Procalcitonin

1. procalcitonin, the precursor of the hormone calcitonin, is produced by the C cells of the thyroid. In
sepsis and septic shock, microbial toxins and inflammatory mediator proteins, are thought to trigger the
production of large amounts of procalcitonin
2. ➧ Explain that a blood sample is needed for the test.
3. To assist in diagnosing bacterial infection and risk for developing sepsis.
INDICATIONS • Assist in the diagnosis of bacteremia and septicemia. • Assist in the differential
diagnosis of bacterial versus viral meningitis. • Assist in the differential diagnosis of
community-acquired bacterial versus viral pneumonia. • Monitor response to antibacterial therapy.

D-Dimer
1. d -Dimers are produced as a degradation product of fibrin clots resulting from the action of three
enzymes: 1) thrombin, due to activation of the coagulation cascade that converts fibrinogen into fibrin
clots; 2) activated factor XIII, which cross-links fibrin clots; and 3) plasmin. The presence of d -dimer
confirms that both thrombin generation and plasmin generation have occurred.. d-Dimers are formed in
inflammatory conditions where plasmin carries out its fibrinolytic action on a fibrin clot
Increased associated with inflammation or severe infection
2. A venous blood sample of 5 mL is collected into a light blue–topped tube containing 3.2% sodium
citrate and aprotinin. Place the specimen in biohazard bag and return to lab immediately. There are no
food, fluid, activity, or medication restrictions unless by medical direction.
3. To assist in diagnosing a diffuse state of hypercoagulation as seen in disseminated intravascular
coagulation (DIC), acute myocardial infarction (MI), deep venous thrombosis (DVT), and pulmonary
embolism (PE).

HS Trop I
1. Troponins are a group of proteins found in skeletal and heart (cardiac) muscle fibres that regulate
muscular contraction. Troponin tests measure the level of cardiac-specific troponin in the blood to help
detect heart injury. The high-sensitivity cardiac troponin test is the latest generation of the cardiac
enzyme testing that allows for the detection of significantly low levels of troponin T.
2. The most common use of troponin tests is to confirm or rule out a heart attack. However, any kind of
damage to heart muscle can potentially cause the release of this chemical into your bloodstream. Other
conditions that can cause your troponin levels to increase include:
● Chronic kidney disease.
● Pulmonary embolism (a blood clot in your lungs).
● Congestive heart failure.
● Heart surgery.
● Heart valve diseases.
● Irregular heart rhythms (arrhythmias).
● Sepsis.
● Exercising too much or too strenuously.
● Extreme emotional strain, such as grief or stress.
3. High-Sensitive Troponin I test helps to diagnose heart attacks more quickly. If the test is negative, it can
also help “rule out” heart damage from coronary artery disease (CAD).
CK-MB
1. CK-MB is an isoenzyme of creatine kinase. Creatine kinase dephosphorylates creatine phosphate to
creatine, providing the energy required for ATP regeneration.
2.
3. When you have an increased creatine kinase (CK) level and the health care practitioner wants to
determine whether it is due to skeletal or heart muscle damage; when it is suspected that you have had
a second heart attack or have ongoing heart damage

Culture and Sensitivity Wound

1. A wound culture involves collecting a specimen of exudates, drainage, or tissue so that the causative
organism can be isolated and pathogens identified. Specimens can be obtained from superficial and
deep wounds
Wound infections and abscesses occur as complications of surgery, trauma, or infection that interrupts
a skin surface. Clinical specimens taken from wounds can harbor any of the following microorganisms.
Pathogenicity depends on the quantity of organisms present. Quantitative or semi-quantitative reporting
of culture results may provide information on the relative importance of the various organisms present
in the lesion and also the response of the infection to antibiotic therapy.
2.
3. • Detect abscess or deep-wound infectious process. • Determine if an infectious organism is the cause
of wound redness, warmth, or edema with drainage at a site. • Determine presence of infectious
organisms in a stage 3 and stage 4 decubitus ulcer. • Isolate and identify organisms responsible for the
presence of pus or other exudate in an open wound.

