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BODY FLUIDS

Body fluids, total volume : 50 percent (in obese) to 70 percent (lean) of body weight
Intracellular : 0.3 - 0.4 of body weight
Extracellular : 0.2 - 0.3 of body weight
Blood
Total volume
Males : 69 ml/kg body weight
Females : 65 ml/kg body weight
Plasma volume
Males : 39 ml/kg body weight
Females : 40 ml/kg body weight
Red blood cell volume
Males : 30 ml/kg body weight (1.15 - 1.21 L/m2 body surface area)
Females : 25 ml/kg body weight (0.95 - 1.00 L/m2 body surface area)
Blood acid-base
Normal range
Arterial
Venous
7.35 - 7.45
7.32 - 7.42
35 - 45
41 - 51
0 2.5

23 - 27
26 - 30
22 - 26
24 - 28
22- 26

96 - 97
40 - 70
80 - 100
25 - 40

Actual pH
PCO2 (mmHg)
Base excess (mmol/L blood)
Total CO2 (mmol/L plasma)
Actual bicarbonate (mmol/L plasma)
Standard bicarbonate(mmol/L plasma)
Oxygen saturation (%)
Oxygen tension PO2 (mmHg)
CEREBROSPINAL FLUID
Cells
Chloride
Glucose
pH
Pressure
Protein, lumbar
Albumin
a1-globulins
a2-globulins
b-globulins
g-globulins
Protein, cisternal
Protein, ventricular

< 5/mm3, all lymphocytes


600 - 700 mg/dl
45- 75 mg/dl or
60% of serum glucose
7.34 - 7.43
50-180 mm H2O
15 - 45 mg/dl
58%
9%
8%
10%
10% (5-12%)
15 - 25 mg/dl
5 - 15 mg/dl

CHEMICAL CONSITUTENTS OF BLOOD


Antistreptolysin titre
Acetoacetate
Acid phosphatase
Acid phosphatase, prostatic
Aldolase

150 - 200 units/ml


0.2 - 2.0 mg/dl
0.5 - 12.0 Bodansky units/dl
2.5 - 12.0 IU/L
1.0 - 6.0 IU/L

Alkaline phosphatase
Child
Adult
Alpha - 1 antitrypsin
Ammonia 10-80 g/dl
Amylase
Ascorbic acid
Bilirubin
Adult
Newborn
At 3 days
Carbon dioxide, total
Caeruloplasmin
Males
Females
Copper
Creatinine phosphokinase, total

5 - 12 Bodansky units/dl
1.4 - 4 Bodansky units/dl
200 - 500 mg/dl
3 - 10 Wohlgemuth units/dl
0.4 - 1.5 mg/dl
0.3 - 1.1 mg/dl
0.4 - 4.0 mg/dl
1.0 - 10.0 mg/dl
18 3.0 mEq/L
36.0 5.6 mg/dl
40.9 6.8 mg/dl
75 - 160 g/dl
0 - 3.4 micromoles/dl

(Duma modification of Hughes method)


Creatinine phosphokinase isoenzymes
MM fraction
MB fraction
BB fraction
Creatinine
Delta amino laevulinic acid
Electrolytes (ISE Analyser)
Potassium
Sodium
Chlorides
Calcium
(Delhi and Ellingboe)

94-95%
0-5%
0-2%
0.6 - 1.4 mg/dl
200 g/dl
3.5 - 4.5 mEq/L
135 - 140 mEq/L
98-110 mEq/L
9-10.5 mg/dl

Phosphorus (Fiskee and Subbarow)


Child
Adult

1.1 - 1.65 mmol (2.2 - 3.3 mEq)/L


3-4.5 mg/dl
0.55 - 1.1 mmol (1.1 - 2.2 mEq)/L

Gamma glutamyl transpeptidase (Rosalki's method)


Male
Female
Gastrin
Glucose, fasting
(GOD-POD method)
Glucose 6-phosphate dehydrogenase
G6-PD screen, qualitative
Immunoglobulin, quantitative (adults)
IgG
IgE
IgA
IgM
Males
Females
IgD
(Ramsay's method)
Insulin, fasting
Iron

