LABORATORY VALUES

PYRAMID POINTS

Explain purpose of test to client Obtain informed consent if required Inform client of specific test preparation Initiate standard (universal) or other precautions as necessary Maintain asepsis Instruct client in post-test procedures & need for follow-up

PYRAMID POINTS

Note if the laboratory value is abnormal Monitor for signs & symptoms that occur as a result of the abnormality Report the significant results to the physician Initiate prescribed interventions based on the laboratory results Document the effectiveness of interventions & follow-up laboratory studies

VENIPUNCTURE SITES

From Leahy, J. & Kizilay, P. (1998). Foundations of nursing practice. Philadelphia: W.B. Saunders, p. 814. (Figure 28-10)

NORMAL ADULT ELECTROLYTE VALUES

Sodium: 135 to 145 mEq/L Potassium: 3.5 to 5.1 mEq/L Chloride: 98 to 107 mEq/L Bicarbonate (venous): 22 to 29 mEq/L

ELECTROLYTES: SERUM SODIUM (Na)

DESCRIPTION

Maintains osmotic pressures & acid-base balance & assists in transmission of nerve impulses Drawing blood samples proximal to an IV infusion of sodium chloride will falsely elevate results

NURSING CONSIDERATION

ELECTROLYTES: SERUM POTASSIUM (K)

A major intracellular cation that regulates cellular H2O balance, electrical conduction in muscle cells, & acid-base balance The body obtains K through dietary ingestion, & the kidneys either preserve or excrete K depending on cellular need K levels are used to evaluate cardiac function, renal function, gastrointestinal (GI) function, & the need for IV replacement therapy

ELECTROLYTES: SERUM POTASSIUM (K)

NURSING CONSIDERATIONS

Use of a tourniquet & pumping the hand prior to venous sampling can increase the value Do not draw blood from a site where an IV infusion exists If the client is receiving K, note on the laboratory form Clients w/ elevated white blood cell counts & platelet counts may have falsely elevated K levels

ELECTROLYTES: SERUM CHLORIDE

DESCRIPTION

Functions in counterbalancing cations such as sodium & acts as a buffer during oxygen & carbon dioxide exchange in red blood cells Aids in digestion & maintaining osmotic pressure & water balance

ELECTROLYTES: SERUM CHLORIDE

NURSING CONSIDERATIONS

Draw blood from an extremity that does not have saline infusing into it Do not allow the client to clench/unclench the hand prior to the blood draw Any condition accompanied by prolonged vomiting, diarrhea, or both will alter levels

NORMAL VALUES: COAGULATION STUDIES

Activated partial thromboplastin time (aPTT)

20 to 36 seconds depending on the type of activator used Adult male, 9.6 to 11.8 seconds Adult female, 9.5 to 11.3 seconds

Prothrombin time (PT)

NORMAL VALUES: COAGULATION STUDIES

International normalized ratio (INR)

2.0 to 3.0 for standard warfarin sodium (Coumadin) therapy 3.0 to 4.5 for high dose warfarin sodium (Coumadin) therapy

Clotting time: 8 to 15 minutes Platelet count: 150,000 to 400,000 cells/L

ACTIVATED PARTIAL THROMBOPLASTIN TIME (aPTT)

DESCRIPTION

Most commonly used to monitor heparin therapy & screen for coagulation disorders Screens for deficiencies & inhibitors of all factors except VII & XIII

ACTIVATED PARTIAL THROMBOPLASTIN TIME (aPTT)

NURSING CONSIDERATIONS

If the client is on intermittent heparin therapy, draw the blood sample one hour prior to the next scheduled dose Do not draw samples from an arm in which heparin is infusing Transport specimen to laboratory immediately The aPTT should be between 1.5 & 2.5 times the normal when the client is on heparin therapy; if the value is prolonged, initiate bleeding precautions

PROTHROMBIN TIME (PT) & INTERNATIONAL

NORMALIZED RATIO (INR)

DESCRIPTION

Prothrombin is a vitamin K-dependent glycoprotein produced by the liver that is necessary for firm fibrin clot formation Each laboratory establishes a normal value or control based on the method used to perform the test (PT)

PROTHROMBIN TIME (PT) & INTERNATIONAL NORMALIZED RATIO (INR)

DESCRIPTION

The PT measures the amount of time it takes for clot formation & is used to monitor response to warfarin sodium (Coumadin) therapy or to screen for dysfunction of the extrinsic system resulting from liver disease, vitamin K deficiency, or disseminated intravascular coagulation (DIC)

