Lab Values

Erythrocyte Studies Normal Lab Values
Here are the normal lab values related to erythrocyte studies which include hemoglobin,
hematocrit, red blood cell count, serum iron, and erythrocyte sedimentation rate. Venous blood
is used as a specimen for complete blood count (CBC) which is a basic screening test that is
frequently ordered to give an idea about the health of a patient.
Red Blood Cells (RBC) Normal Lab Values
Red blood cells or erythrocytes transport oxygen from the lungs to the bodily tissues. RBCs are
produced in the red bone marrow, can survive in the peripheral blood for 120 days, and are
removed from the blood through the bone marrow, liver, and spleen.
Indications of RBC count:
 Helps in diagnosing anemia and blood dyscrasia.

Normal values for red blood cell count:
Range (SI Units) Range (Conventional)
Adult male 4.7—6.2 ✕ 1012/L 4.7—6.2 ✕ 106/mm3
Adult female 4.5—5.0 ✕ 1012/L 4.5—5.0 ✕ 106/mm3
Child 3.5—5.5 ✕ 1012/L 3.5—5.5 ✕ 106/mm3
Newborn 4.8—7.1 ✕ 1012/L 4.8—7.1 ✕ 106/mm3
Hemoglobin (Hgb)
Hemoglobin is the protein component of red blood cells that serves as a vehicle for oxygen and
carbon dioxide transport. It is composed of a pigment (heme) which carries iron, and a protein
(globin). The hemoglobin test is a measure of the total amount of hemoglobin in the blood.
Indications of hemoglobin count:

 Hemoglobin count is indicated to help measure the severity of anemia (low hemoglobin)
or polycythemia (high hemoglobin).
 Monitor the effectiveness of a therapeutic regimen.
Normal and critical values chart for hemoglobin count:
Adult male 140—170 g/L 14—17 g/dL
Adult female 120—150 g/L 12—15 g/dL
Pregnant >110 g/L >11 g/dL
Child 95—150 g/L 9.5—15 g/dL
Newborn 140—240 g/L 14—24 g/dL
Critical values <70 or >200 g/L <7.0 or >20.0 g/dL
🔺Increased hemoglobin levels may indicate:
 Chronic obstructive pulmonary disease

 Congenital heart disease
 Congestive heart disease
 Dehydration
 Hemoconcentration of the blood
 High altitudes
 Polycythemia vera
 Severe burns
🔻Decreased hemoglobin levels may indicate:
 Anemia
 Cancer
 Chronic hemorrhage
 Hemolysis
 Kidney disease
 Lymphoma
 Neoplasia
 Nutritional deficiency
 Sarcoidosis
 Severe hemorrhage
 Sickle cell anemia
 Splenomegaly
 Systemic lupus erythematosus
Hematocrit (Hct)
Hematocrit or packed cell volume (Hct, PCV, or crit) represents the percentage of the total blood
volume that is made up of the red blood cell (RBC).
Normal and critical values for hematocrit count:
Adult male 0.42—0.52 42%—52%
Adult female 0.35—047 35%—47%
Pregnant >0.33 (>33%) >33%
Child 0.30—0.44 30—44%
Newborn 0.44—0.64 44%—64%
Critical values <0.20 or >0.60 <20% or >60%
Increased hematocrit levels may indicate:
 Burns
 Congenital heart disease
 Dehydration
 Eclampsia
 Erythrocytosis
 Polycythemia Vera
 Severe dehydration
Decreased hematocrit levels may indicate:
 Anemia
 Bone marrow failure
 Hemoglobinopathy
 Hemolytic reaction
 Hemorrhage
 Hyperthyroidism
 Leukemia
 Liver cirrhosis
 Malnutrition
 Multiple myelomas
 Normal pregnancy
 Rheumatoid arthritis
Red Blood Cell Indices
Red blood cell indicates (RBC Indices) determine the characteristics of an RBC. It is useful in
diagnosing pernicious and iron deficiency anemias and other liver diseases.
Mean corpuscular volume (MCV): The average size of the individual RBC.
Mean corpuscular hemoglobin (MCH): The amount of Hgb present in one cell.
Mean corpuscular hemoglobin concentration (MCHC): The proportion of each cell
occupied by the Hgb.
Normal Lab Values for RBC Indices are:
Mean corpuscular volume (MCV) 82—98 fL 82—98 mm3
Mean corpuscular hemoglobin (MCH) 0.40—0.53 fmol/cell 26—34 pg/cel
Mean corpuscular hemoglobin concentration (MCHC) 320—360 g/L 32—36 g/dL
Reticulocyte Count 0.005—0.015 0.5%—1.5% of total RBCs

Serum Iron (Fe)
Iron is essential for the production of blood helps transport oxygen from the lungs to the tissues
and carbon dioxide from the tissues to the lungs.
Normal lab values for serum iron:
Adult male 12.5—31.3 µmol/L 70—175 µg/dL
Adult female 8.9—26.8 µmol/L 50—150 µg/dL
Child 8.9—21.5 µmol/L 50—120 µg/dL
Newborn 17.9—44.8 µmol/L 100—250 µg/dL
Total iron—binding capacity (TIBC) 41.2—65.7 µmol/L 229—365 µg/dL
Transferrin 2.15—3.75 g/L 215—375 mg/dL
Indication of serum iron:
 Helps in diagnosing anemia and hemolytic disorder.

Increased serum iron levels may indicate:
 Hemochromatosis
 Hemosiderosis
 Hemolytic anemia
 Hepatic necrosis
 Hepatitis
 Iron poisoning
 Lead toxicity
 Massive transfusion
Decreased serum iron levels:
 Chronic blood loss

 Chronic gastrointestinal blood loss
 Chronic hematuria
 Chronic pathologic menstruation
 Inadequate absorption of iron
 Iron deficiency anemia
Age ESR
Male <50 years: 0—14 mm/hour
50—85 years: 0—19 mm/hour
>85 years: 0—29 mm/hour
Female <50 years: 0—19 mm/hour
50—85 years: 0—29 mm/hour
>85 years: 0—41 mm/hour
Child ≥ 2 years 0—10 mm/hour
 Lack of iron in the diet

 Neoplasia
 Pregnancy (late stages)
Nursing considerations for serum iron:
 Recent intake of a meal containing high iron content may affect the results.
 Drugs that may cause decreased iron levels include adrenocorticotropic hormone,
cholestyramine, colchicine, deferoxamine, and testosterone.
 Drugs that may cause increased iron levels include dextrans, ethanol, estrogens, iron
preparations, methyldopa, and oral contraceptives.
Erythrocyte Sedimentation Rate (ESR)
Erythrocyte sedimentation rate (ESR) is a measurement of the rate at which erythrocytes settle in
a blood sample within one hour.
Normal lab values for erythrocyte sedimentation rate:
Indication for Erythrocyte Sedimentation Rate:
 Assist in the diagnosis of conditions related to acute and chronic infection, inflammation,
and tissue necrosis or infarction.
Increased ESR levels may indicate:
 Bacterial infection
 Chronic renal failure
 Hyperfibrinogenemia
 Inflammatory disease
 Macroglobulinemia
 Malignant diseases
 Severe anemias such as vitamin B12 deficiency or iron deficiency
Decreased ESR levels may indicate:
 Hypofibrinogenemia
 Spherocytosis
Nursing consideration
 Fasting is not required

 Fatty meal prior extraction may cause plasma alterations
Coagulation Studies Normal Lab Values
Physicians order coagulation studies such as platelet count, activated partial thromboplastin
time, prothrombin time, international normalized ratio, bleeding time, and D-dimer to evaluate
the clotting function of an individual. In this section, we’ll discuss the indications and nursing
implications of each lab test.
Platelets (Pt), Mean Platelet Volume (MPV), Fibrinogen

Platelets are produced in the bone marrow and play a role in hemostasis. Platelets function
in hemostatic plug formation, clot retraction, and coagulation factor activation.
Normal and critical values for platelet count and mean platelet volume:
Range (SI Unit) Range (Conventional)
Adult 150—400 ✕ 109/L 150,000—400,000/mm3
Child 150—400 ✕ 109/L 150,000—400,000/mm3
Infant 200—475 ✕ 109/L 200,000—475,000 mm3
Premature infant 100—300 ✕ 109/L 100,000—300,000/mm
Newborn 150—300 ✕ 109/L 150,000—300,000/mm3
Critical values <20 or >1,000 ✕ 109/L <20,000 or >1 million/mm3
Mean Platelet Volume (MPV) 7.4—10.4 fL 7.4—10.4 mm3
Normal and critical values for fibrinogen:
Range
Adult 200–400 mg/dL
Newborn 125–300 mg/dL
Critical value <100 mg/dL

Increased platelet count (Thrombocytosis) may indicate:
 Iron deficiency anemia

 Malignant disorder
 Postsplenectomy syndrome
 Rheumatoid arthritis
Decreased platelet count (Thrombocytopenia) may indicate:
 Cancer
 Chemotherapy
 Disseminated intravascular coagulation
 Hemorrhage
 Hypersplenism
 Immune thrombocytopenia
 Infection
 Inherited thrombocytopenia disorders such as Bernard-Soulier, Wiskott-Aldrich, or Zieve
syndromes
 Leukemia and other myelofibrosis disorders
 Pernicious anemia
 Systemic lupus erythematosus
 Thrombotic thrombocytopenia
Nursing considerations for platelet count:
 High altitudes, persistent cold temperature, and strenuous exercise increase platelet
counts.
 Assess the venipuncture site for bleeding in clients with known thrombocytopenia.
 Bleeding precautions should be instituted in clients with a low platelet count.
Bleeding Time Normal Lab Values
Bleeding time assess the overall hemostatic function (platelet response to injury and
vasoconstrictive ability).
Indication for Bleeding Time
 Useful in detecting disorders of platelet function.

