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Interpret Your Lab Reports
- 7-20-2007
- Categorized in: Medical Conditions
One of the most frightening things I learned while in veterinary school was that blood results are not really abnormal until the body is 70% sick. I found that to be true in my own health as well. When I first started on my path toward becoming a naturopath, I knew I had pre-cervical cancer, was depressed and wanted to die. Yet, only one liver enzyme was a bit out of whack. How could this be? And what surprised me most was how normal the rest of my results were. Well, I've corrected all those abnormal results and have my life back. I also have a whole new bag of tricks at my disposal.
Another thing I found was that my clients had no idea what their lab results meant (or their pet's lab results), what a "rule out" was, or what they could do naturally to repair the abnormal values.
There ARE other options besides medications. For example, cholesterol. It can be abnormal for a variety of reasons, but it is often repaired so easily with natural products such as Chitosan.
Blood Tests:
Reference "normal" ranges and unit measurements can vary from lab to lab (sometimes up to 30% difference). Other factors influencing test results include, dietetic preferences, sex, age, race, species, menstrual cycles, amount of exercise, use of non-prescription drugs (aspirin, cold medications, vitamins, etc.), prescription drugs, alcohol consumption, collection and handling of the specimen. For best comparisons of lab results, tests should be done in the same lab. Always use the normal ranges printed on the lab report of that particular sample.
Blood tests can have false positives and negatives. Interpretation of blood tests takes knowledge of the underlying disease process and experience. If your lab results are outside the normal range, we suggest that you discuss them with your doctor. Often it is not the recent result, but the change from a previous test that is most helpful in trying to place a diagnosis on a condition.
Some tests cost more than others. If you can help the doctor understand why a certain test may be important for you and they can justify it in their mind, you may get to your diagnosis quicker and your insurance may pay for the test saving time, money, and aggravation.
When a doctor evaluates the results of a test, they try to figure out what all the causes could be then "rule out" the ones that don't seem to fit after you add all the other signs and symptoms into the picture. In other words,
There are a number of things that might have caused a high or low level of something, and you need to rule out (by other tests or observations or intuition/gut instinct) several possibilities in attempting to figure out what's really going on.
This is much like putting a jigsaw puzzle together and searching for the exact placement of the pieces to the puzzle. This Sherlock Holmes activity is one of my favorites because I get to add in so many other tidbits of information that the medical system doesn't have time to ask in making a final "jigsaw puzzle" assessment. Below are lists of "Rule Outs" for both high and low levels. You will see a veterinary flare to these as I have put in the rule outs for animals as well. I have included the medical term under each abnormality in parentheses. I have also tried to explain in layman's terms the meaning of many of the scientific jargon.
The Basic Blood Chemistry Panel (Also called a Panel, Serum Chemistry Panel, Chemistry Screen, BMP or Basic Metabolic Panel): For these tests, blood is drawn from the patient who has been fasting 12 hours or more. Three tubes of blood are usually drawn from a vein in the arm (human) or neck (animals).
Alanine (ALT, Alanine aminotransferase--formerly known as SGPT). ALT is an enzyme contained inside the fluid part of each liver cell. The larger the number of cells that are damaged, the higher the number. This test is a good indicator of acute disease (disease coming on quickly), but not for chronic liver diseases like cirrhosis where the cells have died and been replaced by fibrous tissue. ALT stays in the blood stream for about 60 hours. Because of this, sometimes your doctor will want to repeat the blood test to track how the body is responding.
ALT Too High (Liver enzymes elevated): Rule out hepatocellular (liver cell) diseases such as cancer, fatty liver, cell death due to bacteria/viruses/hepatitis or toxins, cirrhosis, obstructive jaundice, and infectious mononeucleosis.
ALT Too Low: Rule out pyridoxine (Vitamin B6) deficiency.
Albumin and Globulin measures the amount and type of protein in your blood. Albumin and globulin are a general index of overall health and nutrition. Globulin is the "antibody" protein important for fighting disease produced by white blood cells. Albumin contains things like clotting factors, fibrin and binding proteins (much like egg white) and it give the blood more substance.
