Table C-1 Serum, Plasma, and Whole Blood Chemistries REFERENCE INTERVALS Conventional Test SI Units Units Acetone • Quantitative <2.0 mg/dL <344 µmol/L • Qualitative Negative Negative Albumin 3.5-5.0 g/dL 35-50 g/L Aldolase 1.5-8.1 U/L 1.5-8.1 U/L α1-Antitrypsin 78-200 mg/dL 0.78-2.0 g/L α1-Fetoprotein <10 ng/mL <10 mcg/L Ammonia 15-45 mcg N/dL 11-32 µmol N/L Amylase 30-122 U/L 0.51-2.07 µkat/L (method dependent) Bicarbonate 22-26 mEq/L 22-26 mmol/L b-Type <100 pg/mL <100 pmol/L natriuretic peptide (BNP) Bilirubin • Total 0.2-1.2 mg/dL 3-21 µmol/L • Indirect 0.1-1.0 mg/dL 1.7-17.0 µmol/L • Direct 0.1-0.3 mg/dL 1.7-5.1 µmol/L Blood gases* • Arterial pH 7.35-7.45 7.35-7.45 • Venous pH • PaCO2 • PvCO2 • PaO2 • PvO2 Calcium (total) 7.32-7.43 35-45 mm Hg 38-55 mm Hg 80-100 mm Hg 38-42 mm Hg 8.6-10.2 mg/dL 7.32-7.43 4.66-5.98 kPa 5.06-7.32 kPa 10.6-13.33 kPa 5.04-5.57 kPa 2.15-2.55 mmol/L Calcium (ionized) CO2 Carotene Chloride 4.64-5.28 mg/dL 1.16-1.32 mmol/L 23-29 mEq/L 10-85 mcg/dL 96-106 mEq/L 23-29 mmol/L 0.19-1.58 µmol/L 96-106 mmol/L Cholesterol <200 mg/dL <5.2 mmol/L • High-density lipoproteins (HDLs) • Low-density lipoproteins Male: >40 mg/dL Female: >50 mg/dL >1.04 mmol/L >1.3 mmol/L Recommended: <100 mg/dL Recommended: <2.6 mmol/L POSSIBLE ETIOLOGY Higher Lower Diabetic ketoacidosis, high-fat diet, low-carbohydrate diet, starvation Dehydration Skeletal muscle disease Acute and chronic inflammation, arthritis Cancer of testes, ovaries, and liver Severe liver disease Acute and chronic pancreatitis, mumps (salivary gland disease), perforated ulcers Chronic liver disease, malabsorption, malnutrition, nephrotic syndrome Renal disease Chronic lung disease (early onset), malnutrition, nephrotic syndrome Compensated respiratory acidosis, metabolic alkalosis Heart failure Compensated respiratory alkalosis, metabolic acidosis Acute alcoholism, cirrhosis of liver, extensive destruction of pancreas Biliary obstruction, impaired liver function, hemolytic anemia, pernicious anemia Alkalosis Acidosis 1656 Compensated metabolic alkalosis Respiratory acidosis Administration of high concentration of oxygen Compensated metabolic acidosis Respiratory alkalosis Chronic lung disease, decreased cardiac output Acute osteoporosis, hyperparathyroidism, vitamin D intoxication, multiple myeloma Acute pancreatitis, hypoparathyroidism, liver disease, malabsorption syndrome, renal failure, vitamin D deficiency Same as bicarbonate Cystic fibrosis, hypothyroidism, pancreatic insufficiency Metabolic acidosis, respiratory alkalosis, corticosteroid therapy, uremia Biliary obstruction, hypothyroidism, idiopathic hypercholesterolemia, renal disease, uncontrolled diabetes Dietary deficiency, malabsorption disorders Addison's disease, diarrhea, metabolic alkalosis, respiratory acidosis, vomiting Extensive liver disease, hyperthyroidism, malnutrition, corticosteroid therapy Test (LDLs) Copper Cortisol Creatine Creatine kinase (CK) REFERENCE INTERVALS Near optimal: 100Near optimal: 2.6129 mg/dL (2.63.34 mmol/L 3.34 mmol/L) Moderate risk for Moderate risk for CAD: 130CAD: 3.37159 mg/dL (3.374.12 mmol/L 4.12 mmol/L) High risk for CAD: High risk for CAD: >160 mg/dL >4.14 mmol/L (>4.14 mmol/L) 80-155 mcg/dL 12.6-24.3 µmol/L 8 AM: 5-23 mcg/dL 0.14-0.63 µmol/L 8 PM: <10 mcg/dL <0.28 µmol/L 0.2-1.0 mg/dL 15.3-76.3 µmol/L POSSIBLE ETIOLOGY Cirrhosis Cushing syndrome, pancreatitis Wilson's disease Adrenal insufficiency, panhypopituitary states Active rheumatoid arthritis, biliary obstruction, hyperthyroidism, renal disorders, severe muscle disease Musculoskeletal