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)
• Endocrine (hyperthyroidism, anterior pituitary hypofunction, adrenal cortical hypofunction)
• Inflammation (phlebitis, RA, Wegener's Eosinophilia-Myalgia, IBD)

Discussion

Most eosinophils are found in tissues rather than blood. When there is an elevation in the blood, it implies a process is occurring in the tissues. Along with Basophils, they function as reservoirs for potent biological materials such as histamine, serotonin, and heparin. Release of these compounds alters the blood supply to tissues, thereby mobilizing the body’s defense mechanism.

GLUCOSE

Optimal Range: 85-100 mg/DL

Causes of Increased

• Diabetes mellitus and insulin resistance syndromes
• Thiamine (B₁) insufficiency
• Hemochromatosis
• Ataxia telangiectasia
• Endocrine hyperfunction (adrenal cortex, pheochromocytoma, acromegaly/ACTH, hypothalamic lesions, Carcinoid, glucagonoma, somatostatinoma, thyrotoxicosis)
• Acute and chronic pancreatitis
• Drugs (anabolic and glucocorticoids, epinephrine, norepinephrine, thiazide diuretics, phenytoin)
• Stress

Causes of Decreased

• Excess insulin (insulinoma, overdosage)
• Impaired glucose tolerance (post-prandial)
• Late/large malignancies
• Endocrine hypofunction (thyroid, adrenal cortex, anterior pituitary)
• High dose salicylates
• Protein malnutrition
• Sometimes in pregnancy
• Various free radical pathologies
• Hypochlorhydria
• Liver dysfunction
• Hereditary
• After gastric surgeries (altered gastric emptying)
• Artifactual (polycythemia, failure to separate serum promptly)

HDL/HIGH DENSITY LIPOPROTEINS

Ideal Range: 55-75

Causes of Increased

• Diabetes mellitus
• Endocrine dysfunction
• Arteriosclerosis
• Liver/biliary dysfunction
• Pancreatic dysfunction
• Renal dysfunction
• Cardiac dysfunction
• Various hyperlipoproteinemias
• Pregnancy
• Systemic lupus erythematosus
• Chronic benign prostate hypertrophy
• Multiple sclerosis

Causes of Decreased

• Tobacco smoking
• Obesity
• Lack of exercise
• Beta-adrenergic blocking agents
• Hypertriglyceridemia
• Genetic
• Diabetes
• Liver dysfunction (reduced synthesis)

Discussion

HDL is comprised of phospholipids and one or two apolipoproteins. It plays a role in the metabolism of other lipoproteins, and in the transport of cholesterol to the liver. The HDL is a class of lipoproteins produced by the liver and intestines. A combination of increased triglyceride, cholesterol, and LDL with reduced HDL is indicative of atherogenic tendencies. A diet high in sugar may decrease HDL while increasing total serum cholesterol.

IRON

Optimal Range: 75-150 mg/ml

Causes of Increased

Hereditary Hemochromatosis

Secondary Hemochromatosis

• Ineffective erythropoiesis (thalassemias, sideroblastic)
• Intra-vascular hemolysis
• Liver disease (alcohol, portocaval shunts)
• Excessive iron intake

Causes of Decreased

• Iron deficiency (low ferritin level; nutritional, blood loss, achlorhydria, small bowel disease, increased demand)
• Chronic disease (liver dysfunction, renal dysfunction, etc.)

Discussion

Iron is known for its relationship to hemoglobin, which transports oxygen. Confirm true iron deficiency before supplementing iron. Never give Iron to someone who has an inflamed liver because this can be toxic. With B₁₂ or Iron deficiencies, give special consideration to increased occurrence in the elderly. The most important test for iron is the serum ferritin. If this is normal then the problem is in iron metabolism rather than iron deficiency or overload.

 LDL CHOLESTEROL

Optimal Range: <130

Causes of Increased

See triglycerides

Causes of Decreased

See cholesterol and triglycerides.

Discussion

Usually a calculation based on the cholesterol, HDL, and triglycerides. Thus using analysis of these measurements is more important.

