Lab Panels – The Basics and What YOU Need to Know

All right. So last time we did this, um, it was me in front of a big black wall with a TV that people could sometimes see the screen and I talked a lot through it. Today you're going to get to see numbers, you're going to get to see 'em some examples. You're gonna get to see a mean writing and doodling and all that stuff. So this is a lot of fun. It makes more sense when I do it this way. Um, of course we hit, just had those, the slight tech limitations. But now I think that we're going to be able to give, uh, to bump this up a notch in terms of quality. So let's get started. So lab panels, um, I don't think that labs are addressed enough. Who here feels like their, um, their current curriculum or [inaudible] or what have you, or program just does not give you enough information in terms of lab panels.
Okay,
perfect. Sarah is all on those emojis. Yeah, nobody does. It's just like, documentation drives me nuts. Hey, you need to chart all of these things, but what do you charting? Nobody knows. Okay. So at lab panel,
sorry I had to get a drink. I didn't go away with lab panels. What we're gonna do is we're gonna go through the different types of panels that you're going to see on a kind of a daily basis when you're in, uh, working in the hospital or in different, maybe you're in a clinic, that kind of stuff. So the first one we're gonna start with is, it's going to get up. So the first thing we're going to look at are metabolic panels. There's two that we're particularly going to look at. And the first one is a basic metabolic panel. So,
okay,
where's my pin? Cool. B And p stands for basic metabolic panel. Okay. So your basic metabolic panel is going to do several things. The first thing it's gonna do is it's going to give you a very, very quick snapshot into, um, what's going on with your patient. These are done typically in a house in La, in, in the house, in house, in the lab, uh, Ad Hospital. They're really quick. It's these values right here. So the first thing I want you to tell me [inaudible] and, and do what, what are we looking at with bun and craton primarily from a BMP standpoint.
Okay.
Brenda says liver. Sarah says kidney. Vanessa says renal function, kidney, kidney. The answer is kidney. So these two guys are gonna be your renal values and we'll go into those a little bit more. Um, oh, a really cool feature that you guys may see at the bottom is this button says that says full screen, you can actually go full screen. I will say that when you do that, you do lose the ability to chat. So it's just kind of one of those tradeoffs. If you actually want to see the full screen, go ahead and you can click that to click out of it. You just need to click escape. But that's another quick way to do that. Uh, in some of this text is really small for if maybe you're on a, if you are on mobile, this may be a little bit small, but you know, I want to make sure that at least in a, in a, in a full container on them, on a browser, you should be able to do that. So being a credit intrarenal when you get a, um, the other thing real quick on these two, so you in also looks at dehydration and then you've got a creatinine, which is more of a renal, but it's also involved in muscles. So you have to be a little bit con, uh, conscious of that glucose sugars. Obviously we're going to look at those. K, N, a, and C. Oh, what are these
lights? Perfect. Yup. These are your electrolytes. So you're going to get, you're going to look at your sodium and potassium, sodium chlorine. You're also going to take a look at bicarb and you're also going to get a look at calcium. So here in these you can see all of these, hey, if I get a BNP on my patient, I'm going to get all of these guys Buni, creatinine, sodium chloride, potassium, glucose, um, your calcium and then your bicarb. All of these things are almost essential things that you have to see or look at whenever you're looking at your basic metabolic panel, but that's what you're going to be looking for. So let's move on to the next one. Hold on. There we go. CMP. CMP stands for comprehensive. Oops, I already have it up there. I'll just draw the arrow. That's the beauty of doing this right. So a comprehensive metabolic panel. So the CNP is, it's not, it's a more in depth panel. So you get your basic metabolic panel plus AOP, alt and AST. If you're down here, who could tell me what these are for? Yup. Vanessa's on it. Liver enzymes. These are liver enzyme level that you're looking. There are also known as l f t, his liver function tests. And then we take a look at albumin and total protein and this thing called GF r.
Okay.
