Pathophysiology for the health professions

737 Pages·2011·49.119 MB·English

by  Dyer, Ruthanna, Gould, Barbara E

HANDY
It may be noted that the normal values presented in various texts differ somewhat. Institutions
TABLES publish a specific set of normal values to be used as a baseline reference by individuals using
that laboratory. Always check the reported values against these norms.
Blood
Conventional Units SI Units
Arterial Blood Gases
Pao2 95–100 mm Hg
Paco2 35–42 mm Hg
pH 7.35–7.45
Bicarbonate (Hco−) 22–26 mEq/L
3
Base excess −2.4 to +2.3 mEq/L
Arterial o2 saturation (Sao2) 96%–98%
Cells
Red blood cells (erythrocytes, RBcs) 4.2–5.9 million (106)/mm3 4.2–5.9 × 1012/L
Platelets (thrombocytes) 150,000–350,000/mm3 150–350 × 109/L
White blood cells (leukocytes, WBcs) 4500–10,500/mm3 4.5–10.5 × 109/L
Differential
Neutrophils (57%–70%) 2000–7500/mm3
Lymphocytes (20%–25%) 2000–4000/mm3
Eosinophils (2%–4%) 400–450/mm3
Monocytes (3%–8%) 500–1000/mm3
Basophils (0.5%–1%) 40–100/mm3
Hemoglobin Male 13.5–18 g/100 mL (135–180 g/L) 8.1–11.2 mmol/L
Female 12–16 g/100 mL (120–160 g/L) 7.4–9.9 mmol/L
Reticulocytes 0.5%–2.5% erythrocytes
Hematocrit Male 45%–52% 0.45–0.52
Female 37%–48% 0.37–0.48
Erythrocyte sedimentation rate (ESR) Male 1–13 mm/hr
Female 1–20 mm/hr
Red cell volume 25–35 mL/kg body weight
Mean corpuscular volume 86–98 µm3
Electrolytes
Sodium (Na+) 135–142 mEq/L 135–142 mmol/L
Potassium (K+) 3.8–5 mEq/L 3.8–5 mmol/L
calcium (ca2+) 4–5 mEq/L 2–2.6 mmol/L
Magnesium (Mg2+) 3 mEq/L 1.25–1.75 mmol/L
chloride (cl−) 95–102 mEq/L 95–102 mmol/L
Nutrients
Amino acids (total) 35–65 mg/dL 1.5–2.5 mmol/L
Glucose (fasting) 70–110 mg/dL 3.9–5.6 mmol/L
Iron (total) 60–150 µg/dL 11–27 µmol/L
Lipids (total) 400–800 mg/dL 4–8 g/L
cholesterol 150–250 mg/dL 4–6.5 mmol/L
HDL >40 mg/dL
LDL <180 mg/dL
Fatty acids (total) 8–20 mg/dL 0.08–0.2 g/L
Triglycerides 75–160 mg/dL 0.85–1.9 mmol/L
Phospholipids 150–380 mg/dL 1.5–3.8 g/L
Vitamin B 150–900 pg/ mL 150–670 pmol/L
12
Proteins
Albumin 3.2–4.5 g/dL 32–45 g/L
Fibrinogen 200–400 mg/dL 2–4 g/L
Immunoglobulins 0.5–1.5 g/dL 5–16 g/L
IgG 640–1350 mg/100 mL 6.4–13.5 g/L
IgM 85–350 mg/100 mL 0.8–3.5 g/L
IgA 70–300 mg/100 mL 0.7–3 g/L
IgE 3–150 mg/100 mL 0.03–1.5 g/L
IgD 0–8 mg/100 mL 0
Hormones
Adrenocorticotropin (AcTH) 15–70 pg/ mL 3.3–15.4 pmol/L
cortisol
8 AM 5–25µg/100 mL 0.14–0.69 µmol/L
8 PM <10µg/100 mL 0–0.28 µmol/L
Triiodothyronine (T) 75–95 ng/100 mL 1.16–3 nmol/L
3
Wastes
Bilirubin (direct) maximum 0.3 mg/dL 5 µmol/L
Bilirubin (indirect) 0.1–1.0 mg/dL 1.7–17 µmol/L
creatinine 0.6–1.2 mg/dL 53–105 µmol/L
Nonprotein nitrogen 20–35 mg/dL 14.3–25 mmol/L
Urea nitrogen 8–22 mg/dL 2.9–8 mmol/L
Uric acid 2–6 mg/dL 0.12–0.36 mmol/L
Urine Cerebrospinal Fluid (CSF)
HANDY
pH 4.5–8 (av. 6) Appearance clear, colorless
Sodium 75–200 mg/24 hr Pressure 70–180 mm Ho
2
Potassium 25–100 mEq/L Albumin 11–48 mg/100 mL TABLES
Ammonia 20–70 mEq/L Glucose 50–75 mg/100 mL
creatinine 1–2 g/24 hr cells occasional WBc
Urea 25–35 g/24 hr Bilirubin 0
