hepatic enzymes
*
AST (Serum Glutamic-Oxalocetic Transaminase - SGOT ) Found primarily in the liver, heart,kidney, pancreas, and muscles. Seen in tissue damage, especially heart and live
Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21
*
ALT (Serum Glutamic-Pyruvic Transaminase - SGPT) - Decreased SGPT in combination with increased cholesterol levels is seen in cases of a congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction
Normal Adult Range: 0 - 48 U/L
Optimal Adult Reading: 24
*
ALKALINE PHOSPHATASE- Used extensively as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth (elevated readings. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies
Normal Adult Range: 20 - 125 U/L
Optimal Adult Reading: 72.5
Normal Children's Range: 40 - 400 U/L
Optimal Children's Reading: 220
*
GGT (Gamma-Glutamyl Transpeptidase) - Elevatedlevels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium.
Normal Adult Female Range: 0 - 45 U/L
Optimal Female Reading: 22.5
Normal Adult Male Range: 0 - 65 U/L
Optimal Male Reading: 32.5
*
LDH (Lactic Acid Dehydrogenase) - Increases are usuallyfound in cellular death and/or leakage fromthe cell or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levelsof the enzyme maybe seen in cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ activity.
Normal Adult Range: 0 - 250 U/L
Optimal Adult Reading: 125
*
TOTAL BILIRUBIN- Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods
Normal Adult Range 0 - 1.3 mg/dl
Optimal Adult Reading: .65
Renal Related:-
*
B.U.N. (Blood Urea Nitrogen) - Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure. Decreased levels may be due to a poor diet, malabsorption, liver damage or low nitrogen intake.
Normal Adult Range: 7 - 25 mg/dl
Optimal Adult Reading: 16 mg/DL
CREATININE - Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting creatinine, muscle degeneration, and some drugs involved in impairment of kidney function,
Congestive heart failure
Normal Adult Range: 0 .7 - 1.4 mg/dl
Optimal Adult Reading: 1.05
Discussion
Creatinine is formed in muscles from creatine, which is formed in the liver. It is a substance that in health is easily excreted by the kidney. Because all Creatinine filtered by the kidneys is excreted into the urine, its levels at any given time interval are ***************alent to the Glomerular Filtration Rate (GFR).
* URIC ACID - High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney.
Normal Adult Female Range: 2.5 - 7.5 mg/dl
Optimal Adult Female Reading: 5.0
Normal Adult Male Range: 3.5 - 7.5 mg/dl
Optimal Adult Male Reading:5.5
* BUN/CREATININE - This calculation is a good measurement of kidney and liver function.
Normal Adult Range: 6 -25 (calculated)
Optimal Adult Reading: 15.5
Protein:-
*
TOTAL PROTEIN - Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism, leukemia, tuberculosis amongst many others.
Normal Adult Range: 6.0 -8.5 g/dl
Optimal Adult Reading: 7.25
*
ALBUMIN- major constituent of serum protein (usually over 50%). High levels are seen in liver disease (rarely) , shock, dehydration, or multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas or hypocalcaemia
Normal Adult Range: 3.2 - 5.0 g/dl
Optimal Adult Reading: 4.1
*
GLOBULIN - Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies (IgA, IgG, IgM, and IgE). Elevated levels are seen with chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, . Lower levels in immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease.
Normal Adult Range: 2.2 - 4.2 g/dl (calculated)
Optimal Adult Reading: 3.2
*
A/G RATIO (Albumin/Globulin Ratio)
Normal Adult Range: 0.8 - 2.0 (calculated)
Optimal Adult Reading: 1.9
Lipids:-
CHOLESTEROL - High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in arthrosclerosis, diabetes, hypothyroidism, pancreatic dysfunction and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia, Hyperthyroidism and infection.
