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Normal Indications Evaluate for: Elevated triglycerides Risk for atherosclerotic heart disease and stroke Description Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue. What would cause increased levels? Myocardial Infarction (MI) Alcoholism Alcoholic cirrhosis High carbohydrate diet Anorexia nervosa Cirrhosis Hypertension (HTN) Nephrotic Syndrome Obesity Renal failure Pancreatitis Stress What would cause decreased levels? Chronic Obstructive Pulmonary Disease (COPD) Liver disease Hyperthyroidism Malnutrition Malabsorption

Normal 135-145 mEq/L Indications Monitor: Extracellular osmolality Electrolyte imbalance Description Sodium (Na+) is the most abundant cation in extracellular fluid. Sodium aids in osmotic pressure, renal retention and excretion of water, acid-base balance, regulation of other cations and anions in the body. Sodium plays a role in blood pressure regulation and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; water follows salt. What would cause increased levels? Cushing Syndrome Hyperaldosteronism Dehydration Burn injury Azotemia (elevated nitrogen) Lactic acidosis (LA) Fever/excessive sweating Excessive IV fluids containing sodium Diabetes Insipidus Osmotic diuresis What would cause decreased levels? Congestive Heart Failure (CHF) Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Cystic Fibrosis Diuretic use Metabolic acidosis Addison’s Disease Nephrotic Syndrome Vomiting Diarrhea Ascites Excessive Antidiuretic Hormone(ADH) Liver failure

Normal 3.5 - 5.0 mEq/L Indications Evaluate: Electrolyte imbalances Cardiac arrhythmias Monitor patients who are: Acidotic Receiving diuretic therapy Description Potassium (K+) is the most abundant intracellular cation and plays a vital role in the transmission of electrical impulses in cardiac and skeletal muscle. It plays a role in acid base equilibrium. In states of acidosis hydrogen will enter the cell which will force potassium out of the cell. A 0.1 decrease in pH will cause a 0.5 increase in K+. What would cause increased levels? Renal failure Hypoaldosteronism Addison’s disease Injury to tissues Diabetes Mellitus (DM) Ketoacidosis Hyperventilation Acidosis Infection Dehydration Burns What would cause decreased levels? Hyperaldosteronism Excess insulin Alkalosis Diarrhea Vomiting Cystic Fibrosis Cushing Syndrome

Normal 25 - 35 seconds Indications Detection of coagulation disorders Evaluate response to Heparin (PT for Coumadin) Preoperative assessment Description Partial Thromboplastin Time (PTT)evaluates the function of factors I, II, V, VIII, IX, X, XI, and XII. PTT represents the amount of time required for a fibrin clot to form. Monitors therapeutic ranges for people taking Heparin. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Clotting Factor Deficiencies: Hypofibrinogenemia Von Willebrand Disease Hemophilia Liver disease: Cirrhosis Vitamin K deficiency Polycythemia Dialysis What would cause decreased levels? N/A

Normal 95 - 100% Indications Determine respiratory status Part of Arterial Blood Gas (ABG) testing Description Oxygen saturation (SaO2) is a measurement of the percentage of how much hemoglobin is saturated with oxygen. Oxygen is transported in the blood in two ways: oxygen dissolved in blood plasma (pO2) and oxygen bound to hemoglobin (SaO2). About 97% of oxygen is bound to hemoglobin while 3% is dissolved in plasma. SaO2 and pO2 have direct relationships, if one is decreased so is the other. The relationship between oxygen saturation (SaO2) and partial pressure O2 (PaO2) is referred to as the oxyhemoglobin (HbO2) dissociation curve. SaO2 of about 90% is associated with PaO2 of about 60 mmHg. What would cause increased levels? Polycythemia Increased inspired O2 Hyperventilation What would cause decreased levels? Anemia’s Hypoventilation Bronchospasm Mucus plugs Atelectasis Pneumothorax Pulmonary edema Adult respiratory distress syndrome

Normal 261 – 280 mOsm/kg Indications Monitor: Electrolyte balance Acid-Base balance Hydration Evaluate function of antidiuretic hormone.   Description Osmolality is a measure of the particles in solution. The size, shape, and charge of the particles do not impact the osmolality   What would cause increased levels? Dehydration Azotemia Hypercalcemia Hyperglycemic Hyperosmolar Nonketotic State (HHNS) Hypernatremia Diabetes Insipidus Hyperglycemia Mannitol therapy Uremia Severe pyelonephritis Shock Ketosis   What would cause decreased levels? Hyponatremia Syndrome of Inappropriate Antidiuretic Hormone (SIADH) Overhydration