Albumin/Globulin Too High: Rule out dehydration, diabetes insipidus (low blood sugar diabetics that can't get enough water), antigenic responses, infection, and gammopathies such as lymphosarcoma, multiple myeloma, and FIP--Feline Infectious Peritonitis
Albumin/Globulin Too Low: Rule out malnutrition, overhydration, advanced liver disease, cancer, acute or chronic hemorrhage, kidney disease (nephrosis), burns, multiple myeloma, metastatic carcinomas, heart disease, loss of blood or protein into the body cavity, malabsorption, parasites and pancreatic atrophy.
False Positives: False elevations can occur with red blood cell damage in the sample (hemolysis) and lipemia (fat in the blood).
Alkaline Phosphatase (Alk. Phos.) Alkaline phosphatase is an enzyme found primarily in bones and the liver but can also be found in other tissues of the body as well such as the intestine, kidney, placenta and in white blood cells. It is thought that this enzyme is increased in the body only when there are actively growing new cells being produced. Alkaline Phosphatase enzymes can be further broken down to find out where they are specifically being produced using a process called electrophoresis (a special test not included in the regular blood panel). The alkaline phosphatase enzyme circulates in the body for about three days before it starts to break down, so if your blood tests are repeatedly high in this area, there are actively growing cells.
Alkaline Phosphatase Too High: Rule outs include gallstones, damage to bones, Paget's disease (a chronic disorder of the adult skeleton in which localized areas of hyperactive bone are replaced by a softened and enlarged osseous structure), rickets, healing fracture, hyperparathyroidism, pulmonary infarction, heart failure, liver disease with too many cells growing (like cancer), obstruction within the liver or the liver not getting what it needs because something is obstructed outside the liver, pancreatitis, severe anemia, lack of oxygen getting to the liver, Cushing's disease, drugs such as glucocorticoids (steroids), primidone, phenobarbital (anti-seizure drugs). An elevated alkaline phosphatase is normal in growing children and in pregnant women.
Alkaline Phosphatase Too Low: Pernicious anemia, hypoparathyroidism, hypophosphatasia and possibly the blood was taken from a collection tube that had EDTA preservative in it.
AST (Aspartate aminotransferase--formerly known as SGOT): AST is an enzyme contained in all cells of the body, but is used as a diagnostic marker for liver and muscle damage. Its half-life is about 12 hours.
AST Too High: Rule out liver disease (death of cells and cancer), skeletal muscle diseases, (myositis and muscular dystrophy), trauma, pancreatitis, renal infarct, eclampsia (milk fever), cancer, cerebral damage, seizures, alcohol, heart tissue disease (heart attacks, pericarditis), infections in the bloodstream (septicemia), intramuscular injections, drugs such as corticosteroids, primidone, antibiotics and other drugs processed through the liver. Hemolysis (ruptured red cells from improper handling of the blood) can also raise AST levels.
AST Too Low: Rule out pyridoxine (Vitamin B6) deficiency, and terminal stages of liver disease.
Bilirubin (Bilirubinemia): Most bilirubin (80%) is a breakdown component from dying red blood cells. Bilirubin is also in macrophages of the spleen and in the liver, bone marrow and nonheme porphyrins. Bilirubin travels via the blood stream in the plasma part of the blood surrounded by albumin, globulin and other proteins. As it gets to the liver via the blood system, it disassociates from these proteins and the liver accepts it into it's own cells by binding (conjugating) it with glucuronic acid. This conjugation makes it water-soluble. From here bilirubin gets into the bile and then dumps into the small intestine, eventually leaving though the feces after it changes form one more times. Some of this bilirubin sneaks back into the bloodstream and is reabsorbed into the blood. This happens repeatedly. Sometimes the bilirubin ends up being excreted via the kidneys and dumps out into the urine. When this happens, it shows up in abnormal levels within the blood and may also show up in the urinalysis on the dipstick test.
Bilirubin Too High (Hyperbilirubinemia): Rule outs include hemolytic anemia, pulmonary infarct, Gilbert's syndrome (mild unconjugated hyperbilirubinemia), Dublin-Johnson syndrome (a genetic symptomatic mild jaundice), neonatal jaundice, inadequate liver uptake or defective conjugation, massive internal hemorrhage, obstruction of bile within the liver or outside the liver, defective secretion, acute or chronic hepatitis, fibrosis of the liver and liver cancer. It can also be falsely elevated when there is too much fat in the bloodstream. If only slightly elevated above the expected ranges, but with all other enzymes (LDH, GOT, GPT, GGT) within expected values, it is probably a condition known as Gilbert’s syndrome and is not significant.
