BODY FLUIDSBody fluids, total volume : 50 percent (in obese) to 70 percent (lean) of body weight Intracellular : 0.3 - 0.4 of body weight Extracellular : 0.2 - 0.3 of body weight

Blood Total volume Males : 69 ml/kg body weight Females : 65 ml/kg body weight

Plasma volume Males : 39 ml/kg body weight Females : 40 ml/kg body weight

Red blood cell volume Males : 30 ml/kg body weight (1.15 - 1.21 L/m2 body surface area) Females : 25 ml/kg body weight (0.95 - 1.00 L/m2 body surface area)

Blood acid-base Normal range

ArterialVenous

Actual pH7.35 - 7.457.32 - 7.42

PCO2 (mmHg)35 - 4541 - 51

Base excess (mmol/L blood)0 2.5

Total CO2 (mmol/L plasma)23 - 2726 - 30

Actual bicarbonate (mmol/L plasma)22 - 2624 - 28

Standard bicarbonate(mmol/L plasma)22- 26

Oxygen saturation (%)96 - 9740 - 70

Oxygen tension PO2 (mmHg)80 - 10025 - 40

CEREBROSPINAL FLUIDCells< 5/mm3, all lymphocytes

Chloride600 - 700 mg/dl

Glucose45- 75 mg/dl or

60% of serum glucose

pH7.34 - 7.43

Pressure50-180 mm H2O

Protein, lumbar15 - 45 mg/dl

Albumin58%

a1-globulins9%

a2-globulins8%

b-globulins10%

g-globulins10% (5-12%)

Protein, cisternal15 - 25 mg/dl

Protein, ventricular5 - 15 mg/dl

CHEMICAL CONSITUTENTS OF BLOODAntistreptolysin titre150 - 200 units/ml

Acetoacetate0.2 - 2.0 mg/dl

Acid phosphatase0.5 - 12.0 Bodansky units/dl

Acid phosphatase, prostatic2.5 - 12.0 IU/L

Aldolase1.0 - 6.0 IU/L

Alkaline phosphatase

Child5 - 12 Bodansky units/dl

Adult1.4 - 4 Bodansky units/dl

Alpha - 1 antitrypsin200 - 500 mg/dl

Ammonia 10-80 g/dl

Amylase3 - 10 Wohlgemuth units/dl

Ascorbic acid0.4 - 1.5 mg/dl

Bilirubin

Adult0.3 - 1.1 mg/dl

Newborn0.4 - 4.0 mg/dl

At 3 days1.0 - 10.0 mg/dl

Carbon dioxide, total18 3.0 mEq/L

Caeruloplasmin

Males36.0 5.6 mg/dl

Females40.9 6.8 mg/dl

Copper75 - 160 g/dl

Creatinine phosphokinase, total0 - 3.4 micromoles/dl

(Duma modification of Hughes method)Creatinine phosphokinase isoenzymes

MM fraction94-95%

MB fraction0-5%

BB fraction0-2%

Creatinine0.6 - 1.4 mg/dl

Delta amino laevulinic acid200 g/dl

Electrolytes (ISE Analyser)

Potassium3.5 - 4.5 mEq/L

Sodium135 - 140 mEq/L

Chlorides98-110 mEq/L

Calcium9-10.5 mg/dl

(Delhi and Ellingboe)

Phosphorus (Fiskee and Subbarow)

Child1.1 - 1.65 mmol (2.2 - 3.3 mEq)/L

3-4.5 mg/dl

Adult0.55 - 1.1 mmol (1.1 - 2.2 mEq)/L

Gamma glutamyl transpeptidase (Rosalki's method)

Male45 U/L

Female35 U/L

Gastrin60 - 200 pg/ml

Glucose, fasting70 - 110 mg/dl

(GOD-POD method)

Glucose 6-phosphate dehydrogenase5-10 IU/g Hb

G6-PD screen, qualitativeNegative

Immunoglobulin, quantitative (adults)