Normal Adult Range: 120 - 240 mg/dl
Optimal Range: 185-200 mg/d
l
Discussion
Cholesterol is an important part of our diet. It is essential to the proper function and structure of cell membranes. Bile acids are derived from cholesterol. The liver, adrenals, sex glands, intestines, and even the placenta, manufacture cholesterol. Cholesterol is best used as an indicator of other metabolic dysfunction. Should not be considered a disease by itself unless extreme, which indicates familial cause. Check triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypo function. Low levels are not necessarily desirable as it is associated with increased incidence of malignancy and mental illness
*
LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial arthrosclerosis
Normal Adult Range: 62 - 130 mg/dl
Optimal Adult Reading: 81 mg/dl
*
HDL (High Density Lipoprotein) - A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.
Normal Adult Range: 35 - 135 mg/dl
Optimal Adult Reading: +85 mg/dl
Discussion
HDL is comprised of phospholipids and one or two apolipoproteins. It plays a role in the metabolism of other lipoproteins and in the transport of cholesterol to the liver. The HDL is a class of lipoproteins produced by the liver and intestines.A combination of increased triglyceride, cholesterol, and LDL with reduced HDL is indicative of atherogenic tendencies. A diet high in sugar may decrease HDL while increasing total serum cholesterol.
*
TRIGLYCERIDES - Increased levels may be present in atherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl
Optimal Adult Reading: 100
*
CHOLESTEROL / LDL RATIO:-
Normal Adult Range: 1 - 6
Optimal Adult Reading: 3.5
Thyroid:-
*
THYROXINE (T4)- Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
Normal Adult Range: 4 - 12 ng/dl
Optimal Adult Reading: 8 ng/dl
Free THYROXINE (T4)- A low level may indicate a diseased thyroid gland or may indicate a non-functioning pituitary gland which is not stimulating the thyroid to produce T4 . If T4 is low and TSH is normal , that is more likely to indicate a problem with the pituitary .
Normal Adult Range: 8-2 ng/dl
*
Free Triiodothyronine (T3) - Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal level of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function.
Normal Adult Range1.4-4.4 pg/ml
*
THYROID-STIMULATING HORMONE (TSH) - produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSHsecretion increases. Mid–rangenormal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have an effect on fertility.
Normal Adult Range: .0.4-4.0 mlU/l
Cardiac:-
*
Creatine phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI, peaking at 16 to 30 hours and returning to baseline within 4 days
o
25-200 U/L
o
32-150 U/L
* CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI, peaks in 24 hours, and remains elevated for up to 72 hours.
o
< 12 IU/L if total CK is <400 IU/L
o
<3.5% of total CK if total CK is >400 IU/L
*
o
(LDH) Lactate dehydrogenase - Total (LDH) will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.
*
140-280 U/L
*
SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours
o
10-42 U/L
GLUCOSE
Optimal Range: 85-100 mg/DL
Causes of Increased
· Diabetes mellitus and insulin resistance syndromes
· Thiamine (B<sub>1) insufficiency
· Stress
· Acute and chronic pancreatitis
· Drugs (anabolic and glucocorticoids, epinephrine, , diuretics,)
Causes of Decreased
*
Excess insulin (insulinoma, over dosage)
*
Impaired glucose tolerance (post-prandial)
*
Late/large malignancies
*
Endocrine hypo function (thyroid, adrenal cortex, anterior pituitary)
*
Protein malnutrition
*
Sometimes in pregnancy
*
Liver dysfunction
*
After gastric surgeries (altered gastric emptying)
*
IRON
Optimal Range: 75-150 mg/ml
Causes of Increased
*
Ineffective erythropoiesis (thalassemias, sideroblastic)
*
Intra-vascular hemolysis
*
Liver disease (alcohol, portocaval shunts)
*
Excessive iron intake
Causes of Decreased
*
Iron deficiency (low ferritin level; nutritional, blood loss, , small bowel disease, increased demand)
*
Chronic disease (liver dysfunction, renal dysfunction, etc.)