Uric acid 0.6–1 g/24 hr
Glucose 0
Protein 0–150 mg/24 hr (trace) Blood Clotting Times
Acetone 0
Bilirubin 0
Hemoglobin/cells 0 Bleeding time 4–8 minutes
casts 0 Duke: earlobe 1–3 minutes
Bacteria <10,000/ mL clotting time 5–15 minutes (Lee White, room
Appearance clear, pale yellow temperature)
INR Values vary with lab technology
and with anticoagulation therapy
Prothrombin time 11–16 seconds
Prothrombin/International 1.5–2.5 seconds
normalized ratio (PT/INR)
Activated partial thromboplastin 25–38 seconds
time (APTT)
clot retraction time begins in 30–60 minutes
50% complete in 2 hours
Blood Coagulation Factors
Factor Name Information
I Fibrinogen Plasma protein synthesized in liver: forms fibrin
II Prothrombin Plasma protein synthesized in liver (vitamin K required): forms
thrombin
III Tissue thromboplastin Released from damaged tissue (extrinsic pathway) and platelets
(intrinsic pathway); phospholipid involved in activation of
clotting process
IV calcium ions Required for many stages of coagulation process
V and VI Proaccelerin; labile factor or accelerator globulin Synthesized in liver: used in prothrombin activation
VII Proconvertin; serum prothrombin conversion Synthesized in liver (vitamin K required); used in extrinsic
accelerator (SPcA) pathway
VIII Antihemophilic factor (AHF) Deficit causes hemophilia A
IX Plasma thromboplastin component (PTc), Synthesized in liver (vitamin K required)
christmas factor, antihemophilic factor B
X Stuart factor Synthesized in liver (vitamin K required); required for both
extrinsic and intrinsic pathways
XI Plasma thromboplastin antecedent (PTA), Synthesized in liver; used for activation of intrinsic pathway
antihemophilic factor c
XII Hageman factor Required in activation of intrinsic pathway
XIII Fibrin stabilizing factor (FSF) From platelets—cross-links fibrin to stabilize clot
pH Scale Serum Enzymes and Isoenzymes and Markers
Alanine aminotransferase (ALT, Elevated in damage to liver, heart,
14 formerly SGPT) muscle, pancreas, kidneys
Prostatic acid phosphatase (PAP) Elevated with metastatic prostatic
More alkaline (basic)
cancer
Fewer hydrogen ions
Alkaline phosphatase (ALP) Elevated in bone disease, liver
Pancreatic secretion pH 8.0
damage
Bile pH 7.6–8.6
Aspartate aminotransferase (AST, Elevated in damage to liver, heart,
Blood pH 7.35–7.45
formerly SGoT) and muscle
7-Neutral
c-reactive protein Elevated with inflammation
Saliva pH 6–7.4 (av. 6.9)
cardiac specific troponin Elevated in myocardial infarction
creatine kinase (cK, formerly cPK) Elevated with heart and skeletal
Urine pH 5–8 (av. 6)
muscle damage
cK MB (isoenzyme) Elevated with MI
Gastric fluids pH 2 More hydrogen ions 2
Gamma-glutamyl-transferase (GGT) Elevated with liver damage due to
More acidic
alcohol
0 Lactate dehydrogenase (LDH) Elevated with liver, heart, kidney,
lung damage
LDH and LDH (isoenzymes) Elevated with MI
1 2
Alpha-fetoprotein (AFP) A marker for some ovarian tumors,
some liver tumors
carcinoembryonic antigen (cEA) A marker for intestinal tumors