IgG570 - 1920 mg/dl

IgE< 0.025 mg/dl

IgA70 - 400 mg/dl

IgM

Males30 - 250 mg/dl

Females30 - 300 mg/dl

IgD0 - 40 mg/dl

(Ramsay's method)

Insulin, fasting6 - 25 U/ml

Iron60 - 140 g/dl

Iron binding capacity 250 - 450 g/dl

(Ramsay's method)

Lactic acid5-15 mg/dl

Lipidogram

Cholesterol140 - 220 mg/dl

Triglycerides10 - 160 mg/dl

Phospholipids150 - 350 mg/dl

Free fatty acids< 18 mg/dl

ChylomicronsAbsent

Beta lipoprotein60 - 75%

Pre-beta lipoprotein8 - 20%

Alpha lipoprotein13 - 24%

LDH70 - 240 IU/L

LDH isoenzymes (Colorimetric method of King)

LDH120 - 34%

LDH228 - 41%

LDH315 - 25%

LDH48-16%

LDH56-15%

Lipase0-160 U/L

Magnesium1.7 - 2.6 mg/dl

Osmolality278 - 305 Osm/kg serum water

Phenosulphonphthalein25% excreted within 15 min after injection of 1 ml dye

Phenylalanine3 mg/dl

Protein, total6.3 - 7.9 g/dl

Albumin3.5 - 5.3 g/dl

Globulin1.8 - 3.6 g/dl

Protein electrophoresis

Alpha - 10.2 - 0.4 g/dl

Alpha - 20.5 - 0.9 g/dl

Beta0.6 - 1.2 g/dl

Gamma0.7 - 1.7 g/dl

SGOT (AST)8 - 40 Karmen units/dl

SGPT (ALT)0 - 40 Karmen units/dl

Sulphate0.5 - 1.5 mg/dl

Urea15 - 45 mg/dl

Urea nitrogen7 - 21 mg/dl

Uric acid2.5 - 7.0 mg/dl

Viscosity1.4 - 1.8 mg/dl

(Serum compared to H2O)

Vitamin A0.15 - 0.60 g/dl

Vitamin B12200 - 850 g/dl

FUNCTION TESTS

CirculationArteriovenus oxygen difference: 30-50 ml/L

Cardiac output (Fick) : 2.5-3.6 L/m2 body surface area per min

Contractility indexes

Maximum left ventricular dp/dt: 1650 300 mmHg/s

Maximum (dp/dt)/p : 44 + 8.4s-1

(dp/dt)/DP at DP = 40 mmHg : 37.6 12.2s-1 (DP = diastolic pressure)

Mean normalised systolic ejection rate (angiography) : 3.32 0.84 end-diastolic volumes per second

Mean velocity of circumferential fibre shortening (angiography) : 1.66 0.42 circumferences per second

Ejection fraction, stroke volume/end-diastolic volume (SV/EDV): Normal range : 0.55-0.78; average : 0.67

End-diastolic volume : 75 15 ml/m2

End-systolic volume : 25 8 ml/m2

Left ventricular work

Stroke work index : 30-110 (g.m)/m2

Left ventricular minute work index : 1.8-6.6 (kg.m)/m2/min

Oxygen consumption index : 110-150 ml

Pressures, intracardiac and intraarterial

Pulmonary vascular resistance : 2-12 (kPa.s)/L (20-120 (dyn.s/cm2)

Systemic vascular resistance : 77-150 (kPa.s)/L (770-1500 dyn.s)/cm2)

Gastrointestinal

Absorption testsD-xylose absorption test : After an overnight fast, 25 g xylose is given in aqueous solution by mouth. Urine collected for the following 5 h should contain 33-53 mmol (5-8 g) (or > 20 percent of ingested dose). Serum xylose should be 1.7-2.7 mmol/L l h after the oral dose (25-40 mg per 100 ml).