Discussion
Iron is known for its relationship to hemoglobin, which transports oxygen. Confirm true iron deficiency before supplementing iron. Never give Iron to someone who has an inflamed liver because this can be toxic. With B<sub>12 or Iron deficiencies, give special consideration to increased occurrence in the elderly. The most important test for iron is the serum ferritin.
*
AST (Serum Glutamic-Oxalocetic Transaminase - SGOT ) Found primarily in the liver, heart,kidney, pancreas, and muscles. Seen in tissue damage, especially heart and live
Normal Adult Range: 0 - 42 U/L
Optimal Adult Reading: 21
*
ALT (Serum Glutamic-Pyruvic Transaminase - SGPT) - Decreased SGPT in combination with increased cholesterol levels is seen in cases of a congested liver. We also see increased levels in mononucleosis, alcoholism, liver damage, kidney infection, chemical pollutants or myocardial infarction
Normal Adult Range: 0 - 48 U/L
Optimal Adult Reading: 24
*
ALKALINE PHOSPHATASE- Used extensively as a tumor marker it is also present in bone injury, pregnancy, or skeletal growth (elevated readings. Low levels are sometimes found in hypoadrenia, protein deficiency, malnutrition and a number of vitamin deficiencies
Normal Adult Range: 20 - 125 U/L
Optimal Adult Reading: 72.5
Normal Children's Range: 40 - 400 U/L
Optimal Children's Reading: 220
*
GGT (Gamma-Glutamyl Transpeptidase) - Elevatedlevels may be found in liver disease, alcoholism, bile-duct obstruction, cholangitis, drug abuse, and in some cases excessive magnesium ingestion. Decreased levels can be found in hypothyroidism, hypothalamic malfunction and low levels of magnesium.
Normal Adult Female Range: 0 - 45 U/L
Optimal Female Reading: 22.5
Normal Adult Male Range: 0 - 65 U/L
Optimal Male Reading: 32.5
*
LDH (Lactic Acid Dehydrogenase) - Increases are usuallyfound in cellular death and/or leakage fromthe cell or in some cases it can be useful in confirming myocardial or pulmonary infarction (only in relation to other tests). Decreased levelsof the enzyme maybe seen in cases of malnutrition, hypoglycemia, adrenal exhaustion or low tissue or organ activity.
Normal Adult Range: 0 - 250 U/L
Optimal Adult Reading: 125
*
TOTAL BILIRUBIN- Elevated in liver disease, mononucleosis, hemolytic anemia, low levels of exposure to the sun, and toxic effects to some drugs, decreased levels are seen in people with an inefficient liver, excessive fat digestion, and possibly a diet low in nitrogen bearing foods
Normal Adult Range 0 - 1.3 mg/dl
Optimal Adult Reading: .65
Renal Related:-
*
B.U.N. (Blood Urea Nitrogen) - Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise or heart failure. Decreased levels may be due to a poor diet, malabsorption, liver damage or low nitrogen intake.
Normal Adult Range: 7 - 25 mg/dl
Optimal Adult Reading: 16 mg/DL
CREATININE - Low levels are sometimes seen in kidney damage, protein starvation, liver disease or pregnancy. Elevated levels are sometimes seen in kidney disease due to the kidneys job of excreting creatinine, muscle degeneration, and some drugs involved in impairment of kidney function,
Congestive heart failure
Normal Adult Range: 0 .7 - 1.4 mg/dl
Optimal Adult Reading: 1.05
Discussion
Creatinine is formed in muscles from creatine, which is formed in the liver. It is a substance that in health is easily excreted by the kidney. Because all Creatinine filtered by the kidneys is excreted into the urine, its levels at any given time interval are ***************alent to the Glomerular Filtration Rate (GFR).
* URIC ACID - High levels are noted in gout, infections, kidney disease, alcoholism, high protein diets, and with toxemia in pregnancy. Low levels may be indicative of kidney disease, malabsorption, poor diet, liver damage or an overly acid kidney.