Bilirubin is also measured in the urine. Sometimes the doctor's will run a test to check both conjugated and unconjugated bilirubin to help them determine where the extra is coming from.
They want to know if the liver is blocked or the blood cells have broken (hemorrhage). When the liver is blocked totally the fecal material will also be gray or whitish (acholic). When increased bilirubin is caused from hemorrhage the stools will be almost orange in color. You will want to tell your doctor this information because they may not ask.
Bilirubin Too Low: Low values are of no concern. Sunlight and fluorescent lights degrade the sample as the bilirubin is very fragile when exposed to light.
Private Home Health Testing, avoid the doctors office!
BUN (Blood Urea Nitrogen, Urea Nitrogen): High values may mean that the kidneys are not working as well as they should in clearing out the breakdown products of digested protein. The major breakdown product of protein you eat is urea, which is first formed in the liver. Urea contains nitrogen and together, in excess quantity, they are both toxic to the body and must be removed. Kidneys normally do an excellent job of removing urea, but when they start to fail, the urine components get all backed up in the system and the blood concentration of urea begins to rise. If you smell the breath, it has a stale, sickly smell (see my handout on the causes of Halitosis for other characteristics of bad breath) The reference range (or range within which most normal people's test values fall) for BUN is 10-20 mg/dl.
BUN Too High (Uremia, Azotemia or Uremic Acidosis): Rule out dehydration (too little water in the tissues), too much exercise, shock due to too much blood being lost (hemorrhagic shock), pancreatitis, intestinal foreign body, adrenal cortical insufficiency (adrenal glands not producing enough of the hormones it is suppose to be producing), or any condition which decreases blood flow to the kidneys, glomerulonephritis (the little tubules that make the urine in the kidneys are swollen and not working right), amyloidosis (the kidney tissue is being replaced with some kind of unnatural protein), pyelonephritis (inflammation/infection of the kidney where the urine pools before it dumps out into the ureters), nephrosis (a condition of the kidneys), calcium nephropathy--also called lymphosarcoma (cancer of the kidneys where the tissues are being replaced by calcium so the urine can't get out), kidney cancers, obstruction of the urine coming out of the kidney, leukemia, heart failure, ruptures of the urine carrying parts (kidney, ureters, bladder, urethra, kidney tubules), too much protein in the diet, bleeding within the intestine, and drugs like amphotericin B. Often, an additional test is done to measure creatinine.
BUN Too Low: Severe liver disease, hepatic venous shunts (portal-caval shunts), anorexia for several days (starving, not eating, fasting), pregnancy.
BUN/Creatinine Ratio: This test is used to differentiate kidney disease from dietary protein metabolism problems. Considered together, the BUN, blood creatinine and their ratio give very good evidence of the filtering function of the kidneys and a measure of the degree of bodily hydration. The ratio of BUN: creatinine is normally 10:1.
BUN/Creatinine Ratio Too High: Rule out dehydration (if the ratio is 20:1 or even higher), certain types of kidney disease, breakdown of blood in the intestinal tract, increased dietary protein, and any clinical circumstance in which insufficient blood is flowing through the blood vessels to the kidneys (such as heart failure or kidney artery disease)..
BUN/Creatinine Ratio Too Low: Rule out certain types of kidney disease, liver disease, malnutrition and Sickle Cell Anemia.
C-Peptide (see under Glucose)
Calcium is controlled in the blood by the parathyroid glands and the kidneys. Calcium is found mostly in bone and is important for proper blood clotting, nerve, and cell activity. Calcium is also found in the bloodstream.
Calcium Too High (Hypercalcemia): Rule out an elevation due to medications such as thiazide-type diuretics, inherited disorders of calcium handling in the kidneys, diets containing too much calcium, too many calcium supplements, too much Vitamin D, multiple myeloma (cancer of the stem cells within the bone that are responsible for producing all types of red and white cells), bone cancer, sarcoid, too much protein in the blood, too much albumin in the blood, fat in the blood (lipemia), excess parathyroid gland activity such as primary hyperparathyroidism (the thyroid gland has some kind of tumor or cancer causing the calcium levels to be to high), and pseudohyperparathyroidism (cancer of the lymphatic system).
