LAB VALUES

As an ALS provider in the inter-hospital transport setting, you will be presented

with various laboratory values pertaining to your patient. It is good to know the possible
medical conditions that you may have to deal with as a result of your patient’s high or
low lab values. The following are the current lab values that are to be documented on
the Butler Patient Care Report (Chemistry-Chem 7/CBC/Coags/cardiac enzymes). You
may be presented with these numbers in a shorthand form that is recognized in many
hospital settings (see figures below). While looking at lab values, keep in mind that
parameters may change depending on the facility. Most lab sheets will have a listing of
the appropriate range and some type of notation next to the given value (High or Low), if
it falls outside of the given range. When documenting lab values, always use the latest
set provided; some patients have lab values that span several days.
A brief description and pertinent information is provided for each value.
 Blood Glucose
o Drawn during normal lab procedures and represented as a venous value.
If you do a finger stick, or use blood from needle catheter, document [FS]
next to the number to signify finger stick
o Normal Range: 80-110mg/dL [milligram/deciliter]
o Follow Maryland EMS Protocols for finger stick readings that require
treatment (symptomatic with BGL <70mg/dL)
 BNP
o Brain Natriuretic Peptide or B-Type Peptide
o A hormone produced by the ventricles that increases in response to
ventricular expansion and pressure overload
o Indicator of CHF (higher values indicate severity)
o Normal Range <100 pg/mL
 180 pg/mL = renal insufficiency with volume overload
 186 pg/mL = mild CHF
 791 pg/mL = moderate CHF
 2013 pg/mL = severe CHF
 Pg/mL = pictogram/milliliter or one trillionth of a milliliter
 BUN
o Blood Urea Nitrogen – evaluation of renal function and hydration
 Urea nitrogen is a waste product of protein metabolism – urea is
formed by the liver and carried to the kidneys for excretion –
because urea is cleared from the bloodstream by the kidneys, a
test measuring how much urea nitrogen remains in the blood can
be used to test renal function (and other factors)
o Elevated BUN (azotemia) occurs in CHF, Shock, Stress, AMI, Chronic
Renal Disease, Urinary Tract Obstruction, GI Bleed, Anabolic Steroid Use
o Decreased BUN associated with Liver Failure and Malnutrition
o Normal Range 6-20 mg/dL [milligram/deciliter]
 Calcium
o Normal Range 8.8 – 10.4 mg/dL [milligram/deciliter] / 4.5 – 5.0 mg/dl
(ionized calcium)
 Ionized calcium can also be shown as 2.24 – 2.46 meq/L or, with
seemingly more variations, 1.03 – 1.4 mmol/L (millimole/Liter)
o Calcium is the most abundant electrolyte in the body. Aside from knowing
the cardiac effects of calcium, you should know that of the roughly 1% of
calcium that is stored outside of bone, about half of that is ionized. Ionized
Calcium, is biologically active calcium, and as such, an ionized calcium
test is commonly drawn
 Chloride
o Increased Chloride occurs with Dehydration, Cushing’s Syndrome,
Hyperventilation, Metabolic Acidosis, Diabetes Insipidus, Eclampsia, some
Head Injuries
o Decreased Chloride occurs with severe vomiting, Chronic Respiratory
Acidosis, Burns, Metabolic Alkalosis, CHF, Addison’s Disease, Over-
hydration
o Normal Range 96-106 mEq/L [milliequivalent/liter]
 CPK (or CK)
o Creatine Phosphokinase (or Creatine Kinase) is a dimeric enzyme
composed of either M or B subunits. These subunits associate to form
three isoenzyme forms, each pertaining to specific tissue
 BB – (CK-BB) predominantly found in brain tissue
 MB – (CK-MB) predominantly heart muscle
 Normal range is 0-3 ng/mL
 MM – (CK-MM) predominantly in skeletal and heart muscle
o Normal Range [Men: 38 -174 units/liter] [Women: 26-140 units/liter]
 CO2
o Carbon Dioxide
o Increased CO2 can occur with severe vomiting, Emphysema
o Decreased CO2 can occur with Diarrhea, Acute Renal Failure, Diabetic
Acidosis
o Normal Range 23-30 mEq/L [milliequivalent/liter]
 <6 mEq/L = severe metabolic acidosis with pH often <7.1 (life
threatening)
 Creatinine
o Evaluator of Kidney function
o Elevated Creatinine indicates decreased renal function
o Elevated Creatinine (>1.5 mg/dL) will usually require a dose of Mucomyst
prior to procedures requiring IV Dye
 For patient information: Mucomyst (acetylcysteine) when taken
orally - in liquid form it has a foul odor (rotten eggs)
 Mucomyst protects the kidneys from Contrast Nephrotoxicity (CN)
by its antioxidant characteristics (specific action is still unknown)
  Normal dosing is 300-600mg po
 As of June 1, 2011 there is a nationwide shortage of Mucomyst (as
with many other commonly used medications) due to drug company
decreases in production – some hospitals have stopped using
Mucomyst as a prophylaxis
o Normal Range [Men: 0.9-1.3 mg/dL] [Women: 0.6-1.1 mg/dL]
 D-Dimer
o D-Dimers are produced by the action of plasmin on cross-linked fibrin. The
presence of D-Dimer confirms that both thrombin generation and plasmin
generation have occurred.
o Used in diagnosis of DIC and screening for venous thrombosis and AMI
o Normal range < 0.0 mcg/L [microgram/liter] (any positive value is a finding)
 Hematocrit (Hct)
o Represented as a percentage by volume of packed red blood cells in
whole blood
o Increased Hct (>60%) associated with spontaneous clotting of blood
o Decreased Hct (<20%) can lead to cardiac failure and death
 For transport awareness, a low Hematocrit can indicate the need
for a blood product infusion
o Presents as a 3:1 ratio to Hemoglobin
o Normal Range [Men: 42-52%] [Women: 36-44%]