Normal Adult Female Range: 2.5 - 7.5 mg/dl
Optimal Adult Female Reading: 5.0
Normal Adult Male Range: 3.5 - 7.5 mg/dl
Optimal Adult Male Reading:5.5
* BUN/CREATININE - This calculation is a good measurement of kidney and liver function.
Normal Adult Range: 6 -25 (calculated)
Optimal Adult Reading: 15.5
Protein:-
*
TOTAL PROTEIN - Decreased levels may be due to poor nutrition, liver disease, malabsorption, diarrhea, or severe burns. Increased levels are seen in lupus, liver disease, chronic infections, alcoholism, leukemia, tuberculosis amongst many others.
Normal Adult Range: 6.0 -8.5 g/dl
Optimal Adult Reading: 7.25
*
ALBUMIN- major constituent of serum protein (usually over 50%). High levels are seen in liver disease (rarely) , shock, dehydration, or multiple myeloma. Lower levels are seen in poor diets, diarrhea, fever, infection, liver disease, inadequate iron intake, third-degree burns and edemas or hypocalcaemia
Normal Adult Range: 3.2 - 5.0 g/dl
Optimal Adult Reading: 4.1
*
GLOBULIN - Globulins have many diverse functions such as, the carrier of some hormones, lipids, metals, and antibodies (IgA, IgG, IgM, and IgE). Elevated levels are seen with chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus are present, . Lower levels in immune compromised patients, poor dietary habits, malabsorption and liver or kidney disease.
Normal Adult Range: 2.2 - 4.2 g/dl (calculated)
Optimal Adult Reading: 3.2
*
A/G RATIO (Albumin/Globulin Ratio)
Normal Adult Range: 0.8 - 2.0 (calculated)
Optimal Adult Reading: 1.9
Lipids:-
CHOLESTEROL - High density lipoproteins (HDL) is desired as opposed to the low density lipoproteins (LDL), two types of cholesterol. Elevated cholesterol has been seen in arthrosclerosis, diabetes, hypothyroidism, pancreatic dysfunction and pregnancy. Low levels are seen in depression, malnutrition, liver insufficiency, malignancies, anemia, Hyperthyroidism and infection.
Normal Adult Range: 120 - 240 mg/dl
Optimal Range: 185-200 mg/d
l
Discussion
Cholesterol is an important part of our diet. It is essential to the proper function and structure of cell membranes. Bile acids are derived from cholesterol. The liver, adrenals, sex glands, intestines, and even the placenta, manufacture cholesterol. Cholesterol is best used as an indicator of other metabolic dysfunction. Should not be considered a disease by itself unless extreme, which indicates familial cause. Check triglycerides and HDL/LDL. Cholesterol is increased with endocrine hypo function. Low levels are not necessarily desirable as it is associated with increased incidence of malignancy and mental illness
*
LDL (Low Density Lipoprotein) - studies correlate the association between high levels of LDL and arterial arthrosclerosis
Normal Adult Range: 62 - 130 mg/dl
Optimal Adult Reading: 81 mg/dl
*
HDL (High Density Lipoprotein) - A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.
Normal Adult Range: 35 - 135 mg/dl
Optimal Adult Reading: +85 mg/dl
Discussion
HDL is comprised of phospholipids and one or two apolipoproteins. It plays a role in the metabolism of other lipoproteins and in the transport of cholesterol to the liver. The HDL is a class of lipoproteins produced by the liver and intestines.A combination of increased triglyceride, cholesterol, and LDL with reduced HDL is indicative of atherogenic tendencies. A diet high in sugar may decrease HDL while increasing total serum cholesterol.
