63-must-know-lab-values

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Wondering what lab values you need to know as a nurse?

While there are literally THOUSANDS of lab values that you can learn, it would be impossible to do so . . .

As you begin working as a nurse on a specialized unit you will have to learn different labs that are important to that field.

On our lab value podcast, 63 Must Know Labs Cheatsheet, and Lab Value course we try to dive deeper into some of the most common laboratory values used in medicine today.

To break it down even further for you and to answer the question that we get from student daily: “What lab values do I need to know for the NCLEX?” . . . I have created this short video.

 

Lab Values Mentioned in the Video:

ABG Lab Values

  • pH 7.35 – 7.45
  • pCO2 35 – 45
  • HCO3 22 – 26

Renal Lab Values

  • BUN 5 – 20
  • Creatinine 0.6 – 1.2

Cholesterol Lab Value

  • Cholesterol <200

CBC Lab Values

  • HCT F:36 – 46 M:42 – 52
  • HgB F:12 – 15 M:14 – 17
  • Platelets 200,000 – 450,000 <20,000 be very concerned!
  • WBC 5,000 – 10,000

Electrolyte Lab Values

  • Potassium 3.5 – 5
  • Sodium 135 – 145

 

Glucose Lab Values

  • Glucose 70 – 100
  • HgBA1C 4 – 6% >7 is diabetic

Bleeding Time Lab Values

  • PT 11 – 13
  • PTT not on therapy 25 – 35 on therapy –> 2x normal
  • INR on coumadin 2-3 w/o coiumadin 0.8 – 1.2

Activated Partial Thromboplastin Time

Activated Partial Thromboplastin Time
Abbreviation
APTT
Normal Range
25-39 seconds
Description

APPT  is a test that measures the amount of time it takes for a fibrin clot to form after reagents have been added to the specimen.   It is useful in diagnosis clotting disorders.  In conjunction with PT it can be used to differentiate the specific factor that may be missing.

Indications
  • Identifying
    • Congenital deficiencies in clotting
  • Monitoring
    • Effects of liver disease
    • Protein deficiency
    • Fat malabsorption on clotting
Increased Levels
  • Vitamin K deficiency
  • DIC
  • Patients on hemodialysis
  • Afibrinogenemia
  • Polycythemia
  • Liver disease
  • Von Willebrand disease
Decreased Levels
  • N/A

Alanine Aminotransferase (ALT)

Alanine Aminotransferase (ALT)
Abbreviation
ALT
Normal Range
13 – 69 U/L
Description

ALT is an enzyme made in the liver.  This enzyme is found in highest concentrations in the liver , but is found to lesser extent in heart, skeletal muscle and kidney.  Damage to the liver results in a significant increase in this enzyme.

Indications
  • Monitoring
    • progression of liver disease or liver damage
  • It can also aid in monitoring response to treatments
Increased Levels
  • Cirrhosis
  • Muscle damage
  • Preeclampsia
  • Biliary tract obstruction
  • Burns
  • Pancreatitis
  • Long-term alcohol abuse
  • Liver Cancer
  • Muscular dystrophy
  • MI
  • Myositis
  • Shock
  • Infections mononucleosis
Decreased Levels
  • Pyridoxal phosphate deficiency

Albumin

Albumin
Normal Range
3.5 - 6.0 g/dL
Description

Albumin is a transport protein in the blood.  It helps maintain the oncotic pressure of the blood.  Albumin levels will drop if synthesis is slowed, protein intake is inadequate, or there are increased losses.  Albumin has a long half life, however, so levels are not a good indicator of acute illness.

Indications
  • Evaluation of chronic illness
  • Liver disease
  • Nutritional status
Increased Levels
  • Dehydration
  • Hyper infusion
  • Albumin
Decreased Levels
  • Inadequate intake
  • Liver disease
  • Inflammation
  • Chronic disease
  • Losses (fistula, hemorrhage, kidney disease, burns)
  • Over hydration
  • Increased catabolism
  • Congestive heart failure

Alkaline Phosphatase

Alkaline Phosphatase
Normal Range
40-130 U/L
Description

Alkaline phosphatase (ALP) is located in several places in the body: liver, intestines, biliary tract, bones, placenta.  Different isoenzymes of ALP can be used to determine different disorders: liver, bone, intestine, certain cancers.  It can also be used to determine bone turnover  in postmenopausal women.

Indications
  • Identifying
    • Hepatobiliary disease
    • Malignancies
    • Bone disease
    • Bone damage in renal patients
  • useful in evaluating bone growth in children.
Increased Levels
  • Liver disease
  • Bone disease
  • Pregnancy
  • Amyloidosis
  • Lung cancer
  • Pancreatic cancer
  • Congestive heart failure
  • Ulcerative colitis
  • Hodgkin’s disease
  • Chronic renal failure
  • Sarcoidosis
Decreased Levels
  • Hypophophatasia
  • Anemia
  • Kwashiorkor
  • Cretinism
  • Hypothyroidism
  • Zinc or magnesium deficiency
  • Scurvy

Ammonia (NH3)

Ammonia (NH3)
Abbreviation
NH3
Normal Range
19-60 mcg/dL
Description

Ammonia (NH3) is a byproduct created when protein is broken down.  Ammonia is converted into urea in the liver, and urea is excreted by the kidneys. During liver disease, ammonia levels rise and can have a negative effect on the brain.