Creatinine
1. Creatinine is a byproduct in the breakdown of muscle creatine phosphate resulting from energy
metabolism. It is produced at a constant rate depending on the muscle mass of the person and is
removed from the body by the kidneys. Production of creatinine is constant as long as muscle mass
remains constant. A disorder of kidney function reduces excretion of creatinine, resulting in increased
blood creatinine levels.
2. There are no food, fluid, or medication restrictions unless by medical direction. Instruct the patient to
refrain from excessive exercise for 8 hr before the test.
3. Assess a known or suspected disorder involving muscles in the absence of kidney disease. • Evaluate
known or suspected impairment of kidney function
*increased in liver disease due to fluid retention; dehydration

Potassium
1. *decreased in alcohol misuse and alkalosis
Potassium is the principal electrolyte (cation) of intracellular fluid and the primary buffer within the cell
itself. Ninety percent of potassium is concentrated within the cell; only small amounts are contained in
bone and blood. Damaged cells release potassium into the blood. Potassium plays an important role in
nerve conduction, muscle function, acid-base balance, and osmotic pressure. Along with calcium and
magnesium, potassium controls the rate and force of contraction of the heart and, thus, the cardiac
output
2. There are no food, fluid, activity, or medication restrictions unless by medical direction. Instruct the
patient not to clench and unclench the fist immediately before or during specimen collection.
3. To evaluate fluid and electrolyte balance related to potassium levels toward diagnosing disorders such
as acidosis, acute kidney injury, chronic kidney disease, and dehydration and to monitor the
effectiveness of therapeutic interventions.
 *• Assess a known or suspected disorder associated with kidney disease, glucose metabolism, trauma,
or burns. • Assist in the evaluation of electrolyte imbalances; this test is especially indicated in older
adult patients, patients receiving hyperalimentation supplements, patients on hemodialysis, and
patients with hypertension. • Evaluate cardiac dysrhythmia to determine whether altered potassium
levels are contributing to the problem, especially during digoxin therapy, which leads to ventricular
irritability. • Evaluate the effects of drug therapy, especially diuretics. • Evaluate the response to
treatment for abnormal potassium levels. • Monitor known or suspected acidosis, because potassium
moves from RBCs into the extracellular fluid in acidotic states. • Routine screen of electrolytes in acute
and chronic illness.

Alkaline Phosphatase
1. ALP is an enzyme found in the liver; in Kupffer cells lining the biliary tract; and in bones, intestines, and
placenta. Additional sources of ALP include the proximal tubules of the kidneys, pulmonary alveolar
cells, germ cells, vascular bed, lactating mammary glands, and granulocytes of circulating blood.
-Alkaline phosphatase (ALP) is an enzyme originating mainly in the bone, liver, and placenta, with some
activity in the kidney and intestines. It is called alkaline because it functions best at a pH of 9. ALP
levels are age and gender dependent. Postpuberty ALP is mainly of liver origin. Alkaline phosphatase is
used as an index of liver and bone disease when correlated with other clinical findings. In bone
disease, the enzyme level rises in proportion to new bone cell production resulting from osteoblastic
activity and the deposit of calcium in the bones. In liver disease, the blood level rises when excretion of
this enzyme is impaired as a result of obstruction in the biliary tract. Used alone, alkaline phosphatase
may be misleading.
2. Obtain a 5-mL fasting venous blood sample
3. Evaluate signs and symptoms of various disorders associated with elevated ALP levels, such as biliary
obstruction, hepatobiliary disease, and bone disease, including malignant processes. • Differentiate
obstructive hepatobiliary tract disorders from hepatocellular disease; greater elevations of ALP are
seen in the former. • Determine effects of kidney disease on bone metabolism. • Determine bone
growth or destruction in children with abnormal growth patterns.
● Elevated levels of ALP in liver disease (correlated with abnormal liver function tests) occur in the
● following conditions:
● c. Hepatocellular cirrhosis
● g. Diabetes mellitus (causes increased synthesis), diabetic hepatic lipidosis
● h. Chronic alcohol ingestion

SGPT/ALT
1. ALT is an enzyme produced by the liver. The highest concentration of ALT is found in liver cells;
moderate amounts are found in kidney cells; and smaller amounts are found in heart, pancreas, spleen,
skeletal muscle, and red blood cells. When liver damage occurs, serum levels of ALT may increase as
much as 50 times normal, making this a sensitive test for evaluating liver function.
2. There are no food, fluid, activity, or medication restrictions unless by medical direction.
3. Monitor liver damage resulting from hepatotoxic drugs. • Monitor response to treatment of liver
disease, with tissue repair indicated by gradually declining levels.