45 U/L
35 U/L
60 - 200 pg/ml
70 - 110 mg/dl
5-10 IU/g Hb
Negative
570 - 1920 mg/dl
< 0.025 mg/dl
70 - 400 mg/dl
30 - 250 mg/dl
30 - 300 mg/dl
0 - 40 mg/dl
6 - 25 U/ml
60 - 140 g/dl

Iron binding capacity


(Ramsay's method)
Lactic acid
Lipidogram
Cholesterol
Triglycerides
Phospholipids
Free fatty acids
Chylomicrons
Beta lipoprotein
Pre-beta lipoprotein
Alpha lipoprotein
LDH

250 - 450 g/dl


5-15 mg/dl
140 - 220 mg/dl
10 - 160 mg/dl
150 - 350 mg/dl
< 18 mg/dl
Absent
60 - 75%
8 - 20%
13 - 24%
70 - 240 IU/L

LDH isoenzymes (Colorimetric method of King)


LDH1
LDH2
LDH3
LDH4
LDH5
Lipase
Magnesium
Osmolality
Phenosulphonphthalein
Phenylalanine
Protein, total
Albumin
Globulin
Protein electrophoresis
Alpha - 1
Alpha - 2
Beta
Gamma
SGOT (AST)
SGPT (ALT)
Sulphate
Urea
Urea nitrogen
Uric acid
Viscosity
(Serum compared to H2O)
Vitamin A
Vitamin B12

20 - 34%
28 - 41%
15 - 25%
8-16%
6-15%
0-160 U/L
1.7 - 2.6 mg/dl
278 - 305 Osm/kg serum water
25% excreted within 15 min after injection of 1
ml dye
3 mg/dl
6.3 - 7.9 g/dl
3.5 - 5.3 g/dl
1.8 - 3.6 g/dl
0.2 - 0.4 g/dl
0.5 - 0.9 g/dl
0.6 - 1.2 g/dl
0.7 - 1.7 g/dl
8 - 40 Karmen units/dl
0 - 40 Karmen units/dl
0.5 - 1.5 mg/dl
15 - 45 mg/dl
7 - 21 mg/dl
2.5 - 7.0 mg/dl
1.4 - 1.8 mg/dl
0.15 - 0.60 g/dl
200 - 850 g/dl

FUNCTION TESTS
Circulation
Arteriovenus oxygen difference: 30-50 ml/L
Cardiac output (Fick) : 2.5-3.6 L/m2 body surface area per min
Contractility indexes
Maximum left ventricular dp/dt: 1650 300 mmHg/s
Maximum (dp/dt)/p : 44 + 8.4s-1
(dp/dt)/DP at DP = 40 mmHg : 37.6 12.2s-1 (DP = diastolic pressure)
Mean normalised systolic ejection rate (angiography) : 3.32 0.84 end-diastolic volumes per second
Mean velocity of circumferential fibre shortening (angiography) : 1.66 0.42 circumferences per second
Ejection fraction, stroke volume/end-diastolic volume (SV/EDV): Normal range : 0.55-0.78; average : 0.67

