TEST Sodium

REFERENCE 135 145 meq/L

Hypernatremia: Diabetes insipidus Severe vomiting Diarrhea Aldosteronism (Sodium Retention) Hyperkalemia

CLINICAL SIGNIFICANCE

Potassium

3.8 5.5 meq/L

Chloride

100 108 meq/L

Hyperchloremia: Bicarbonate loss due to diarrhea / primary aldosteronism Hypercalcemia: Hyperparathyroidism Pagets Bone Myeloma (fracture)

Calcium

Unionized: 8.9 10.1 mg/dL Ionized: 4 5 mg/dL

RBC

4 6 million/mcL

Drugs that can increase sodium: 1. Lithium 2. Vasopressin 3. Corticosteroids 4. Methyldopa 5. Hydralazine 6. Reserpine Hypokalemia Increase K levels: 1. Repeated fist clenching before blood extraction. 2. Delaying blood flow after tourniquet. 3. Spironolactone 4. Pen G Therapy (IM) 5. Renal toxicity from amphotericin B and tetracycline. Hypochloremia: Increase of Increase chloride levels: bicarbonate 1. Ammonium chloride 2. Cholestyramine 3. Boric acid 4. Phenylbutazone 5. Oxyphenbutazone Hypocalcemia: Increase calcium levels: Hypoparathyroidism 1. Excessive ingestion of Parathyroidectomy Vitamin D Acute pancreatitis 2. Use of androgens Malabsorption of calcium 3. Calciferol (Rowachol: Activated calcium salts) 4. Estrogen 5. Thiazide diuretics Anemia and Bleeding Mixing with anticoagulants

Hyponatremia: Sweating in diuretic treatment

INTERFERING FACTOR

Drugs that can lower sodium levels: 1. Diuretics

Decrease K levels: 1. Insulin and glucose administration 2. Diuretics

Decrease chloride levels: 1. Thiazide diuretics 2. Furosemide 3. Bicarbonate 4. Prolong infusion of D5 W. False decrease calcium: 1. Chronic laxative use 2. Excessive transfusion of blood 3. Corticosteroids 4. Prolong tourniquet application

Hemoglobin Hematocrit RBC Index

M: 14 18 g/dL F: 12 16 g/dL M: 42 54% F: 38 47% MCV: 84 99 pg MCH: 26 32 pg MCHC: 30 36 g/dL

Polycythemia vera Polycythemia vera MCV: Macrocytic anemia - deficiency in folate Megaloblastic anemia - deficiency in Vit. B12

Anemia Anemia MCV & MCHC: Microcytic anemia - due to iron deficiency (Thalassemia) Decrease in WBC: - Bone marrow depression (leukopenia) due to viral infection or reaction to drugs. Leukocytosis bacterial infection Leukopenia Gangrene Tissue necrosis (due to burns) Acute MI

Mixing with anticoagulants Mixing with anticoagulants

WBC

4000 10000 / mcL Differential count: Neutrophils 48 77% Lymphocytes 16 43% Monocytes 0 1% Eosinophils 0 7% Basophils 0 2%

Infection

Platelets

140,000 400,000 per mcL

Thrombocytosis - hemorrhage infection & cancer iron deficiency Anemia.

Thrombocytopenia - a plastic / hypoplastic bone marrow depression Dengue

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