PROTHROMBIN TIME (PT) & INTERNATIONAL NORMALIZED RATIO (INR)

DESCRIPTION

A PT value w/in 2 seconds (plus or minus) of the control is considered normal The INR standardizes the PT ratio & is calculated in the laboratory setting by raising the observed PT ratio to the power of the International Sensitivity Index specific to the thromboplastin reagent used

PROTHROMBIN TIME (PT) & INTERNATIONAL NORMALIZED RATIO (INR)

NURSING CONSIDERATIONS

A baseline PT should be drawn before starting anticoagulation therapy Note the time of collection on the laboratory form Provide direct pressure to the site for 3 to 5 minutes if a coagulation defect is present Concurrent warfarin sodium (Coumadin) therapy w/ heparin therapy can lengthen the PT for up to 5 hours after dosing

PROTHROMBIN TIME (PT) & INTERNATIONAL NORMALIZED RATIO (INR)

NURSING CONSIDERATIONS

Diets high in green leafy vegetables can increase the absorption of vitamin K, which shortens the PT A PT greater than 30 seconds places the client at risk for hemorrhage Oral anticoagulation therapy usually maintains the PT at 1.5 to 2 times the laboratory control value

CLOTTING TIME

DESCRIPTION

Measures the time required for the interaction of all factors involved in the clotting process The client should not receive heparin therapy for 3 hours prior to specimen collection The test result is prolonged by any anticoagulant therapy, test tube agitation, or high temperature changes that may affect the specimen

NURSING CONSIDERATIONS

PLATELET COUNT

DESCRIPTION

Platelets are produced by the bone marrow to function in hemostasis Monitor for bleeding in clients w/ known thrombocytopenia High altitudes, chronic cold weather, & exercise increase platelet counts Bleeding precautions should be instituted in clients w/ a low platelet count

NURSING CONSIDERATIONS

NORMAL VALUES: GASTROINTESTINAL STUDIES

Albumin: 3.4 to 5 g/dL Alkaline phosphatase: 4.5 to 13 King-Armstrong units/dL Ammonia: 35 to 65 g/dL

NORMAL VALUES: GASTROINTESTINAL STUDIES

Amylase: 24 to 151 IU/L Bilirubin Direct: 0 to 0.3 mg/dL Indirect: 0.1 to 1.0 mg/dL Total: less than 1.5 mg/dL Lipase: 10 to 140 U/L

NORMAL VALUES: GASTROINTESTINAL STUDIES

Lipids

Cholesterol: 140 to 199 mg/dL Low-density lipoprotein (LDL): less than 130 mg/dL High-density lipoprotein (HDL): 30 to 70 mg/dL Triglycerides: less than 200 mg/dL

Protein: 6.0 to 8.0 g/dL

NORMAL VALUES: GASTROINTESTINAL STUDIES

Uric acid

Male: 4.5 to 8 mg/dL Female: 2.5 to 6.2 mg/dL

ALBUMIN

A main plasma protein of blood

Maintains oncotic pressure & transports bilirubin, fatty acids, medications, hormones, & other substances that are insoluble in water Draw from an extremity the does not have an IV infusing into it Instruct the client to consume a low-fat diet on the day of the test

NURSING CONSIDERATIONS

ALKALINE PHOSPHATASE

An enzyme normally found in bone, liver, intestine, & placenta

The level rises during periods of bone growth, liver disease, & bile duct obstruction The client may need to fast 10 to 12 hours prior to the test Hepatotoxic medications administered w/in 12 hours prior to specimen collection invalidate the test Transport specimen to laboratory immediately

NURSING CONSIDERATIONS

AMMONIA

DESCRIPTION

A waste product from nitrogen breakdown during protein metabolism Metabolized by the liver & excreted by the kidneys as urea Elevated levels due to hepatic dysfunction may lead to encephalopathy Not a reliable indicator of hepatic coma

AMMONIA

NURSING CONSIDERATIONS

Instruct client to fast, except for water, & refrain from smoking for 8 to 10 hours prior to the test Place the specimen in an ice water bath Transport to the laboratory immediately

AMYLASE

An enzyme produced by the pancreas & salivary glands that aids in the digestion of complex carbohydrates & is excreted by the kidneys