Prostate-specific antigen (PSA) A marker for recurrent prostatic
cancer
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Barbara E. Gould, MEd
Professor Emerita
School of Health Sciences
Seneca college of Applied Arts and Technology
Toronto, ontario, canada
Ruthanna Dyer, PhD
Assistant Professor
Faculty of Science and Engineering
York University
Toronto, ontario, canada
3251 Riverport Lane
St. Louis, Missouri 63043
PATHOPHYSIOLOGY FOR THE HEALTH PROFESSIONS,
FOURTH EDITION ISBN: 978-1-4377-0965-0
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Last digit is the print number: 9 8 7 6 5 4 3 2 1
To my family with my thanks
for the love and inspiration you give me.
B.E.G.
To my first teacher, Naomi, with fond remembrance
and to my family: my thanks
and appreciation for your support.
R.A.D.
To all who have contributed in some way to this work:
students, colleagues, friends, extended family, and health care providers,
with appreciation.
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Reviewers
Renee Becker, AAS Linda Kimble, RN, MSN, CNP
certified Medical Transcriptionist Health Educator/consultant
Exact-Med/UTTc Transcription Training Program curriculum Development consultant
Direct East canton, ohio
ND career & Tech Ed Teacher certification
Program Director Aaron K. Koseki, PhD, RRT
Exact-Med/United Tribes Transcription Training chair and Professor
Bismark, North Dakota Health Sciences Department
Kapiolani community college
Elizabeth A. Berro, MA, RN, PNP Honolulu, Hawaii
clinical Instructor
BS Nurse Education Giulianne Krug, MA, OTR/L
Lienhard School of Nursing clinical Assistant Professor
Pace University Department of occupational Therapy and
Pleasantville, New York occupational Science
University of Missouri
Roslyn L. Chester, BA, MS, RDH columbia, Missouri
Allied Health and Human Services Department
Baltimore city community college Joanne Lavin, RN, CS, EdD
Baltimore, Maryland Professor
Department of Nursing
Julie A. Evancho, RNC, CWS, LNHA Kingsborough community college
Teaching Assistant Brooklyn, New York
Robert T. White LPN School
Alliance city Schools Debra Morrison, RN, BScN, MN(C)
Alliance, ohio Faculty
School of Health and community Services
Kim Garrett, MS, RN, APRN-ACNP, CCRN Durham college
Assistant Professor oshawa, ontario
Adult Health and Gerontological Nursing
Rush University college of Health Sciences J. Steve Smith, MD
chicago, Illinois Instructor, Pathophysiology
Education and Infection control Director clinical coordinator
Ely Bommenson community Hospital & Nursing clinical Laboratory Sciences Program
Home University of West Florida
Ely, Minnesota Pensacola, Florida
Krishna Head, MHS, CRADC Erich K. Stabenau, PhD
certified Reciprocal Alcohol and Drug counselor Professor and chair
TASc, Inc. Biology Department
chicago, Illinois Bradley University
Peoria, Illinois
Nixie Hnetkovsky, BS, MS
Instructor
Life Science Department
Frontier community college
Fairfield, Illinois
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