injury or disease, myocardial infarction, severe myocarditis, exercise, numerous IM injections Diabetes mellitus Male: 20-200 U/L Female: 20-180 U/L <4%-6% of total CK 0.6-1.3 mg/dL 10-250 ng/mL Male: 20-200 U/L Female: 20-180 U/L <0.4-0.6 53-115 µmol/L 10-250 mcg/L Folate (folic acid) Gamma glutamyl transferase (GGT) Glucose (fasting) Haptoglobin 3-16 ng/mL 7-36 nmol/L 0-30 U/L 0-0.5 µkat/L Liver disease, infectious mononucleosis, pancreatitis, hyperthyroidism 70-99 mg/dL 3.9-5.5 mmol/L 26-185 mg/dL 260-1850 mg/L Acute stress, Cushing disease, diabetes mellitus, hyperthyroidism, pancreatic insufficiency Infectious and inflammatory processes, cancer Insulin (fasting) Iron, total Iron-binding capacity Lactic acid (LLactate) Lactic dehydrogenase (LDH) Lactic dehydrogenase isoenzymes • LDH1 • LDH2 • LDH3 4-24 µU/mL 29-172 pmol/L 50-175 mcg/dL 250-425 mcg/dL 9.0-31.3 µmol/L 44.8-76.1 µmol/L Acromegaly, adenoma of pancreatic islet cells, untreated mild case of type 2 diabetes Excessive RBC destruction Iron-deficient state, polycythemia 6.3-22.5 mcg/dL 0.7-2.5 mmol/L Acidosis, heart failure, shock 140-280 U/L 0.83-2.5 µkat/L Heart failure, hemolytic disorders, hepatitis, metastatic cancer of liver, myocardial infarction, pernicious anemia, pulmonary embolus, skeletal muscle damage 18%-33% 28%-40% 18%-30% 0.18-0.33 0.28-0.40 0.18-0.30 Myocardial infarction, pernicious anemia Pulmonary embolus, sickle cell crisis Malignant lymphoma, pulmonary embolus • CK-MB Creatinine Ferritin Acute myocardial infarction Severe renal disease Sideroblastic anemia, anemia of chronic disease (infection, inflammation, liver disease) Hypothyroidism Iron-deficiency anemia Alcoholism, hemolytic anemia, inadequate diet, malabsorption syndrome, megaloblastic anemia Hypothyroidism Addison's disease, hepatic disease, hypothyroidism, insulin overdosage, pancreatic tumor, pituitary hypofunction Hemolytic anemia, mononucleosis, toxoplasmosis, chronic liver disease 1657 Inadequately treated type 1 diabetes mellitus Iron-deficiency anemia, anemia of chronic disease Cancer, chronic infections, pernicious anemia Test • LDH4 • LDH5 REFERENCE INTERVALS 6%-16% 0.06-0.16 2%-13% 0.02-0.13 Lipase Magnesium Osmolality O2 saturation (arterial) (SaO2) pH Phenylalanine Phosphatase, acid Phosphatase, alkaline Phosphorus (phosphate) Potassium 31-186 U/L 1.5-2.5 mEq/L 275-295 mOsm/kg >95% 0.5-3.2 µkat/L 0.75-1.25 mmol/L 275-295 mmol/kg >0.95 See Blood gases 0.8-1.8 mg/dL 0-0.6 U/L 48-109 µmol/L 0-90 µkat/L 38-126 U/L 0.65-2.14 µkat/L 2.4-4.4 mg/dL 0.78-1.42 mmol/L 3.5-5.0 mEq/L 3.5-5.0 mmol/L 15-70 ng/dL 0.5-2.2 nmol/L 200-2500 ng/dL <40 ng/dL 6.4-79.5 nmol/L 1.28 nmol/L <4 ng/mL <4 mcg/L 6.4-8.3 g/dL 3.5-5.0 g/dL 2.0-3.5 g/dL 1.5 : 1-2.5 : 1 64-83 g/L 35-50 g/L 20-35 g/L 1.5 : 1-2.5 : 1 135-145 mEq/L 135-145 mmol/L Male: 2801100 ng/dL Female: 1570 ng/dL 4.6-11.0 mcg/dL Male: 10.438.17 nmol/L Female: 0.522.43 nmol/L 59-142 nmol/L 0.8-2.7 ng/dL 10-35 pmol/L Progesterone (female) • Follicular phase • Luteal phase • Postmenopaus e Prostatespecific antigen (PSA) Proteins • Total • Albumin • Globulin • Albumin/globu lin ratio Sodium Testosterone T4 (thyroxine), total T4 (thyroxine), POSSIBLE ETIOLOGY Systemic lupus erythematosus, pulmonary infarction Heart failure, hepatitis, pulmonary embolus and infarction, skeletal muscle damage Acute pancreatitis, hepatic disorders, perforated peptic ulcer Addison's disease, hypothyroidism, renal failure Chronic renal disease, diabetes mellitus Polycythemia Phenylketonuria Advanced Paget's disease, cancer of prostate, hyperparathyroidism