End-diastolic volume : 75 15 ml/m2


End-systolic volume : 25 8 ml/m2
Left ventricular work
Stroke work index : 30-110 (g.m)/m2
Left ventricular minute work index : 1.8-6.6 (kg.m)/m2/min
Oxygen consumption index : 110-150 ml
Pressures, intracardiac and intraarterial
Pulmonary vascular resistance : 2-12 (kPa.s)/L (20-120 (dyn.s/cm 2)
Systemic vascular resistance : 77-150 (kPa.s)/L (770-1500 dyn.s)/cm 2)
Gastrointestinal
Absorption tests
D-xylose absorption test : After an overnight fast, 25 g xylose is given in aqueous solution by mouth. Urine
collected for the following 5 h should contain 33-53 mmol (5-8 g) (or > 20 percent of ingested dose). Serum
xylose should be 1.7-2.7 mmol/L l h after the oral dose (25-40 mg per 100 ml).
Vitamin A absorption test : A fasting blood specimen is obtained and 200,000 units of vitamin A in oil is given
by mouth. Serum vitamin A levels should rise to twice fasting level in 3-5 h.
Bentiromide test (pancreatic function): 500 mg bentiromide (Chymex) orally; p-aminobenzoic acid (PABA)
measured in plasma and/or urine.
Plasma : 3.6 ( 1.1) mg/L at 90 min
Urine : 50 percent recovered in 6 h
Gastric juice
Volume
24 h : 2-3 L
Nocturnal : 600-700 ml
Basal fasting : 30-70 ml/h
Conversion factor for SI
Reaction
pH : 1.6-1.8
Titratable acidity of fasting juice : 4.9 mol/s (15-35 mEq/h)
0.261
Acid output
Basal
Females (mean 1 SD) : 0.6 0.5 mol/s (2.0 1.8 mEq/h)
0.2778
Maximal (after subcutaneous histamine acid
phosphate 0.004 mg/kg body weight and
preceded by 50 mg promethazine or after
betazole 1.7 mg/kg body weight or
pentagastrin 6 g/kg body weight):
Females (mean 1 SD) : 4.4 1.4 mol/s
0.2778
(16 5 mEq/h)
Males (mean 1 SD) : 6.4 1.4 mol/s
0.2778
(23 5 mEq/h)
Basal acid output/maximal acid output ratio : 0.6 or less
Gastrin, serum : 40-200 ng/L (40-200 pg/ml)
Secretin test (pancreatic exocrine function ) : 1 unit per kg body weight, intravenously
Volume (pancreatic juice): 2.0 ml/kg in 80 min

Bicarbonate concentration : 80 mmol/L (80 mEq/L)

Bicarbonate output : 10 mmol in 30 min (10 mEq in 30 min)

Haematology
Haemogram
Total erythrocyte count
Males
Females
Haemoglobin
Males
Females
Packed cell volume
Males
Females
Mean corpuscular volume
Mean corpuscular haemoglobin
Mean corpuscular haemoglobin
concentration 30-35%
Total leucocyte count
Differential count
Neutrophils
Eosinophils
Lymphocytes
Monocytes
Platelets
Reticulocyte count
Erythrocyte sedimentation rate
(Westergen)
Male
Female
Blood volume
Average plasma volume

4.5 - 5.5 millions/cmm


4.1 - 4.8 millions/cmm
14.5 - 16.5 g/dL
12.0 - 14.5 g/dL
38 - 50%
34 - 43%
78 - 94 c
24 - 33 g
4000 - 11000/cmm
60 - 70%
1 - 7%
20 - 30%
1- 6%
150, 000 - 450,000/cmm
0.5 - 2% of erythrocytes
0 - 15 mm at end of 1 h
0 - 20 mm end of 1 h
45 5 ml/kg body weight
1487 112 ml/sq meter body
surface

Erythrocyte osmotic fragility test


Increased fragility

Lysis of RBCs seen with over


0.5% of sodium chloride;
haemolysis incomplete in
0.3% sodium chloride

Coagulation studies
Bleeding time (Ivys method)
Coagulation time (Lee and White)
One-stage prothrombin time (Quick)
Clot retraction
Euglobulin lysis time
Fibrin degradation products
Fibrinogen
Activated partial thromboplastin
Time (PTT)
Thrombin time
Whole blood clot lysis time

1.7 min
4 - 8 min
Control 1 sec
40 - 65%
120 - 240 min
10 g/dl
200 - 400 mg/dl
24 - 35 sec
9 - 10 sec (control + 3 sec)
< 24 hours

Bone marrow study Normal percentage (range)


WBC reticulum cells
Blasts
Promyelocytes
Myel-neutro
Myel-eosino

0.2 (0.1 - 2.0)


2.0 (0.3 - 5.0)
5.0 (1.0 - 8.0)
12.0 (5.0 - 21.0)
1.5 (0.5 - 3.0)

Myel-baso
Metamyelocytes

0.3 (0.0 - 0.5)