In acute pancreatitis, the amylase level is greatly increased; the level starts rising in 3 to 6 hours after the onset of pain, peaks at about 24 hours, & returns to normal in 2 to 3 days after the onset of pain

AMYLASE

NURSING CONSIDERATIONS

List medications that the client has taken 24 hours prior to the test on the laboratory form Note that many medications may cause false-positive or false-negative results Results are invalidated if the specimen was obtained less than 72 hours after cholecystography w/ radiopaque dyes

BILIRUBIN
Produced by the liver, spleen, & bone marrow & is also a by-product of hemoglobin breakdown Total bilirubin levels can be broken down into direct bilirubin, which is primarily excreted via the intestinal tract, & indirect bilirubin, which circulates primarily in the bloodstream Total bilirubin levels rise w/ any type of jaundice, whereas direct & indirect levels rise depending on the etiology of the jaundice

BILIRUBIN

BILIRUBIN

NURSING CONSIDERATIONS

Instruct the client to eat a diet low in yellow foods such as carrots, yams, yellow beans, & pumpkins for 3 to 4 days before sampling Instruct the client to fast for 4 hours before sampling Note that results will be elevated w/ the use of alcohol, morphine, theophylline, ascorbic acid, & aspirin Note that results are invalidated if the client received a radioactive scan w/in 24 hours prior to the test

LIPASE

DESCRIPTION

A pancreatic enzyme that changes fats & triglycerides into fatty acids & glycerol Elevated lipase levels occur in pancreatic disorders; elevations may not occur until 24 to 36 hours after the onset of illness & may remain elevated for up to 14 days

LIPASE

NURSING CONSIDERATIONS

Endoscopic retrograde cholangiopancreatography (ERCP) may increase lipase activity Traumatic venipuncture can inhibit lipase activity

LIPIDS

Blood lipids consist primarily of cholesterol, triglycerides, & phospholipids Lipid assessment includes total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), & triglycerides Cholesterol is present in all body tissues & is a major component of low-density lipoproteins (LDL), brain & nerve cells, cell membranes, & some gallstones

LIPIDS
Triglycerides comprise a major part of very low-density lipoproteins (VLDL) & a small part of low-density lipoproteins (LDL) Triglycerides are synthesized in the liver from fatty acids, protein, & glucose, & are obtained from the diet

LIPIDS

NURSING CONSIDERATIONS

Oral contraceptives may increase the levels of lipids in the serum Instruct the client to fast from foods & fluids, except for water, for 12 to 14 hours & from alcohol for 24 hours prior to the test Instruct the client that the evening meal prior to the test should be free from high-cholesterol foods Cholesterol levels tend to decrease temporarily w/ major illness or surgery

PROTEIN

Reflects the total amount of albumin & globulins in the serum Regulates osmotic pressure & is comprised of coagulation factors for hemostasis, enzymes, hormones, tissue growth & repair, & pH buffers Do not draw in an extremity w/ an IV infusion Instruct the client to avoid a high-fat diet for 8 hours prior to the test

NURSING CONSIDERATIONS

URIC ACID

Elevated amounts deposit in joints & soft tissue & cause gout Conditions of fast cell turnover, as well as slowed renal excretion of uric acid, may cause uricemia Elevated amounts of urinary uric acid precipitate into urate stones in the kidneys

NURSING CONSIDERATIONS

Instruct the client to fast for 8 hours prior to the test Aminophylline, caffeine, & vitamin C may cause falsely elevated results

NORMAL VALUES: GLUCOSE STUDIES

Fasting blood glucose: 70 to 110 mg/dL Glucose monitoring (capillary blood): 60 to 110 mg/dL Glycosylated hemoglobin

Values are expressed as a % of the total Hgb Diabetic w/ good control: 7.5% or less Diabetic w/ fair control: 7.6 to 8.9% Diabetic w/ poor control: 9% or greater

NORMAL VALUES: GLUCOSE STUDIES

GLUCOSE TOLERANCE TEST, ORAL

Baseline fasting: 70 to 110 mg/dL 30 minute fasting: 110 to 170 mg/dL 60 minute fasting: 120 to 170 mg/dL 90 minute fasting: 100 to 140 mg/dL 120 minute fasting: 70 to 120 mg/dL Glucose, 2 hour postprandial: < 140 mg/dL

FASTING BLOOD GLUCOSE (FBS)

