LAB RESULTS

Arterial Blood Gasses (ABG)

An ABG is a blood test that measures the acidity, or pH, and the levels of
oxygen (O2) and carbon dioxide (CO2) from an artery. The test is used to check
the function of the patient’s lungs and how well they are able to move oxygen and
remove carbon dioxide. This test is commonly performed in the ICU and ER setting;
however, ABGs can be drawn on any patient on any floor depending on their diagnosis.
An ABG is different from a VBG, which tests the venous blood and can
accurately determine pH and CO2 but is unable to provide reliable O2 data. For this
reason, arterial testing has become the gold standard in sick patients who are at risk
for sudden decompensation or those with a respiratory component.
ABGs are drawn for a variety of reasons. These may include concern for:
 Lung Failure
 Kidney Failure
 Shock
 Trauma
 Uncontrolled diabetes
 Asthma
 Chronic Obstructive Pulmonary Disease
 Hemorrhage
 Drug Overdose
 Metabolic Disease
 Chemical Poisoning
An Arterial Blood Gas requires the nurse to collect a small sample of blood -
generally a minimum of 0.5 ml, but a full 1 ml is preferred. Blood can be drawn via an
arterial stick from the wrist (radial artery), groin (femoral artery), or forearm (brachial)
artery). Once the blood is obtained, it is either sent to the hospital’s central lab for
analysis or tested by the respiratory therapist on the unit’s blood gas analyzer.
There are five key components to an ABG. They include:
 pH
 Partial pressure of oxygen (PaO2)
 Partial pressure of carbon dioxide (PaCO2)
 Bicarbonate (HCO3)
  Oxygen saturation (O2 Sat)
Blood gases can also measure hemoglobin and hematocrit as well as electrolyte
values such as potassium, calcium, and sodium. If a clinician wishes to obtain these
values, a SuperGas is run.
The aforementioned five components all have different normal values and
represent different aspects of the blood gas. According to the National Institute of
Health, typical normal values are:
 pH: 7.38-7.42; A value less than this range would be considered acidic
while a value greater than this range would be considered alkaline.
 Partial pressure of oxygen (PaO2): 75 to 100 mmHg
 Partial pressure of carbon dioxide (PaCO2): 38-42 mmHg
 Bicarbonate (HCO3): 22-26 mEq/L
 Oxygen saturation (O2 Sat): 94-100%
If the values in the result are not normal, then it may indicate one or more or
the following issues:
 A person is not getting enough oxygen
 A person is not getting rid of enough carbon dioxide
 There is a problem with a person's kidney function (metabolic)
The first value a nurse should look at is the pH to determine if the patient is in
normal range, above, or below. If a patient’s pH > 7.45, the patient is alkalotic. If the
pH < 7.38, then the patient is acidotic.
Next, examine the PaCO2. This will determine if the changes in the blood gas
are due to the respiratory system or metabolically driven. In combination with the
HCO3, the nurse will be able to fully comprehend the blood gas. Below is a chart that
contains the different values and determining if the patient is suffering from a
respiratory or a metabolic component. This will enable the medical team to treat the
patient adequately.
The CO2 is the respiratory component of the blood gas: if the CO2 (acid) is low
and the pH is high then the patient would have respiratory alkalosis. These two values
move in opposite directions. On the other hand, the HCO3 is the metabolic
component of the blood gas. If the HCO3 (base) is low and the pH is higher than
normal, then the patient is in metabolic acidosis.
What’s respiratory acidosis?
Respiratory acidosis (also called respiratory failure, which is typically caused
by an underlying disease or condition) is a condition that occurs when the lungs can’t
remove enough of the carbon dioxide (CO2) produced by the body. Excess CO2
causes the pH of blood and other bodily fluids to decrease, making them too acidic.
Normally, the body is able to balance the ions that control acidity. Acidosis occurs
when the pH of the blood falls below 7.38 (normal blood pH is between 7.38 and 7.45).
Normally, the lungs take in oxygen and exhale CO2. Oxygen passes from the lungs
into the blood. CO2 passes from the blood into the lungs. However, sometimes the
lungs can’t remove enough CO2. This may be due to a decrease in respiratory rate or
decrease in air movement due to an underlying condition such as:
 Diseases of the airways, such as asthma and COPD
 Diseases of the lung tissue, such as pulmonary fibrosis, which causes scarring
and thickening of the lungs
 Diseases that can affect the chest, such as scoliosis
 Diseases affecting the nerves and muscles that signal the lungs to inflate or
deflate
 Medicines that suppress breathing, including powerful pain medicines, such as
narcotics, and "downers," such as benzodiazepines, often when combined with
alcohol
 Severe obesity, which restricts how much the lungs can expand
 Obstructive sleep apnea
Due to this problems, the lungs can’t efficiently get rid of CO 2; so the excess