*
TRIGLYCERIDES - Increased levels may be present in atherosclerosis, hypothyroidism, liver disease, pancreatitis, myocardial infarction, metabolic disorders, toxemia, and nephrotic syndrome. Decreased levels may be present in chronic obstructive pulmonary disease, brain infarction, hyperthyroidism, malnutrition, and malabsorption.
Normal Adult Range: 0 - 200 mg/dl
Optimal Adult Reading: 100
*
CHOLESTEROL / LDL RATIO:-
Normal Adult Range: 1 - 6
Optimal Adult Reading: 3.5
Thyroid:-
*
THYROXINE (T4)- Increased levels are found in hyperthyroidism, acute thyroiditis, and hepatitis. Low levels can be found in Cretinism, hypothyroidism, cirrhosis, malnutrition, and chronic thyroiditis.
Normal Adult Range: 4 - 12 ng/dl
Optimal Adult Reading: 8 ng/dl
Free THYROXINE (T4)- A low level may indicate a diseased thyroid gland or may indicate a non-functioning pituitary gland which is not stimulating the thyroid to produce T4 . If T4 is low and TSH is normal , that is more likely to indicate a problem with the pituitary .
Normal Adult Range: 8-2 ng/dl
*
Free Triiodothyronine (T3) - Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal level of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function.
Normal Adult Range1.4-4.4 pg/ml
*
THYROID-STIMULATING HORMONE (TSH) - produced by the anterior pituitary gland, causes the release and distribution of stored thyroid hormones. When T4 and T3 are too high, TSH secretion decreases, when T4 and T3 are low, TSHsecretion increases. Mid–rangenormal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypothyroidism, which can have an effect on fertility.
Normal Adult Range: .0.4-4.0 mlU/l
Cardiac:-
*
Creatine phosphokinase (CK) - Levels rise 4 to 8 hours after an acute MI, peaking at 16 to 30 hours and returning to baseline within 4 days
o
25-200 U/L
o
32-150 U/L
* CK-MB CK isoenzyme - It begins to increase 6 to 10 hours after an acute MI, peaks in 24 hours, and remains elevated for up to 72 hours.
o
< 12 IU/L if total CK is <400 IU/L
o
<3.5% of total CK if total CK is >400 IU/L
*
o
(LDH) Lactate dehydrogenase - Total (LDH) will begin to rise 2 to 5 days after an MI; the elevation can last 10 days.
*
140-280 U/L
*
SGOT - will begin to rise in 8-12 hours and peak in 18-30 hours
o
10-42 U/L
GLUCOSE
Optimal Range: 85-100 mg/DL
Causes of Increased
· Diabetes mellitus and insulin resistance syndromes
· Thiamine (B<sub>1) insufficiency
· Stress
· Acute and chronic pancreatitis
· Drugs (anabolic and glucocorticoids, epinephrine, , diuretics,)
Causes of Decreased
*
Excess insulin (insulinoma, over dosage)
*
Impaired glucose tolerance (post-prandial)
*
Late/large malignancies
*
Endocrine hypo function (thyroid, adrenal cortex, anterior pituitary)
*
Protein malnutrition
*
Sometimes in pregnancy
*
Liver dysfunction
*
After gastric surgeries (altered gastric emptying)
*
IRON
Optimal Range: 75-150 mg/ml
Causes of Increased
*
Ineffective erythropoiesis (thalassemias, sideroblastic)
*
Intra-vascular hemolysis
*
Liver disease (alcohol, portocaval shunts)
*
Excessive iron intake
Causes of Decreased
*
Iron deficiency (low ferritin level; nutritional, blood loss, , small bowel disease, increased demand)
*
Chronic disease (liver dysfunction, renal dysfunction, etc.)
Discussion
Iron is known for its relationship to hemoglobin, which transports oxygen. Confirm true iron deficiency before supplementing iron. Never give Iron to someone who has an inflamed liver because this can be toxic. With B<sub>12 or Iron deficiencies, give special consideration to increased occurrence in the elderly. The most important test for iron is the serum ferritin.