Calcium Too Low (Hypocalcemia): Rule out certain drugs like Fosamax and furosemide-type diuretics, not enough dietary calcium, not enough dietary Vitamin D, overhydration, malabsorption, nutritional secondary hypoparathyroidism, hypercalcitoninism, eclampsia (milk fever--the baby or muscle contractions during birth have used up too much of the calcium), pancreatitis with fat necrosis (an infection in the pancreas which has affected all the extra fat in the body causing it to die from lack of circulation and nutrition), and not enough protein or albumin in the blood. Calcium is bound to a particular type of blood protein called albumin in the blood, so a low albumin level will cause the total calcium level in the blood to drop in proportion.
Cholesterol. There are two types of cholesterol, those obtained from the diet (exogenous) and that produced within the body (endogenous). Most of the endogenous cholesterol is formed by the liver, but each cell also produces a little bit as well which makes up part of the cellular membrane. With just small modifications, cholesterol can be used as the body needs it as steroids and cholic acid. Cholic acid uses approximately 80% of the body's cholesterol, which is converted into bile--that substance that helps us digest fats. Cutting out saturated fats from your diet can decrease your cholesterol levels from 15-25%. Eating more unsaturated fats (oils, nuts, seeds) can decrease your cholesterol. The saturated and unsaturated fats fight for the same receptor sites on cells. Saturated fats make the cell membranes sluggish (so you get arthritis and other degenerative diseases) and unsaturated fats make the membranes more liquid so the body works better. (See the Eicosinoid handout.) Lack of insulin and thyroid hormones will also increase the cholesterol levels.
Cholesterol is further broken down as follows:
Total Cholesterol: High cholesterol in the blood is a major risk factor for heart and blood vessel disease. Cholesterol in itself is not all bad. In fact, our bodies need a certain amount of this substance to function properly. However, when the level gets too high, vascular disease can result. Total cholesterol of less than 200, and an LDL Cholesterol of 100 or less is considered optimal by the National Heart, Lung, and Blood Institute. As the level of blood cholesterol increases, so does the possibility of plugging the arteries due to cholesterol plaque build-up. This is called "hardening of the arteries" or atherosclerosis. When the arteries feeding the heart become plugged, a heart attack may occur. If the arteries that go to the brain are affected, a stroke occurs.
There are three major kinds of cholesterol, High Density Lipoprotein (HDL) , Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL). The lower the density of cholesterol, the more cholesterol molecules there are.
HDL (High Density Lipoprotein) cholesterol is a "good cholesterol" as it protects against heart disease by helping remove excess cholesterol deposited in the arteries. High levels seem to be associated with low incidence of coronary heart disease.
LDL (Low Density Lipoprotein) cholesterol is considered to be "bad cholesterol" because cholesterol deposits form in the arteries when LDL levels are high. LDL levels of less than 130 are recommended. One hundred is optimal and values greater than 160 are considered high risk. Those persons who have established coronary or vascular disease may be instructed by their doctor to get their LDL cholesterol well below 100. You should ask your doctor which LDL target he or she wants for you.
There are two ways to report LDL. The most common is simply an estimate calculated from the Total Cholesterol, HDL, and triglycerides results. This may read "LDL Calc" on your results . A directly measured LDL cholesterol is usually more accurate, but more expensive and may require that your doctor specify the Direct LDL test.
VLDL (Very Low Density Lipoprotein: This is the only lipoprotein initially formed in the liver and contains mostly triglycerides and very little phospholipids and cholesterol. As they flow through the blood vessels they are quickly broken up and used as energy or stored as fat.
Cholesterol Too High: Rule out hypothyroidism, obstructive jaundice, liver disease, nephrosis, diabetes mellitus, familial, pancreatitis, hyperadrenocorticism, diet, retained anger and resentment.
Cholesterol Too Low: Rule out hyperthyroidism, infection, malnutrition, heart failure, malignancies, low fat diet, intestinal malabsorption and hepatic insufficiency.