SGOT/AST
1. Aspartate aminotransferase (AST) is an enzyme that catalyzes the reversible transfer of an amino
group between aspartate and α-ketoglutaric acid in the citric acid or Krebs cycle, a powerful and
essential biochemical pathway for releasing stored energy. AST exists in large amounts in liver and
myocardial cells and in smaller but significant amounts in skeletal muscle, kidneys, pancreas, red blood
 cells, and the brain. Serum AST rises when there is damage to the tissues and cells where the enzyme
is found, and levels directly reflect the extent of damage.
. The enzyme is released into the circulation following the injury or death of cells. Any disease that
causes change in these highly metabolic tissues will result in a rise in AST levels. The amount of AST
in the blood is directly related to the number of damaged cells and the amount of time that passes
between injury to the tissue and the test. Following severe cell damage, the blood AST level will rise in
12 hours and remain elevated for about 5 days. This test is used to evaluate liver and heart disease.
*AST is released from any damaged cell in which it is stored, so conditions that affect the liver, kidneys,
heart, pancreas, red blood cells, or skeletal muscle and cause cellular destruction demonstrate
elevated AST levels.
2. There are no food, fluid, activity, or medication restrictions unless by medical direction.
3. Monitor response to therapy with potentially hepatotoxic or nephrotoxic drugs. • Monitor response to
treatment for various disorders of hepatic function in which AST may be elevated, with tissue repair
indicated by declining levels.

Total Bilirubin
1. . Total bilirubin is the sum of unconjugated or indirect bilirubin, monoglucuronide and diglucuronide
(conjugated or direct bilirubin), and albuminbound delta bilirubin.
Bilirubin is a by-product of heme catabolism from aged RBCs and is primarily produced in the liver and
spleen. Unconjugated bilirubin is carried to the liver by albumin, where it is conjugated with glucuronic
acid. Conjugated bilirubin is water soluble and more easily excreted. Most of the conjugated bilirubin
enters the bile and is transported directly into the small intestine; a small portion of the conjugated
bilirubin remains in the bile and is stored in the gallbladder
A multipurpose laboratory test that acts as an indicator for various diseases of the liver, for disease that
affects the liver, or for conditions associated with red blood cell (RBC) hemolysis
Unconjugated bilirubin circulates freely in the blood until it reaches the liver, where it is conjugated with
glucuronide transferase and then excreted into the bile. An increase in unconjugated bilirubin is more
frequently associated with increased destruction of RBCs (hemolysis) as well as in neonatal jaundice.
An increase in free-flowing bilirubin is more likely seen in dysfunction or blockage of the liver. A routine
examination measures only the total bilirubin. A normal level of total bilirubin rules out any significant
impairment of the excretory function of the liver or excessive hemolysis of red cells. Only when total
bilirubin levels are elevated will there be a call for differentiation of the bilirubin levels by conjugated and
unconjugated types.
Bilirubin results from the breakdown of hemoglobin in the RBCs and is a byproduct of hemolysis (i.e.,
RBC destruction). It is produced by the reticuloendothelial system. Removed from the body by the liver,
which excretes it into the bile, bilirubin gives the bile its major pigmentation. Usually, a small amount of
bilirubin is found in the serum. A rise in serum bilirubin levels occurs when there is excessive
destruction of RBCs or when the liver is unable to excrete the normal amounts of bilirubin produced.
2. Ensure that patient is fasting
3. Assist in the evaluation of liver and biliary disease. • Monitor the effects of drug reactions on liver
function.
Total bilirubin increased due to sepsis

Direct Bilirubin
1.
2.
3.

Indirect Bilirubin
 1.
2.
3.

GGT
1. Glutamyltransferase (GGT) assists with the reabsorption of amino acids and peptides from the
glomerular filtrate and intestinal lumen. Hepatobiliary, renal tubular, and pancreatic tissues contain large
amounts of GGT. Other sources include the prostate gland, brain, and heart. GGT is elevated in all
types of liver disease and is more responsive to biliary obstruction, cholangitis, or cholecystitis than any
of the other enzymes used as markers for liver disease
* This test is used to determine liver cell dysfunction and to detect alcohol-induced liver disease.
Because the GGT is very sensitive to the amount of alcohol consumed by chronic drinkers, it can be
used to monitor the cessation or reduction of alcohol consumption in chronic alcoholic patients and
early-risk drinkers.
2. There are no food, fluid, activity, or medication restrictions unless by medical direction.
3. Assist in the diagnosis of obstructive jaundice in neonates. • Detect the presence of liver disease. •
Evaluate and monitor patients with known or suspected alcohol misuse (levels rise after ingestion of
small amounts of alcohol).