Prolonged bleeding time or increased levels may indicate:

 Bernard-Soulier syndrome
 Capillary fragility
 Clotting factor deficiency
 Collagen vascular disease
 Connective tissue disorder
 Cushing’s syndrome
 Glanzmann’s thrombasthenia
 Henoch-Schonlein syndrome
 Hereditary telangiectasia
 Hypersplenism
 Leukemia
 Primary or metastatic tumor infiltration of bone marrow
 Severe liver disease
 Thrombocytopenia
 Uremia
 Von Willebrand’s disease
Nursing Considerations for Bleeding Time
 Assess and validate that the client has not been receiving anticoagulants, aspirin,
or aspirin-containing products for 3 days prior to the test.
 Inform the client that punctures are made to measure the time it takes for bleeding to
stop.
 Apply pressure dressing to clients with bleeding tendencies after the procedure.
Normal Values for Bleeding Time
Duke Method Ivy Method
1–3 minutes 1–9 minutes
D-Dimer Test
D-Dimer is a blood test that measures clot formation and lysis that results from the degradation
of fibrin.
Indication of D-Dimer Test
 Helps to diagnose the presence of thrombus in conditions such as deep vein

thrombosis, pulmonary embolism, or stroke.
 Used to diagnose disseminated intravascular coagulation (DIC).
 Monitor the effectiveness of treatment.
Normal Lab Value for D-Dimer:
D-Dimer
<0.4 µg/mL
Prothrombin Time, International Normalized Ratio (PT/INR)
Prothrombin is a vitamin K-dependent glycoprotein produced by the liver that is essential for
fibrin clot formation. Each laboratory establishes a normal or control value based on the method
used to perform the PT test. The PT measures the amount of time it takes in seconds for clot
formation, the international normalized ratio (INR) is calculated from a PT result to monitor the
effectiveness of warfarin.
Indication for PT and INR
 Monitor response to warfarin sodium (Coumadin) therapy.

 Screen for dysfunction of the extrinsic clotting system resulting from vitamin K deficiency
disseminated intravascular coagulation or liver disease.
Normal and Critical Lab Values for Prothrombin Time (PT):
Range
Normal 11—13 seconds
Full anticoagulant therapy >1.5—2 times control value
Critical value >20 seconds
Normal and Critical Lab Value for International Normalized Ratio (INR)
The INR standardizes the PT ratio and is calculated in the laboratory setting by raising the
observed PT ratio to the power of the international sensitivity index specific to the
thromboplastin reagent used.
Range
Normal 0.8—1.2
Therapeutic INR range for patients on warfarin 2.0—3.0
Therapeutic INR range for patients with mechanical heart valves 3.0—4.0
Critical value >5.0
Increased prothrombin time may indicate:
 Bile duct obstruction

 Coumarin ingestion
 Hepatitis
 Hereditary factor deficiency
 Liver cirrhosis
 Massive blood transfusion
 Salicylate intoxication
 Vitamin K deficiency
Decreased prothrombin time may indicate:
 Blood clots quickly due to:

 Supplements containing vitamin K
 High intake of foods that contain vitamin K, such as liver, broccoli, kale, turnip greens
and soybeans
Nursing Care for Prothrombin Time
 If a PT is prescribed, the baseline specimen should be drawn before anticoagulation

therapy is started; note the time of collection on the laboratory form.
 Provide direct pressure to the venipuncture site for 3 to 5 minutes.
 Concurrent warfarin therapy with heparin therapy can lengthen the PT for up to 5 hours
after dosing.
 Diets high in green leafy vegetables can increase the absorption of vitamin K, which
shortens the PT.
 Orally administered anticoagulation therapy usually maintains the PT at 1.5 to 2 times
the laboratory control value.
 Initiate bleeding precautions, if the PT value is longer than 30 seconds in a client
receiving warfarin therapy.
Activated Partial Thromboplastin Time (APTT)
Activated partial thromboplastin time (APTT) evaluates the function of the contact activation
pathway and coagulation sequence by measuring the amount of time it requires for recalcified
citrated plasma to clot after partial thromboplastin is added to it. The test screens for
deficiencies and inhibitors of all factors, except factors VII and XIII.
Normal and critical lab values for activated partial thromboplastin time (aPTT) and partial
thromboplastin time (PTT):
aPTT PTT
Normal 30—40 seconds 60—70 seconds
1.5—2.5 times control value 1.5—2.5 seconds times control value

Patients receiving anticoagulant therapy
(60—80 seconds) (120—140 seconds)
Critical values none or >70 seconds none or >100 seconds
Indication for APTT:
 Monitors the effectiveness of heparin therapy.

 Detect coagulation disorders in clotting factors such as hemophilia A (factor VIII)
and hemophilia B (factor IX).
 Determine individuals who may be prone to bleeding during invasive procedures.
Increased APTT levels may indicate:
 Congenital clotting factor deficiencies

 Hemophilia
 Heparin administration
 Hypofibrinogenemia von Willebrand’s disease
 Leukemia
 Liver cirrhosis
 Vitamin K deficiency
Decreased APTT levels may indicate:
 Early stages of disseminated intravascular coagulation
 Extensive cancer
Nursing consideration for APTT:
 Do not draw samples from an arm into which heparin is infusing.

 If the client is receiving intermittent heparin by intermittent injection, plan to draw the
blood sample 1 hour before the next dose of heparin.
 Apply direct pressure to the venipuncture site.
 Blood specimen should be transported to the laboratory immediately.
 The aPTT should be between 1.5 and 2.5 times normal when the client is receiving
heparin therapy.
 Monitor for signs of bleeding if the aPTT value is longer than 90 seconds in a patient
receiving heparin therapy.
White Blood Cells and Differential
The normal laboratory value for WBC count has two components: the total number of white
blood cells and differential count.
White Blood Cells (WBC)
White blood cells act as the body’s first line of defense against foreign bodies, tissues, and
other substances. WBC count assesses the total number of WBC in a cubic millimeter of blood.
White blood cell differential provides specific information on white blood cell types:
 Neutrophils are the most common type of WBC and serve as the primary defense
against infection.
 Lymphocytes play a big role in response to inflammation or infection.
 Monocytes are cells that respond to infection, inflammation, and foreign bodies by
killing and digesting the foreign organism (phagocytosis).
 Eosinophils respond during an allergic reaction and parasitic infections.
 Basophils are involved during an allergic reaction, inflammation, and autoimmune
diseases.
 Bands are immature WBCs that are first released from the bone marrow into the blood.
Normal and critical lab values for white blood cell count:
Adult 5.0—10 ✕ 109 cells/L 5000—10,000/mm3
Child (≤2 years) 6.2—17 ✕ 109 cells/L 6,200—17,000/mm3

Newborn 9.0—30 ✕ 109 cells/L 9,000—30,000/mm3
Critical values 2.0—40 ✕ 109 cells/L <2,000 or > 40,000/mm
WBC Range (SI Unit) Range (Conventional)
Neutrophils 2,500—8,000/mm3 55—70%
Lymphocytes 1,000—4,000/mm3 20—40%
Monocytes 100—700/mm3 2—8%
Eosinophils 50—500/mm3 1—4%
Basophils 25—100/mm3 0.5—1%
Bands 0—700/mm3 0—2%
Normal lab values for WBC differential:
Increased WBC count (Leukocytosis) may indicate:
 Inflammation
 Infection
 Leukemic neoplasia
 Stress
 Tissue necrosis
 Trauma
Decreased WBC count (Leukopenia) may indicate:
 Autoimmune disease
 Bone marrow infiltration (e.g., myelofibrosis)
 Congenital marrow aplasia
 Drug toxicity (e.g., chloramphenicol)
 Severe infection
Nursing consideration for WBC count:
 A high total WBC count with a left shift means that the bone marrow will release an
increased amount of neutrophils in response to inflammation or infection.
 A “shift to the right” which is usually seen in liver disease, megaloblastic and pernicious
anemia, and Down syndrome, indicates that cells have more than the usual number of
nuclear segments.
 A “shift to the left” indicates an increased number of immature neutrophils is found in
the blood.
 A low total WBC count with a left shift means a recovery from bone
marrow depression or an infection of such intensity that the demand for neutrophils in
the tissue is greater than the capacity of the bone marrow to release them into the
circulation.
Serum Electrolytes Normal Lab Values
Electrolytes are minerals that are involved in some of the important functions in our body.
Serum electrolytes are routinely ordered for a patient admitted to a hospital as a screening test
for electrolyte and acid-base imbalances. Here we discuss the normal lab values of the
commonly ordered serum tests: potassium, serum sodium, serum chloride, and serum
bicarbonate. Serum electrolytes may be ordered as a “Chem 7” or as a “basic metabolic panel
(BMP)”.
Serum Sodium (Na+) Normal Lab Values
Sodium is a major cation of extracellular fluid that maintains osmotic pressure and acid-base
balance, and assists in the transmission of nerve impulses. Sodium is absorbed from the
small intestine and excreted in the urine in amounts dependent on dietary intake.
Normal and critical values for serum Sodium (Na+):

