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General Lab values
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BASOPHILS

Typical Ref. Range: 0-3% of WBC

Optimal Range: 0-1% of WBC

Causes of Increased

  • Chronic Hemolytic anemia
  • Chronic Hypersensitivity reactions (foods, drugs, inhalants)
  • Myeloproliferative Disorders (polycythemia vera, CGL, basophilic leukemia)
  • Urticaria Pigmentosa
  • Ulcerative Colitis
  • Parasites (with elevated eosinophils)
  • Chickenpox
  • Myxedema (Severe hypothyroidism)
  • Systemic inflammatory conditions

Discussion

Basophils are involved in: (1) Lysosomes that contain enzymes needed for relief of histamines; (2) Allergic responses with release of histamine, kinins, and slow-reacting substance of anaphylaxis; (3) Release of heparin to prevent blood clotting. Basophils contain hyaluronic acid, a protective ingredient to insure a normal inflammatory process.

BUN (BLOOD UREA NITROGEN)

Typical Ref. Range: 5-25 mg/DL

Optimal Range: 12-20 mg/DL

Causes of Increased ("Azotemia")

Renal dysfunction (creatinine increases proportionately)

Pre-renal Azotemia (less proportional creatinine elevation)

  • Diabetes mellitus, uncontrolled
  • Starvation/dehydration/diarrhea
  • Congestive heart failure (decreased renal circulation)
  • GI hemorrhage and obstruction
  • Shock/Tissue necrosis/ Third degree burns
  • Renal Artery Stenosis (with hypertension)

Post-Renal

  • Renal vein thrombosis
  • Urinary tract obstruction

Non-Renal

  • Gout
  • Increased protein catabolism (Tetracycline, Addison's, excess glucocorticoids)
  • High protein diet

Causes of Decreased

  • Syndrome of Inappropriate ADH secretion (SIADH)
  • Liver/biliary dysfunction (severe)
  • Malnutrition (inadequate protein digestion or intake)
  • Celiac Sprue
  • Advanced stages of acidosis
  • Zinc deficiency
  • Posterior pituitary hypofunction
  • Anabolic hormones
  • May be seen during normal pregnancy

Discussion

Urea is a by-product of nitrogen (protein) utilization and is converted to ammonia when combined H2O.

CALCIUM, Total Serum

Typical Ref. Range: 8.5-10.8 mg%

Optimal Range: 9.5-10.2 mg%

Causes of Increased

Increased Parathyroid Hormone (PTH)

  • Primary Hyperparathyroidism (tumor, hyperplasia)
  • Secondary Hyperparathyroidism (after Vitamin D deficiency, after renal transplant)
  • Tertiary Hyperparathyroidism (Chronic Renal Failure)
  • Aluminum induced bone disease
  • Familial (low urine calcium)
  • Drugs: lithium, theophylline
  • Pheochromocytoma

Normal or Decreased Parathyroid Hormone

  • Malignancy (esp lung, myeloma, breast, squamous cell)
  • Endocrine (Anterior pituitary dysfunction, thyrotoxicosis or hypothyroidism, acute adrenal cortical hypofunction, ovarian hyperfunction)
  • Hypophosphatasia
  • Toxic effects of non-medicinal metals (Cadmium)
  • Granulomatous Disease (Sarcoidosis)
  • Milk-alkali Syndrome
  • Medications: Thiazide diuretics, Tamoxifen and other anti-estrogens, TPN
  • Epilepsy
  • Paget's Disease
  • Immobilization from any cause
  • Excess ingestion of Vitamin D or A
  • Pregnancy and lactation

Causes of Decreased

Low parathyroid hormone (PTH)

  • Hypoparathyroidism (surgical, autoimmune, radiation)
  • Magnesium deficiency (end organ resistance)

Normal or increased parathyroid hormone (PTH)

  • Ovarian hypofunction
  • Vitamin D insufficiency
  • Anticonvulsants
  • Rapid bone deposition
  • Protein malnutrition
  • Digestive dysfunction (Hypochlorhydria)
  • Renal dysfunction
  • Pancreas dysfunction
  • Pregnancy
  • Metabolic acidosis

Discussion

Serum calcium is not at all reflective of total body stores of calcium but rather reflects the metabolic and hormonal state of the individual. Ionic or free calcium is not only the biologically active form of calcium but reflects the amount of albumin and the blood pH. In acidemia, calcium becomes ionized and liberated from serum proteins. In alkalemia, more calcium is bound to proteins as well as precipitating out of solution. This may lead to extra-osseous deposition or kidney stones. The Calcium/Phosphorus ratio is an index of great value in detecting more subtle hormonal imbalances.

Serum calcium can not be properly interpreted without serum albumin level. Use the formula Adjusted Calcium = Serum calcium - serum albumin + 4. By far the most common causes of hypercalcemia are primary hyperparathyroidism, malignancy, and drug-induced. A PTH, calcium, albumin and phosphorus level drawn simultaneously helps classify the etiology into main groups. Watch for signs of calcium deposition and kidney stones.

