This document provides reference ranges and interpretations for various common lab values. It discusses lab abnormalities that may indicate conditions like diabetes, liver and kidney dysfunction, malnutrition, and more. Key labs it outlines include glucose, BUN, creatinine, albumin, electrolytes, liver enzymes, lipids, and others. It also covers labs relevant to conditions like alcoholism, refeeding syndrome, and heart-related diseases.

1. How to interpret different lab values
(These values are based on Mountain Home Lab values)
Glucose normal 74-106 mg/dL
High: DM, Stress chronic hepatic function, pancreatitis, chronic malnutrition or
re-feeding syndrome
Low: medications, enzyme deficiencies, tumors, insulin overdose, alcohol abuse,
starvation
BUN: normal 7-18mg/dL
High: Rapid protein catabolism/tissue necrosis(Burns, cancer) or impairment of
kidney function, dehydration, MI, excessive pro intake, Rhabdomyolysis
Low: malnutrition, Malabsorption, liver disease, over- hydration (excessive IV
fluids)
Creatinine: normal: 0.6-1.3
High: CHF, impaired renal function, shock, diabetic acidosis, muscle damage,
starvation, high meat intake.
Low: severe loss of muscle mass, liver disease, over-hydration
GFR: Non-black : 60 mL/min (adult) each hospital usually leaves this open for
interpretation.
GFR black: <70mL/min
High: burns over-hydration
Low: CHF, renal disease
Albumin: normal 3.4-5.0g/dL
High: dehydration, high minerals in blood
Low: acute/ chronic infections, liver dysfunction, heart failure, edema, diarrhea,
over-hydration, cancer, ESRD, burns, malnutrition, alcoholism
Prealbumin (PAB): Normal Value: 16-35 mg/dL
Better marker for nutrition, influenced by inflammation status.
Half life 2-3 days
High: renal failure
Low: hepatic disease, stress, infection, malnutrition, low pro intake
AST: normal men: 12-78 U/L
Women: 12-78U/L
High: liver disease, MI, pancreatitis, alcoholism, cancer, burns
Low: taking vitamin C, uncontrolled DM
ALT: normal men: 15-37U/L
Women: 15-37U/L
High: liver disease, cirrhosis, alcoholism, pancreatitis

2. Low: malnutrition, urinary infection
Bilirubin: Normal Values: Total: 0.2-1 mg/dL
Direct: < 0.3mg/dL
High: hepatitis, jaundice, drug intoxication, prolonged fasting, cirrhosis,
obstruction of common bile duct, or hepatic ducts due to stones
Ammonia (NH3): Normal value: 7-27 umol/dL (adult)
High: liver disease, hepatic encephalopathy, severe heart disease
Lipase: Normal Value: 26-63 U/L (adults)
High: pancreatitis, renal insufficiency, gallstones
Low: protein malnutrition, viral hepatitis
Amylase: Normal Value: 30-110 U/L (adults)
High: pancreatitis, alcohol poisoning, renal insufficiency, acute cholecystitis
Low: hepatitis, cirrhosis, severe burns
Electrolytes and minerals:
Calcium: 8.5-10.1 mg/dL
High: Chronic renal disease, high Ca and Vit D intake
Low: elevated phosphorus, diarrhea, low Mg, starvation, Malabsorption, low
albumin, Vit D deficiency, over-hydration, steatorrhea
Sodium: 136-145 mEq/L (adults)
High: dehydration, coma
Low: over-hydration, edema, vomiting, diarrhea, starvation
Potassium: Normal Value: 3.5-5.1 mEq/L
High: renal failure, tissue damage
Low: malabsorption, malnutrition, diarrhea, vomiting, hepatic disease, c acidosis,
re-feeding syndrome
Chloride: Normal Value: 98-107 mEq/L
High: dehydration, anemia, diarrhea, renal insufficiency
Low: Emesis, gastric suction, over-hydration, fever
Phosphorus: Normal Value: 2.5-4.9 mg/dl
High: ESRD, hypocalcemia,
Low: alcoholism, re-feeding syndrome
Magnesium: Normal Values: 1.8-2.4mEq/L

3. High: renal failure, dehydration
Low: chronic diarrhea, alcoholism, pancreatitis, renal disease, cirrhosis, re-
feeding syndrome, over-hydration
Labs for heart related disease
Creatine phosphokinase (CPK): Normal Value:
High: Hepatic or uremic coma, striated muscle disease, muscular dystrophy, MI,
CVA, trama, alcoholic liver disease, encephalitis. Enzyme found in the heart muscle,
skeletal muscle and brain. Damage cell releases enzymes and levels increase.
(other name for CPK) Creatine Kinase: Normal Value 24-170 U/L (adult)
High: muscle breakdown, Rhabdomyolysis
Lactate Dehydrogenase (LDH): Normal Value 105-230 U/L
High: Acute MI, Heart failure, alcoholic liver disease, hepatitis, cancer, leukemia,
renal failure, anemia, muscular dystrophy. Enzymes found in many tissues, but does rise
24-72 hours after MI. Levels return to normal in about 4 days.
Troponin:
High: Cardiac contractile proteins, released as myocardial tissue dies. These
levels are detected with great sensitivity and are detectable 20 minutes following injury.
Last 4-10 hrs after MI onset, chronic renal failure
Apoliprotein Apo a or Apo B:
Low levels of Apo A = increase risk of CAD
C-Reactive Protein (CRP): Normal Value: 0.8 mg/dl mod risk: 1-3mg ↑ > 3mg
Increases in: trauma, infection, inflammation, surgery, neoplastic disease. When
increased risk for CHD & other cardio disease
Cholesterol: desirable range 51-200mg borderline: 200-239 high risk > 240 Child: 70-
175
High: CHD, DM, obesity, high fat diet, alcohol intake, CRF, Acute MI
Low: malnutrition, low lipids in blood, malapsorption, Hepatic disease, low fat
diet, sepsis, anemia
Total Chol. < 150 = malnutrition
HDL: Low <40mg/dL High: >60 mg/dL
High: vigorus exercise, insulin therapy, moderate alcohol intake
Low: starvation, obesity, liver disease, DM, smoking, AIDS
LDL: Optimal: < 100mg/dL, above optimal: 100-129 mg/dL, borderline: 130-159
mg/dL, high: 160-189mg/dL, very high: > 190mg/dL
High: hyperlipidemia, high fat diet, hepatic disease, acute trauma, DM