11.0 (6.0 - 17.0)
11.0 (7.0 - 15.0)
20.0 (7.0 - 15.0)
20.0 (0.5 - 4.0)
0.2 (0.0 - 0.7)
10.0 (3.0 - 17.0)
0.4 (0.0 - 2.0)
2.0 (0.5 - 5.0)
0.4 (0.03 - 3.0)
4.0 (1.0 - 8.0)

Stab forms
PMN neutrophils
PMN eosinophils
PMN basophils
Lymphocytes
Plasma cells
Monocytes
Megakaryocytes
RBC : Pronormoblasts
Normoblasts
Basophilic
1.4 (0.5 - 2.4)
Polychromatophilic
18.0 (7.0 - 32.0)
Orthochromatic
2.0 (0.4 - 4.6)
Unclassified cells
0.3 (0.0 - 0.9)
M : E ratio
3.5 : 1
Haemoglobin studies (normal and
abnormal)
Haemoglobin A1
0.5% of total Hb
Haemoglobin A1C
Up to 6% of total Hb
Haemoglobin A2
1.5 - 3.5% of total Hb
Haemoglobin, foetal 0-2% of
total Hb
Haemoglobin, plasma
0-5% of total Hb
Haemoglobin, serum
2-3 mg/dl
Methaemoglobin
< 1.8%
Haptoglobin, serum
100 - 300 mg/dl
Haemochromogens, plasma
3-5 mg/dl
Haemolysis test
Acid haemolysis test (Ham) No haemolysis
Cold haemolysis test
(Donath - Landsteiner)
No haemolysis
Erythrocyte life-span
Normal
120 days
51
Cr - labeled half-life
28 days
Iron turnover rate (plasma)
29 - 42 mg/24 h
Osmotic fragility
Haemolysis begins
0.45 - 0.38 NaCl
Haemolysis completed
0.33 - 0.30 NaCl
Corrected rate
Reticulocyte index =
2
Reticulocyte index correction factor
Corrected
Observed rate x patients haematocrit
rate =
Normal haematocrit (45)
Haematocrit
Correction factor
45
1.00
40
0.71
35
0.52
30
0.38
25
0.28
20
0.20
15
0.13
Note : Reticulocyte index = percent reticulocytes x correction factor haematocrit and early bone marrow release
Schilling test : 7-40% of orally administered radiolabelled vitamin B12 excreted in urine after flushing with
intramuscular injection of B12
Hormones and metabolites

Adrenocorticortropin (ACTH), serum


15 - 70 pg/ml
Aldosterone, serum
210 mEq/day sodium diet
Supine
48 29 pg/dl
Upright (2 h)
65 23 pg/dl
110 mEq/day sodium diet
Supine
107 45 pg/dl
Upright (2 h)
532 228 pg/dl
Urine
5 - 19 g/24 h
Calcitonin, serum
None detectable
Catecholamines, free urinary
110 ug/24 h
Cortisol, serum
8 AM
5 - 25 g/dl
8 PM
5 - 25 ug/dl
Cosyntropin stimulation
(30-90 min after 0.25 mg cosyntropin intramuscularly or 10 g/dL rise over
intravenously)
baseline
Overnight suppression (8 AM) (serum cortisol after 1 mg
5 g/dl
dexamethasone orally at 11 pm)
Urine
20 - 70 g/24 h
11-deoxycortisol, serum, basal
< 0 - 1.4 g/dl
Metyrapone stimulation (30 mg/dl orally 8 h prior)
> 1.5 g/dl
Oestrogens, urine (increased during pregnancy, decreased after menopause)
Males
4 - 25 g/24 h
1 - 11 g/24 h
0 - 6 g/24 h
3 - 8 g/ 24 h

Total
Oestriol
Oestradiol
Oestrone
Oestriocholanolone, serum

Females
5 - 100 g/24 h
0 - 65 g/24 h
0 - 14 g/24 h
4 - 31 g/24 h
1.2 g/24 h

Follicle-stimulating hormone, serum


Males
Females
Follicular phase
Peak midcycle
Luteal phase
Postmenopausal

6 - 18 U/dl
5 - 20 U/dl
12 - 30 U/dl
5 - 15 U/dl
50 U/dl

Free thyroxine index, serum


Adult, fasting
Glucose load (100 g orally)