Vitamin A absorption test : A fasting blood specimen is obtained and 200,000 units of vitamin A in oil is given by mouth. Serum vitamin A levels should rise to twice fasting level in 3-5 h.

Bentiromide test (pancreatic function): 500 mg bentiromide (Chymex) orally; p-aminobenzoic acid (PABA) measured in plasma and/or urine.

Plasma : 3.6 ( 1.1) mg/L at 90 min

Urine : 50 percent recovered in 6 h

Gastric juiceVolume

24 h : 2-3 L

Nocturnal : 600-700 ml

Basal fasting : 30-70 ml/h

Conversion factor for SI

Reaction

pH : 1.6-1.8

Titratable acidity of fasting juice : 4.9 mol/s (15-35 mEq/h)0.261

Acid output

Basal

Females (mean 1 SD) : 0.6 0.5 mol/s (2.0 1.8 mEq/h)0.2778

Maximal (after subcutaneous histamine acid

phosphate 0.004 mg/kg body weight and

preceded by 50 mg promethazine or after

betazole 1.7 mg/kg body weight or

pentagastrin 6 g/kg body weight):

Females (mean 1 SD) : 4.4 1.4 mol/s0.2778

(16 5 mEq/h)

Males (mean 1 SD) : 6.4 1.4 mol/s0.2778

(23 5 mEq/h)

Basal acid output/maximal acid output ratio : 0.6 or less

Gastrin, serum : 40-200 ng/L (40-200 pg/ml)

Secretin test (pancreatic exocrine function ) : 1 unit per kg body weight, intravenously

Volume (pancreatic juice): 2.0 ml/kg in 80 min

Bicarbonate concentration : 80 mmol/L (80 mEq/L)

Bicarbonate output : 10 mmol in 30 min (10 mEq in 30 min)

Haematology

HaemogramTotal erythrocyte count

Males4.5 - 5.5 millions/cmm

Females4.1 - 4.8 millions/cmm

Haemoglobin

Males14.5 - 16.5 g/dL

Females12.0 - 14.5 g/dL

Packed cell volume

Males38 - 50%

Females34 - 43%

Mean corpuscular volume78 - 94 c

Mean corpuscular haemoglobin24 - 33 g

Mean corpuscular haemoglobin

concentration 30-35%

Total leucocyte count4000 - 11000/cmm

Differential count

Neutrophils60 - 70%

Eosinophils1 - 7%

Lymphocytes20 - 30%

Monocytes1- 6%

Platelets150, 000 - 450,000/cmm

Reticulocyte count0.5 - 2% of erythrocytes

Erythrocyte sedimentation rate

(Westergen)

Male0 - 15 mm at end of 1 h

Female0 - 20 mm end of 1 h

Blood volume

Average plasma volume45 5 ml/kg body weight 1487 112 ml/sq meter body surface

Erythrocyte osmotic fragility test

Increased fragilityLysis of RBCs seen with over 0.5% of sodium chloride; haemolysis incomplete in 0.3% sodium chloride

Coagulation studies

Bleeding time (Ivys method)1.7 min

Coagulation time (Lee and White)4 - 8 min

One-stage prothrombin time (Quick)Control 1 sec

Clot retraction40 - 65%

Euglobulin lysis time120 - 240 min

Fibrin degradation products10 g/dl

Fibrinogen200 - 400 mg/dl

Activated partial thromboplastin

Time (PTT)24 - 35 sec

Thrombin time9 - 10 sec (control + 3 sec)

Whole blood clot lysis time< 24 hours

Bone marrow study Normal percentage (range)

WBC reticulum cells0.2 (0.1 - 2.0)

Blasts2.0 (0.3 - 5.0)

Promyelocytes5.0 (1.0 - 8.0)

Myel-neutro12.0 (5.0 - 21.0)

Myel-eosino1.5 (0.5 - 3.0)