CO2 diffuses through cell membranes (especially into red blood cells). The CO2 will
then bind with H2O and becomes carbonic acid (H2CO3), which eventually gets
converted into hydrogen ions and carbonate ion (HCO3-). The HCO3- will then escape
the cell into the blood and try to counteract the excess CO2. However, the hydrogen
ions are acidic and can mess up with the intracellular environment.
Three or five days after the onset of respiratory acidosis, the body will start to
compensate using the kidney. The kidney tubules will start to reabsorb more HCO3-
into the blood stream, which produces a substantial raise in the blood’s pH (no longer
acidic).
Symptoms
Symptoms may include:
  Confusion
 Anxiety
 Easy fatigue
 Lethargy
 Shortness of breath
 Sleepiness
 Tremors (shaking)
 Warm and flushed skin
 Sweating
What’s respiratory alkalosis?
Respiratory alkalosis occurs when the levels of carbon dioxide and oxygen
in the blood are not balanced. Your body needs oxygen to function properly. When
you inhale, you introduce oxygen into the lungs. When you exhale, you release carbon
dioxide, which is a waste product. Normally, the respiratory system keeps these two
gases in balance. Respiratory alkalosis occurs when you breathe too fast or too deep
and carbon dioxide levels drop too low. This causes the pH of the blood to rise and
become too alkaline.
Hyperventilation is typically the underlying cause of respiratory alkalosis.
Hyperventilation is also known as over-breathing. Someone who is hyperventilating
breathes very deeply or rapidly. Panic attacks and anxiety are the most common
causes of hyperventilation. However, they’re not the only possible causes. Others
include:
 heart attack
 pain
 drug use
 asthma
 fever
 chronic obstructive pulmonary disease
 infection
 pulmonary embolism
 pregnancy
 hypoxia
 Three or five days after the onset of respiratory alkalosis, the body will start to
compensate using the kidneys. The kidneys will then start to excrete more bicarbonate
(HCO3-) which is quite effective in lowering the blood’s pH.
What’s metabolic acidosis?
Metabolic acidosis happens when the chemical balance of acids and bases in
your blood gets thrown off where the blood becomes more acid. Your body:
 Is making too much acid
  Isn't getting rid of enough acid
 Doesn't have enough base to offset a normal amount of acid due to excess loss
in kidney or the digestive tract
When any of these happen, chemical reactions and processes in your body don't work
right.
Usually, when the blood’s pH starts to fall, the body has some mechanisms to
keep it in balance. One of them is hydrogen ions (which are acidic) will enter cell, and
in return potassium ions will move out of cells and into the blood. This will help with
the acidosis but will result in hyperkalemia. Another mechanism involves the
respiratory system. Chemoreceptors that are located in the walls of the carotid artery
the aortic arch will start to fire when the pH falls, signaling the respiratory system to
increase the respiratory rate and depth of breathing (hyperventilation). As a result,
more CO2 are moved out of the body which helps in elevating the pH.
What’s metabolic alkalosis?
Metabolic alkalosis develops when your body loses too much acid (loss of
hydrogen ions) or gains too much base (HCO3-), or a combination of both. This can be
attributed to:
 excess vomiting, which causes electrolyte loss and loss of hydrogen ions
When we vomit, we lose our gastric secretion, which is very acidic and
contains a lot of hydrogen ions. Furthermore, normally the acidity of the gastric
secretion is countered with HCO3- secreted by the pancreas, so that enzymes like
trypsin and chymotrypsin can work perfectly. However, in the case of vomiting, the
HCO3- are not secreted into the intestine, and build up in the blood instead.
Combining the loss of hydrogen ions and the gain of HCO3- in the blood, this leads
to alkalosis.
 overuse of diuretics (any substance that increase the production of urine)
 adrenal disease
One of the examples of this is kidney tumor, which secretes a hormone
called aldosterone excessively. Aldosterone makes the alpha-intercalated cells in
the kidney dump out hydrogen ion and absorb HCO 3- more. This causes the pH
to rise (alkalosis).
 a large loss of potassium or sodium in a short amount of time
 antacids
 accidental ingestion of bicarbonate, which can be found in baking soda or in
antacids (NaHCO3), which is used to neutralize stomach acid and relieve
indigestion. The HCO3- then can be reabsorbed into the blood.
 laxatives
 alcohol abuse
The body has a few mechanisms to counter the rise in pH. One of them is
moving hydrogen ions out into the blood, and moving potassium ions into cells,
causing the blood to become more acid and lowers the pH. Another mechanism to
counter the alkalosis involves the respiratory system and the chemoreceptors. When
the rise in pH is detected, the chemoreceptors will fire less than usual, causing the
respiratory rate to drop, resulting in less CO2 leaving the body, which lowers down the
pH.