 Hemoglobin (Hgb)
o The oxygen carrying protein of red blood cells
o Increased levels found in CHF, COPD
o Decreased levels found in Anemia, Hypothyroidism, Liver Disease,
Hemorrhage
o Normal Range [Men: 14.0-17.4 g/dL] [Women: 12.0-16.0 g/dL]
 Heparin Anti-Xa
o Some facilities (particularly MedStar facilities) will use this test instead of,
or in conjunction with, PTT or APTT tests
o Heparin works on the protein antithrombin and interferes with the clotting
process by inhibiting coagulation factors (particularly factors Xa and IIa
[thrombin])
o Ranges specific to type of Heparin being administered
 LMWH [Low Molecular Weight Heparin] (Lovenox) [1.0 – 2.0 U/ml –
for once a day injection therapy]
 UFH [Unfractionated Heparin] (Heparin) [0.4 – 0.7 U/ml]
o Normal Therapeutic Ranges 0.30 – 0.70 U/ml (correlates to PTT range of
55-98 seconds)
 HCO3 <<ABG VALUES>>
o Bicarbonate – a chemical buffer that keeps the pH of blood from becoming
too acidic or too basic
 Remember in acid/base balance, CO2 combines with water to make
carbonic acid. Carbonic acid is unstable, and readily dissolves into
 hydrogen and HCO3 – in general, a low HCO3 indicates an acidic
state while a high HCO3 indicates a base state
 CO2 + H2O  H2CO3  H+ + HCO3 (carbonic acid-bicarbonate buffer
system)
o Normal Range 22 – 29 mEq/L
 INR
o International Normalized Ratio
o Comparative rating of PT ratios
o Normal Range 0.7-1.0 second
 Elevated readings (>1.5) may delay procedures
 Magnesium
o Magnesium is the body’s fourth most abundant mineral, with 50% of total
body magnesium found in bone. The other half is found predominantly in
cells, tissues and organs. Only 1% of magnesium is found in blood – but
the body works very hard to keep blood levels of magnesium constant
o Normal Range 1.8-2.6 mg/dL
 <1.2 mg/dL = tetany (muscle spasms) occur
 5..5-10 mg/dL = CNS depression, nausea, vomiting, fatigue
 10-15 mg/dL = coma, ECG changes, respiratory paralysis
 30 mg/dL = complete heart block
 34-40 mg/dL = cardiac arrest
 Myoglobin (mb)
o Earliest biological marker of myocardial necrosis – presents in peripheral
blood 2-3 hours after onset of pain and peaks in 6-9 hours
o Sensitive indicator of AMI but is not specific for cardiac muscle
o Normal Range 5-70 ng/ml [nanograms/milliliter]
 O2 Saturation % (or SaO2) <<ABG VALUES>>
o How much Hemoglobin in the blood is carrying oxygen
o When measured by use of a pulse oximeter, it is referred to as SpO2
o Normal Ranges:
 Arterial: 90 – 98 %
 Venous: 40 – 70 %
 PaCO2 (or pCO2) <<ABG VALUES>>
o Partial Pressure of carbon dioxide
 This measures how much CO2 is dissolved in the blood and how
well CO2 can move out of the body
 Remember, gas naturally travels from higher concentration to lower
concentration – the PaCO2 in the pulmonary arteries is roughly
45mmHg, while the PaCO2 in the alveoli is about 40mmHg – while
the pressure gradient is far less than the PaO2 exchange, CO2 is 20
times more soluble in plasma & alveolar fluid than O2, so equal
amounts of these gases are exchanged
o Normal Ranges:
 Arterial: 35 – 45 mmHg
 Venous: 38 – 52 mmHg
 PaO2 (or pO2) <<ABG VALUES>>
o Partial pressure of oxygen
 This measures the pressure of O2 dissolved in the blood & how well
O2 is able to move from the airspace of the lungs into the blood
 Remember, gas naturally travels from higher concentration to lower
concentration – the PaO2 in the pulmonary arteries is roughly
40mmHg, while the PaO2 in the alveoli is slightly above 100mmHg
– O2 readily leaves the alveoli and travels into the pulmonary arties
o Normal Ranges:
 Arterial 70 – 100 mmHg
 Venous: 28 – 48 mmHg
 Platelets (thrombocytes)
o Normal Range 140-400 (140-400x109/L) [140,000,000,000 –
400,000,000,000 / L]
o Since the value is so high, you may see a platelet count in the range of
140,000 – 400,00 / L (micro liter)
 Values <20 associated with tendency for spontaneous bleeding,
prolonged bleeding time, petechial rash, ecchymosis
 Potassium (K+)
o Increased levels (Hyperkalemia) may cause Sinus Bradycardia, Sinus
Arrest, First Degree AV Block, Idioventricular Rhythm, Nodal Rhythm, V-
Tach, V-Fib, Ventricular Arrest, Elevated T Waves, Flattened P Waves
 Common causes of Hyperkalemia are renal inefficiency and renal
failure (there’s a reason that every paramedic test has a question
about a dialysis patient presenting with shortness of breath and
peaked T-Waves!)
o Decreased levels (Hypokalemia) may cause PVCs, Atrial Tachycardia,
Nodal Tachycardia, V-Tach, V-Fib, U Waves, Depressed t Waves, peaked
P Waves
 Common causes of Hypokalemia are polyuria, loop and thiazide
diuretic use, and diarrhea
o Normal Range 3.5-5.2 mEq/L [milliequivalents/liter]
 <2.5 mEq/L causes V-Fib
 >8.0 mEq/L causes muscle irritability including myocardial irritability
 Potassium blood level rises 0.6 mEq/L for every 0.1 decrease in
blood pH
 pH <<ABG VALUES>>
o Potential Hydrogen
o Relative concentration of hydrogen ions in the blood
 Low pH = acidic
 High pH = alkaline
o Normal Ranges:
 Arterial Blood Gas (7.35 – 7.45)
 Venous Blood Gas (7.32 – 7.42)
 PT
o Prothrombin Time
 o Prothrombin is a protein produced by the liver for clotting of blood
o Prothrombin production depends on adequate vitamin K intake and
absorption
o Normal Range 11-13 seconds (can vary by laboratory)
 PTT
o Partial Thromboplastin Time (also APTT – Activated PTT)
o Normal Range 21-35 seconds
 Therapeutic Range = 2-2.5 times the normal range
 Readings above 70 seconds signify spontaneous bleeding
 Readings above 90 seconds require prompt notification and an
added awareness for possible bleeding
 Sodium (Na )+

