Chemistry Panel Review

Creatinine (0.6-1)mg/dl
mean for men 1.13 and women 0.93 mg/ dL
 Creatinine is derived from the metabolism of creatine in skeletal muscle and
dietary meat intake.

 High creatinine levels means kidney function affected:

 Prerenal: Reduced blood flow to the kidney due to shock, dehydration, CHF,
low urine Na<20,
 Intrinsic , intrarenal : Damage of glomeruli, tubules, or interstitium in
glumerulonephritis, or acute tubular necrosis(ATN)
 Post renal- renal insufficiency: urinary tract obstruction

Blood urea nitrogen (BUN) test

In general, around 6 to 24 mg/dL
BUN/ Creatinine Ratio
The ratio of BUN to creatinine is between 1:10 and 1:20.

An increased ratio above 1:20 may be due:

1.Decrease in the flow of blood to the kidneys in CHF,
2.Dehydration
3.Increased protein from gastrointestinal bleeding, or increased
protein in the diet.
 Glomerular filtration rate (GFR)
Kidneys filter approximately 180 liters per day (125
mL/min) of plasma. GFR depends on age, sex, size.

GFR is used to assess the degree of kidney impairment and

gives a measure of the number of functioning nephrons

 Creatinine clearence(Ccr) = Glomerular filtration rate

(GFR)
Aspartate transaminase(AST)
Serum glutamic-oxaloacetic transaminase (SGOT)
AST : M 16 – 63 U/L, F 6 – 64 U/L
Alanine transaminase(ALT)
Serum glutamic-pyruvic transaminase(SGPT)
ALT : F 9 – 52 U/L, M 21 – 72 U/L

AST and ALT are the two of the most important tests to
detect liver injury, although ALT is more specific than AST
 AST/ALT ratio
• In most types of liver disease, the ALT level is higher than
AST.

• Alcohol abuse — The diagnosis of alcohol abuse observed

with AST to ALT ratio of 2:1 or greater. strongly suggests
alcohol abuse
Alkaline Phosphatase(ALP)
0-17 yrs:20-350 U/L , 17-61 yrs 38-126 U/L,
>61 yrs 62-130 U/L

• The alkaline phosphatase test (ALP) is used to help detect

liver disease or bone disorders

• Elevated ALP alone strongly suggest bone disorders

 Gamma- glutamyl Transferase (GGT)
GGT: M 0 – 78 U/L, F 4 – 53 U/L

• GGT is not recommend for routine use. It can be useful in

determining the cause of a high ALP.
Bilirubin
• Bilirubin is the catabolic product of hemoglobin.
• Bilirubin exists in two main forms; conjugated ( direct)
and unconjugated bilirubin ( indirect)

-The metabolism of bilirubin takes place predominantly in the liver.

Bilirubin enters the liver in the unconjugated form and thereby converted
to the conjugated form after some metabolic conversions.

-Indirect bilirubin is bound to albumin, which is the common carrier

protein of bilirubin
• The key difference between the Direct and Indirect bilirubin is that
direct bilirubin is the bilirubin that is conjugated with glucuronic acid
while the indirect bilirubin is not conjugated to the liver, and it
attaches to the carrier protein albumin.

• Total bilirubin = direct + indirect

Total Bilirubin 0.1-1.4 mg/dl Direct Bilirubin 0 – 0.3 mg/dl
Indirect bilirubin: 0.2-0.8 mg/dL

 total High levels of bilirubin could mean your liver is not functioning correctly.
However, high levels can also be due to medications, exercise, or certain foods.
Bilirubin is also a product of breakdown of red blood cells, and an elevated reading
may be related to disorders of red blood cells and not liver disease

Indirect Hyperbillirubinemia: RBCs hemolysis

o Physiologic and pathologic jaundice caused by accelerated breakdown of RBCs
leading to anemia and possible kernicterus in newborns
o RBC hemolysis in sickle cell, or pernicious anemias, or a blood transfusion reaction

Direct Hyperbillirubinemia(Conjugated) in:

 blockage of the liver or bile ducts
 hepatitis, trauma to the liver,
 Cirrhosis, a drug reaction, or
 long-term alcohol abuse.
Jaundice
 Total protein: 6.3-8 gm/dl
Albumin: 3.6- 4.6 gm/dl
Globulin: 1.8-4 gm/dl

Albumin = maintains the osmotic pressure of the blood, preventing

the plasma from leaking into the tissues
Globulins = Transporter other substances and as antibodies, protecting
the body against infection

Low albumin levels can suggest:

• liver disease.
• Kidney diseases when albumin leaks to the urine
• Malnutrition
LACTIC ACID