© 2007 by Dr. Denice M. Moffat
Another thing I found was that my clients had no idea what their lab results meant (or their pet's lab results), what a "rule out" was, or what they could do naturally to repair the abnormal values.
There ARE other options besides medications. For example, cholesterol. It can be abnormal for a variety of reasons, but it is often repaired so easily with natural products such as Chitosan.
Blood Tests:
Reference "normal" ranges and unit measurements can vary from lab to lab (sometimes up to 30% difference). Other factors influencing test results include, dietetic preferences, sex, age, race, species, menstrual cycles, amount of exercise, use of non-prescription drugs (aspirin, cold medications, vitamins, etc.), prescription drugs, alcohol consumption, collection and handling of the specimen. For best comparisons of lab results, tests should be done in the same lab. Always use the normal ranges printed on the lab report of that particular sample.
Blood tests can have false positives and negatives. Interpretation of blood tests takes knowledge of the underlying disease process and experience. If your lab results are outside the normal range, we suggest that you discuss them with your doctor. Often it is not the recent result, but the change from a previous test that is most helpful in trying to place a diagnosis on a condition.
Some tests cost more than others. If you can help the doctor understand why a certain test may be important for you and they can justify it in their mind, you may get to your diagnosis quicker and your insurance may pay for the test saving time, money, and aggravation.
When a doctor evaluates the results of a test, they try to figure out what all the causes could be then "rule out" the ones that don't seem to fit after you add all the other signs and symptoms into the picture. In other words,
There are a number of things that might have caused a high or low level of something, and you need to rule out (by other tests or observations or intuition/gut instinct) several possibilities in attempting to figure out what's really going on.
This is much like putting a jigsaw puzzle together and searching for the exact placement of the pieces to the puzzle. This Sherlock Holmes activity is one of my favorites because I get to add in so many other tidbits of information that the medical system doesn't have time to ask in making a final "jigsaw puzzle" assessment. Below are lists of "Rule Outs" for both high and low levels. You will see a veterinary flare to these as I have put in the rule outs for animals as well. I have included the medical term under each abnormality in parentheses. I have also tried to explain in layman's terms the meaning of many of the scientific jargon.
The Basic Blood Chemistry Panel (Also called a Panel, Serum Chemistry Panel, Chemistry Screen, BMP or Basic Metabolic Panel): For these tests, blood is drawn from the patient who has been fasting 12 hours or more. Three tubes of blood are usually drawn from a vein in the arm (human) or neck (animals).
Alanine (ALT, Alanine aminotransferase--formerly known as SGPT). ALT is an enzyme contained inside the fluid part of each liver cell. The larger the number of cells that are damaged, the higher the number. This test is a good indicator of acute disease (disease coming on quickly), but not for chronic liver diseases like cirrhosis where the cells have died and been replaced by fibrous tissue. ALT stays in the blood stream for about 60 hours. Because of this, sometimes your doctor will want to repeat the blood test to track how the body is responding.
ALT Too High (Liver enzymes elevated): Rule out hepatocellular (liver cell) diseases such as cancer, fatty liver, cell death due to bacteria/viruses/hepatitis or toxins, cirrhosis, obstructive jaundice, and infectious mononeucleosis.
ALT Too Low: Rule out pyridoxine (Vitamin B6) deficiency.
Albumin and Globulin measures the amount and type of protein in your blood. Albumin and globulin are a general index of overall health and nutrition. Globulin is the "antibody" protein important for fighting disease produced by white blood cells. Albumin contains things like clotting factors, fibrin and binding proteins (much like egg white) and it give the blood more substance.
Albumin/Globulin Too High: Rule out dehydration, diabetes insipidus (low blood sugar diabetics that can't get enough water), antigenic responses, infection, and gammopathies such as lymphosarcoma, multiple myeloma, and FIP--Feline Infectious Peritonitis
Albumin/Globulin Too Low: Rule out malnutrition, overhydration, advanced liver disease, cancer, acute or chronic hemorrhage, kidney disease (nephrosis), burns, multiple myeloma, metastatic carcinomas, heart disease, loss of blood or protein into the body cavity, malabsorption, parasites and pancreatic atrophy.