Glucose is a monosaccharide found in fruits & is formed from the digestion of carbohydrates & the conversion of glycogen by the liver Glucose is the bodys main source of cellular energy & is essential for brain & erythrocyte function FBS levels are used to help diagnose diabetes mellitus & hypoglycemia

FASTING BLOOD GLUCOSE (FBS)

NURSING CONSIDERATIONS

Instruct the client to fast for 8 to 12 hours prior to the test Instruct the client w/ diabetes mellitus to w/hold morning insulin or oral hypoglycemic medication until after the blood is drawn

GLYCOSYLATED HEMOGLOBIN

Glycosylated hemoglobin is blood glucose bound to hemoglobin HbA1c (glycosylated hemoglobin A) is a reflection of how well blood glucose levels have been controlled for up to the prior 4 months Hyperglycemia in diabetics is usually a cause of an increase in HbA1c
Fasting is not required prior to the test

NURSING CONSIDERATION

GLUCOSE TOLERANCE TEST (GTT)

DESCRIPTION

Aids in the diagnosis of diabetes mellitus If the glucose levels peak at higher than normal at 1 & 2 hours after injection or ingestion of glucose & are slower than normal to return to fasting levels, then diabetes mellitus is confirmed

GLUCOSE TOLERANCE TEST (GTT)

NURSING CONSIDERATIONS

Instruct the client to eat a highcarbohydrate (200 to 300 g) diet for 3 days before the test Instruct the client to avoid alcohol, coffee, & smoking for 36 hours before testing Instruct the client to fast for 10 to 16 hours prior to the test

GLUCOSE TOLERANCE TEST (GTT)

NURSING CONSIDERATIONS

Instruct the client to avoid strenuous exercise for 8 hours before & after the test Instruct the client w/ diabetes mellitus to w/hold morning insulin or oral hypoglycemic medication Instruct the client that the test will take 3 to 5 hours, requires intravenous or oral administration of glucose, & multiple blood samples

NORMAL VALUES: RENAL FUNCTION STUDIES

Serum creatinine: 0.6 to 1.3 mg/dL Blood urea nitrogen (BUN): 8 to 25 mg/dL

SERUM CREATININE

DESCRIPTION

A very specific indicator of renal function, revealing the balance between creatinine formation & excretion Increased levels indicate a slowing of the glomerular filtration rate

NURSING CONSIDERATION

Instruct the client to avoid excessive exercise for 8 hours & avoid excessive red meat intake for 24 hours before the test

BLOOD UREA NITROGEN (BUN)

Urea is normally freely filtered through the renal glomeruli, w/ a small amount reabsorbed in the tubules & the remainder excreted in the urine Elevated values may be a result of prerenal, renal, or postrenal causes Both creatinine levels & urea nitrogen levels should be analyzed when evaluating renal function

NURSING CONSIDERATION

NORMAL VALUES: SERUM ENZYMES/CARDIAC MARKERS

Creatine kinase (CK): 26 to 174 U/L CK isoenzymes

CK-MB: 0 to 5% of total CK-MM: 95 to 100% of total CK- BB: 0%

NORMAL VALUES: SERUM ENZYMES/CARDIAC MARKERS

Troponins

Troponin I: less than 0.6 ng/mL; greater than 1.5 ng/mL is consistent w/ a myocardial infarction Troponin T: greater than 0.1 to 0.2 ng/mL is consistent w/ a myocardial infarction

NORMAL VALUES: SERUM ENZYMES/CARDIAC MARKERS

Lactate dehydrogenase (LDH): 70 to 200 IU/L LDH isoenzymes

LDH LDH LDH LDH LDH

1: 2: 3: 4: 5:

14 to 26 % 29 to 39 % 20 to 26 % 8 to 16 % 6 to 16 %

CREATINE KINASE (CK)

An enzyme found in muscle & brain tissue & reflects tissue catabolism due to cell trauma The test is performed to detect myocardial or skeletal muscle damage or central nervous system damage Isoenzymes include CK-MB (cardiac), CK-BB (brain), & CK-MM (muscles) CK-MB is found mainly in cardiac muscle, CK-BB is found mainly in brain tissue, & CK-MM is found mainly is skeletal muscle

CREATINE KINASE (CK)

NURSING CONSIDERATIONS

If the test is to evaluate skeletal muscle, instruct the client to avoid strenuous physical activity for 24 hours prior to the test Instruct the client to avoid ingestion of alcohol for 24 hours prior to the test Invasive procedures & IM injections may falsely elevate CK levels

