
• Adult respiratory distress syndrome

Normal 261 – 280 mOsm/kg

Indications

• Monitor:
  • Electrolyte balance
  • Acid-Base balance
  • Hydration
• Evaluate function of antidiuretic hormone.

Description Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality

What would cause increased levels?

• Dehydration
• Azotemia
• Hypercalcemia
• Hyperglycemic Hyperosmolar Nonketotic State (HHNS)
• Hypernatremia
• Diabetes Insipidus
• Hyperglycemia
• Mannitol therapy
• Uremia
• Severe pyelonephritis
• Shock
• Ketosis

What would cause decreased levels?

• Hyponatremia
• Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
• Overhydration

Normal 1.6 – 2.6 mg/dL

Indications

• Monitor:
  • Renal failure
  • Chronic alcoholism
  • Cardiac arrhythmias

Description Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.

What would cause increased levels?

• Renal insufficiency
• Uncontrolled Diabetes Mellitus (DM)
• Addison Disease
• Dehydration
• Hypothyroidism
• Overuse of antacids
• Tissue trauma

What would cause decreased levels?

• Alcoholism
• Diabetic acidosis
• Renal failure:
  • Glomerulonephritis
• Hypercalcemia
• Malnutrition
• Malabsorption
• Hypoparathyroidism
• Diarrhea

Normal

Normal 0.3 -2.6 mmol/L

Indications

• Determine cause of acidosis
• Evaluate tissue oxygenation

Description Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid.

What would cause increased levels?

• Shock
• Sepsis
• Tissue ischemia
• Carbon monoxide poisoning
• Lactic acidosis
• Diabetes Mellitus (DM)
• Heart failure
• Pulmonary edema
• Strenuous exercise

What would cause decreased levels?

• N/A

Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5

Indications

• Evaluate therapeutic doses of Warfarin
• Identify patients at higher risk for bleeding
• Identify cause of:
  • Bleeding
  • Deficiencies

Description International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.

What would cause increased levels?

• Disseminated Intravascular Coagulation (DIC)
• Liver disease
• Vitamin K deficiency
• Warfarin

What would cause decreased levels?

• Too much vitamin K
• Estrogen containing medications such as birth control

Normal >60 optimal mg/dL

Indications

• Monitor risks of heart disease

Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver.

What would cause increased levels?

• Familial HDL Lipoproteinemia
• Exercise
• Unsaturated fats:
  • Mono-
  • Poly-
• Hypothyroid

What would cause decreased levels?

• Metabolic Syndrome
• Hepatocellular disease:
  • Hepatitis
  • Cirrhosis
• Hypoproteinemia:
  • Nephrotic Syndrome
  • Malnutrition
• Smoking
• High saturated and trans fat diets
• Excess body weight
• Hyperthyroid