Adult 135—145 mmol/L 135—145 mEq/L
Child 136—145 mmol/L 136—145 mEq/L
Infant 134—150 mmol/L 134—150 mEq/L
Newborn 134—144 mmol/L 134—144 mEq/L
Critical values <120 or >160 mmol/L <120 or >160 mEq/L
Indications for Serum Sodium
 Determine whole-body stores of sodium, because the ion is predominantly extracellular

 Monitor the effectiveness of drug, especially diuretics, on serum sodium levels.
Increased sodium levels (Hypernatremia) may indicate:
 Diabetes insipidus
 Excessive dietary intake
 Excessive IV sodium administration
 Excessive sweating
 Extensive thermal burns
 Hyperaldosteronism
 Osmotic diuresis
Decreased sodium levels (Hyponatremia) may indicate:
 Ascites
 Addison’s disease
 Congestive heart failure
 Chronic renal insufficiency
 Deficient dietary intake
 Deficient sodium in IV fluids
 Diarrhea
 Diuretic administration
 Excessive oral water intake
 Excessive IV water intake
 Intraluminal bowel loss (e.g., ileus or mechanical obstruction)
 Osmotic dilution
 Peripheral edema
 Pleural effusion
 Syndrome of inappropriate ADH (SIADH) secretion
 Vomiting or nasogastric aspiration
Nursing consideration for Serum Sodium
 Drawing blood samples from an extremity in which an intravenous (IV) solution of

sodium chloride is infusing increases the level, producing inaccurate results.
Serum Potassium (K+)
Potassium is the most abundant intracellular cation that serves important functions such as
regulate acid-base equilibrium, control cellular water balance, and transmit electrical impulses in
skeletal and cardiac muscles.
Normal and critical values for Potassium (K+):
Adult 3.5—5.0 mmol/L 3.5—5.0 mEq/L
Child 3.4—4.7 mmol/L 3.4—4.7 mEq/L
Infant 4.1—5.3 mmol/L 4.1—5.3 mEq/L
Newborn 3.9—5.9 mmol/L 3.9—5.9 mEq/L
Critical values (Adult) <3.0 or >6.1 mmol/L <3.0 or >6.1 mEq/L
Critical values (Newborn) <2.5 or >8.0 mmol/L <2.5 or >8.0 mEq/L
Indications for Serum Potassium

 Evaluates cardiac function, renal function, gastrointestinal function, and the need for IV
replacement therapy.
Increased potassium levels (Hyperkalemia) may indicate:
 Acidosis
 Acute or chronic renal failure
 Aldosterone-inhibiting diuretics
 Crush injuries to tissues
 Dehydration
 Excessive dietary intake
 Excessive IV intake
 Hemolysis
 Hemolyzed blood transfusion
 Hypoaldosteronism
 Infection
Decreased potassium levels (Hypokalemia) may indicate:
 Ascites
 Burns
 Cystic fibrosis
 Deficient dietary intake
 Deficient IV intake
 Diuretics
 Gastrointestinal disorders such as nausea and vomiting
 Glucose administration
 Hyperaldosteronism
 Insulin administration
 Licorice administration
 Renal artery stenosis
 Renal tubular acidosis
 Surgery
 Trauma
Nursing Considerations for Serum Potassium
 Note on the laboratory form if the client is receiving potassium supplementation.

 Clients with elevated white blood cell counts and platelet counts may have falsely
elevated potassium levels.
Serum Chloride (Cl-)
Chloride is a hydrochloric acid salt that is the most abundant body anion in the extracellular
fluid. Functions to counterbalance cations, such as sodium, and acts as a buffer during oxygen
and carbon dioxide exchange in red blood cells (RBCs). Aids in digestion and maintaining
osmotic pressure and water balance.
Normal and critical values for Chloride (Cl-):
Premature infant 95—110 mmol/L 95—110 mEq/L
Increased chloride levels (Hyperchloremia) may indicate:
 Anemia
 Dehydration
 Eclampsia
 Excessive infusion of normal saline
 Hyperparathyroidism
 Hyperventilation
 Kidney dysfunction
 Metabolic acidosis
 Multiple myelomas
 Renal tubular acidosis
 Respiratory alkalosis
Decreased chloride levels (Hypochloremia) may indicate:
 Aldosteronism
 Burns
 Chronic gastric suction
 Chronic respiratory acidosis
 Diuretic therapy
 Hypokalemia
 Metabolic alkalosis
 Overhydration
 Respiratory alkalosis
 Salt-losing nephritis
 Syndrome of inappropriate antidiuretic hormone (SIADH)
 Vomiting
Nursing Considerations for Serum Chloride
 Any condition accompanied by prolonged vomiting, diarrhea, or both will alter chloride
levels.
Magnesium (Mg)
Magnesium is used as an index to determine metabolic activity and renal function. Magnesium
is needed in the blood-clotting mechanisms, regulates neuromuscular activity, acts as a cofactor
that modifies the activity of many enzymes, and has an effect on the metabolism of calcium.
Normal and critical values for Magnesium (Mg):
Adult 0.7—1.05 mmol/L 1.3—2.1 mEq/L
Child 0.7—0.85 mmol/L 1.4—1.7 mEq/L
Newborn 0.7—1.0 mmol/L 1.4—2.0 mEq/L
Critical values <0.25 or >1.5 mmol/L <0.5 or >3.0 mEq/L
Increased magnesium levels (Hypermagnesemia) may indicate:
 Hypothyroidism
 Ingestion of magnesium-containing antacids or salt
 Renal insufficiency
 Uncontrolled diabetes
Decreased magnesium levels (Hypomagnesemia) may indicate:
 Alcoholism
 Chronic renal disease
 Diabetic acidosis
 Hypoparathyroidism
 Malabsorption
 Malnutrition
Nursing Considerations
 Prolonged use of magnesium products causes increased serum levels.

 Long-term parenteral nutrition therapy or excessive loss of body fluids may decrease
serum levels.
Serum Osmolality
Serum osmolality is a measure of the solute concentration of the blood. Particles include sodium
ions, glucose, and urea. Serum osmolality is usually estimated by doubling the serum sodium
because sodium is a major determinant of serum osmolality.
Normal and critical values for Serum Osmolality:
Adult 285—295 mmol/kg 285—295 mOsm/kg H2O
Child 275—290 mmol/kg 275—290 mOsm/kg H2O
Critical values <265 or >320 mmol/kg <265 or >320 mOsm/kg H20
Serum Bicarbonate (HCO3-)
Part of the bicarbonate-carbonic acid buffering system and mainly responsible for regulating the
pH of body fluids.
Normal and critical values for Serum Bicarbonate (HCO3-):

Infant 20—28 mmol/L 20—28 mEq/L
Nursing consideration for Serum Bicarbonate
 Ingestion of acidic or alkaline solutions may cause increased or decreased results,

respectively.
Phosphorus (P)
Phosphorus (Phosphate) is important in bone formation, energy storage and release, urinary
acid-base buffering, and carbohydrate metabolism. Phosphorus is absorbed from food and is
excreted by the kidneys. High concentrations of phosphorus are stored in bone and
skeletal muscle.
Normal and critical values for Phosphorus (P):
Adult 0.97—1.45 mmol/L 3.0—4.5 mg/dL
Child 1.45—2.1 mmol/L 4.45—6.5 mg/dL
Newborn 1.4—3.0 mmol/L 4.3—9.3 mg/dL

Critical values <0.32 mmol/L <1.0 mg/dL
Increased phosphorus levels (Hyperphosphatemia) may indicate:
 Acidosis
 Acromegaly
 Advanced myeloma or lymphoma
 Bone metastasis
 Hypocalcemia
 Increased dietary or IV intake of phosphorus
 Liver disease
 Renal failure
 Rhabdomyolysis
 Sarcoidosis
Decreased phosphorus levels (Hypophosphatemia) may indicate:
 Alkalosis
 Chronic alcoholism
 Chronic antacid ingestion
 Diabetic acidosis
 Hypercalcemia
 Hyperinsulinism
 Inadequate dietary ingestion of phosphorus
 Malnutrition
 Osteomalacia (adult)
 Rickets (child)
 Sepsis
 Vitamin D deficiency
Nursing Consideration
 Instruct the client to fast before the test.