APTT:
1. The aPTT is used to detect deficiencies in the intrinsic coagulation system, to detect incubating
anticoagulants, and to monitor heparin therapy. It is part of a coagulation panel workup. The aPTT time
represents the time required for formation of a firm fibrin clot after tissue thromboplastin reagents and
calcium are added to a plasma specimen. The aPTT tests assist in identifying the cause of or tendency
for bleeding as related to coagulation defects
2. There are no food, fluid, activity, or medication restrictions unless by medical direction. Draw blood
sample 1 hour before next dose of heparin.
3. • Monitor the hemostatic effects of conditions such as liver disease, protein deficiency, and fat
malabsorption.*prolonged associated with liver disease

Control:
1.
2.
3.

Gram Stain
1. It divides bacteria into two physiologic groups: gram-positive and gram-negative organisms. The Gram
stain permits morphologic study of the sampled bacteria and divides all bacteria according to their
ability or inability to pick up one or both of the stains. Gram-positive and gram-negative bacteria exhibit
different properties, which helps to identify and differentiate them. Gram stain is a technique commonly
used to identify bacterial organisms on the basis of their specific staining characteristics. The method
involves smearing a small amount of specimen on a slide, and then exposing it to gentian or crystal
violet, iodine, alcohol, and safranin O. G
2. No special prep
3. To provide a quick identification of gram-negative or gram-positive organisms to assist in medical
management.

KOH:
 1. A KOH prep test is a simple, non-invasive procedure for diagnosing fungal infections of the skin or
nails. Cells are obtained from the affected area, placed on a slide with a solution consisting of
potassium hydroxide, and examined under a microscope to look for signs of a fungus. The KOH
(Potassium hydroxide) procedure is a method used to examine specimens for yeast. KOH serves as an
enzymatic agent that breaks down debris in a specimen, such as epithelial cells and WBCs, to view
yeast or pseudohyphae.
2. No need
3. To detect a fungal infection, to determine which specific fungus or fungi are present, and to help guide
treatment

CBC:
1. A complete blood count (CBC) is a group of tests used for basic screening purposes. The results can
provide valuable diagnostic information regarding the overall health of the patient and the patient’s
response to disease and treatment.
The CBC is a basic screening test and is one of the most frequently ordered laboratory procedures.
The findings in the CBC give valuable diagnostic information about the hematologic and other body
systems, prognosis, response to treatment, and recovery. The CBC consists of a series of tests that
determine number, variety, percentage, concentrations, and quality of blood cells
2.
3. To evaluate numerous conditions involving red blood cells (RBCs), white blood cells (WBCs), and
platelets. This test is also used to indicate inflammation, infection, and response to chemotherapy

ABG
1. Measurements of arterial blood gases (ABGs) are obtained to assess adequacy of oxygenation and
ventilation, to evaluate acid-base status by measuring the respiratory and nonrespiratory components,
and to monitor effectiveness of therapy (e.g., supplemental oxygen). They are also used to monitor
critically ill patients, to establish baseline values in the perioperative and postoperative period, to detect
and treat electrolyte imbalances, to titrate appropriate oxygen flow rates, to qualify a patient for use of
oxygen at home, and in conjunction with pulmonary function testing.
Blood gas analysis is used to evaluate respiratory function and provide a measure for determining
acid-base balance. Respiratory, renal, and cardiovascular system functions are integrated in order to
maintain normal acid-base balance. Therefore, respiratory or metabolic disorders may cause abnormal
blood gas findings.
2.
3. Arterial samples provide information about the ability of the lungs to regulate acid-base balance
through retention or release of CO 2 . Effectiveness of the kidneys in maintaining appropriate
bicarbonate levels also can be gauged. Arterial blood measurements indicate how well the lungs are
oxygenating blood.
Blood gas values are used to determine acid-base status, the type of imbalance, and the degree of
compensation

CXR
1. Chest radiography, commonly called chest x-ray, is one of the most frequently performed diagnostic
imaging studies. This study yields information about the pulmonary, cardiac, and skeletal systems. The
lungs, filled with air, are easily penetrated by x-rays and appear black on chest images
2.
3. Evaluate known or suspected pulmonary disorders, chest trauma, cardiovascular disorders, and
skeletal disorders. Monitor resolution, progression, or maintenance of disease. • Monitor effectiveness
of the treatment regimen.
CELLULITIS

Cellulitis is a common bacterial skin infection. It is an acute bacterial infection causing inflammation of the deep
dermis and surrounding subcutaneous tissue.