Indications
  • Identifying liver disease
  • Monitoring hepatic encephalopathy
  • Evaluating effectiveness of treatment.
Increased Levels
  • Liver Failure
  • Hepatic Coma (Hepatic Encephalopathy)
  • Reye’s syndrome
  • Total Parental Nutrition (TPN)
  • Gastrointestinal Hemorrhage
Decreased Levels
  • Some Antibiotics:
    • Neomycin
  • Hypertension

Amylase

Amylase
Normal Range
0-130 U/L
Description

Amylase is made in the pancreas.  It is an enzyme that breaks down carbohydrates to allow our body to absorb it.  Monitoring amylase levels can identify problems with the pancreas.

Indications
  • Diagnosing:
    • Pancreatitis
    • Pancreatic Duct Obstruction
    • Macroamylasemia
  • Trauma to Pancreas
Increased Levels
  • Pancreatitis
  • Pancreatic Cancer
  • Pancreatic Cyst
  • DKA
  • Peritonitis
  • Abdominal Trauma
  • Duodenal Obstruction
  • Mumps
  • Alcohol use
Decreased Levels
  • Pancreatic Insufficiency
  • Pancreatectomy
  • Toxemia of Pregnancy
  • Cystic Fibrosis
  • Liver Disease

Aspartate Aminotransferase (AST)

Abbreviation
AST
Normal Range
12-37 U/L
Description

Aspartate aminotransferase (AST) is an enzyme primarily found in liver and heart cells and to a smaller extent, AST can also be found in the pancreas, kidneys, skeletal muscle, and brain.  Levels of AST increase from cell death (necrosis) because the AST enzyme is released into the blood.

Indications
  • Monitor progression of:
    • Liver disease
    • Response to treatments.
  • Monitor liver toxic medications
Increased Levels
  • Liver disease
  • Liver cancer
  • Shock
  • Congestive Heart Failure (CHF)
  • Pericarditis
  • Biliary tract obstruction
  • Dermatomyositis
  • Pancreatitis
  • Muscular Dystrophy
  • CVA
  • Hemolytic anemia
  • Delirium Tremens (DT)
Decreased Levels
  • N/A

Blood Urea Nitrogen (BUN)

Blood Urea Nitrogen (BUN)
Abbreviation
BUN
Normal Range
7-20 mg/dL
Description

Blood urea nitrogen (BUN) measures the amount of urea in the blood. When protein is broken down ammonia is formed.  Ammonia is converted to urea in the liver and is eventually excreted in the kidneys.

Indications
  • Identifying:
    • Liver Problems
    • Renal Problems
    • Hydration Status
    • Tumor Lysis
  • Evaluate effects of drugs on:
    • Liver
    • Kidney
  • Monitor effectiveness of hemodialysis
Increased Levels
  • Renal Failure
  • Congestive Heart Failure (CHF)
  • Myocardial Infarction (MI)
  • Kidney Disease
  • Shock
  • Dehydration
  • Excessive Protein Intake
  • Diabetes Mellitus (DM)
  • Gastrointestinal (GI) bleed
  • Urinary Tract Obstruction
Decreased Levels
  • Liver Failure
  • Over-hydration
  • Inadequate Protein Intake
  • Pregnancy

Brain Type Natriuretic Peptide (BNP)

Brain Type Natriuretic Peptide (BNP)
Abbreviation
BNP
Normal Range
<100 pg/mL
Description

Brain natriureticpeptide (BNP) is a hormone made by the heart. When the heart is stressed or working hard to pump blood, it releases BNP.

Indications
  • Identify:
    • Congestive Heart Failure (CHF)
    • Effectiveness of Treatment
    • Severity of Disease
Increased Levels
  • Congestive Heart Failure (CHF)
  • Kidney Failure
Decreased Levels
  • N/A

C-Reactive Protein (CRP)

C-Reactive Protein (CRP)
Abbreviation
CRP
Normal Range
<1.0 mg/L
Description

C-reactive protein (CRP) is made in the liver in response to inflammation. CRP is a good indicator because it increases quickly in the inflammatory response, and drops when inflammation resolves.

Indications
  • Indicates:
    • Appendicitis
    • Pelvic Inflammatory Disease (PID)
    • Crohn’s
    • Ulcerative Colitis
    • Rheumatoid Arthritis (RA)
    • Lupus (SLE – Systemic Lupus Erythematosus)
  • Monitor or Identify:
    • Inflammation in the body
  • Evaluate:
    • Coronary Artery Disease (CAD)
Increased Levels
  • Bacterial Infection
  • Crohn’s Disease
  • Inflammatory Bowel Disease
  • Lupus
  • Rheumatoid Arthritis (RA)
  • Pregnancy
  • Myocardial Infarction (MI)
Decreased Levels
  • N/A

Calcium (Ca+)

Calcium (Ca+)
Abbreviation
Ca+
Normal Range
8.4-10.2 mg/dL
Description

Calcium (Ca+), a positive ion in the body, is necessary for neuromuscular processes, bone mineralization, and hormonal secretion.  The parathyroid gland and vitamin D are responsible for calcium regulation in the body. In the blood, about half of calcium travels in ion form, the other half is bound to proteins like albumin. When albumin levels are low, calcium levels will appear lower. Calcium has an important relationship with phosphorus: they are inversely proportional.