Total Calcium (Ca+), Ionized Calcium
Calcium (Ca+) is a cation absorbed into the bloodstream from dietary sources and functions in
bone formation, nerve impulse transmission, and contraction of myocardial and skeletal
muscles. Calcium aids in blood clotting by converting prothrombin to thrombin.
Normal and critical values for Total Calcium (Ca):
9.0—10.5 mg/dL or
Adult 2.3—2.6 mmol/L
4.5—5.2 mEq/L
8.8—10.8 mg/dL or
Child 2.2—2.7 mmol/L
4.4—5.4 mEq/L
9.0—10.6 mg/dL or
10 days to 2 years 2.3—2.7 mmol/L
4.5—5.3 mEq/L
9.0—11.5 mg/dL or
Umbilical 2.3—2.9 mmol/L
4.5—5.7 mEq/L
7.6—10.4 mg/dL or
<10 days 1.9—2.6 mmol/L
3.8—5.2 mEq/L
<6.0 or 13 mg/dL or
Critical values <1.5 or >3.2 mmol/L
<3.0 or >6.5 mEq/L
Normal and critical values for Ionized Calcium:
4.5—5.6 mg/dL or
Adult 1.1—1.4 mmol/L
2.3—2.8 mEq/L
4.8—5.5 mg/dL or
<18 years 1.2—1.4 mmol/L
2.4—2.7 mEq/L
Newborn 1.1—1.4 mmol/L 4.2—5.6 mg/dL or

2.1—2.8 mEq/L
<2.2 or >7.0 mg/dL or

Critical values <0.5 or >1.8 mmol/L
<1.1 or >1.4 mEq/L
Increased calcium levels (Hypercalcemia) may indicate:
 Acromegaly
 Granulomatous infections such as tuberculosis and sarcoidosis
 Hyperthyroidism
 Lymphoma
 Metastatic tumor to the bone
 Milk-alkali syndrome
 Nonparathyroid PTH-producing tumor such as renal or lung carcinoma
 Paget’s disease of bone
 Prolonged immobilization
 Vitamin D intoxication
Decreased calcium levels (Hypocalcemia) may indicate:
 Alkalosis
 Fat embolism
 Hyperphosphatemia secondary to renal failure
 Malabsorption
 Osteomalacia
 Pancreatitis
 Renal failure
 Rickets
 Vitamin D deficiency
 Instruct the client to eat a diet with a normal calcium level (800 mg/day) for 3 days
before the exam.
 Instruct the client that fasting may be required for 8 hours before the test.
 Note that calcium levels can be affected by decreased protein levels and the use
of anticonvulsant medications
Renal Function Studies Normal Lab Values
In this section, we’ll be discussing the normal laboratory values of serum creatinine and blood
urea nitrogen, including their indications and nursing considerations. These laboratory tests are
helpful in determining the kidney function of an individual.
Serum Creatinine (Cr), Creatinine (Urine), and Creatinine Clearance (CrCl)
Creatinine is a specific indicator of renal function. Increased levels of creatinine indicate a

slowing of the glomerular filtration rate.
Normal and critical values for Creatinine (Serum):
Creatinine (Serum) 285—295 mmol/kg 285—295 mOsm/kg H2O
Critical values 275—290 mmol/kg 275—290 mOsm/kg H2O
Normal values for Creatinine (Urine):
Male 124—230 µmol/kg/day 14—26 mg/kg/24 hours
Female 97—177 µmol/kg/day 11—20 mg/kg/24 hours
Normal lab values for Creatinine Clearance (CrCl):
Male 1.78—2.32 mL/sec 107—139 mL/min
Female 1.45—1.78 mL/sec 87—107 mL/min

Newborn 0.67—1.08 mL/sec 40—65 mL/min
Increased creatinine levels may indicate:
 Acromegaly
 Acute tubular necrosis
 Dehydration
 Diabetic nephropathy
 Gigantism
 Glomerulonephritis
 Nephritis
 Pyelonephritis
 Rhabdomyolysis
 Shock
 Urinary tract obstruction
Decreased creatinine levels may indicate:
 Debilitation
 Myasthenia gravis
 Muscular dystrophy
 Instruct the client to avoid excessive exercise for 8 hours and excessive red meat intake
for 24 hours before the test.
Blood Urea Nitrogen (BUN)
Urea nitrogen is the nitrogen portion of urea, a substance formed in the liver through an
enzymatic protein breakdown process. Urea is normally freely filtered through the renal
glomeruli, with a small amount reabsorbed in the tubules and the remainder excreted in the
urine. Elevated levels indicate a slowing of the glomerular filtration rate.
Normal lab values and critical values for Blood Urea Nitrogen (BUN):
Adult 3.57—7.14 mmol/L 10—20 mg/dL
Child 1.79—6.43 mmol/L 5—18 mg/dL
Infant 1.79—6.43 mmol/L 5—18 mg/dL
Newborn 1.07—4.28 mmol/L 3—12 mg/dL
Critical values >35.7 mmol/L >100 mg/dL
Normal value for Estimate Glomerular Filtration Rate (eGFR):
Estimated Glomerular Filtration Rate (eGFR)
>60 mL/min/1.73 m2
Increased blood urea nitrogen levels may indicate:
 Alimentary tube feeding

 Bladder outlet obstructions
 Burns
 Dehydration
 Excessive protein catabolism
 Excessive protein ingestion
 Gastrointestinal (GI) bleeding
 Glomerulonephritis
 Hypovolemia
 Myocardial infarction
 Nephrotoxic drugs
 Pyelonephritis
 Renal failure
 Sepsis
 Shock
 Starvation
 Ureteral obstruction
Decreased blood urea nitrogen levels may indicate:
 Liver failure
 Malnutrition or malabsorption
 Nephrotic syndrome
 Overhydration due to fluid overload or syndrome of inappropriate antidiuretic hormone
(SIADH)
 Pregnancy
Nursing consideration
 BUN and creatinine ratios should be analyzed when renal function is evaluated.
Liver Function Studies Normal Lab Values
Conditions affecting the gastrointestinal tract can be easily evaluated by studying the normal
laboratory values of alanine aminotransferase, aspartate aminotransferase, bilirubin, albumin,
ammonia, amylase, lipase, protein, and lipids.
Alanine Aminotransferase (ALT)
Alanine Aminotransferase (ALT) test is used to identify hepatocellular injury and inflammation of
the liver and to monitor improvement or worsening of the disease. ALT was formerly known as
serum pyretic transaminase (SGPT).
Normal values for Alanine Aminotransferase (ALT, SGPT):
Male 0.17—0.92 µkat/L 10—55 units/L
Female 0.12—0.50 µkat/L 7—30 units/L
Increased Alanine Aminotransferase (ALT)

Levels may indicate:
 Cirrhosis
 Cholestasis
 Hepatitis
 Hepatic ischemia
 Hepatic tumor
 Hepatotoxic drugs
 Infectious mononucleosis
 Myositis
 Obstructive jaundice
 Pancreatitis
 Severe burns
 Shock
 Trauma to striated muscle
Decreased Alanine Aminotransferase (ALT) levels:
 Is expected and is normal

 No fasting is required.
 Previous intramuscular injections may cause elevated levels.
Aspartate Aminotransferase (AST)
Aspartate Aminotransferase (AST) test is used to evaluate a client with a suspected

hepatocellular disease, injury, or inflammation (may also be used along with cardiac markers to
evaluate coronary artery occlusive disease). AST was formerly known as serum glutamic-
oxaloacetic transaminase (SGOT).
Normal values for Aspartate Aminotransferase (AST, SGOT):
Male 0.17—0.67 µkat/L 10—40 units/L
Female 0.15—0.42 µkat/L 9—25 units/L
Increased Aspartate Aminotransferase (AST) levels may indicate:
 Heart diseases
 Cardiac operations
 Cardiac catheterization and angioplasty
 Myocardial infarctions
 Liver diseases
 Drug-induced liver injury
 Hepatitis
 Hepatic cirrhosis
 Hepatic infiltrative process
 Hepatic metastasis
 Hepatic surgery
 Infectious mononucleosis with hepatitis
 Skeletal muscle diseases
 Heat stroke
 Multiple traumas
 Primary muscle diseases
 Progressive muscular dystrophy
 Recent convulsions
 Recent noncardiac surgery
 Severe, deep burns
 Skeletal muscle trauma
 Other diseases
 Acute hemolytic anemia
 Acute pancreatitis
Decreased Aspartate Aminotransferase (AST) levels may indicate:
 Acute renal disease