4. Low AIDS
Triglycerides: Desirable <150 mg/dl
High: >200 mg/dl assoc with vascular disease
>500 mg/dl pancreatic risk
>1000 mg/dl substantial pancreatic risk
Blood related lab values
WBC (leukocytes):
Leukocytosis: (high WBC) >11,300/mm3 (4.4-11.3x10^3)
Acute infection, leukemia, trauma, toxins, drugs, cancer
Leukopenia: (low WBC) <4400/mm3
Viral infection, overwhelming bacterial infections, medications, HIV, AIDS
Ferritin: Normal Value: Men: 20-250 ng/ml
Women: 10-120 ng/ml
Indicator of Iron status for iron deficiency anemia
Classification of Anemia
Normocytic (normal)
Microcytic (small)
-Impaired heme synthesis
-Resulting from inability to absorb, transport, store, use iron or impaired
ability/deficiency of protein, iron, Vit A, Vit C, copper.
Pernicious Anemia
Marcrocytic (large)
-Results from decrease ability to synthesize new cells and DNA
-Due to deficiency in B12, folate, thiamin, pyridoxine
Megaloblastic Anemia
-There is a folic acid or vitamin B12 deficiency that causes immature,
large RBC in an abnormal shape
Another issue that can occur in a hospital setting that labs will help to identify, is when
patients receive high volumes of fluids, labs to look for changes in with a sudden
decrease: Na, Creat, BUN, alb, Ca, Cl, Mg
Sudden increase: GFR, K, Phos
Other things to look for would be a severely positive I&O, weight gain and edema.

5. Issues to look for with alcoholism
In some cases, such as alcoholism, when AST and ALT are elevated it can be prudent to
check the lipase, amylase and lipid panel to check for possible underlying pancreas
issues.
Labs associated with alcoholics
High: AST, ALT, Bili, Ammonia
Low: Glucose, BUN, Creat, Alb, amylase, lipase, Mg, Phos
Refeeding syndrome
Alcoholics are very susceptible to this syndrome. When they drink their calories and stop
eating the balance in their body goes.
When a patient has had poor nutrition intake for quite some time a syndrome can occur;
this syndrome is called re-feeding syndrome (RFS). The most common lab value
associated with RFS is hypophosphatemia. You will usually see this occur within 4 days
of starting to feed a patient.
In starvation fat and protein stores are catabolised to produce energy. This results in
an intracellular loss of phosphate. Malnourished patients’ intracellular phosphate stores can
be depleted despite normal serum phosphate concentrations. This is seen when people who
have severe malnutrition are given large amounts of carbohydrates in a short period of
time, and their secretion of insulin increases; this stimulates cellular uptake of phosphate,
which can lead to profound hypophosphataemia, together with cellular uptake of potassium
and magnesium. When you see the decrease of phosphorus in the blood, you usually see
an increase of phosphate in the urine. You will also see hypokalemia, hypomagnesemia,
hyperglycemia.
Major effects of a low phosphate resulting in -
1) Muscle - myopathy, rhabdomyolysis
2) Haematology - haemolysis, tissue hypoxia, reduced white cell and platelet
function
3) Neurology - malaise, confusion, coma
4) Skeleton - rickets, osteomalacia
People at risk for RFS:
1) elderly, who may have dementia and a poor PO intake
2) People with chronic malnutrition issues such as gastric bypass or lap-band
procedure, rapid weight loss, severe exacerbations of crohns disease and
more.
3) Chronic alcoholics
4) Patients unfed for 7-10 days with evidence of stress/depletion
5) Anorexia Nervosa
6) Oncology patients on chemotherapy

6. 7) Chronic antacid users
8) Chronic diuretic users
9) Classic Marasmus
10) Hyperglycemia eg DM
Re-feeding syndrome can be a very serious issue and can lead to death it can also lead to
other significant risks including confusion, coma and convulsions and cardiac failure.

7. 7) Chronic antacid users
8) Chronic diuretic users
9) Classic Marasmus
10) Hyperglycemia eg DM
Re-feeding syndrome can be a very serious issue and can lead to death it can also lead to
other significant risks including confusion, coma and convulsions and cardiac failure.