5 ng/dl
< 5 ng/dl

Levodopa stimulation (500 mg orally in a fasting state) baseline within 2 h


17-hydroxycorticosteroids, urine
Males
Females

2 - 12 mg/24 h
2 - 8 mg/24 h

5-hydroxyindoleacetic acid
(5-HIAA), urine
Insulin, plasma
Fasting
Hypoglycaemia

2- 9 mg/24 h
6 - 126 U/ml
< 5 U/ml

17-ketogenic steroids, urine


Under 8 years
Adolescent
Adult males
females
Metanephrine, urine
Norepinephrine, urine
Parathyroid hormone, serum
Radioactive iodine 131I uptake
(RAIU)
Renin activity, plasma
Normal diet
Supine
Upright
Low-sodium diet
Supine
Upright
Diuretics and lowsodium diet
Testosterone
Total plasma bound
Adolescent males
Adult
males
Females
Unbound
Adult
males
Females 0.09 - 1.30
mg/dl
Thyroid-stimulating hormone,
serum
Thyroxine (T4), serum
Total
Free
Thyroxine-binding globulin
capacity, serum
Thyroxine index, free
Tri-iodothyronine (T3), serum
T3 resin uptake
Vanillyl mandelic acid (VMA),
urine

0-2 mg/24 h
0-18 mg/24 h
8-18 mg/24 h
5-15 mg/24 h
1.3 mg/24 h
100 mg/24 h
150-300 pg/ml
(varies with serum
calcium)
5-25% at 24 h
(varies with iodine
intake)
1.1 0.8 mg/dl
1.9 1.7 mg/dl
2.7 1.8 mg/dl
6.6 2.5 mg/dl
10.0 3.7 mg/dl

100 mg/dl
300 - 100 mg/dl
25 - 90mg/dl
3 - 24 mg/dl
< 10 U/ml
4.5 - 11.5 g/dl
0.8 - 2.4 /dl
15 - 25 g T4/dl
1-4 mg/dl
70-190 mg/dl
25 - 45%
1-8 g/24 h

Renal function tests


Anion gap
Na+ - (HCO-3 + Cl-)
10 2 mEq/dL
Osmolality
Osmolality (serum) = 2 Na+ (mEq/L) +
BUN (mg/dl)
Glucose (mg/dl)
+
2.8
18
Bicarbonate deficit
HCO-3 deficit = body weight (kg) x 0.4 (desired HCO-3 - observed HCO-3)
Ucr x V
Creatinine clearance
Pcr
= 130 20 ml/min in males
= 120 15 ml/min in females
where

Ucr = Urine creatinine (mg/dl)


Pcr = Plasma creatinine (mg/dl)
V = Urine volume/(ml) 24 h
Renal plasma flow
RPF =

Upah X V
ppah

= 700 100 ml/min in males


= 600 100 ml/min in females
where
Upah = Urine para-aminohippuric acid
V = Urine volume/24 h
ppah = Plasma para-aminohippuric acid
Summary of values useful in pulmonary physiology
Pulmonary mechanics
Spirometry : volume-time curves
Forced vital capacity
Forced expiratory volume 3.0 litres
in 1 s
FEV1/FVC
Maximal midexpiratory flow
Maximal expiratory flow rate
Spirometry: flow-volume curves
Maximal expiratory flow 5.5 litres per second
at 50% of expired vital capacity
Maximal expiratory flow 3.0 litres per second
at 75% of expired vital capacity
Resistance to airflow
Pulmonary resistance
Airway resistance
Specific conductance
Pulmonary compliance
Static recoil pressure 25 5 cm H2O
at total lung capacity
Compliance of lungs (static)
Compliance of lungs 0.1 L/cm H2O
and thorax
Dynamic compliance of 0.25 0.05 litres
20 breaths per minute
Maximal static respiratory pressures
Maximal inspiratory pressure
Maximal expiratory pressure