Indications
  • Identify problems with:
    • Parathyroid
    • Neuromuscular functions
    • Diseases that affect bone
    • Effectiveness of treatments.
Increased Levels
  • Cancers:
    • Breast, lung, and multiple myeloma are the most common
  • Hyperparathyroidism
  • Acidosis
  • Renal transplant
  • Sarcoidosis
  • Vitamin D toxicity
  • Dehydration
Decreased Levels
  • Malnutrition
  • Cirrhosis
  • Chronic Renal Failure
  • Hypoparathyroidism
  • Alkalosis
  • Hypomagnesemia
  • Hypoalbuminemia
  • Hyperphosphatemia
  • Malabsorption
  • Alcoholism
  • Osteomalacia
  • Vitamin D deficiency

Chloride (Cl-)

Chloride (Cl-)
Abbreviation
Cl-
Normal Range
96-108 mEq/L
Description

Chloride (Cl), an anion found in the blood, works together with sodium to help maintain oncotic pressure and water balance in the body.  Chloride is inversely related to bicarbonate levels in the blood.  Chloride is also part of hydrochloric acid (HCL) which is utilized in the stomach to breakdown food.  When Red Blood Cells (RBCs) take up CO2 they take up chloride as well.  The negative ion bicarbonate then leaves the red blood cell so that the electrical charge is maintained.  Extra chloride is excreted into the urine by the kidneys.

Indications
  • Identify
    • Acid-Base Imbalance
Increased Levels
  • Dehydration
  • Acute Renal Failure
  • Cushing Disease
  • Metabolic Acidosis
  • Respiratory Alkalosis
Decreased Levels
  • Congestive Heart Failure (CHF)
  • Water intoxication
  • Burns
  • Metabolic Alkalosis
  • Respiratory Acidosis
  • Addison Disease
  • Salt-losing Nephritis
  • Excessive sweating
  • Diarrhea
  • Vomiting

Cholesterol (Chol)

Cholesterol (Chol)
Abbreviation
Chol
Normal Range
<200 mg/dL
Description

Cholesterol (Chol) is a lipid in the body.  It is a part of cell membranes as well as a precursor for vitamin D, steroids, and bile acids.  Cholesterol is primarily synthesized in the liver and intestines and is transported via lipoproteins.  There are multiple types of lipoproteins, each have slightly different functions. The two most common types of lipoproteins are high-density lipoprotein (HDL) and low-density lipoprotein (LDL).

Indications
  • Determine risk of cardiovascular disease
  • Evaluate response to treatment
Increased Levels
  • Malabsorption
  • Liver disease
  • Diabetes Mellitus (DM)
  • Obesity
  • Cushing Syndrome
  • Hypothyroidism
  • Alcoholism
  • Nephrotic Syndrome
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Gout
  • Werner’s Syndrome
  • Ischemic Heart Disease
  • Von Gierke Disease
  • Acute Intermittent Porphyria
  • Pregnancy
Decreased Levels
  • Burns
  • Tangier disease
  • Pernicious anemia
  • Thalassemia
  • Hyperthyroidism
  • Chronic Myelocytic Leukemia
  • Malnutrition
  • Polycythemia Vera
  • Anorexia

Creatine Kinase (CK)

Creatine Kinase (CK)
Abbreviation
CK
Normal Range
55 - 170 U/L
Description

Creatine kinase (CK) enzyme is found in heart and skeletal muscle and to a lesser extent brain. When damage is done to these types of tissue CK is released into the blood. There are three isoenzymes, and depending on which one is elevated this lab value can help determine timing, location, extent of damage. The three isoenzymes are CK-MB (cardiac), CK-MM (skeletal), and CK-BB (brain).

Indications
  • Monitor:
    • Muscle damage
  • Diagnose:
    • Acute Myocardial Infarction(MI)
    • Ischemia
    • Muscular Dystrophy
  • Evaluate success of treatment
Increased Levels
  • Muscle damage
  • Rhabdomyolysis
  • Muscular Dystrophy
  • Heart attack
  • Exercise
  • Kennedy’s Disease
  • Stroke
Decreased Levels
  • Early pregnancy
  • Small stature

Creatinine (Cr)

Creatinine (Cr)
Abbreviation
Cr
Normal Range
0.7-1.4 mg/dL
Description

Creatinine (Cr) is a byproduct of creatine metabolism, and it is excreted by the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable.

Indications
  • Identify:
    • Muscular disorders
    • Renal disease
Increased Levels
  • Gigantism
  • Acromegaly
  • Renal disease
  • Rhabdomyolysis
  • Congestive Heart Failure (CHF)
  • Dehydration
  • Shock
  • Hyperparathyroidism
Decreased Levels
  • Loss of muscle mass
  • Muscular Dystrophy
  • Inadequate protein intake
  • Pregnancy
  • Liver disease

Creatinine Clearance

Creatinine Clearance
Normal Range
85 to 125 mL/min
Description

Creatinine is a byproduct of Creatine metabolism, and it is excreted in the kidneys. Creatinine is created in proportion to muscle mass and usually stays stable. Urine and blood levels are compared to determine creatinine clearance from the blood. Any disease that affects the kidneys ability to clear waste products will increase blood creatinine levels and decrease creatinine clearance levels.