LYMPHOCYTES

Optimal Range: 30-45% of WBC but depends on depends on absolute counts as well

Causes of Increased

• Infection (acute viral, chronic infections, parasites, Brucella)
• Relative neutropenia (hyperthyroidism, anterior pituitary hypofunction, adrenal cortical hypofunction)
• Stress
• Radiation
• Lead poisoning
• Food intolerances (Metabolic Rejectivity Syndrome)

Causes of Decreased

• Acute bacterial infections
• Adrenal cortical hyperfunction
• Systemic lupus erythematosis
• Immunodeficiency syndromes (HIV)
• Debilitating Diseases (TB, Hodgkin's, SLE, terminal cancer, renal failure)

Discussion

Lymphocytes react to the toxic by-products of protein metabolism. A leukocyte with a single nucleus that is second in abundance to neutrophils in the peripheral blood. They originate from the erythroblasts of the spleen, tonsils, thymus and bone marrow. Must assess in the context of the total WBC and WBC profile.

 MAGNESIUM, Serum

Optimal Range: 2-3 mg/DL

Causes of Increased

Endocrine

• Hypothyroidism
• Adrenal cortical hypofunction
• Hyperparathyroidism

Other

• Renal dysfunction (acute and chronic)
• Excessive magnesium intake
• Lithium use

Causes of Decreased

Excessive Urinary Losses

• Renal dysfunction (Tubular acidosis, glomerulonephritis, interstitial nephritis, etc)
• Hypercalcemia or hypophosphatemia
• Alcohol
• Hyperthyroidism
• Hyperaldosteronism
• Diuresis (diabetic ketoacidosis, hyperglycemia, acidosis, SIADH

Decreased Intake of magnesium

• Protein calorie malnutrition and starvation
• Chronic alcohol abuse
• Pregnancy

Increased Intestinal Losses

• Malabsorption syndromes
• Laxative abuse
• Severe diarrhea
• Pancreatic dysfunction

Altered Distribution

• Pancreatitis
• Excess catecholamines (medications, herbs, etc.)
• Alkalemia
• Hungry bone syndrome
• Digitalis, cyclosporin or diuretics may increase serum magnesium levels.
• The form of supplemental magnesium can be very important in terms of gastrointestinal absorption and systemic utilization.

Discussion

The serum magnesium is not reflective of total magnesium stores. Unfortunately there is not a good test for magnesium, but a red cell Mg level is preferable to serum magnesium. Approximately 2/3 to ¾ of magnesium in blood is not attached to protein. In other words, approximately one-third is bound to protein, the rest exists as free cations.It occurs in the serum as approximately a 5:1 ratio to total serum calcium. Low magnesium is much more common than excess. Magnesium plays a role in both carbohydrate and protein metabolism and can be lost through the gastrointestinal tract, kidneys, and in sweat.

MONOCYTES

Optimal Range: 3-8%

Causes of Increased

Infections

• Bacterial (TB, SBE, syphilis, Brucella, Listeria)
• Viral (hepatitis, mumps)
• Parasites (malaria, Kala-Azar)
• Other (Rickettsia, mycotic, protozoa)

Hematologic

• Preleukemia
• Leukemias (CML, AML)
• Lymphomas (Hodgkin's and Non Hodgkin's)
• Myeloproliferative Disorders (PCV, myelosclerosis)
• Hemolytic anemias

Autoimmune Disorders

• Collagen Vascular Diseases (PAN, SLE, RA)
• Ulcerative Colitis and regional Ileitis (Crohns)
• Cirrhosis
• Hand-Schuller Christian Disease
• Malignancy

Discussion

Monocytes are secondary defense cells.

NEUTROPHILS

Optimal Range: 50-60% WBC

Causes of Increased

Physiologic

• Newborn
• Pregnancy and delivery
• Emotional and physical stress
• Nausea and vomiting
• UV light, cold stress, heat stress

Acute infections

• Bacterial
• Certain viral
• Mycotic
• Spirochetes (syphilis)
• Parasites

Acute Inflammation

• Acute RA, vasculitis, myositis
• Rheumatic fever
• Hypersensitivity reactions

Metabolic Abnormalities

• Uremia
• Diabetic acidosis
• thyrotoxicosis
• Polycythemia
• Adrenal dysfunction
• Gout
• Influenza
• Rheumatoid arthritis

Causes of Decreased

• Chronic infections
• Bone marrow depression
• Iron, Vitamin B₁₂, Vitamin B₆ and folic acid anemias
• Systemic lupus erythematosis

Discussion

Neutrophils are part of the body’s defense system, but originate in the immune system. They are one of the first to react to invading macrophages. Neutrophils are first to respond, so they will be elevated early in the infection and decrease with effective treatment.