False Positives: False elevations can occur with red blood cell damage in the sample (hemolysis) and lipemia (fat in the blood).
Alkaline Phosphatase (Alk. Phos.) Alkaline phosphatase is an enzyme found primarily in bones and the liver but can also be found in other tissues of the body as well such as the intestine, kidney, placenta and in white blood cells. It is thought that this enzyme is increased in the body only when there are actively growing new cells being produced. Alkaline Phosphatase enzymes can be further broken down to find out where they are specifically being produced using a process called electrophoresis (a special test not included in the regular blood panel). The alkaline phosphatase enzyme circulates in the body for about three days before it starts to break down, so if your blood tests are repeatedly high in this area, there are actively growing cells.
Alkaline Phosphatase Too High: Rule outs include gallstones, damage to bones, Paget's disease (a chronic disorder of the adult skeleton in which localized areas of hyperactive bone are replaced by a softened and enlarged osseous structure), rickets, healing fracture, hyperparathyroidism, pulmonary infarction, heart failure, liver disease with too many cells growing (like cancer), obstruction within the liver or the liver not getting what it needs because something is obstructed outside the liver, pancreatitis, severe anemia, lack of oxygen getting to the liver, Cushing's disease, drugs such as glucocorticoids (steroids), primidone, phenobarbital (anti-seizure drugs). An elevated alkaline phosphatase is normal in growing children and in pregnant women.
Alkaline Phosphatase Too Low: Pernicious anemia, hypoparathyroidism, hypophosphatasia and possibly the blood was taken from a collection tube that had EDTA preservative in it.
AST (Aspartate aminotransferase--formerly known as SGOT): AST is an enzyme contained in all cells of the body, but is used as a diagnostic marker for liver and muscle damage. Its half-life is about 12 hours.
AST Too High: Rule out liver disease (death of cells and cancer), skeletal muscle diseases, (myositis and muscular dystrophy), trauma, pancreatitis, renal infarct, eclampsia (milk fever), cancer, cerebral damage, seizures, alcohol, heart tissue disease (heart attacks, pericarditis), infections in the bloodstream (septicemia), intramuscular injections, drugs such as corticosteroids, primidone, antibiotics and other drugs processed through the liver. Hemolysis (ruptured red cells from improper handling of the blood) can also raise AST levels.
AST Too Low: Rule out pyridoxine (Vitamin B6) deficiency, and terminal stages of liver disease.
Bilirubin (Bilirubinemia): Most bilirubin (80%) is a breakdown component from dying red blood cells. Bilirubin is also in macrophages of the spleen and in the liver, bone marrow and nonheme porphyrins. Bilirubin travels via the blood stream in the plasma part of the blood surrounded by albumin, globulin and other proteins. As it gets to the liver via the blood system, it disassociates from these proteins and the liver accepts it into it's own cells by binding (conjugating) it with glucuronic acid. This conjugation makes it water-soluble. From here bilirubin gets into the bile and then dumps into the small intestine, eventually leaving though the feces after it changes form one more times. Some of this bilirubin sneaks back into the bloodstream and is reabsorbed into the blood. This happens repeatedly. Sometimes the bilirubin ends up being excreted via the kidneys and dumps out into the urine. When this happens, it shows up in abnormal levels within the blood and may also show up in the urinalysis on the dipstick test.
Bilirubin Too High (Hyperbilirubinemia): Rule outs include hemolytic anemia, pulmonary infarct, Gilbert's syndrome (mild unconjugated hyperbilirubinemia), Dublin-Johnson syndrome (a genetic symptomatic mild jaundice), neonatal jaundice, inadequate liver uptake or defective conjugation, massive internal hemorrhage, obstruction of bile within the liver or outside the liver, defective secretion, acute or chronic hepatitis, fibrosis of the liver and liver cancer. It can also be falsely elevated when there is too much fat in the bloodstream. If only slightly elevated above the expected ranges, but with all other enzymes (LDH, GOT, GPT, GGT) within expected values, it is probably a condition known as Gilbert’s syndrome and is not significant.
Bilirubin is also measured in the urine. Sometimes the doctor's will run a test to check both conjugated and unconjugated bilirubin to help them determine where the extra is coming from.