o Normal Range 135-145 mEq/L [milliequivalents/liter]

 An electrolyte and mineral that helps maintain water and electrolyte
balance as well as muscle and nerve function
 Heparin can cause a decrease in sodium levels
 Corticosteroids, calcium, fluorides, and iron can increase sodium
levels
 <125 mEq/L (hyponatremia) causes weakness, dehydration
 <90-105 mEq/L (severe hyponatremia) causes severe neurological
symptoms, vascular problems
 >152 mEq/L (hypernatremia) results in cardiovascular and renal
symptoms
 >160 mEq/L (severe hypernatremia) can cause heart failure
 Troponin
o Cardiac protein is released with very small areas of myocardial damage as
early as 1 to 3 hours after injury – levels return to normal within 5 to 7
days
o Drawn in serial samples at 0,4,8, and 12 hours
o Ranges:
 0-0.4 ng/mL = negative reading
 0.4-1.0 ng/mL = possible positive reading
 >1.0 ng/mL = positive reading
 White Blood Count (WBC)
o Normal Range [African/Black: 3.2-10] [Other: 4.5-10.5] (WBC = 3.2-10
<total population> or 4.5-10.5 x109/L <non-African )
 Levels below 0.5 and above 30.0 are critical
Below are the common notation figures for pertinent lab data that are used on our
assessment form. You may also see these figures on Emergency Department
assessment forms, or other History and Physical documentation. The diagrams show
where each lab is to be written in the form, and immediately below, the generally
accepted normal value ranges for each lab. As a Critical Care Provider, you should be
familiar with these figures, and the normal ranges for each lab result presented.

Na+ Cl BUN
BGL
K+ CO2 Creat
Chemistry Panel, sometimes
135-145 96-106 6-20
called “Chem-7” 80-110
3.5-5.2 23-30 0.6-1.3

Blood, or CBC (Complete

Hgb
WBC PLTS
Blood Count) – while not Hct

actually all of the values of a 12-17

3.2-10.5 140-400
CBC, these are the four most 36-52

common

PT PTT

INR
Coagulation or “CoAg” times

11-13 21-35

0.7-1.0