 PHOSPHORUS

Optimal Range: 3.8-4.2

Causes of Increased

• Renal dysfunction
• Magnesium deficiency
• Bone sources (healing fractures, immobilization, malignancy)
• Endocrine (hypoparathyroidism, excess estrogen, adrenal steroids, growth hormone)
• Sarcoidosis
• Liver dysfunction
• Diabetes
• Drug induced (calcium containing antacids, excess Vitamin D, phosphate enemas or sodas, etidronate sodium)
• High Calcium levels

Causes of Decreased

Intracellular phosphorus shift

• Alkalosis or recovery from acidosis (COPD, Diabetic ketoacidosis, asthma, nervousness from having your blood drawn)
• Carbohydrate intake (alcoholism)
• Beta-adrenergic agents (anti-asthma agents, etc) or stress

Gastrointestinal Losses

• Diarrhea
• Malabsorption including hypochlorhydria
• Nasogastric suctioning
• Aluminum containing (phosphorus binding) antacid use

Renal Phosphorus Losses

• Hypomagnesemia
• Hypokalemia
• Renal Disease
• Diuretics (thiazide, loop diuretics - furosemide, mannitol, acetazolamide)
• Corticosteroids
• Xanthine derivatives

Other

• Protein malnutrition
• Insufficient Vitamin D
• Liver dysfunction
• Low serum Calcium levels
• Hyperparathyroidism
• Trauma, Burns

Discussion

Phosphorus is a critical constituent of all the body’s tissues. It is essential to the formation of muscle, red blood cells, ATP, the maintenance of acid-base balance and lowering blood viscosity, as well as to the nervous system and the intermediary metabolism of carbohydrates, protein and fat. Check dietary phosphate intake. Must combine with potassium, parathyroid hormone, calcium and magnesium levels since the phosphorus level responds to these influences.

POTASSIUM

Optimal Range: 4.1-4.6 mEq/L

Causes of Increased

Redistribution

• Acidosis (respiratory or metabolic)
• Medications (insulin, beta-blockers, arginine, digitalis toxicity)
• Hyperkalemic Periodic Paralysis
• Diabetes

Renal dysfunction

Endocrine dysfunctions

• Aldosterone antagonism (spironolactone, triamterene, amiloride, hypoaldosteronism)
• 21-hydroxylase deficiency
• Adrenal cortical hypofunction

Other

• Potassium load from muscle death, IV fluids
• High white blood cell count or platelet count
• Hemolyzed blood, clenched fist or improper specimen handling

Causes of Decreased

Gastrointestinal Losses

• Gastric (vomiting, nasogastric suction, pyloric obstruction)
• Intestinal (diarrhea, malabsorption, fistula)

Redistribution into cells

• Familial Hypokalemic Periodic Paralysis
• Alkalosis
• Medications (insulin, catecholamines, beta₂-adrenergic agents, barium)
• Hypothermia
• Acute Myeloid leukemia

Urinary Losses

• Diuretics (thiazide, loop diuretics, furosemide, ethacrynic acid)
• Magnesium depletion
• Antibiotics (carbenicillin, amphotericin B)
• Mineralocorticoids (licorice, chewing tobacco, carbenoxalone, Florinef, Cushing's disease, hyperaldosteronism, congenital adrenal hyperplasia 11 or 17 hydroxylase deficiency)
• Renal disease (Bartter's Syndrome, Renal tubular acidosis I and II)Hypertension
• High renin states (hypertension)

Other (sweating, insufficient potassium intake)

Discussion

Potassium is the major intracellular electrolyte that must be in balance with its counterpart, sodium. It is a major electrolyte that is considered with cardiac irregularity and sensitivity. A low serum potassium level may be seen on EKG with irregular patterns of premature ventricular beats (PVC's).

FREE T4 (THYROXINE, Direct)

Optimal Range: 1.1-1.7 ug/dl

Causes of Increased

• Hyperthyroidism
• Thyroiditis, initially
• Use of oral thyroid or thyroxine
• Poor T4 to T3 conversion (liver dysfunction, estrogen, selenium deficiency
• Pregnancy
• Reduced Thyroglobulin-Binding-Globulin (phenytoin, rifampin, steroids, dopamine, carbamazepine)

Causes of Decreased

• Hypothyroidism
• Thyroiditis, chronic with glandular destruction
• Iodine deficiency
• Fatty acid deficiency
• Anterior pituitary hypofunction (with low TSH)
• Kidney dysfunction

*Familial history, body morphology analysis per Page, and female hormonal balance may be helpful.