Myel-baso0.3 (0.0 - 0.5)

Metamyelocytes11.0 (6.0 - 17.0)

Stab forms11.0 (7.0 - 15.0)

PMN neutrophils20.0 (7.0 - 15.0)

PMN eosinophils20.0 (0.5 - 4.0)

PMN basophils0.2 (0.0 - 0.7)

Lymphocytes10.0 (3.0 - 17.0)

Plasma cells0.4 (0.0 - 2.0)

Monocytes2.0 (0.5 - 5.0)

Megakaryocytes0.4 (0.03 - 3.0)

RBC : Pronormoblasts4.0 (1.0 - 8.0)

Normoblasts

Basophilic1.4 (0.5 - 2.4)

Polychromatophilic18.0 (7.0 - 32.0)

Orthochromatic2.0 (0.4 - 4.6)

Unclassified cells0.3 (0.0 - 0.9)

M : E ratio3.5 : 1

Haemoglobin studies (normal and abnormal)

Haemoglobin A10.5% of total Hb

Haemoglobin A1CUp to 6% of total Hb

Haemoglobin A21.5 - 3.5% of total Hb

Haemoglobin, foetal 0-2% of total Hb

Haemoglobin, plasma0-5% of total Hb

Haemoglobin, serum2-3 mg/dl

Methaemoglobin< 1.8%

Haptoglobin, serum100 - 300 mg/dl

Haemochromogens, plasma3-5 mg/dl

Haemolysis test

Acid haemolysis test (Ham)No haemolysis

Cold haemolysis test

(Donath - Landsteiner)No haemolysis

Erythrocyte life-span

Normal120 days

51Cr - labeled half-life28 days

Iron turnover rate (plasma)29 - 42 mg/24 h

Osmotic fragility

Haemolysis begins0.45 - 0.38 NaCl

Haemolysis completed0.33 - 0.30 NaCl

Reticulocyte index =Corrected rate2

Reticulocyte index correction factor

Corrected rate =Observed rate x patients haematocritNormal haematocrit (45)

HaematocritCorrection factor

451.00

400.71

350.52

300.38

250.28

200.20

150.13

Note : Reticulocyte index = percent reticulocytes x correction factor haematocrit and early bone marrow releaseSchilling test : 7-40% of orally administered radiolabelled vitamin B12 excreted in urine after flushing with intramuscular injection of B12Hormones and metabolites Adrenocorticortropin (ACTH), serum15 - 70 pg/ml

Aldosterone, serum

210 mEq/day sodium diet

Supine48 29 pg/dl

Upright (2 h)65 23 pg/dl

110 mEq/day sodium diet

Supine107 45 pg/dl

Upright (2 h)532 228 pg/dl

Urine5 - 19 g/24 h

Calcitonin, serumNone detectable

Catecholamines, free urinary110 ug/24 h

Cortisol, serum

8 AM5 - 25 g/dl

8 PM5 - 25 ug/dl

Cosyntropin stimulation

(30-90 min after 0.25 mg cosyntropin intramuscularly or intravenously)10 g/dL rise over baseline

Overnight suppression (8 AM) (serum cortisol after 1 mg dexamethasone orally at 11 pm)5 g/dl

Urine20 - 70 g/24 h

11-deoxycortisol, serum, basal< 0 - 1.4 g/dl

Metyrapone stimulation (30 mg/dl orally 8 h prior)> 1.5 g/dl

Oestrogens, urine (increased during pregnancy, decreased after menopause)