 Beriberi
 Chronic renal dialysis
 Diabetic ketoacidosis
 Pregnancy
 No fasting is required.
 Previous intramuscular injections may cause elevated levels.
Bilirubin
Bilirubin is produced by the liver, spleen, and bone marrow and is also a by-product of
hemoglobin breakdown. Total bilirubin levels can be broken into direct bilirubin, which is
excreted primarily via the intestinal tract, and indirect bilirubin, which circulates primarily in the
bloodstream. Total bilirubin levels increase with any type of jaundice; direct and indirect bilirubin
levels help differentiate the cause of jaundice.
Normal values and critical values for total, direct, and indirect bilirubin:
Adult 5.1—17 μmol/L 0.3—1.0 mg/dL
Newborn 17.1—205 µmol/L 1.0—12.0 mg/dL
Critical values (Adult) >205 µmol/L >12 mg/dL
Critical values (Newborn) >256 µmol/L >15 mg/dL
Direct bilirubin (conjugated) 1.7—5.1 μmol/L 0.1—0.3 mg/dL
Indirect bilirubin (unconjugated) 3.4—12.0 μmol/L 0.2—0.8 mg/dL
Increased conjugated (direct) bilirubin levels may indicate:
 Cholestasis from drugs

 Dubin-Johnson syndrome
 Extensive liver metastasis
 Extrahepatic duct obstruction (gallstone, inflammation, scarring, surgical trauma, or
tumor)
 Gallstones
 Rotor’s syndrome
Increased unconjugated (indirect) bilirubin levels may indicate:
 Cirrhosis
 Crigler-Najjar syndrome
 Erythroblastosis fetalis
 Gilbert’s syndrome
 Hemolytic jaundice
 Hepatitis
 Large-volume blood transfusion
 Neonatal hyperbilirubinemia
 Resolution of a large hematoma
 Pernicious anemia
 Sepsis
 Transfusion reaction
 Instruct the client to eat a diet low in yellow foods, avoiding foods such as carrots, yams,
yellow beans, and pumpkin, for 3 to 4 days before the blood is drawn.
 Instruct the client to fast for 4 hours before the blood is drawn.
 Note that results will be elevated with the ingestion of alcohol or the administration
of morphine sulfate, theophylline, ascorbic acid (vitamin C), or acetylsalicylic acid
(Aspirin).
 Note that results are invalidated if the client has received a radioactive scan within 24
hours before the test.
Albumin
Albumin is the main plasma protein of blood that maintains oncotic pressure and transports
bilirubin, fatty acids, medications, hormones, and other substances that are insoluble in water.
Albumin is increased in conditions such as dehydration, diarrhea, and metastatic carcinoma;
decreased in conditions such as acute infection, ascites, and alcoholism. Presence of detectable
albumin, or protein, in the urine is indicative of abnormal renal function.
Normal lab values for Albumin:
Adult 35—50 g/L 3.5—5.0 g/dL
Child 40—59 g/L 4.0—5.9 g/dL
Infant 44—54 g/L 4.4—5.4 g/dL
Newborn 35—54 g/L 3.5—5.4 g/dL
Premature infant 30—42 g/L 3.0—4.2 g/dL
Increased albumin levels (Hyperalbuminemia) may indicate:

 Dehydration
 Severe diarrhea
 Severe vomiting
Decreased albumin levels (Hypoalbuminemia) may indicate:
 Acute liver failure

 Cirrhosis
 Familial idiopathic dysproteinemia
 Inflammatory disease
 Increased capillary permeability
 Malnutrition
 Pregnancy
 Protein-losing enteropathies
 Protein-losing nephropathies
 Severe burns
 Severe malnutrition
 Ulcerative colitis
 Fasting is not required.

Ammonia
Ammonia is a by-product of protein catabolism; most of it is created by bacteria acting on

proteins present in the gut. Ammonia is metabolized by the liver and excreted by the kidneys as
urea. Elevated levels resulting from hepatic dysfunction may lead to encephalopathy. Venous
ammonia levels are not a reliable indicator of hepatic coma.
Adult 7—57 µmol/L 10—80 µg/dL
Child 29—57 µmol/L 40—80 µg/dL
Newborn 64—107 µmol/L 90—150 µg/dL
Normal values for Ammonia:
 Instruct the client to fast, except for water, and to refrain from smoking for 8 to 10 hours
before the test; smoking increases ammonia levels.
 Place the specimen on ice and transport to the laboratory immediately.
Amylase
Amylase is an enzyme, produced by the pancreas and salivary glands, aids in the digestion of
complex carbohydrates and is excreted by the kidneys. In acute pancreatitis, the amylase level
may exceed five times the normal value; the level starts rising 6 hours after the onset of pain,
peaks at about 24 hours, and returns to normal in 2 to 3 days after the onset of pain. In chronic
pancreatitis, the rise in serum amylase usually does not normally exceed three times the normal
value.
Normal values for amylase:
30–220 units/L or
Adult 60—120 Somogyi units/dL
500 nkat/L
3—32.5 units/L or
Newborn 6—65 Somogyi units/dL
50—542 nkat/L
Increased amylase levels may indicate:
 Acute cholecystitis
 Duodenal obstruction
 Ectopic pregnancy
 Necrotic bowel
 Parotiditis
 Penetrating peptic ulcer
 Perforated peptic ulcer
 Perforated bowel
 Pulmonary infarction
Decreased amylase levels may indicate:
 Chronic pancreatitis
 Cystic fibrosis
 Liver disease
 Preeclampsia
 On the laboratory form, list the medications that the client has taken during the previous
24 hours before the test.
 Note that many medications may cause false-positive or false-negative results.
 Results are invalidated if the specimen was obtained less than 72 hours after
cholecystography with radiopaque dyes.
Lipase
Lipase is a pancreatic enzyme converts fats and triglycerides into fatty acids and glycerol.
Elevated lipase levels occur in pancreatic disorders; elevations may not occur until 24 to 36
hours after the onset of illness and may remain elevated for up to 14 days.
Normal values for Lipase:
Lipase
0—160 units/L
Increased lipase levels may indicate:
 Acute cholecystitis
 Bowel obstruction or infarction
 Cholangitis
 Chronic relapsing pancreatitis
 Extrahepatic duct obstruction
 Pancreatic cancer
 Pancreatic pseudocyst
 Peptic ulcer disease
 Renal failure
 Salivary gland inflammation or tumor
Decreased lipase levels may indicate:
 Chronic conditions such as cystic fibrosis

 Endoscopic retrograde cholangiopancreatography (ERCP) may increase lipase activity.

Serum Protein
Serum protein reflects the total amount of albumin and globulins in the plasma. Protein
regulates osmotic pressure and is necessary for the formation of many hormones, enzymes, and
antibodies; it is a major source of building material for blood, skin, hair, nails, and internal
organs. Increased in conditions such as Addison’s disease, autoimmune collagen disorders,
chronic infection, and Crohn’s disease. Decreased in conditions such as burns, cirrhosis, edema,
and severe hepatic disease.
Normal values for Total Protein (Serum):
Adult 54—83 g/L 5.4—8.3 g/dL
Child 62—80 g/L 6.2—8.0 g/dL
Infant 60—67 g/L 6.0—6.7 g/dL
Newborn 46—74 g/L 4.6—7.4 g/dL
Premature infant 42—76 g/L 4.2—7.6 g/dL
Increased protein levels may indicate:
 Amyloidosis
 Dehydration
 Hepatitis B
 Hepatitis C
 Human immunodeficiency virus
 Multiple myeloma
Decreased protein levels may indicate:
 Agammaglobulinemia
 Bleeding
 Celiac disease
 Extensive burns
 Inflammatory bowel disease
 Kidney disorder
 Liver disease
 Severe malnutrition
Glucose Studies Normal Lab Values
Understanding the normal laboratory values of blood glucose is an essential key in

managing diabetes mellitus. Included in this section are the lab values and nursing
considerations for glycosylated hemoglobin, fasting blood sugar, glucose tolerance test,
and diabetes mellitus antibody panel.
Fasting Blood Glucose
Fasting blood glucose or fasting blood sugar (FBS) levels are used to help diagnose diabetes
mellitus and hypoglycemia. Glucose is a monosaccharide found in fruits and is formed from the
digestion of carbohydrates and the conversion of glycogen by the liver. Glucose is the main
source of cellular energy for the body and is essential for brain and erythrocyte function.
Normal values for Glucose Studies:
Glucose (Random, Casual) <11.1 mmol/L <200 mg/dL
Fasting Blood Sugar (FBS) <6.1 mmol/L 70—110 mg/dL
2-hr Postprandial Glucose <7.7 mmol/L < 140 mg/dL
Increased glucose levels (Hyperglycemia) may indicate:
 Acromegaly
 Acute stress response
 Corticosteroid therapy
 Diabetes mellitus
 Glucagonoma
 Pheochromocytoma
Increased postprandial glucose levels (Postprandial hyperglycemia) may indicate:
 Acromegaly
 Extensive liver disease
 Gestational diabetes mellitus
 Glucagonoma
 Hyperthyroidism
 Malnutrition
Decreased glucose levels (Hypoglycemia) may indicate:
 Extensive liver disease
 Hypopituitarism
 Hypothyroidism
 Insulinoma
 Insulin overdose
 Starvation
Decreased postprandial glucose levels (Postprandial hypoglycemia) may indicate:
 Hypopituitarism
 Hypothyroidism
 Insulinoma
 Insulin overdose
 Malabsorption or maldigestion
Nursing consideration:
 Instruct the client to fast for 8 to 12 hours before the test.