Indications
  • Used to determine:
    • Kidney damage in renal disease
    • Glomerular function
    • Effectiveness of treatment
Increased Levels
  • Diabetes Mellitus (DM)
  • Exercise
  • Pregnancy
  • High protein diets
Decreased Levels
  • Renal disease
  • Congestive Heart Failure (CHF)
  • Obstruction within kidney
  • Dehydration

D-Dimer (DDI)

D-Dimer (DDI)
Abbreviation
DDI
Normal Range
≤ 250 ng/mL
Description

D-dimer (DDI) is a product of fibrinolysis, the process of plasminogen breaking down fibrin clots. Two products are made by fibrinolysis: D-dimer (DDI) and Fibrin Degradation Products (FDP). D-dimer levels are elevated in the setting of clot breakdown, but will be even higher in the setting of Disseminated Intravascular Coagulation (DIC).

Indications
  • Identify and monitor Disseminated Intravascular Coagulation (DIC)
  • Rule out a blood clot:
    • Pulmonary Embolism (PE)
    • Deep Vein Thrombosis (DVT)
    • Stroke
Increased Levels
  • Surgery
  • Trauma
  • Infection
  • Cancer
  • Heart attack
  • Pregnancy
  • Deep Vein Thrombosis (DVT)
  • Disseminated Intravascular Coagulation (DIC)
Decreased Levels
  • N/A

Erythrocyte Sedimentation Rate (ESR)

Erythrocyte Sedimentation Rate (ESR)
Abbreviation
ESR
Normal Range
0-20 mm/h
Description

The Erythrocyte Sedimentation Rate (ESR) test measures sedimentation of Red Blood Cells (RBCs).  The inflammatory process affects proteins in the blood which causes RBCs to stick together and settle out of liquid.  Normal blood has very little settling, but during the inflammatory process the ESR is elevated.

Indications
  • Identifies inflammation which assists in diagnosing:
    • Cancer
    • Infection
    • Autoimmune diseases
Increased Levels
  • Anemia
  • Chronic Renal Failure
  • Systemic Lupus Erythematosus (SLE)
  • Infection
  • Tuberculosis
  • Pregnancy
  • Polymyalgia Rheumatica
  • Multiple myeloma
  • Medications:
    • Oral contraceptives
    • Theophylline
    • Vitamin A
Decreased Levels
  • Sickle cell anemia
  • Polycythemia Vera
  • Leukocytosis
  • Congestive Heart Failure (CHF)
  • Medications:
    • Aspirin
    • Cortisone
    • Quinine

Ferritin

Ferritin
Normal Range
20-300 ng/mL
Description

Ferritin is a protein that stores iron. It is formed in the liver spleen and bone marrow. Ferritin in the blood is usually proportional to stored ferritin. Ferritin is a more sensitive and specific test for identifying iron-deficiency anemia, however, it is usually measured in conjunction with total iron binding capacity and iron.

Indications
  • Diagnosing:
    • Iron-deficiency anemia
    • Hemochromatosis
  • Monitor:
    • Iron levels
Increased Levels
  • Inflammation
  • Alcoholic liver disease
  • Multiple blood transfusions
  • Hemochromatosis
Decreased Levels
  • Long term Gastrointestinal(GI) bleeding
  • Iron-deficiency anemia
  • Heavy menstrual bleeding

Folic Acid

Folic Acid
Normal Range
2 - 20 ng/mL
Description

Folic acid is an essential water soluble B vitamin.  It is stored in the liver and is an important part of Red Blood Cell (RBC) and White Blood Cell (WBC) function, DNA replication, and cell division.

Indications
  • Diagnose megaloblastic anemia
  • Monitor effects of long-term Total Parenteral Nutrition (TPN)
  • Identify Folate Deficiency
Increased Levels
  • Excess folate intake
Decreased Levels
  • Vitamin B12 deficiency
  • Pernicious anemia
  • Hemolytic anemia
  • Celiac Disease or Crohn Disease
  • Inflammatory Bowel Disease (IBS)
  • Alcoholism
  • Malnutrition

Glucose

Glucose
Normal Range
70-115 mg/dL
Description

Glucose is a sugar molecule that is a component of carbohydrates. Glucose provides energy in the body and is absorbed from the blood to the cells for nourishment via insulin. The pancreas secretes insulin to helps regulate levels of glucose in the blood. Glucose levels naturally rise after meals with the intake of carbohydrates.

Indications
  • Diagnose:
    • Hypoglycemia
    • Hyperglycemia
    • Diabetes Mellitus (DM)
  • Monitor treatments for Diabetes Mellitus (DM)
Increased Levels
  • Diabetes Mellitus (DM)
  • Stress
  • Pancreatitis
  • Chronic Renal Failure
  • Cushing Syndrome
  • Corticosteroid therapy
Decreased Levels
  • Insulinoma
  • Hypothyroidism
  • Hypopituitarism
  • Addison Disease
  • Insulin overdose
  • Starvation

Glycosylated Hemoglobin (HbA1c)

Glycosylated Hemoglobin (HbA1c)
Abbreviation
HbA1c
Normal Range
5.6-7.5 % of total Hgb
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.

Indications
  • Assess control of blood sugars over a several month time frame
  • Diagnose Diabetes Mellitus (DM)
Increased Levels
  • Poorly controlled Diabetes Mellitus(DM)
  • Non-Diabetic Hyperglycemia:
    • Stress
    • Cushing Syndrome
    • Pheochromocytoma
    • Corticosteroid Therapy
Decreased Levels
  • Renal failure
  • Blood loss
  • Hemolytic anemia
  • Sickle cell anemia

Hematocrit (Hct)

Hematocrit (Hct)
Abbreviation
Hct
Normal Range
Male: 41 - 50% | Female: 36 - 44%
Description

Hematocrit (Hct) is the percentage of the blood that is made up of packed Red Blood Cells (RBCs).  A hematocrit level of 40% indicates that there are 40 mL packed red blood cells in 100 mL of blood.