They want to know if the liver is blocked or the blood cells have broken (hemorrhage). When the liver is blocked totally the fecal material will also be gray or whitish (acholic). When increased bilirubin is caused from hemorrhage the stools will be almost orange in color. You will want to tell your doctor this information because they may not ask.
Bilirubin Too Low: Low values are of no concern. Sunlight and fluorescent lights degrade the sample as the bilirubin is very fragile when exposed to light.
Private Home Health Testing, avoid the doctors office!
BUN (Blood Urea Nitrogen, Urea Nitrogen): High values may mean that the kidneys are not working as well as they should in clearing out the breakdown products of digested protein. The major breakdown product of protein you eat is urea, which is first formed in the liver. Urea contains nitrogen and together, in excess quantity, they are both toxic to the body and must be removed. Kidneys normally do an excellent job of removing urea, but when they start to fail, the urine components get all backed up in the system and the blood concentration of urea begins to rise. If you smell the breath, it has a stale, sickly smell (see my handout on the causes of Halitosis for other characteristics of bad breath) The reference range (or range within which most normal people's test values fall) for BUN is 10-20 mg/dl.
BUN Too High (Uremia, Azotemia or Uremic Acidosis): Rule out dehydration (too little water in the tissues), too much exercise, shock due to too much blood being lost (hemorrhagic shock), pancreatitis, intestinal foreign body, adrenal cortical insufficiency (adrenal glands not producing enough of the hormones it is suppose to be producing), or any condition which decreases blood flow to the kidneys, glomerulonephritis (the little tubules that make the urine in the kidneys are swollen and not working right), amyloidosis (the kidney tissue is being replaced with some kind of unnatural protein), pyelonephritis (inflammation/infection of the kidney where the urine pools before it dumps out into the ureters), nephrosis (a condition of the kidneys), calcium nephropathy--also called lymphosarcoma (cancer of the kidneys where the tissues are being replaced by calcium so the urine can't get out), kidney cancers, obstruction of the urine coming out of the kidney, leukemia, heart failure, ruptures of the urine carrying parts (kidney, ureters, bladder, urethra, kidney tubules), too much protein in the diet, bleeding within the intestine, and drugs like amphotericin B. Often, an additional test is done to measure creatinine.
BUN Too Low: Severe liver disease, hepatic venous shunts (portal-caval shunts), anorexia for several days (starving, not eating, fasting), pregnancy.
BUN/Creatinine Ratio: This test is used to differentiate kidney disease from dietary protein metabolism problems. Considered together, the BUN, blood creatinine and their ratio give very good evidence of the filtering function of the kidneys and a measure of the degree of bodily hydration. The ratio of BUN: creatinine is normally 10:1.
BUN/Creatinine Ratio Too High: Rule out dehydration (if the ratio is 20:1 or even higher), certain types of kidney disease, breakdown of blood in the intestinal tract, increased dietary protein, and any clinical circumstance in which insufficient blood is flowing through the blood vessels to the kidneys (such as heart failure or kidney artery disease)..
BUN/Creatinine Ratio Too Low: Rule out certain types of kidney disease, liver disease, malnutrition and Sickle Cell Anemia.
C-Peptide (see under Glucose)
Calcium is controlled in the blood by the parathyroid glands and the kidneys. Calcium is found mostly in bone and is important for proper blood clotting, nerve, and cell activity. Calcium is also found in the bloodstream.
Calcium Too High (Hypercalcemia): Rule out an elevation due to medications such as thiazide-type diuretics, inherited disorders of calcium handling in the kidneys, diets containing too much calcium, too many calcium supplements, too much Vitamin D, multiple myeloma (cancer of the stem cells within the bone that are responsible for producing all types of red and white cells), bone cancer, sarcoid, too much protein in the blood, too much albumin in the blood, fat in the blood (lipemia), excess parathyroid gland activity such as primary hyperparathyroidism (the thyroid gland has some kind of tumor or cancer causing the calcium levels to be to high), and pseudohyperparathyroidism (cancer of the lymphatic system).