 

CHLORIDE

Optimal Range: 101-103 mEq/L

Causes of Increased

  • Metabolic acidosis (primary CO2 deficit)
  • Renal dysfunction (Polycystic, obstruction, tubular acidosis, pyelonephritis)
  • Excess sodium chloride intake (IV solutions)
  • Adrenal cortical hyperfunction
  • Severe dehydration (diabetes)
  • Diabetes insipidus
  • Hyperparathyroidism
  • Anterior pituitary hypofunction

Signs, Causes & Symptoms Decreased

Renal chloride loss

  • Loop diuretics (furosemide)
  • Bartter's Syndrome
  • Salt-losing nephropathies

GI chloride loss

  • Zollinger-Ellison Syndrome
  • Secretory diarrhea

Other

  • Metabolic alkalosis (primary CO2 excess)
  • Chronic compensated respiratory acidosis
  • Congestive Heart Failure
  • Overhydration
  • Syndrome of Inappropriate ADH (SIADH)
  • Burns
  • Diabetes
  • Adrenal cortical hypofunction (Addison's)
  • Hypoparathyroidism
  • Perspiration (Cystic Fibrosis)

Discussion

Chloride contributes to the body’s acid/base balance. Along with Sodium, Potassium and Carbon Dioxide, it is important in evaluating acid/base relationships, state of hydration, adrenal and renal functions. Its level varies inversely with Carbon Dioxide. Chloride elevation indicates acidosis, decrease indicate alkalosis.

CHOLESTEROL

Optimal Range: 185-200 mg/dl

Causes of Increased

  • Hypothyroidism
  • Hepatobiliary dysfunction
  • Pancreatic dysfunction
  • Renal dysfunction (Nephrotic Syndrome, chronic insufficiency)
  • Familial hyperlipoproteinemias II, III and V
  • Pregnancy
  • Insulin (resistance, treatment)
  • Anabolic/anaerobic metabolic states (glucocorticosteroids)
  • Acute Intermittent Porphyria
  • Diet high in refined carbohydrates

Causes of Decreased

  • Herpes Zoster
  • Various free radical pathologies (Autoimmunity, acute/active infection, catabolic metabolism)
  • Hyperthyroidism
  • Depression
  • Malignancies
  • Anemia
  • Abetalipoproteinemias (lack of microsomal triglyceride transfer protein)
  • Tangier's Disease (defective HDL synthesis)
  • Malabsorption/malnutrition
  • Cardiac dysfunction
  • Liver/biliary disease (hepatitis, mononucleosis)

Discussion

Cholesterol is an important part of our diet. It is essential to the proper function and structure of cell membranes. Bile acids are derived from cholesterol. The liver, adrenals, sex glands, intestines, and even the placenta, manufacture cholesterol. Cholesterol is best used as an indicator of other metabolic dysfunction. Should not be considered a disease by itself unless extreme, which indicates familial cause. Check triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypofunction. Low levels are not necessarily desirable as it is associated with increased incidence of malignancy and mental illness.

 CO2 BICARBONATE

Typical Ref. Range: Serum pH: 7.35-40; PaCO2: 35-45 mm/HG; PaO2: 80-100 mm/HG; HCO3: 22-32 mEq/L

Optimal Range: 24-28mEq/L

Causes of Increased

Metabolic Alkalosis

  • Excess bicarbonate intake (calcium antacids)
  • Adrenal cortical hyperfunction
  • Compensated Respiratory acidosis
  • Hyperventilation
  • Renal dysfunction
  • Long-term diuretic therapy
  • PVC's with hypokalemia
  • Milk-alkali Syndrome

Causes of Decreased

Metabolic Acidosis

  • Asthma
  • Chronic renal dysfunction (uremia)
  • Fever
  • High Anion Gap acidosis (see AG list)

Discussion

As a compensatory reaction to metabolic acidosis, the lungs eliminate CO2 + and as s result HCO3 - will be retained. As a compensatory reaction to metabolic alkalosis, the lungs decrease ventilation to increase the blood CO2 + and the kidneys conserve H+ to excrete HCO3 -.

CREATININE

Optimal Range: 0.8-1.1

Causes of Increased

  • Renal dysfunction (including obstruction)
  • Congestive heart failure
  • Starvation-dehydration
  • Uncontrolled diabetes (can interfere with test)
  • Muscle degeneration

Causes of Decreased

  • Muscle atrophy
  • Liver disease
  • Pregnancy

Discussion

Creatinine is formed in muscles from creatine, which is formed in the liver. It is a substance that in health is easily excreted by the kidney. Because all Creatinine filtered by the kidneys is excreted into the urine, its levels at any given time interval are equivalent to the Glomerular Filtration Rate (GFR).

EOSINOPHILS

Optimal Range: 0-3% WBC

Causes of Increased

  • Systemic parasitic infestation
  • Systemic fungal infections (Cocci, Histo, ABPA)
  • Allergic diseases (food, inhalant/environmental, asthma, eczema)
  • Skin disorders (atopic dermatitis, eczema, urticaria, pemphigus, dermatitis herpetiformis)
  • Pulmonary Syndromes (ABPA, Loeffler's, PIE, Hypersensitivity pneumonitis)
  • Collagen Vascular Diseases (DM, PSS, eosinophilic fasciitis, hypersensitivity vasculitis)
  • Malignancy (Ovarian, epidermoid, bladder, lung, colon)
  • Immunodeficiency (W-A Syndrome, Hyper-IgE, IgA Def, Nezelof's)
  • Hematologic (PCV, PA, Myelofibrosis, CML)
  • Drugs (arsenic, phenothiazines, gold, iodides, nitrofurantoin, PAS, ampicillin, phenytoin, streptomycin, sulfonamides)
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