BE- Normal range: -2 until +2 mEq/L

The metabolic component of the acid–base balance is reflected in the base
excess. This is a calculated value derived from blood pH and PaCO 2. It is defined as
the amount of acid required to restore a litre of blood to its normal pH at a PaCO 2 of
40 mmHg. The base excess increases in metabolic alkalosis and decreases (or
becomes more negative) in metabolic acidosis, but its utility in interpreting blood gas
results is controversial.

CK-
Creatine kinase (CK) is an enzyme found in the heart, brain, skeletal muscle,
and other tissues. Increased amounts of CK are released into the blood when there is
muscle damage. This test measures the amount of creatine kinase in the blood. THe
normal amount is in the following table:

Men 5-100 IU/L

Women 10-70 IU/L

Pregnancy 5-40 IU/L

The small amount of CK that is normally in the blood comes primarily from
skeletal muscles. Any condition that causes muscle damage and/or interferes with
muscle energy production or use can cause an increase in CK. For example,
strenuous exercise and inflammation of muscles, called myositis, can increase CK as
can muscle diseases (myopathies) such as muscular dystrophy. Rhabdomyolysis, an
extreme breakdown of skeletal muscle tissue, is associated with significantly elevated
levels of CK. This condition can be caused by serious physical, chemical, or biological
injury to muscles. Examples of causes include:
• Trauma, crushing injuries (e.g., car accidents, disasters such as earthquakes)
• High-voltage electrical shock
• Serious burns
• Blood clot (thrombosis) that blocks blood flow
• Toxins (e.g., heavy metals, snake venom, carbon monoxide)
• Infections (e.g., HIV, influenza, Streptococcus) — more common cause in children
than adults
• Inherited genetic and metabolic disorders that affect muscles' ability to get or use
energy
• Diseases such as muscular dystrophy and underlying conditions such as
uncontrolled diabetes, hypothyroidism, and hyperthyroidism
• Several drugs (examples include drugs of abuse (ethanol, cocaine), some
antibiotics, antidepressants, corticosteroids, lithium, salicylates and statins)
 Complications can result from the rapid release of cell contents into the blood.
This has been known to cause damage to kidneys (acute kidney injury, AKI)
and disseminated intravascular coagulation (DIC - the proteins in the blood
involved in blood clotting become overactive). Once diagnosed and depending on
the extent of injury, a person with rhabdomyolysis may be treated
with intravenous fluids and other supportive care as well as procedures used to
protect organs (e.g., dialysis to prevent/limit kidney damage).
A high CK, or a rise in levels in subsequent samples, generally indicates that
there has been some recent muscle damage but will not indicate its location or cause.
Serial test results that peak and then begin to drop indicate that new muscle damage
has diminished, while increasing and persistent elevations suggest continued damage.
Increased CK levels may be seen in some muscular disorders (myopathies),
which have a wide variety of causes. People may have CK levels that are significantly
to greatly increased, depending upon the severity of muscle damage. Those who have
rhabdomyolysis may have CK levels that are 100 times normal levels and
occasionally even higher.
 Increased CK may be seen with, for example:
 Recent crush and compression muscle injuries, trauma, burns, and
electrocution
 Inherited myopathies, such as muscular dystrophy
 Hormonal (endocrine) disorders, such as thyroid disorders, Addison
disease or Cushing disease
 Strenuous exercise
 Prolonged surgeries
 Seizures
 Infections – viral (such as influenza and HIV), bacterial, fungal,
and parasitic (such as malaria)
 Connective tissue disorders (e.g. lupus, rheumatoid arthritis)
 Celiac disease
 Renal failure
 In critically ill patients
 High fever accompanied by shivering
 A blood clot (thrombosis) blocking the flow of blood
 Any drug or toxin that interferes with muscle energy production or increases
energy requirements
Normal CK levels may indicate that there has not been muscle damage or that
it occurred several days prior to testing, while moderately increased CK levels may be
seen following strenuous exercise such as in weight lifting, contact sports, or long
exercise sessions.

Random Glucose
Blood glucose levels will fluctuate widely during the day depending on when
you take your meals and what you eat. So, results from a random blood glucose test
will depend on when during the day you take the test. Normally, a person’s blood
glucose level should be under 125 mg/dL. You may start your day at below 100 mg/dL
in the morning before breakfast and your blood glucose may rise as high as 140 mg/dL
about 2 hours after meals during the day. The table below shows a typical range of
fluctuation for blood glucose levels for a person with diabetes and someone without
diabetes.