 Instruct a client with diabetes mellitus to withhold morning insulin or oral hypoglycemic
medication until after the blood is drawn.
Glucose Tolerance Test (GTT)
The glucose tolerance test (GTT) aids in the diagnosis of diabetes mellitus. If the glucose levels
peak at higher than normal at 1 and 2 hours after injection or ingestion of glucose and are
slower than normal to return to fasting levels, then diabetes mellitus is confirmed.
Normal values for Glucose Tolerance Test (GTT):

Fasting <6.1 mmol/L <110 mg/dL
30 minutes 6.1—9.4 mmol/L 110—170 mg/dL
1 hour <10.0 mmol/L <180 mg/dL
2 hours <7.8 mmol/L <140 mg/dL
3 hours <6.4 mmol/L 70—115 mg/dL
4 hours <6.4 mmol/L 70—115 mg/dL
Abnormal Glucose tolerance test may indicate:
 Acromegaly
 Glucagonoma
 Myxedema
 Post-gastrectomy
 Somogyi response to hypoglycemia
 Instruct the client to eat a high-carbohydrate (200 to 300 g) diet for 3 days before the
test.
 Instruct the client to avoid alcohol, coffee, and smoking for 36 hours before the test.
 Instruct the client to avoid strenuous exercise for 8 hours before and after the test.
 Instruct the client to fast for 10 to 16 hours before the test.
 Instruct the client with diabetes mellitus to withhold morning insulin or oral
hypoglycemic medication.
 Instruct the client that the test may take 3 to 5 hours, requires IV or oral administration
of glucose, and the taking of multiple blood samples.
Glycosylated Hemoglobin (HbA1c)
Glycosylated hemoglobin is blood glucose bound to hemoglobin. Hemoglobin A₁C

(glycosylated hemoglobin A; HbA1c) is a reflection of how well blood glucose levels have been
controlled for the past 3 to 4 months. Hyperglycemia in clients with diabetes is usually a cause
of an increase in the HbA1c.
Reference values for Glycosylated hemoglobin (HbA1c):
Range
Nondiabetic adult 4%—5.9%
Good diabetic control <7%
Fair diabetic control 8%—9%
Poor diabetic control >9%
Increased Glycosylated hemoglobin (HbA1c) levels may indicate:
 Newly diagnosed diabetic patient

 Non-diabetic hyperglycemia
 Poorly controlled diabetic patient
 Pregnancy
 Splenectomized patients
Decreased Glycosylated hemoglobin (HbA1c) levels may indicate:
 Chronic blood loss

 Fasting is not required before the test.

Diabetes Mellitus Autoantibody Panel
Used to evaluate insulin resistance and to identify type 1 diabetes and clients with a
suspected allergy to insulin.
Normal Lab Value for DM Autoantibody Panel:
 Less than 1:4 titer with no antibody detected

Increased levels may indicate:
 Allergies to insulin
 Factitious hypoglycemia
 Insulin resistance
 Type I diabetes mellitus/ Insulin-dependent diabetes mellitus
Lipoprotein Profile (Lipid Profile) Normal Lab Values
Lipid assessment or lipid profile includes total cholesterol, high-density lipoprotein (HDL), low-
density lipoprotein (LDL), and triglycerides.
 Cholesterol is present in all body tissues and is a major component of LDL, brain, and
nerve cells, cell membranes, and some gallbladder stones.
 Triglycerides constitute a major part of very-low-density lipoproteins and a small part of
LDLs. Increased cholesterol levels, LDL levels, and triglyceride levels place the client at
risk for coronary artery disease. HDL helps protect against the risk of coronary artery
disease.
Normal and critical lab values for Lipid Profile:
Cholesterol
Adult <5.20 mmol/L <200 mg/dL
Child 3.1—5.2 mmol/L 120—200 mg/dL
Infant 1.8—4.5 mmol/L 70—175 mg/dL

Newborn 1.4—3.5 mmol/L 53—135 mg/dL
High-density lipoprotein (HDL)
Male >0.75 mmol/L >45 mg/dL
Female >0.91 mmol/L >55 mg/dL
Low-density lipoprotein (LDL) <3.4 mmol/L <130 mg/dL
Very low-density lipoprotein (VLDL) 0.18—0.83 mmol/L 7—32 mg/dL
Triglycerides (TGs) 0.45—1.81 mmol/L 40—160 mg/dL
Critical values (TGs) >4.5 mmol/L >400 mg/dL
High-density lipoprotein (HDL)
Increased HDL levels may indicate:
 Extensive exercise
 Familial HDL lipoproteinemia
Decreased HDL levels may indicate:
 Familial low HDL

 Hepatocellular disease (e.g., cirrhosis or hepatitis)
 Hypoproteinemia (e.g.,malnutrition or nephrotic syndrome)
 Metabolic syndrome
Low-density lipoprotein (LDL) and Very-low-density lipoprotein (VLDL)
Increased LDL and VLDL levels may indicate:

 Alcohol consumption
 Apoprotein CII deficiency
 Chronic liver disease
 Familial hypercholesterolemia type IIa
 Familial LDL lipoproteinemia
 Gammopathies (e.g., multiple myeloma)
 Glycogen storage disease (e.g., von Gierke’s disease)
 Hepatoma
 Hypothyroidism
 Nephrotic syndrome
Decreased LDL and VLDL Levels may indicate:
 Familial hypolipoproteinemia
 Hyperthyroidism
 Hypoproteinemia (e.g., severe burns, malnutrition, or malabsorption)
 Oral contraceptives may increase the lipid level.

 Instruct the client to abstain from foods and fluid, except for water, for 12 to 14 hours
and from alcohol for 24 hours before the test.
 Instruct the client to avoid consuming high-cholesterol foods with the evening meal
before the test.
Cardiac Markers and Serum Enzymes
Serum enzymes and cardiac markers are released into the circulation normally following a
myocardial injury as seen in acute myocardial infarction (MI) or other conditions such as heart
failure.
Creatine Kinase (CK)
Creatine kinase (CK) is an enzyme found in muscle and brain tissue that reflects tissue
catabolism resulting from cell trauma. The CK level begins to rise within 6 hours of muscle
damage, peaks at 18 hours, and returns to normal in 2 to 3 days. The test for CK is performed to
detect myocardial or skeletal muscle damage or central nervous system damage. Isoenzymes
include CK-MB (cardiac), CK-BB (brain), and CK-MM (muscles):
 CK-MM is found mainly in skeletal muscle.

 CK-MB is found mainly in cardiac muscle
 CK-BB is found mainly in brain tissue
Normal values for total creatine kinase (CK):
Male 917—2833 nkat/L 55—170 units/L
Female 500—2250 nkat/L 30—135 units/L
Newborn 1133—9667 nkat/L 68—580 units/L
Normal values for total CK isoenzymes:
Normal Range
CK-MM 100%
CK-MB 0%
CK-BB 0%
Increased levels of total creatine phosphokinase (CPK):
 Disease or injury affecting the brain, heart muscle, and skeletal muscle
Increased levels of CPK-BB isoenzyme:
 Adenocarcinoma (breast and lungs)

 Disease involving the central nervous system
 Pulmonary infarction
Increased levels of CPK-MB isoenzyme:
 Acute myocardial infarction