Bone diseases, marked hyperparathyroidism, obstruction of biliary system, rickets Healing fractures, hypoparathyroidism, renal disease, vitamin D intoxication Addison's disease, diabetic ketosis, massive tissue destruction, renal failure Adrenal hyperplasia, choriocarcinoma of ovary, pregnancy, cysts of ovary Chronic alcoholism, severe malabsorption Addison's disease, diuretic therapy Anemia, cardiac decompensation, respiratory disorders Excessive vitamin D ingestion, hypothyroidism Diabetes mellitus, hyperparathyroidism, vitamin D deficiency Cushing syndrome, diarrhea (severe), diuretic therapy, gastrointestinal fistula, pyloric obstruction, starvation, vomiting Threatened abortion, hypogonadism, amenorrhea, ovarian tumor Prostate cancer Burns, cirrhosis (globulin fraction), dehydration Liver disease, malabsorption 1658 Multiple myeloma (globulin fraction), shock, vomiting Malnutrition, nephrotic syndrome, proteinuria, renal disease, severe burns Dehydration, impaired renal function, primary aldosteronism, corticosteroid therapy Addison's disease, diabetic ketoacidosis, diuretic therapy, excessive loss from GI tract, excessive perspiration, water intoxication Hypofunction of testes, hypogonadism Polycystic ovary, virilizing tumors Hyperthyroidism, thyroiditis Cretinism, hypothyroidism, myxedema Test free T3 uptake T3 (triiodothyroni ne), total Thyroidstimulating hormone (TSH) Transaminases • Aspartate aminotransfera se (AST) • Alanine aminotransfera se (ALT) Transferrin Transferrin saturation (%) Triglycerides Troponins (cardiac) • Troponin T (cTnT) • Troponin I (cTnI) Urea nitrogen (BUN) Uric acid REFERENCE INTERVALS POSSIBLE ETIOLOGY 24%-34% Age 20-50: 70204 ng/dL Age >50: 40181 ng/dL 0.4-4.2 µU/mL 0.24-0.34 1.08-3.14 nmol/L Hyperthyroidism Hyperthyroidism Hypothyroidism Hypothyroidism 0.4-4.2 mU/L Myxedema, primary hypothyroidism, Graves' disease Secondary hypothyroidism 10-30 U/L 0.17-0.51 µkat/L Liver disease, myocardial infarction, pulmonary infarction, acute hepatitis 10-40 U/L 0.17-0.68 µkat/L Liver disease, shock 190-380 mg/dL 15%-50% 1.9-3.8 g/L 15%-50% <150 mg/dL <1.7 mmol/L Diabetes mellitus, hyperlipidemia, hypothyroidism, liver disease Myocardial infarction Malnutrition <0.5 ng/mL (<0.5 mcg/L) <0.1 ng/mL (<0.1 mcg/L) 6-20 mg/dL 2.1-7.1 mmol/L Malnutrition, severe liver damage Male: 4.47.6 mg/dL Female: 2.36.6 mg/dL 30-80 mcg/dL Male: 262452 µmol/L Female: 137393 µmol/L 1.05-2.80 µmol/L Increase in protein catabolism (fever, stress), renal disease, urinary tract infection Gout, gross tissue destruction, high-protein weight reduction diet, leukemia, renal failure 0.62-2.79 nmol/L Administration of uricosuric drugs Vitamin A Excess ingestion of vitamin A Vitamin A deficiency (retinol) Vitamin B12 Chronic myeloid leukemia Strict vegetarianism, malabsorption syndrome, pernicious anemia, total or 200-835 pg/mL 148-616 pmol/L (cobalamin) partial gastrectomy Vitamin C Excessive ingestion of vitamin C Connective tissue disorders, hepatic disease, renal disease, rheumatic fever, 0.4-2.0 mg/dL 23-114 µmol/L (ascorbic acid) vitamin C deficiency Zinc Alcoholic cirrhosis 70-120 mcg/dL 10.7-120 µmol/L * Because arterial blood gases are influenced by altitude, the value for PaO2 decreases as altitude increases. The lower value is normal for an altitude of 1 mile. PaCO2, Partial pressure of CO2 in arterial blood; PaO2, partial pressure of oxygen in arterial blood; PvCO2, partial pressure of CO2 in venous blood; PvO2, partial pressure of oxygen in venous blood; RBC, red blood cell; SaO2, arterial oxygen saturation.