TROPONINS

Troponin is a regulatory protein found in striated muscle The troponins function together in the contractile apparatus for striated muscle in skeletal muscle & in the myocardium Increased amounts of troponins are released into the bloodstream when an infarction causes damage to the myocardium Serial measurements are important to compare to a baseline test Client does not need to fast

NURSING CONSIDERATION

LACTATE DEHYDROGENASE (LD OR LDH)

The isoenzymes that are particularly affected w/ acute myocardial infarction are the LDH1 & LDH2 This enzyme begins to elevate approximately 24 hours after myocardial infarction & peaks in 48 to 72 hours; thereafter, it returns to normal, usually w/in 7 to 14 days The presence of an LD flip (when LD1 is higher than LD2), is helpful in diagnosing a myocardial infarction

LACTATE DEHYDROGENASE (LD OR LDH)

NURSING CONSIDERATIONS

LDH isoenzymes should be interpreted in view of the clinical findings Testing should be repeated on 3 consecutive days

NORMAL VALUES: ERYTHROCYTE STUDIES

Erythrocyte sedimentation rate (ESR): 0 to 30 mm/hour depending on age of client Hemoglobin

Male: 14 to 16.5 g/dL Female: 12 to 15 g/dL

Male: 42 to 52% Female: 35 to 47%

Hematocrit

NORMAL VALUES: ERYTHROCYTE STUDIES

Serum iron

Male: 65 to 175 g/dL Female: 50 to 170 g/dL Female: 4 to 5.5 million/L Male: 4.5 to 6.2 million/L

Red blood cell (RBC) count

ERYTHROCYTE SEDIMENTATION RATE

DESCRIPTION

The rate at which erythrocytes settle out of anticoagulated blood in 1 hour Not diagnostic of any particular disease but indicates that a disease process is ongoing Fasting is not necessary, but a fatty meal may cause plasma alterations

NURSING CONSIDERATION

HEMOGLOBIN & HEMATOCRIT

Hemoglobin is the main component of erythrocytes & serves as the vehicle for the transportation of oxygen & carbon dioxide

Hemoglobin determinations are important in determining anemia Hematocrit determines red blood cell mass & is an important measurement in the determination of anemia or polycythemia Fasting is not required

NURSING CONSIDERATION

SERUM IRON

DESCRIPTION

Iron is mostly found in hemoglobin Iron acts as a carrier of oxygen from the lungs to the tissues & indirectly aids in the return of carbon dioxide to the lungs Aids in diagnosing anemias & hemolytic disorders Level will be increased if the client has ingested iron prior to the test

NURSING CONSIDERATION

RED BLOOD CELL (RBC) COUNT

DESCRIPTION

RBCs function in hemoglobin transport, which results in delivery of oxygen to the body tissues RBCs are formed by red bone marrow, have a life span of 120 days, & are removed from the blood by the liver, spleen, & bone marrow Aid in diagnosing anemias & blood dyscrasias Fasting is not required

NURSING CONSIDERATION

NORMAL VALUES: ELEMENTS

Calcium: 8.6 to 10.0 mg/dL Magnesium: 1.6 to 2.6 mg/dL Phosphorus: 2.7 to 4.5 mg/dL

CALCIUM

Functions in bone formation, nerve impulse transmission, & contraction of myocardial & skeletal muscles Aids in blood clotting by converting prothrombin to thrombin Instruct the client to eat a diet w/ normal calcium levels (800 mg/day) for 3 days before the test Instruct the client that fasting may be required for 8 hours prior to the test

NURSING CONSIDERATIONS

MAGNESIUM

Magnesium is needed in the blood-clotting mechanism, regulates neuromuscular activity, acts as a cofactor that modifies the activity of many enzymes, & has an effect on the metabolism of calcium Prolonged use of magnesium products will cause increased levels Long-term total parenteral nutrition therapy or excessive loss of body fluids may cause decreased levels

NURSING CONSIDERATIONS

PHOSPHORUS

DESCRIPTION

Important in bone formation, energy storage & release, urinary acid-base buffering, & carbohydrate metabolism Absorbed from food & excreted by the kidneys High concentrations of phosphorus are stored in bone & skeletal muscle Instruct the client to fast prior to the test

NURSING CONSIDERATION

THYROID STUDIES

DESCRIPTION

Performed if a thyroid disorder is suspected Helpful to differentiate primary thyroid disease from secondary causes & from abnormalities in thyroxine-binding globulin levels

