ANCC PMHNP LAB VALUES

T4, FREE THYROXINE 0.8-2.8 Increased In Graves Decreased In Hypothyroidism TSH 2- 10 mu/l Normal values can range from 0.4 - 4.0 mIU/L (milli-international units per liter), Calcium, Ca++ 8.8-10.5 <7.0, tetany >11.0, hyperparathyroidism >13.5, hypercalcemic coma, metastatic cancer Sodium, Na+ 135-148 mEq/L hypernatremia dehydration hypovolemia diabetes insipidus eating too much salt gastroenteritis drugs such as adrenocorticosteroids, methyldopa, hydrazine, cough meds hyponatremia drugs such as lithium, vasopressin, diuretics addisons renal disorder gi fluid loss Magnesium, Mg 1.3 - 2.1 mEq/L lithium can increase hypomagnesemia depression, confusion, irritability,nystagmus, tetany, convulsions, ataxia, increased reflexes, muscle weakness hypermagnesemia N/V, respiratory depression, hypotension, depressed skeletal muscle contraction and nerve function, bradycardia Potassium, K+ 3.5-5.1 mEq/L hyperkalemia chronic marijuana use can elevate potassium Chloride, Cl 98 - 106 passive transport through sodium major anion in the extracellular fluid Liver - ALT 5 - 35 U/L - depakote can increase, safe to use up to 2 times normal limit Liver - AST 5 - 40 U/L slight elevation can occur in DT's depakote can increase, safe to use up to 2 times normal limit Liver - GGT 10 - 38 IU/L Thrombocytopenia Platelet count normal = 150,000-450,000 if below - bone marrow doesn't make enough platelets. or bone marrow makes enough platelets, but the body destroys them or uses them up. or - The spleen holds on to too many platelets. The spleen is an organ that normally stores about one-third of the body's platelets. It also helps your body fight infection and remove unwanted cell material. can be caused by Valproate Neutropenia A normal ANC is above 1,500 cells per microliter. An ANC less than 500 cells/µL is defined as neutropenia and significantly increases the risk of infection. Neutropenia is the condition of a low ANC, Clozapine - WBC => 3500 to initiate therapy, ANC MUST BE =>2000/mm, ck wbc/anc weekly x 6 months, then Q other week for 6 months; if stable then Q 4 weeks. after therapy test for at least 4 weeks, LIVER PANEL ALP, AST, ASP, BILIRUBIN, ALBUMIN, TTL PROTEIN, CBC with WBC DIFFERENTIAL, PLATELET COUNT. FOR VALPROATE THERAPY - CK BASELINE AND MONTHLY FOR SEVERAL MONTHS CREATININE 0.5-1.2 normal, kidney damage if elevated , athletes may be higher BUN 10-20 mg/dL LITHIUM THERAPY CREATININE/BUN, SERUM ELECTROLYTES, CBC W/WBC & DIFF, URINALYSIS, EKG, ck levels (post dose 12 hrs trough), after 4 days on med, then q 4-5 days during initial therapy lithium levels during acute tx 0.8 -1.2, during maintenance 0.6 - 1.0 ALP 44-147 CK, creatine kinase <240, indicates muscle injury of heart, brain, skeletal muscle, elevated in MI, myositis, rhabdomysitis BUN 10-20, increased in impaired kidney function, significant dehydration, measure with lithium Creatinine 0.4-0.8, may vary with age gender, ethnicity, more sensitive then bun, GFR >90, best measurement of kidney function, no need to adjust dose depakote if GFR > 60 SIGNS OF LITHIUM TOXICITY nystagmus, ataxia, increased deep tendon reflexes, altered mental status, cardiac arrhythmias what meds do to lithium ACE inhibitors, ARB's, nsaid, tetracyclines, metronidazole can INCREASE LITHIUM DECREASES LITHIUM LEVELS potassium-sparing diuretics, thiazide diuretics, theophyline decreases lithium Examples of ARB's ALL INCREASE LITHIUM Valsartan Telmisartan Losartan Irbesartan Irbesartan Azilsartan Olmesartan Olmesartan Examples of Ace Inhibitors ALL INCREASE LITHIUM Enalapril (Vasotec/Renitec) Ramipril (Altace/Prilace/Ramace/Ramiwin/Triatec/Tritace) Quinapril (Accupril) Perindopril (Coversyl/Aceon/Perindo) Lisinopril (Listril/Lopril/Novatec/Prinivil/Zestril) Benazepril (Lotensin) Imidapril (Tanatril) Trandolapril