Calcium Too Low (Hypocalcemia): Rule out certain drugs like Fosamax and furosemide-type diuretics, not enough dietary calcium, not enough dietary Vitamin D, overhydration, malabsorption, nutritional secondary hypoparathyroidism, hypercalcitoninism, eclampsia (milk fever--the baby or muscle contractions during birth have used up too much of the calcium), pancreatitis with fat necrosis (an infection in the pancreas which has affected all the extra fat in the body causing it to die from lack of circulation and nutrition), and not enough protein or albumin in the blood. Calcium is bound to a particular type of blood protein called albumin in the blood, so a low albumin level will cause the total calcium level in the blood to drop in proportion.
Cholesterol. There are two types of cholesterol, those obtained from the diet (exogenous) and that produced within the body (endogenous). Most of the endogenous cholesterol is formed by the liver, but each cell also produces a little bit as well which makes up part of the cellular membrane. With just small modifications, cholesterol can be used as the body needs it as steroids and cholic acid. Cholic acid uses approximately 80% of the body's cholesterol, which is converted into bile--that substance that helps us digest fats. Cutting out saturated fats from your diet can decrease your cholesterol levels from 15-25%. Eating more unsaturated fats (oils, nuts, seeds) can decrease your cholesterol. The saturated and unsaturated fats fight for the same receptor sites on cells. Saturated fats make the cell membranes sluggish (so you get arthritis and other degenerative diseases) and unsaturated fats make the membranes more liquid so the body works better. (See the Eicosinoid handout.) Lack of insulin and thyroid hormones will also increase the cholesterol levels.
Cholesterol is further broken down as follows:
Total Cholesterol: High cholesterol in the blood is a major risk factor for heart and blood vessel disease. Cholesterol in itself is not all bad. In fact, our bodies need a certain amount of this substance to function properly. However, when the level gets too high, vascular disease can result. Total cholesterol of less than 200, and an LDL Cholesterol of 100 or less is considered optimal by the National Heart, Lung, and Blood Institute. As the level of blood cholesterol increases, so does the possibility of plugging the arteries due to cholesterol plaque build-up. This is called "hardening of the arteries" or atherosclerosis. When the arteries feeding the heart become plugged, a heart attack may occur. If the arteries that go to the brain are affected, a stroke occurs.
There are three major kinds of cholesterol, High Density Lipoprotein (HDL) , Low Density Lipoprotein (LDL), and Very Low Density Lipoprotein (VLDL). The lower the density of cholesterol, the more cholesterol molecules there are.
HDL (High Density Lipoprotein) cholesterol is a "good cholesterol" as it protects against heart disease by helping remove excess cholesterol deposited in the arteries. High levels seem to be associated with low incidence of coronary heart disease.
LDL (Low Density Lipoprotein) cholesterol is considered to be "bad cholesterol" because cholesterol deposits form in the arteries when LDL levels are high. LDL levels of less than 130 are recommended. One hundred is optimal and values greater than 160 are considered high risk. Those persons who have established coronary or vascular disease may be instructed by their doctor to get their LDL cholesterol well below 100. You should ask your doctor which LDL target he or she wants for you.
There are two ways to report LDL. The most common is simply an estimate calculated from the Total Cholesterol, HDL, and triglycerides results. This may read "LDL Calc" on your results . A directly measured LDL cholesterol is usually more accurate, but more expensive and may require that your doctor specify the Direct LDL test.
VLDL (Very Low Density Lipoprotein: This is the only lipoprotein initially formed in the liver and contains mostly triglycerides and very little phospholipids and cholesterol. As they flow through the blood vessels they are quickly broken up and used as energy or stored as fat.
Cholesterol Too High: Rule out hypothyroidism, obstructive jaundice, liver disease, nephrosis, diabetes mellitus, familial, pancreatitis, hyperadrenocorticism, diet, retained anger and resentment.
Cholesterol Too Low: Rule out hyperthyroidism, infection, malnutrition, heart failure, malignancies, low fat diet, intestinal malabsorption and hepatic insufficiency.
© 2007 by Dr. Denice M. Moffat
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The Cure for Health Care and Indigenous Power is to Remove the AMA and FDA, and Unleash the Power and Creativity of the Free Market. Many People Have Been Brainwashed into Thinking the State Protects Them. The Truth is the Exact Opposite. ~ Morris Fishbein |
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