Cellulitis usually follows a breach in the skin, such as a fissure, cut, laceration, insect bite, or puncture
wound.although a portal of entry may not be obvious; the breach may involve microscopic skin changes or
invasive qualities of certain bacteria.

Cellulitis has been classically considered to be an infection without formation of abscess (nonpurulent),
purulent drainage, or ulceration.
It typically presents as a poorly demarcated, warm, erythematous area with associated edema and tenderness
to palpation. The patient may present with constitutional symptoms of generalized malaise, fatigue, and
fevers. Two of the four criteria (warmth, erythema, edema, or tenderness) are required to make the diagnosis.
Its most common presentation is on the lower extremities but can affect any area of the body. It is most often
unilateral and rarely (if ever) presents bilaterally.

Patients who are immunocompromised, colonized with methicillin-resistant Staphylococcus aureus, bitten by
animals, or have comorbidities such as diabetes mellitus may become infected with other bacteria. Organisms
on the skin and its appendages gain entrance to the dermis and multiply to cause cellulitis. Cellulitis most
commonly results from infection with group A beta-hemolytic streptococcus.

The incidence was higher in males and in those individuals aged 45-64 years.

Signs&Symptoms:
● Fever (>100.5°F), especially when associated with chills
● Cellulitis with surrounding soft, fluctuant areas that are suggestive of abscess formation
● Red streaking from an area of cellulitis or a fast-spreading area of redness, which indicates that
the infection may need closer observation, change in antibiotic treatment, or inpatient supportive
care
● Significant pain not relieved by acetaminophen or ibuprofen
● Inability to move an extremity or joint because of pain

SEPSIS & Septic Shock

Sepsis is a life-threatening syndrome usually caused by bacterial infection such as cellulitis. Sepsis is a
response of the body's immune system that results in organ dysfunction or failure. Sepsis can be caused by an
obvious injury or infection or a more complicated etiology. Septic shock occurs in a subset of patients with
sepsis and comprises of an underlying circulatory and cellular/metabolic abnormality that is associated with
increased mortality. Septic shock is defined by persisting hypotension requiring vasopressors to maintain a
mean arterial pressure of 65 mm Hg or higher and a serum lactate level greater than 2 mmol/L (18 mg/dL)
despite adequate volume resuscitation.
Sepsis is a leading killer worldwide, accounting for about 8 million deaths each year. Mortality for severe sepsis
is between 15% and 30% in high-income countries; it is 50% or higher in low-income countries.

● Fever, with or without shaking chills (temperature >38.3ºC or < 36ºC)

● Impaired mental status (in the setting of fever or hypoperfusion)
● Increased breathing rate (>20 breaths/min) resulting in respiratory alkalosis
● Warm or cold skin, depending on the adequacy of organ perfusion and dilation of the superficial
skin vessels
● Hypotension requiring pressor agents to maintain systolic blood pressure above 65 mm Hg
● Fever (usually >101°F [38°C]), chills, or rigors
● Confusion
● Anxiety
● Difficulty breathing
● Fatigue, malaise
● Nausea and vomiting
● Cyanosis
● Low urine output
● Fever (temperature higher than 38 C or hypothermia (temperature less than 36 C)
● Tachycardia (heart rate more than 90 beats per minute),
● Tachypnea (respiratory rate more than 20 breaths per minute)
● Leukocytosis (WBC greater than 12,000/cu mm) / leukopenia (white blood cells (WBC) less than
4,000/cu mm) with or without bandemia (more than 10%).

Mahapatra, S. (2022, June 21). Septic Shock. StatPearls - NCBI Bookshelf.

https://www.ncbi.nlm.nih.gov/books/NBK430939/
K, M. & P, A. (2020). Septic Shock: Practice Essentials, Background, Pathophysiology.
https://emedicine.medscape.com/article/168402-overview
B. AM. & B, MS. (2023). Bacterial Sepsis Clinical Presentation: History, History and Physical
Examination, Physical Examination. https://emedicine.medscape.com/article/234587-clinical#b4
Herchline, T. E., MD. (n.d.). Cellulitis: Practice Essentials, Background, Pathophysiology.
https://emedicine.medscape.com/article/214222-overview