Normal values
4.0 litres
75%
4.0 litres per second
8.0 litres per second

< 3.0 cm H2O/s per


litre
< 2.5 cm H2O/s per
litre
> 0.13 cm H2O/s

0.2 L/cm H2O

per cm H2O
> 90 cm H2O
> 150 cm H3O

Lung volumes
Total lung capacity
Functional residual capacity
Residual volume
Inspiratory capacity
Expiratory reserve volume
Vital capacity

6-7 litres
2-3 litres
1-2 litres
4.5 litres
3.2 litres
4-5 litres

Gas exchange (sea level)


Arterial O2 tension

95 5 mmHg

Arterial CO2 tension


Arterial O2 saturation
Arterial blood pH
Arterial bicarbonate
Base excess
Diffusing capacity for 25 ml co/min/mmHg
carbon monoxide (single breath)
Dead space volume
Physiologic dead space :
dead spacetidal volume ratio (rest) (exercise)
Alveolar-arterial difference for O2

40 2 mmHg
97 2%
7.40 0.02
24 2 mmol/L
0 2 mmol/L
50 25 ml
35% VT
20% VT
20 mmHg

Semen
Liquefaction
Morphology
Motility
pH
Spermatocrit
Spermatocyte count
Volume

Complete in 15 min
60% normal forms
75% motile forms
7.2 - 8.0
10%
50 million/dl
2.0 - 6.6 ml

Stool
Bulk
Wet weight
Dry weight
Coproporphyrin
Fat (on a diet containing
30 g fat/day)
Nitrogen
Urobilinogen
Water

< 197 g/24 h


< 66.4 g/24 h
12 - 832 mg/24 h
< 7.2 g/24 h or 30%
dry weight
< 2.2 g/24 h
40 - 280 mg/24 h
Approximately 65%

Synovial fluid
Cells
Polymorphonuclear cells
Crystals
Fibrin clot
Glucose
Hyaluronic acid
pH
Protein
Albumin
a1-globulins
a2-globulins
b-globulins
g-globulins
Relative viscosity
Uric acid

200 cells/mm3
25%
None
None
Same as serum
2.45 - 3.97 g/L
7.32 - 7.64
2.5 g/dL
63%
7%
7%
9%
14%
300
Same as serum

Urine
Acidity, titrable
Ammonia
Amylase
Bence-Jones protein
Bilirubin
Calcium :
Normal diet
Low-calcium diet
Chloride
Copper
Creatinine
Adults
Children
Creatinine
Glucose
Qualitative
Quantitative
Haemoglobin
Homogentisic acid
Iron
Lead
Myoglobin
Osmolality
pH
Phenylpyruvic acid, quantitative
Phosphorus
Porphobilinogen
Qualitative
Quantitative
Porphyrin
Coproporphyrin
Uroporphyrin
Potassium
Protein
Qualitative
Quantitative
Sodium
Specific gravity
Uric acid
Urobilinogen

20-40 mEq/24 h
20 - 50 mEq/24 h
25 - 260 Somogyi unit/h
None detected
None detected
0.05 - 0.31 mEq/kg body weight/24 h
150 mg/24 h
120 - 240 mEq/24 h
(varies with dietary intake)
0-32 g/24 h
0 - 200 mg in 24 h
7 - 11 mg in 24 h
1.0 - 1.6 g/24 h or
15-25 mg/kg
body weight/24 h
None detected
16-300 mg/24 h
None detected
None detected
40 - 140 g/24 h
0 - 120 g/24 h
None detected
50 - 1200 mOsm/L
4.6 - 8.0
None detected
0.8 - 2.0 g/24 h
None detected
0-2.4 mg/24 h
50 - 250 g/24 h
10 - 30 g/24 h
25 - 100 mEq/24 h
Non detected
10 - 150 mg/24 h
10 - 150 mEq/24 h
(varies with dietary sodium intake)
1.003 - 1.030
600 - 700 mg/24 h
1.0 Enrich units/24 h