 Cardiac aneurysm surgery
 Cardiac defibrillation
 Cardiac ischemia
 Myocarditis
 Ventricular arrhythmias
Increased levels of CPK-MM isoenzyme:
 Crush injuries
 Delirium tremens
 Electroconvulsive therapy
 Electromyography
 Hypokalemia
 Hypothyroidism
 IM injections
 Malignant hyperthermia
 Myositis
 Recent convulsions
 Recent surgery
 Rhabdomyolysis
 Shock
 Trauma
 If the test is to evaluate skeletal muscle, instruct the client to avoid strenuous physical
activity for 24 hours before the test.
 Instruct the client to avoid ingestion of alcohol for 24 hours before the test.
 Invasive procedures and intramuscular injections may falsely elevate CK levels.
Myoglobin
Myoglobin, an oxygen-binding protein that is found in striated (cardiac and skeletal) muscle,
releases oxygen at very low tensions. Any injury to skeletal muscle will cause a release of
myoglobin into the blood. Myoglobin rise in 2-4 hours after an MI making it an early marker for
determining cardiac damage.
Normal Lab Values for Myoglobin
Myoglobin
5—70 ng/mL
Myoglobin
Increased myoglobin levels:
 Malignant hyperthermia
 Myositis
 Rhabdomyolysis
 Skeletal muscle ischemia
 Skeletal muscle trauma
 The level can rise as early as 2 hours after a myocardial infarction, with a rapid decline in
the level after 7 hours.
 Because the myoglobin level is not cardiac specific and rises and falls so rapidly, its use in
diagnosing myocardial infarction may be limited.
Troponin I and Troponin T
Troponin is a regulatory protein found in striated muscle (myocardial and skeletal). Increased
amounts of troponin are released into the bloodstream when an infarction causes damage to
the myocardium. Troponin levels are elevated as early as 3 hours after MI. Troponin T and
Troponin I start to rise after 4-6 hours and peaks at 10-24 hours. Troponin T returns to normal
values after 10 days. Troponin I returns—normal values after 4 days. Serial measurements are
important to compare with a baseline test; elevations are clinically significant in the diagnosis of
cardiac pathology.
Normal values for Troponins:
Normal Range
Troponin <0.4 ng/mL
Cardiac troponin T* <0.1 ng/mL
Cardiac troponin I* <0.03 ng/mL
Increased troponin levels may indicate:
 Myocardial injury
 Rotate venipuncture sites.

 Testing is repeated in 12 hours or as prescribed, followed by daily testing for 3 to 5 days.
Natriuretic Peptides
Natriuretic peptides are neuroendocrine peptides that are used to identify clients with heart
failure. There are three major peptides:
 atrial natriuretic peptides (ANP) synthesized in cardiac ventricle muscle,

 brain natriuretic peptides (BNP) synthesized in the cardiac ventricle muscle
 C-type natriuretic peptides (CNP) synthesized by endothelial cells.
BNP is the primary marker for identifying heart failure as the cause of dyspnea. The higher the
BNP level, the more severe the heart failure. If the BNP level is elevated, dyspnea is due to heart
failure; if it is normal, the dyspnea is due to a pulmonary problem.
Normal values for Natriuretic Peptides:
Normal Range
Atrial natriuretic peptide (ANP) 22—77 ng/L
Brain natriuretic peptide (BNP) <100 ng/L
C-type natriuretic peptide (CNP) Reference range provided with results should be reviewed
Natriuretic peptides
Increased natriuretic peptides levels:

 Cor pulmonale
 Heart transplant rejection
 Systemic hypertension
 Fasting is not required.

HIV and AIDS Testing
The following laboratory tests are used to diagnose human immunodeficiency virus (HIV), which
is the cause of acquired immunodeficiency syndrome (AIDS). Common tests used to determine
the presence of antibodies to HIV include ELISA, Western blot, and Immunofluorescence assay
(IFA).
 A single reactive ELISA test by itself cannot be used to diagnose HIV and should be
repeated in duplicate with the same blood sample; if the result is repeatedly reactive,
follow-up tests using Western blot or IFA should be performed.
 A positive Western blot or IFA results is considered confirmatory for HIV.
 A positive ELISA result that fails to be confirmed by Western blot or IFA should not be
considered negative, and repeat testing should take place in 3 to 6 months.
CD4+ T-cell counts
CD4+ T-cell counts help Monitors the progression of HIV. As the condition progresses, usually
the number of CD4+ T-cells decreases, with a resultant decrease in immunity. In general, the
immune system remains healthy with CD4+ T-cell counts higher than 500 cells/L. Immune
system problems occur when the CD4+ T-cell count is between 200 and 499 cells/L. Severe
immune system problems occur when the CD4+ T-cell count is lower than 200 cells/L.
Normal values for HIV and AIDS Testing:
Normal Range
T cells 800—2,500 cells/µL
T-helper cells (CD4) 600—1,500 cells/µL
T-suppressor cells (CD8) 300—1,000 cells/µL
B cells 100—450 cells/µL
Natural killer cells 75—500 cells/µL
CD4—CD8 ratio >1
Increased CD4+ T-cell counts may indicate:
 B-cell lymphoma
 T-cell lymphoma
 Chronic lymphatic leukemia
Decreased CD4+ T-cell counts may indicate:
 Congenital immunodeficiency
 HIV-positive patients
 Organ transplants
Thyroid Studies Normal Lab Values
Thyroid studies are performed if a thyroid disorder is suspected. Common laboratory blood tests
such as thyroxine, TSH, T4, and T3 are done to evaluate thyroid function. Thyroid studies help
differentiate primary thyroid disease from secondary causes and from abnormalities in
thyroxine-binding globulin levels. Thyroid peroxidase antibodies test may be done to identify
the presence of autoimmune conditions involving the thyroid gland.
Normal values for thyroid function tests:
Triiodothyronine, total (T3) 1.2—3.5 nmol/L 80—230 ng/dL
Thyroxine, total (T4) 64—155 nmol/L 5—12 µg/dL
Thyroxine, free (FT4) 10—31 pmol/L 0.8—2.4 ng/dL
Thyroid—stimulating hormone (thyrotropin) 0.2—5.4 mIU/L 0.2—5.4 µunits/mL
Triiodothyronine (T₃)
Increased triiodothyronine levels may indicate:
 Acute thyroiditis
 Congenital hyperproteinemia
 Factitious hyperthyroidism
 Grave’s disease
 Hepatitis
 Pregnancy
 Plummer’s disease
 Struma ovarii
 Toxic thyroid adenoma
Decreased triiodothyronine levels may indicate:
 Cirrhosis
 Cretinism
 Hypothalamic failure
 Hypothyroidism
 Iodine insufficiency
 Liver disease
 Myxedema
 Pituitary insufficiency
 Protein malnutrition and other protein-depleted states
 Renal failure
 Thyroid surgical ablation
Thyroxine (T₄)
Increased thyroxine levels may indicate:
 Familial dysalbuminemic hyperthyroxinemia
 Hepatitis
 Pregnancy
 Struma ovarii
Decreased thyroxine levels may indicate:
 Cirrhosis
 Cretinism
 Myxedema
 Protein-depleted states
 Renal failure
 Surgical ablation
Thyroxine, free (FT₄)
Increased Thyroxine, free (FT₄) levels may indicate:
 Familial dysalbuminemic hyperthyroxinemia
 Hepatitis
 Pregnancy
 Struma ovarii
Decreased Thyroxine Levels may indicate:
 Cirrhosis
 Cretinism
 Myxedema
 Protein-depleted states
 Renal failure
 Surgical ablation
Thyroid-stimulating hormone (thyrotropin)
Abnormal findings:
 Acute starvation
 Hyperthyroidism
 Hypothyroidism
 Old age
 Psychiatric primary depression
 Pregnancy
 Results of the test may be invalid if the client has undergone a radionuclide scan within 7
days before the test.
Arterial Blood Gas (ABG) Normal Lab Values
Arterial Blood Gases (ABGs) are measured in a laboratory test to determine the extent of
compensation by the buffer system. It measures the acidity (pH) and the levels of oxygen and
carbon dioxide in arterial blood. Blood for an ABG test is taken from an artery whereas most
other blood tests are done on a sample of blood taken from a vein. To help you interpret ABG
results, check out our 8-Step Guide to ABG Analysis Tic-Tac-Toe Method.
Normal values for arterial blood gasses (ABG):
Range (SI Units)
Arterial Blood pH
Adult/Child 7.35—745
Newborn 7.32—7.49
ph (Venous) 7.31—7.41
Critical values (pH): <7.25 or >7.6
Partial pressure of carbon dioxide

(PaCO2)
Adult 35—45 mmHg
Child 26—41 mmHg
PCO2 (venous) 40—50 mmHg
Critical values (PCO2 ) <20 or >60 mmHg
Bicarbonate (HCO3)
Range (SI Units)
Adult/Child 22—26 mEq/L
Newborn 16—24 mEq/L
Critical values (HCO3) <10 or >40 mEq/L
Partial pressure of oxygen (PaO2)
Adult 80—100 mmHg
Newborn 60—70 mmHg
PaO2 (venous) 40—50 mmHg
Critical value (PaO2) <40 mmHg
Oxygen Saturation (SaO2)
Adult >95%
Newborn 40—90%
Range (SI Units)
Critical value (SaO2) <75%
Oxygen Content (O2)
Arterial 15—22 vol%
Venous 11—16 vol%
Base Excess
Base Excess Normal 0 ± 2 mEq/L
Critical value (Base Excess) ±3 mEq/L
Alveolar Arterial O2 Difference <10 mmHg
Increased pH levels (Alkalosis)
Metabolic alkalosis may indicate:
 Aldosteronism
 Chronic vomiting
 Chronic and high-volume gastric suction
 Hypochloremia
 Hypokalemia
 Mercurial diuretics
Respiratory alkalosis may indicate:
 Acute and severe pulmonary disease