Indications
  • Identify:
    • Anemia
    • Bleeding
    • Bleeding disorder
    • Fluid imbalances
Increased Levels
  • Erythrocytosis
  • Polycythemia Vera
  • Shock
  • Dehydration
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congenital Heart Disease
Decreased Levels
  • Anemia
  • Blood loss
  • Bone marrow disorders:
    • Leukemia
    • Lymphoma
    • Hodgkin disease
    • Multiple myeloma
    • Aplastic anemia
  • Hyperthyroidism
  • Renal disease
  • Rheumatoid arthritis (RA)

Hemoglobin (Hbg)

Hemoglobin (Hbg)
Abbreviation
Hbg
Normal Range
Male: 13.5 - 16.5 g/dL | Female: 12.0 - 15.0 g/dL
Description

Hemoglobin (Hbg), an iron containing compound, is the main protein in Red Blood Cells (RBCs). It enables oxygen and carbon dioxide (CO2) to bind to RBCs for transport throughout the body.

Indications

Identify:

  • Bleeding disorders
  • Anemia
  • Blood loss
Increased Levels
  • Erythrocytosis
  • Polycythemia Vera
  • Shock
  • Dehydration
  • Severe burns
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Congenital Heart Disease
Decreased Levels
  • Anemia
  • Blood Loss
  • Bone Marrow Disorders:
    • Leukemia
    • Lymphoma
    • Multiple myeloma
    • Aplastic anemia
  • Severe burns
  • Hyperthyroidism
  • Renal disease
  • Systemic Lupus Erythematosus (SLE)

High Density Lipoprotein (HDL)

Abbreviation
HDL
Normal Range
>60 optimal mg/dL
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.

Indications
  • Monitor risks of heart disease
Increased Levels
  • Familial HDL Lipoproteinemia
  • Exercise
  • Unsaturated fats:
    • Mono-
    • Poly-
  • Hypothyroid
Decreased Levels
  • Metabolic Syndrome
  • Hepatocellular disease:
    • Hepatitis
    • Cirrhosis
  • Hypoproteinemia:
    • Nephrotic Syndrome
    • Malnutrition
  • Smoking
  • High saturated and trans fat diets
  • Excess body weight
  • Hyperthyroid

International Normalized Ratio (INR)

International Normalized Ratio (INR)
Abbreviation
INR
Normal Range
0.8 - 1.2 Therapeutic Levels on Warfarin 2.0 – 3.5
Description

International normalized ratio(INR) takes results from a prothrombin time test and standardizes it regardless of collection method.

Indications
  • Evaluate therapeutic doses of Warfarin
  • Identify patients at higher risk for bleeding
  • Identify cause of:
    • Bleeding
    • Deficiencies
Increased Levels
  • Disseminated Intravascular Coagulation (DIC)
  • Liver disease
  • Vitamin K deficiency
  • Warfarin
Decreased Levels
  • Too much vitamin K
  • Estrogen containing medications such as birth control

Iron (Fe)

Iron (Fe)
Abbreviation
Fe
Normal Range
50-175 ug/dL
Description

Iron (Fe) is an element that is an important component of hemoglobin in red blood cells.  Hemoglobin transports oxygen from the lungs to all the cells of the body.  Most of the iron in the body is located in hemoglobin, but some iron is located in myoglobin as well as some iron is stored in the liver, bone marrow, and spleen.  The storage form of iron is ferritin.  Iron is transported in the blood by a protein called transferrin.

Indications
  • Identify:
    • Blood loss
    • Hemochromatosis
    • Malabsorption of iron
    • Iron overload
    • Type of anemia:
      • Thalassemia
      • Sideroblastic anemia
Increased Levels
  • Hemochromatosis
  • Lead toxicity
  • Iron poisoning
  • Acute liver disease
  • Multiple blood transfusions
  • Hemolytic anemia
  • Sideroblastic anemia
Decreased Levels
  • Blood Loss:
    • Gastrointestinal (GI) bleeding
    • Heavy menstruation
    • Chronic hematuria
  • Hypothyroidism
  • Iron-deficiency anemia
  • Inadequate absorption of iron

Lactic Acid

Lactic Acid
Normal Range
0.3 -2.6 mmol/L
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.

Indications
  • Determine cause of acidosis
  • Evaluate tissue oxygenation
Increased Levels
  • Shock
  • Sepsis
  • Tissue ischemia
  • Carbon monoxide poisoning
  • Lactic acidosis
  • Diabetes Mellitus (DM)
  • Heart failure
  • Pulmonary edema
  • Strenuous exercise
Decreased Levels
  • N/A

Lipase

Lipase
Normal Range
23 - 300 U/L
Description

Lipase is an enzyme created in the pancreas.  It travels to the intestines where it aids in the breakdown of fats.  If damage occurs to certain parts of the pancreas, lipase is released into the bloodstream.

Indications
  • Diagnose:
    • Pancreatitis
    • Pancreatic cancer
Increased Levels
  • Pancreatitis
  • Pancreatic cyst
  • Pseudocyst
  • Pancreatic duct obstruction
  • Renal failure
  • Cholecystitis
  • Peptic ulcer disease
Decreased Levels
  • N/A

Low Density Lipoprotein

Low Density Lipoprotein
Abbreviation
LDL
Normal Range
<70 mg/dL
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).  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.