Males

Females

Total

4 - 25 g/24 h

5 - 100 g/24 h

Oestriol

1 - 11 g/24 h

0 - 65 g/24 h

Oestradiol

0 - 6 g/24 h

0 - 14 g/24 h

Oestrone

3 - 8 g/ 24 h

4 - 31 g/24 h

Oestriocholanolone, serum

1.2 g/24 h

Follicle-stimulating hormone, serum

Males6 - 18 U/dl

Females

Follicular phase5 - 20 U/dl

Peak midcycle12 - 30 U/dl

Luteal phase5 - 15 U/dl

Postmenopausal50 U/dl

Free thyroxine index, serum

Adult, fasting5 ng/dl

Glucose load (100 g orally)< 5 ng/dl

Levodopa stimulation (500 mg orally in a fasting state) baseline within 2 h

17-hydroxycorticosteroids, urine

Males2 - 12 mg/24 h

Females2 - 8 mg/24 h

5-hydroxyindoleacetic acid

(5-HIAA), urine2- 9 mg/24 h

Insulin, plasma

Fasting6 - 126 U/ml

Hypoglycaemia< 5 U/ml

17-ketogenic steroids, urine

Under 8 years0-2 mg/24 h

Adolescent0-18 mg/24 h

Adultmales8-18 mg/24 h

females5-15 mg/24 h

Metanephrine, urine1.3 mg/24 h

Norepinephrine, urine100 mg/24 h

Parathyroid hormone, serum150-300 pg/ml (varies with serum calcium)

Radioactive iodine 131I uptake (RAIU)5-25% at 24 h (varies with iodine intake)

Renin activity, plasma

Normal diet

Supine1.1 0.8 mg/dl

Upright1.9 1.7 mg/dl

Low-sodium diet

Supine2.7 1.8 mg/dl

Upright6.6 2.5 mg/dl

Diuretics and low-sodium diet10.0 3.7 mg/dl

Testosterone

Total plasma bound

Adolescent males100 mg/dl

Adultmales300 - 100 mg/dl

Females 25 - 90mg/dl

Unbound

Adultmales3 - 24 mg/dl

Females 0.09 - 1.30 mg/dl

Thyroid-stimulating hormone, serum< 10 U/ml

Thyroxine (T4), serum

Total4.5 - 11.5 g/dl

Free0.8 - 2.4 /dl

Thyroxine-binding globulin

capacity, serum15 - 25 g T4/dl

Thyroxine index, free1-4 mg/dl

Tri-iodothyronine (T3), serum70-190 mg/dl

T3 resin uptake25 - 45%

Vanillyl mandelic acid (VMA), urine1-8 g/24 h

Renal function testsAnion gap

Na+ - (HCO-3 + Cl-) 10 2 mEq/dL

Osmolality

Osmolality (serum) = 2 Na+ (mEq/L) +

BUN (mg/dl)2.8+Glucose (mg/dl)18

Bicarbonate deficit

HCO-3 deficit = body weight (kg) x 0.4 (desired HCO-3 - observed HCO-3)

Creatinine clearance Ucr x VPcr

= 130 20 ml/min in males

= 120 15 ml/min in females

where

Ucr = Urine creatinine (mg/dl)

Pcr = Plasma creatinine (mg/dl)