Normal 1.6 – 2.6 mg/dL Indications Monitor: Renal failure Chronic alcoholism Cardiac arrhythmias Description Magnesium (Mg) is a cation necessary for protein synthesis, nucleic acid synthesis, muscle contraction, ATP (adenosine triphosphate) use, nerve impulse conduction, and blood clotting. Magnesium affects the absorption of sodium, calcium, phosphorus, potassium.   What would cause increased levels? Renal insufficiency Uncontrolled Diabetes Mellitus (DM) Addison Disease Dehydration Hypothyroidism Overuse of antacids Tissue trauma   What would cause decreased levels? Alcoholism Diabetic acidosis Renal failure: Glomerulonephritis Hypercalcemia Malnutrition Malabsorption Hypoparathyroidism Diarrhea

Normal Indications Useful in determining risk of cardiovascular disease. Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein, LDL, and very low-density lipoprotein (VLDL). LDL cholesterol is considered bad cholesterol because as it travels through the blood, it deposits cholesterol into the lining of blood vessels, causing atherosclerosis and an increase in cardiovascular disease. What would cause increased levels? Diet high in saturated fats Nephrotic Syndrome Alcoholism Chronic liver disease: Hepatitis Cirrhosis Hypothyroidism Cushing’s Syndrome What would cause decreased levels? Regular physical activity Hyperthyroidism Hypoproteinemia: Malabsorption Severe burns Malnutrition

Normal 0.3 -2.6 mmol/L Indications Determine cause of acidosis Evaluate tissue oxygenation Description Lactate (Lactic Acid) is a byproduct of anaerobic metabolism. Normally, the tissues use aerobic metabolism to breakdown glucose for energy and the byproduct is CO2 and H2O which we excrete through our kidneys and exhalation. However, if the tissues are starved of oxygen (hypoxic), they use anaerobic metabolism. This can be compounded if the liver is also hypoxic causing the liver to be unable to clear the lactic acid. What would cause increased levels? Shock Sepsis Tissue ischemia Carbon monoxide poisoning Lactic acidosis Diabetes Mellitus (DM) Heart failure Pulmonary edema Strenuous exercise What would cause decreased levels? N/A

Normal 0.8 - 1.2 Therapeutic Levels of Warfarin 2.0 – 3.5 Indications Evaluate therapeutic doses of Warfarin Identify patients at higher risk for bleeding Identify cause of: Bleeding Deficiencies Description International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method. What would cause increased levels? Disseminated Intravascular Coagulation (DIC) Liver disease Vitamin K deficiency Warfarin What would cause decreased levels? Too much vitamin K Estrogen containing medications such as birth control

Normal >60 optimal mg/dL Indications Monitor risks of heart disease Description Cholesterol is transported via lipoproteins. There are multiple types of lipoproteins and they each have slightly different functions: high-density lipoprotein (HDL), low-density lipoprotein (LDL) very low-density lipoprotein (VLDL). HDL cholesterol is considered the good cholesterol because it travels through the blood picking up extra cholesterol and taking it back to the liver. What would cause increased levels? Familial HDL Lipoproteinemia Exercise Unsaturated fats: Mono- Poly- Hypothyroid What would cause decreased levels? Metabolic Syndrome Hepatocellular disease: Hepatitis Cirrhosis Hypoproteinemia: Nephrotic Syndrome Malnutrition Smoking High saturated and trans fat diets Excess body weight Hyperthyroid

Normal 5.6-7.5 % of total Hgb Indications Assess control of blood sugars over a several month time frame Diagnose Diabetes Mellitus (DM) Description Glycosylated Hemoglobin (HbA1c) is the combination of glucose and hemoglobin. When glucose is elevated in the blood the amount of glycosylated hemoglobin increases proportionally. A red blood cells lifespan is about 4 months, so you can get an idea of blood sugar control over the last several months. What would cause increased levels? Poorly controlled Diabetes Mellitus(DM) Non-Diabetic Hyperglycemia: Stress Cushing Syndrome Pheochromocytoma Corticosteroid Therapy What would cause decreased levels? Renal failure Blood loss Hemolytic anemia Sickle cell anemia