Indications
  • Useful in determining risk of cardiovascular disease.
Increased Levels
  • Diet high in saturated fats
  • Nephrotic Syndrome
  • Alcoholism
  • Chronic liver disease:
    • Hepatitis
    • Cirrhosis
  • Hypothyroidism
  • Cushings Syndrome
Decreased Levels
  • Regular physical activity
  • Hyperthyroidism
  • Hypoproteinemia:
    • Malabsorption
    • Severe burns
    • Malnutrition

Magnesium

Magnesium
Abbreviation
Mg
Normal Range
1.6 – 2.6 mg/dL
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.

Indications
  • Monitor:
    • Renal failure
    • Chronic alcoholism
    • Cardiac arrhythmias
Increased Levels
  • Renal insufficiency
  • Uncontrolled Diabetes Mellitus (DM)
  • Addison Disease
  • Dehydration
  • Hypothyroidism
  • Over use of antacids
  • Tissue trauma
Decreased Levels
  • Alcoholism
  • Diabetic acidosis
  • Renal failure:
    • Glomerulonephritis
  • Hyercalcemia
  • Malnutrition
  • Malabsorption
  • Hypoparathyroidism
  • Diarrhea

Osmolality

Osmolality
Normal Range
261 – 280 mOsm/kg
Description

Osmolality is a measure of the particles in solution.  The size, shape, and charge of the particles do not impact the osmolality

Indications
  • Monitor:
    • Electrolyte balance
    • Acid-Base balance
    • Hydration
  • Evaluate function of antidiuretic hormone.
Increased Levels
  • Dehydration
  • Azotemia
  • Hypercalcemia
  • Hyperosmolar Hyperglycemia Syndrome (HHS)
  • Hypernatremia
  • Diabetes Insipidus
  • Hyperglycemia
  • Mannitol therapy
  • Uremia
  • Severe pyelonephritis
  • Shock
  • Ketosis
Decreased Levels
  • Hyponatremia
  • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
  • Overhydration

Oxygen Saturation (SaO2)

Oxygen Saturation (SaO2)
Abbreviation
SaO2
Normal Range
95 - 100%
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.  For more information on PaO2, SaO2 and oxyhemoglobin dissociation curve visit this link HERE.

Indications
  • Determine respiratory status
  • Part of Arterial Blood Gas (ABG) testing
Increased Levels
  • Polycythemia
  • Increased inspired O2
  • Hyperventilation
Decreased Levels
  • Anemia’s
  • Hypoventilation
  • Bronchospasm
  • Mucus plugs
  • Atelectasis
  • Pneumothorax
  • Pulmonary edema
  • Adult respiratory distress syndrome

Partial Thromboplastin Time (PTT)

Partial Thromboplastin Time (PTT)
Abbreviation
PTT
Normal Range
25 - 35 seconds
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.

Indications
  • Detection of coagulation disorders
  • Evaluate response to Heparin (PT for Coumadin)
  • Preoperative assessment
Increased Levels
  • Disseminated Intravascular Coagulation (DIC)
  • Clotting Factor Deficiencies:
    • Hypofibrinogenemia
    • Von Willebrand Disease
    • Hemophillia
  • Liver disease:
    • Cirrhosis
  • Vitamin K deficiency
  • Polycythemia
  • Dialysis
Decreased Levels

N/A

Platelets (PLT)

Platelets (PLT)
Abbreviation
(PLT)
Normal Range
100,000 - 450,000 cells/mcL
Description

Platelets (PLT) play a role in coagulation, hemostasis, and thrombus formation.  Platelets are the smallest blood cell, damaged vessels send out signals that result in platelets traveling to the area and becoming “active”.

Indications
  • Determine clotting vs bleeding disorders
Increased Levels
  • Malignancy
  • Polycythemia Vera
  • Postsplenectomy syndrome
  • Rheumatoid Arthritis (RA)
  • Iron-deficiency anemia
  • Hemolytic anemia
  • Tuberculosis
  • Birth control
Decreased Levels
  • Idiopathic Thrombocytopenia (ITP)
  • Inherited thrombocytopenia disorders:
    • Wiskott-Aldrich Syndrome
    • Bernard-Soulier Syndrome
    • Zieve Syndrome
  • Infection:
    • Hepatitis
    • Human Immunodeficiency Virus (HIV)
    • Measles
    • Sepsis
  • Hypersplenism
  • Hemorrhage
  • Leukemia
  • Lymphoma
  • Drug Therapy:
    • Aspirin
    • Ibuprofen
    • Sulfa antibiotics
    • Hydralazine
    • Thiazide diuretics
  • Systemic Lupus Erythematosus (SLE)
  • Hemolytic anemia’s

Potassium (K+)

Potassium (K+)
Abbreviation
K+
Normal Range
3.5 - 5.0 mEq/L
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 with enter the cell as this happens it will force potassium out of the cell, a 0.1 decrease in pH will cause a 0.5 increase in K+.