V = Urine volume/(ml) 24 h

Renal plasma flow

RPF =Upah X Vppah

= 700 100 ml/min in males

= 600 100 ml/min in females

where

Upah = Urine para-aminohippuric acid

V = Urine volume/24 h

ppah = Plasma para-aminohippuric acid

Summary of values useful in pulmonary physiologyPulmonary mechanicsNormal values

Spirometry : volume-time curves

Forced vital capacity4.0 litres

Forced expiratory volume 3.0 litres

in 1 s

FEV1/FVC75%

Maximal midexpiratory flow4.0 litres per second

Maximal expiratory flow rate8.0 litres per second

Spirometry: flow-volume curves

Maximal expiratory flow 5.5 litres per second

at 50% of expired vital capacity

Maximal expiratory flow 3.0 litres per second

at 75% of expired vital capacity

Resistance to airflow

Pulmonary resistance< 3.0 cm H2O/s per litre

Airway resistance< 2.5 cm H2O/s per litre

Specific conductance> 0.13 cm H2O/s

Pulmonary compliance

Static recoil pressure 25 5 cm H2O

at total lung capacity

Compliance of lungs (static)0.2 L/cm H2O

Compliance of lungs 0.1 L/cm H2O

and thorax

Dynamic compliance of 0.25 0.05 litres

20 breaths per minuteper cm H2O

Maximal static respiratory pressures

Maximal inspiratory pressure> 90 cm H2O

Maximal expiratory pressure> 150 cm H3O

Lung volumesTotal lung capacity6-7 litres

Functional residual capacity2-3 litres

Residual volume1-2 litres

Inspiratory capacity4.5 litres

Expiratory reserve volume3.2 litres

Vital capacity4-5 litres

Gas exchange (sea level)Arterial O2 tension95 5 mmHg

Arterial CO2 tension40 2 mmHg

Arterial O2 saturation97 2%

Arterial blood pH7.40 0.02

Arterial bicarbonate24 2 mmol/L

Base excess0 2 mmol/L

Diffusing capacity for 25 ml co/min/mmHg

carbon monoxide (single breath)

Dead space volume50 25 ml

Physiologic dead space :

dead space- 35% VT

tidal volume ratio (rest) (exercise) 20% VT

Alveolar-arterial difference for O2 20 mmHg

Semen LiquefactionComplete in 15 min

Morphology60% normal forms

Motility75% motile forms

pH7.2 - 8.0

Spermatocrit10%

Spermatocyte count50 million/dl

Volume2.0 - 6.6 ml

StoolBulk

Wet weight< 197 g/24 h

Dry weight< 66.4 g/24 h

Coproporphyrin12 - 832 mg/24 h

Fat (on a diet containing < 7.2 g/24 h or 30%

30 g fat/day)dry weight

Nitrogen< 2.2 g/24 h

Urobilinogen40 - 280 mg/24 h

WaterApproximately 65%

Synovial fluidCells200 cells/mm3

Polymorphonuclear cells25%

CrystalsNone

Fibrin clotNone

GlucoseSame as serum

Hyaluronic acid2.45 - 3.97 g/L

pH7.32 - 7.64

Protein2.5 g/dL

Albumin63%

a1-globulins7%

a2-globulins7%

b-globulins9%

g-globulins14%

Relative viscosity300

Uric acidSame as serum

Urine Acidity, titrable20-40 mEq/24 h

Ammonia20 - 50 mEq/24 h

Amylase25 - 260 Somogyi unit/h

Bence-Jones proteinNone detected

BilirubinNone detected

Calcium :Normal diet0.05 - 0.31 mEq/kg body weight/24 h

Low-calcium diet150 mg/24 h

Chloride120 - 240 mEq/24 h (varies with dietary intake)

Copper0-32 g/24 h

Creatinine

Adults0 - 200 mg in 24 h

Children7 - 11 mg in 24 h

Creatinine1.0 - 1.6 g/24 h or 15-25 mg/kg body weight/24 h

Glucose

QualitativeNone detected

Quantitative16-300 mg/24 h

HaemoglobinNone detected

Homogentisic acidNone detected

Iron40 - 140 g/24 h

Lead0 - 120 g/24 h

MyoglobinNone detected

Osmolality50 - 1200 mOsm/L

pH4.6 - 8.0

Phenylpyruvic acid, quantitativeNone detected

Phosphorus0.8 - 2.0 g/24 h

Porphobilinogen

QualitativeNone detected

Quantitative0-2.4 mg/24 h

Porphyrin

Coproporphyrin50 - 250 g/24 h

Uroporphyrin10 - 30 g/24 h

Potassium25 - 100 mEq/24 h

Protein

QualitativeNon detected

Quantitative10 - 150 mg/24 h

Sodium10 - 150 mEq/24 h (varies with dietary sodium intake)

Specific gravity1.003 - 1.030

Uric acid600 - 700 mg/24 h

Urobilinogen1.0 Enrich units/24 h