 Anxiety neuroses
 Carbon monoxide poisoning
 Chronic heart failure
 Cystic fibrosis
 Pain
 Pregnancy
 Pulmonary emboli
 Shock
Decreased pH (Acidosis)
Metabolic acidosis may indicate:
 Ketoacidosis
 Lactic acidosis
 Renal failure
 Severe diarrhea
Respiratory acidosis may indicate:
 Respiratory failure
Pco2
Increased Pco2 levels may indicate:

 Head trauma
 Overoxygenation in a patient with COPD
 Oversedation
 Pickwickian syndrome
Decreased Pco2 levels may indicate:
 Anxiety
 Hypoxemia
 Pain
 Pregnancy
 Pulmonary emboli
Po2 and O2 content
Increased Po2, increased O2 content may indicate:
 Hyperventilation
 Increased inspired O2
Decreased Po2, increased O2 content may indicate:
 Adult respiratory distress syndrome

 Anemias
 Atelectasis
 Atrial or ventricular cardiac septal defects
 Bronchospasm
 Emboli
 Inadequate oxygen in inspired air (suffocation)Mucus plug
 Pneumothorax
 Pulmonary edema
 Restrictive lung disease
 Severe hypoventilation (e.g., neurologic somnolence, oversedation)
HCO3
Increased HCO3 levels may indicate:
 Aldosteronism
 Chronic and high-volume gastric suction
 Chronic vomiting
 Use of mercurial diuretics
Decreased HCO3 levels may indicate:
 Acute renal failure

 Chronic and severe diarrhea
 Chronic use of loop diuretics
 Starvation
Hepatitis Testing
Serological tests for specific hepatitis virus markers assist in determining the specific type of
hepatitis. Tests for hepatitis include radioimmunoassay, enzyme-linked immunosorbent assay
(ELISA), and microparticle enzyme immunoassay.
Reference guide for hepatitis testing:

 Hepatitis A: Presence of immunoglobulin M (IgM) antibody to Hepatitis A and presence
of total antibody (IgG and IgM) may suggest recent or current Hep A infection.
 Hepatitis B: Detection of Hep B core Antigen (HBcAg), envelope antigen (HBeAg), and
surface antigen (HBsAg), or their corresponding antibodies.
 Hepatitis C: Confirmed by the presence of antibodies to Hep C virus.
 Hepatitis D: Detection of Hep D antigen (HDAg) early in the course of infection and
detection of Hep D virus antibody in later stages of the disease.
 Hepatitis E: Specific serological tests for hepatitis E virus include detection of IgM and
IgG antibodies to hepatitis E.
 If the radioimmunoassay technique is being used, the injection of radionuclides within 1

week before the blood test is performed may cause falsely elevated results.
Therapeutic Drug Monitoring Normal Lab Values
Monitoring the therapeutic levels of certain medications is often conducted when the patient is
taking medications with a narrow therapeutic range where a slight imbalance could be critical.
Drug monitoring includes drawing blood samples for peak and trough levels to determine if
blood serum levels of a specific drug are at a therapeutic level and not a subtherapeutic or toxic
level. The peak level indicates the highest concentration of the drug in the blood serum while
the trough level represents the lowest concentration. The following are the normal therapeutic
serum medication levels:
Therapeutic Therapeutic Toxic Level Toxic Level
Drug Name Drug Class
Level (SI) Level (CV) (SI) (CV)
Acetaminophen >170
Analgesic 66—132 µmol/L 10—20 µg/mL >25 µg/mL
(Tylenol) µmol/L
>430
Amikacin Sulfate Aminoglycoside 26—43 µmol/L 15—25 µg/mL >250 µg/mL
µmol/L
Aminophylline 55.50—111 >111

Bronchodilator 10—20 µg/mL >20 µg/mL
(Norphyl) µmol/L µmol/L
433—541 >1800
Amitriptyline (Elavil) Antidepressants 120—150 ng/mL >500 ng/mL
nmol/L nmol/L
Carbamazepine
Anticonvulsants 21—51 µmol/L 5—12 µg/mL >50 µmol/L >12 µg/mL
(Tegretol)
>330
Cyclosporine (Gengraf) Calcineurin inhibitors 83—333 nmol/L 100—400 ng/mL >400 ng/mL
nmol/L
Desipramine 563—1126 >1890

Antidepressants 150—300 ng/mL >500 ng/mL
(Norpramin) nmol/L nmol/L
Digitoxin (Digibind) Cardiac Glycoside 20—33 nmol/L 15—25 ng/mL >33 nmol/L >25 ng/mL
Digoxin (Lanoxin) Antiarrhythmics 1—2.6 nmol/L 0.8—2 ng/mL >3 nmol/L >2.4 ng/mL
Disopyramide (Norpace) Antiarrhythmics 6—15 µmol/L 2—5 µg/mL >15 µmol/L >5 µg/mL
283—708 >700
Ethosuximide (Zarontin) Anticonvulsants 40—100 µg/mL >100 µg/mL
μmol/L μmol/L
Gentamicin (Garamycin) Aminoglycosides 10—21 µmol/L 5—10 µg/mL >25 µmol/L >12 µg/mL
535—1170 >1780
Imipramine (Tofranil) Antidepressants 150—300 ng/mL >500 ng/mL
nmol/L nmol/L
Kanamycin (Kantrex) Aminoglycosides 41—52 µmol/L 20—25 µg/mL >70 µmol/L >35 µg/mL

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Erythrocyte Studies Normal Lab Values

Red Blood Cells (RBC) Normal Lab Values

Indications of RBC count:

 Helps in diagnosing anemia and blood dyscrasia.

Range (SI Units) Range (Conventional)

Adult male 4.7—6.2 ✕ 1012/L 4.7—6.2 ✕ 106/mm3

Adult female 4.5—5.0 ✕ 1012/L 4.5—5.0 ✕ 106/mm3

Child 3.5—5.5 ✕ 1012/L 3.5—5.5 ✕ 106/mm3

Newborn 4.8—7.1 ✕ 1012/L 4.8—7.1 ✕ 106/mm3

Indications of hemoglobin count:

Range (SI Units) Range (Conventional)

Adult male 140—170 g/L 14—17 g/dL

Adult female 120—150 g/L 12—15 g/dL

Pregnant >110 g/L >11 g/dL

Child 95—150 g/L 9.5—15 g/dL

Newborn 140—240 g/L 14—24 g/dL

Critical values <70 or >200 g/L <7.0 or >20.0 g/dL

🔺Increased hemoglobin levels may indicate:

 Chronic obstructive pulmonary disease

Normal and critical values for hematocrit count:

Range (SI Units) Range (Conventional)

Adult male 0.42—0.52 42%—52%

Adult female 0.35—047 35%—47%

Pregnant >0.33 (>33%) >33%

Child 0.30—0.44 30—44%

Newborn 0.44—0.64 44%—64%

Critical values <0.20 or >0.60 <20% or >60%

Increased hematocrit levels may indicate:

Range (SI Units) Range (Conventional)

Mean corpuscular volume (MCV) 82—98 fL 82—98 mm3

Mean corpuscular hemoglobin (MCH) 0.40—0.53 fmol/cell 26—34 pg/cel

Mean corpuscular hemoglobin concentration (MCHC) 320—360 g/L 32—36 g/dL

Reticulocyte Count 0.005—0.015 0.5%—1.5% of total RBCs

Serum Iron (Fe)

Normal lab values for serum iron:

Range (SI Units) Range (Conventional)

Adult male 12.5—31.3 µmol/L 70—175 µg/dL

Adult female 8.9—26.8 µmol/L 50—150 µg/dL

Child 8.9—21.5 µmol/L 50—120 µg/dL

Newborn 17.9—44.8 µmol/L 100—250 µg/dL

Total iron—binding capacity (TIBC) 41.2—65.7 µmol/L 229—365 µg/dL

Transferrin 2.15—3.75 g/L 215—375 mg/dL

Indication of serum iron:

 Helps in diagnosing anemia and hemolytic disorder.

 Chronic blood loss

Male <50 years: 0—14 mm/hour

50—85 years: 0—19 mm/hour

>85 years: 0—29 mm/hour

Female <50 years: 0—19 mm/hour

50—85 years: 0—29 mm/hour

>85 years: 0—41 mm/hour

Child ≥ 2 years 0—10 mm/hour

 Lack of iron in the diet

Normal lab values for erythrocyte sedimentation rate:

Indication for Erythrocyte Sedimentation Rate:

 Fasting is not required

Platelets (Pt), Mean Platelet Volume (MPV), Fibrinogen

Range (SI Unit) Range (Conventional)

Adult 150—400 ✕ 109/L 150,000—400,000/mm3