Indications
  • Evaluate:
    • Electrolyte imbalances
    • Cardiac arrhythmias
  • Monitor patients who are:
    • Acidotic
    • Receiving diuretic therapy

 

Increased Levels
  • Renal failure
  • Hypoaldosteronism
  • Addison disease
  • Injury to tissues
  • Diabetes Mellitus (DM)
  • Ketoacidosis
  • Hyperventilation
  • Acidosis
  • Infection
  • Dehydration
  • Burns
Decreased Levels
  • Hyperaldosteronism
  • Excess insulin
  • Alkalosis
  • Diarrhea
  • Vomiting
  • Cystic Fibrosis
  • Cushing Syndrome

Prostate Specific Antigen (PSA)

Prostate Specific Antigen (PSA)
Abbreviation
PSA
Normal Range
Male: < 4 ng/mL Female: < 0.5 ng/mL
Description

Prostate Specific Antigen (PSA) is produced by the prostate. Used in conjunction with digital exam this test is helpful in diagnosing and assessing prostate abnormalities.

Indications
  • Evaluate:
    • Enlarged prostate when prostate cancer is suspected
    • Stage of cancer
    • Effectiveness of treatments
Increased Levels
  • Benign Prostatic Hypertrophy (BPH)
  • Prostate cancer
  • Prostatitis
  • Urinary retention
Decreased Levels
  • N/A

Red Blood Cell (RBC)

Red Blood Cell (RBC)
Abbreviation
RBC
Normal Range
Male: 4.5 - 5.5 x106/cells/mm3 Female: 4.0 - 4.9 x106/cells/mm3
Description

Red Blood Cells (RBCs) contain hemoglobin which is responsible for oxygen transport throughout the body.  RBCs are primarily produced in the bone marrow, they have a life span of 120 days and are destroyed in the spleen and liver. RBC production is regulated by erythropoietin (EPO) which is produced and released from the kidneys.

Indications
  • Identify:
    • Anemia
    • Blood loss
Increased Levels
  • Dehydration
  • Polycythemia Vera
  • Chronic Obstructive Pulmonary Disease (COPD)
  • High altitude
  • Congenital heart disease
  • CorPulmonale
  • Pulmonary fibrosis
  • Thalassemia trait
Decreased Levels
  • Chemotherapy
  • Anemia
  • Hemorrhage
  • Hemolysis
  • Hemoglobinopathy
  • Advanced cancer
  • Leukemia
  • Lymphoma
  • Pernicious anemia
  • Rheumatoid disease
  • Organ failure
  • Bone marrow failure
  • Hypervolemia
  • Pregnancy

Sodium (Na+)

Sodium (Na+)
Abbreviation
Na+
Normal Range
135-145 mEq/L
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, plays a role in blood pressure regulation, and stimulation of neuromuscular reactions. Sodium and water have a direct relationship; Water follows salt.

Indications
  • Monitor:
    • Extracellular osmolality
    • Electrolyte balance
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
Decreased Levels
  • Congestive Heart Failure (CHF)
  • Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
  • Cystic Fibrosis
  • Diuretic use
  • Metabolic acidosis
  • Addison Disease
  • Nephrotic Syndrome
  • Vomiting
  • Diarrhea
  • Ascites
  • Excessive Antidiuretic Hormone(ADH)
  • Liver failure

Thyroid Stimulating Hormone (TSH)

Thyroid Stimulating Hormone (TSH)
Abbreviation
TSH
Normal Range
2-10 mU/L
Description

Thyroid Stimulating Hormone (TSH) is released from the pituitary in response to low levels of thyroid hormone. TSH communicates to the thyroid gland to release the thyroid hormones: Triiodothyronine (T3) and Thyroxine (T4). Thyroid hormones regulate metabolism. T3 and T4 have and inverse relationship with TSH.

Indications
  • Diagnose:
    • Hyperthyroidism
    • Hypothyroidism
  • Monitor thyroid replacement therapy
Increased Levels
  • Hypothyroidism
  • Thyroidectomy
  • Thyroid dysfunction
  • Thyroiditis
  • Thyroid Agenesis
  • Large doses of iodine
  • Pituitary TSH-secreting tumor
Decreased Levels
  • Pituitary hypofunction
  • Hyperthyroidism

Total Bilirubin (T. Billi)

Total Bilirubin (T. Billi)
Abbreviation
T. Billi
Normal Range
0.1 - 1.2 mg/dL
Description

Total Bilirubin (T.Billi) is the sum of conjugated and unconjugated serum bilirubin. One of the byproducts of red blood cell breakdown is bilirubin.  Bilirubin is made in the bone marrow, liver, or spleen and is transported by albumin to the liver in the form of unconjugated bilirubin.  Once in the liver, sugars bind to the unconjugated bilirubin, turning it to conjugated bilirubin. It is then excreted from the gall bladder into the small intestine. Eventually, it is excreted in the feces or urine.  Excess bilirubin causes a yellowing of the skin and the whites of the eyes called jaundice.

Indications
  • Identifying:
    • Liver Disease
    • Obstructive Jaundice
    • Biliary Disease
    • Newborn Jaundice
    • Effectiveness of Treatment
Increased Levels
  • Post-blood transfusions
  • Newborn Jaundice
  • Pernicious anemia
  • Hepatic jaundice
  • Liver tumors
  • Biliary obstruction
  • Cholecystitis
  • Cholangitis
  • Cirrhosis
  • Hepatitis
  • Hematoma
  • Alcoholism
  • Gilbert’s Disease
  • Mono
  • Hypothyroidism
  • Breast milk jaundice.
Decreased Levels
  • N/A

Triglycerides (TG)

Triglycerides (TG)
Abbreviation
TG
Normal Range
<150 mg/dL
Description

Triglycerides (TG) are required to provide energy during the metabolic process, excess triglycerides are stored in adipose tissue.