THYROID STUDIES

NORMAL VALUES

NURSING CONSIDERATION

Thyroid-stimulating hormone (thyrotropin; TSH): 0.2 to 5.4 U/mL Thyroxine (T4): 5.0 to 12.0 g/dL Thyroxine, free (FT4): 0.8 to 2.4 ng/dL Triiodothyronine (T3): 80 to 230 ng/dL

Test results are invalid if the client had undergone a radionuclide scan w/in 7 days prior to the test

WHITE BLOOD CELL (WBC) COUNT

DESCRIPTION

White blood cells function in the bodys immune defense system The WBC count assesses each leukocyte distribution (differentiation) 4500 to 11,000/L

NORMAL VALUE

NORMAL ADULT WHITE BLOOD CELL DIFFERENTIAL

Neutrophils: 56% or 1800 to 7800/L Bands: 3% or 0 to 700/L Eosinophils: 2.7% or 0 to 450/L Basophils: 0.3% or 0 to 200/L Lymphocytes: 34% or 1000 to 4800/L Monocytes: 4% or 0 to 800/L

WHITE BLOOD CELL (WBC) COUNT

NURSING CONSIDERATIONS

A shift to the left means there is an increased number of immature neutrophils in the peripheral blood A low total WBC count w/ a left shift indicates a recovery from bone marrow depression or an infection of such intensity that the demand for neutrophils in the tissue is greater than the capacity of the bone marrow to release them in the circulation

WHITE BLOOD CELL (WBC) COUNT

NURSING CONSIDERATIONS

A high total WBC count w/ a left shift indicates an increased release of neutrophils by the bone marrow in response to an overwhelming infection or inflammation A shift to the right means cells have more than the usual number of nuclear segments; found in liver disease, Down syndrome, or megaloblastic & pernicious anemia

HEPATITIS TESTS

DESCRIPTION

Tests include radioimmune assay (RIA), enzyme-linked immunosorbent assay (ELISA), or microparticle enzyme immunoassay (MEIA) Serologic tests for specific hepatitis virus markers assist in defining the specific type of hepatitis

HEPATITIS TESTS

VALUES

The presence of IgM antibody to hepatitis A virus (IgM anti-HAV) & the total antibody to hepatitis A virus (total anti-HAV) identify the disease Detection of core antigen (HBcAg), envelope antigen (HBeAg), & surface antigen (HBsAg), or their corresponding antibodies, constitutes hepatitis B assessment Hepatitis C is confirmed by the presence of antibodies to hepatitis C (anti-HCV)

HEPATITIS TESTS

VALUES

Serologic hepatitis delta virus (HDV) determination is made by detection of the hepatitis D antigen (HDAg) early in the course of the infection & by detection of anti-HDV antibody in the later disease stages

HEPATITIS TESTS

VALUES

Specific serologic tests for hepatitis E virus (HEV) include detection of IgM & IgG antibodies to hepatitis E (anti-HEV) Hepatitis G (HGV) has been found in some blood donors, IV drug users, hemodialysis clients, & clients w/ hemophilia; however, HGV does not appear to cause significant liver disease

HEPATITIS TESTS

NURSING CONSIDERATION

If using RIA technique, the injection of radionuclides w/in 1 week prior to the test may falsely elevate results

NORMAL ADULT VALUES: URINE TESTS

Chloride: 110 to 250 mEq/24 hr Magnesium: 7.3 to 12.2 mg/dL/day Potassium: 25 to 125 mEq/24 hr

NORMAL ADULT VALUES: URINE TESTS

Protein: 40 to 150 mg/24 hr Sodium: 40 to 220 mEq/24 hr Uric acid: 250 to 750 mg/24 hr pH: 4.5 to 7.8 Specific gravity: 1.016 to 1.022

Therapeutic Serum Medication Levels

Acetaminophen (Tylenol): 10 to 20 g/mL Carbamazepine (Tegretol): 5 to 12 g/mL Digoxin (Lanoxin): 0.5 to 2.0 g/mL Gentamicin (Garamycin): 5 to 10 g/mL Lithium (Lithobid): 0.5 to 1.3 mEq/L Magnesium sulfate: 4 to 7 mg/dL

Therapeutic Serum Medication

Levels

Phenytoin (Dilantin): 10 to 20 g/mL Theophylline (Aminophylline, Theo-Dur): 10 to 20 g/mL