Discussion

A low FT4 must viewed in context of the TSH and FT3. Effect of TBG should also be considered. See hyperthyroid and hypothyroid. A Basal Body Temp may help determine degree and effect of treatment.

TRIGLYCERIDE

Optimal Range: 70-100 mg/dl

Causes of Increased

• Primary Familial Hypertriglyceridemia
• Diabetes, insulin resistance
• Alcoholism, especially if acute
• Oral contraceptives
• Chronic kidney disease (nephrotic syndrome, renal failure)
• Acute pancreatitis
• Gout
• Glycogen Storage Diseases
• Gout
• After a meal containing fat
• Excess fructose consumption
• Omega -3 fatty acid deficiency

Causes of Decreased

• Hyperthyroidism
• Hyperparathyroidism
• Protein malnutrition (vegetarians)
• Autoimmune disorders, immunodeficiency states, infections

Discussion

Triglycerides are esters of glycerol combined with three chains of fatty acids. Elevated triglycerides indicate poor utilization or overproduction. Decreased suggest poor release of fatty acids, endocrine hyperfunction and/or immune dysfunction. A full lipid profile with cholesterol, HDL, LDL can determine if familial. Most cases have a compromised liver or endocrine function.

 TSH

Optimal Range: 1.0-2.5 mcIU/ml

Causes of Increased

• Hypothyroidism
• Liver dysfunction
• Anterior pituitary hyperfunction
• Drugs (dopamine antagonists, chlorpromazine, haloperidol, iodine)

*Increased TSH usually indicates a need for more serum thyroxine (T4). See additional testing and discussion.

Causes of Decreased

• Hyperthyroidism
• Anterior pituitary hypofunction
• Pregnancy
• Drugs (glucocorticoids, dopamine and agonists, levodopa, pyridoxine)

*See discussion on excessive T4 or T3.

Discussion

Cholesterol levels often inversely correlate with thyroid function. Liver function must be intact. If hyperthyroid with decreased cholesterol, consider pituitary dysfunction. If hypothyroid, cholesterol may increase because of the formation of bile, reducing the cholesterol pool. If TSH is normal, but FT4 levels are abnormal, consider sex hormones. Consider the elderly and those with a family history as thyroid disorder vulnerable.

 

URIC ACID

Optimal Range: Male: 3.5-5.9 mg/DL; Female: 3.0-5.5 mg/DL

Causes of Increased

• Gout
• Dehydration
• Acute inflammation (active psoriasis, toxemia of pregnancy, RA)
• Hematologic disorders (leukemia, lymphoma, hemolytic anemia, megaloblastic anemia, infectious mononucleosis, polycythemia vera)
• Arteriosclerosis
• Liver dysfunction
• Renal dysfunction
• Hypothyroidism
• Hyperparathyroidism
• Diabetes
• Lead poisoning
• Drug-induced (thiazides, salicylates at low dose, ethambutol, nicotinic acid, cytotoxic agents)
• Tissue necrosis (chemotherapy, starvation, radiation, lactic acidosis)

Causes of Decreased

• Folic acid/B₁₂ anemia (relapse)
• Pregnancy
• Hepatobiliary dysfunction (severe alcoholism, biliary obstruction, Wilson's Disease, hemochromatosis)
• Drugs (allopurinol, probenecid, glyceryl guiacolate, high dose ascorbic acid, high dose salicylates, corticosteroids)
• Acute Intermittent Porphyria
• Renal tubular disease
• SIADH
• Chronic debilitating disease
• Galactosemia
• Molybdenum deficiency

Discussion

Formed from the breakdown of nucleic acids. Each cell nucleus breaks down with cellular breakdown. If this is too massive, the kidneys and liver cannot keep up. This is the first test thought of to diagnose gout. It is also involved in kidney stone formation. If there is no renal or hepatic problem, alkaline mineral deficiency may be the problem.

 WBC(White Blood Cells)

Optimal Range: 4.0-5.5 Th/cu.mm

Causes of Increased

• Infection (parasites, abscess, etc)
• Adrenal dysfunction
• Asthma
• May be seen in late pregnancy
• Systemic lupus
• Leukemias

Causes of Decreased

• Hepatitis
• Hyperparathyroidism
• Adrenal dysfunction
• Rheumatoid arthritis
• Influenza (early stages)
• Vitamin and mineral deficiencies.

Discussion

During a state of infection/inflammation, WBCs move freely through the blood, destroying invasive bacteria and viruses. Look at the WBC differential to differentiate granular from non-granular leukocytes.