Indications
  • Evaluate for:
    • Elevated triglycerides
    • Risk for atherosclerotic heart disease and stroke
Increased Levels
  • Myocardial Infarction (MI)
  • Alcoholism
  • Alcoholic cirrhosis
  • High carbohydrate diet
  • Anorexia nervosa
  • Cirrhosis
  • Hypertension (HTN)
  • Nephrotic Syndrome
  • Obesity
  • Renal failure
  • Pancreatitis
  • Stress
Decreased Levels
  • Chronic Obstructive Pulmonary Disease (COPD)
  • Liver disease
  • Hyperthyroidism
  • Malnutrition
  • Malabsorption

Troponin I (cTNL)

Troponin I (cTNL)
Abbreviation
cTNL
Normal Range
There is a wide range of normal values among varying institutions and texts with regard to Troponin I. It is essential to verify institutional norms. < 0.035 ng/mL
Description

Troponins are proteins that initiate contraction of muscle fibers.  Troponin I (cTNL) is specific to heart muscle.  Troponin levels stay elevated for a week after muscle damage before returning to normal.

Indications
  • Evaluating damage to heart muscle
  • Diagnose a Myocardial Infarction (MI)
Increased Levels
  • Heart damage
  • Myocardial Infarction (MI)
Decreased Levels
  • N/A

White Blood Cell (WBC)

White Blood Cell (WBC)
Abbreviation
WBC
Normal Range
4,500 - 10,000 cells/mcL
Description

White blood cells (WBCs) are created in the bone marrow. Their primary function is to defend the body against infection. There are various types of WBCs which have different shapes and functions. Decreased WBC count is called Leukopenia and increased WBC count is called Leukocytosis.

Indications
  • Evaluate for infection
Increased Levels
  • Infection/inflammation
  • Leukemic Neoplasia
  • Trauma/stress
  • Tissue necrosis
  • Pregnancy
  • Cushing Disease
  • Asthma
  • Allergic reaction
Decreased Levels
  • Systemic Lupus Erythematosus (SLE)
  • Anemia
  • Rheumatoid Arthritis (RA)
  • Chemotherapy/radiation
  • Overwhelming infections (WBCs are all used up)

How to Study Lab Values so You Remember

Like everything else in nursing school, learning lab values is like learning a whole new language.

Prior to nursing school I knew what Potassium, Sodium, RBCs, WBCs, blood sugars, and a few other BIG laboratory values were, but I didn’t have a real grasp on what they meant.

When a patient comes into the hospital you will find that the only number they usually want to know from a laboratory panel is the blood glucose . . . their “sugars” . . .

The patient WANTS to be involved in their health care, but they really don’t know what a Lactic Acid level is and why we care.

To work as a competent member of the health care team it is important that you not only learn the important lab values but also what they mean.

This helps you in a few ways:

  • You can anticipate what labs will be ordered on a given patient
  • You can talk (with knowledge) to providers about a patients care
  • You can educate family members and patients
  • You stop being a task rabbit that is just drawing blood and actually become a member of the health care team

So let’s talk about a few ways you can study to actually retain laboratory value information: 

  1. Determine the most essential labs for your floor – as I’ve mentioned a few times . . . it’s impossible to learn EVERY lab value.  Start be determining which values you REALLY need to know to do a good job on your floor.  If you work on a cardiac floor . . . learn all you can about your cardiac enzymes.  If you work ICU . . . learn about your sepsis labs, ABGs, etc. Once you have a grasp on these labs you can move on to others.
  2. Focus on the # first – once you know WHICH labs you need to know, focus on memorizing the normal ranges.  You don’t need to worry too much at this point about the unit of measurement . . . that will come with time.  For now just start to learn what the normal ranges are for each of the values.
  3. Understand the “WHY” – in everything we do here at NRSNG we strive to teach you the WHY . . . don’t be satisfied with just the name and normal range . . . that’s baby stuff.  Dive into the information and start uncovering WHY the lab value would be ordered. This is the foundation of critical thinking. Getting past simple memorization and really digging to understand why we would order lactic acid on a suspected sepsis patient.
  4. What do elevated and low levels mean – lastly, focus your energy on understanding why a lab value would be high or low.  Now that you know why we are ordering the value dig into what it really means if a patient has an elevated level . . . what is causing the hyperkalemia in a renal patient?  Why is that going to cause cardiac arrythmias? HgBA1C is elevated in a diabetic patient . . .what does that mean?  Why?  How does hemoglobin and blood sugar relate?

If you study your labs in this order you will quickly find that not only are you learning them, but you are understanding them and taking part in the care of the patient at a much deeper level.

Many nurses and nursing students stop at the .  . . “What values do I NEED to know?” . . . that seems to me like the path of least resistance and doesn’t really get you where you need to be as a nurse.

If you recall, we have spoken a lot about Blooms Taxonomy a lot on NRSNG.  The reason for that is that it provides a framework for you to determine how deeply you are critically thinking about a topic and understanding.

Bloom’s Taxonomy is the foundation to critical thinking in nursing and the NCLEX.

A Lifelong Nursing Resource

We have set this page up as a resource that covers nearly every lab value you will encounter . . .

Use the guide above to select a lab value, listen to the podcast, read the post, take notes, and focus on the ones you need to know . . . then come back and start again.

Come back to this page often throughout your career.

Download the free cheatsheet at the top.

Bookmark the page.

And master lab values one by one!

 

63-must-know-lab-values

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