I'm not going to ask you what GFR stands for. I'll tell you in a minute, but tell me what we're looking at with GFR and Watson. Yep. Okay, cool. Mary's on it. Cool. It's the glomerular filtration rate. Now GFR is specific to the kidney period. No, that's all right. I have those days I think. I think I was having a rough morning with my keyboard. It was not working. So with GFR, it's a really important, um, kidney function. How many of, how many of you? A show of hands, quote unquote of hands. Um,
okay.
Who can tell me a w who has been in this session before or a similar session
where I did a lab panel. Ping has done, ping has done it. Cool. I think Brenda's been in this one. Okay. Now this is back. Excellent. First Time. Excellent. Cool. Um, the reason I ask this because I always go over this when I do this, this tutoring session, but GFR, who can tell me the rule of thumb for GFR to determine percentage of, um, functional kidney value?
Yeah.
I'll give you a second to type cause this may be a little bit more complicated. Okay, cool. So the rule of thumb, I'll write it down, GFR, if you look right here, so 90 to 120. So GFR stands for [inaudible] spelling.
Hmm.
Well malleolar filtration,
right? Okay.
If you look here, it's at 90 to 120. It's based, it's based on a, uh, a body surface area. PSA. So, uh, with the GFR it's 90 to 120 mils per minute per 1.73 meters squared, a body weight or body surface area. And sorry, the rule of thumb, this is really close to approximately a hundred. So if I have a patient whose GFR is a hundred mils per minute per 1.73 meters squared of body surface area, they have essentially a hundred percent kidney function. Now let's say I change that GFR to 60, 60 mils. I think I just get myself away here. One 73 meter square. About what percentage?
Okay.
Of the, uh, kidney is functioning
60. The easiest way. The simplest right way to say it is that for every mil per minute of body surface area is the amount of functional kidney. So if it's 20 I'm writing up here, if it's 20 then I know it's 20% if it's 40 it's 40% if it's 80, it's about 80% so they start to classify a patient's kidneys, kidney function, and their need for dialysis based on the GFR. So if you ever see GFR and they go, Oh, is GFRs 24 great, I know that he's got, he's lost about 75% of his kidney function. Does that make sense?
Perfect. It's simple enough that I think seriously, that's groovy. She's still at, she's still in my lingo. Um, for the most part that's going to be like one GFR is really difficult to remember. It's a, it's a strange formula. It's a strange unit. Um, so on the inclax or in practice when you see it, you know, doing it this way means that hey, I've got a good idea. It's, it's basically should be about 190 to 100. Is normal, every hospital or facilities different in terms of what their, uh, abnormals are. And then you get nephrologist involved and, uh, you get dialysis technicians involved and everything, it looks a little bit more cloudy, but for the most part, as a standard rule of thumb, a hundred, 100 mils per minute is your, that value is we've got 100% functioning, 60 [inaudible], 60%, et cetera, et cetera. Okay? So that's what the CMP is. I've kind of digressed it. We'll go, I mean, we'll circle back to this in a minute, but that's what that kind of general rule of thumb for that conference and metabolic panelists. So let's go over, and this is an important, um, thing I want you guys to know with this, uh, mag and phos are not included on a CMP or a BMP. So that means what you'll get is you'll get an order that'll say BMP plus mag and phos.
Okay?
That's what you'll get. That'll be your order. So basically you have to order these additional, uh, labs. So just know that if anybody, if, if your, your provider says, Hey, I want to turn the mag, let's order it. BNP be like, Hey, I need a, I need a separate order for mag. It's typically not included. Your facility may vary, but the general rule of thumb is that mag and phos are additional and you have to ask for them. All right, next one. Let's take a look. CBC with differential. This is one of my favorites. I'm doing another one of these sessions. I think it's tomorrow I'm doing, um, CBC. So I'm actually gonna break down this aisle a lot more tomorrow. So just go over to that. Tutoring the tutoring one page. Fine. Find it. If you're not already signed up for it, it's not up for it and come back cause it'll be cool cause we're gonna break it down. Love CBCS. Um, I always felt, because I spent a lot of time looking at them, um, you could always start to key in and see where your, your patients trends were going. So, uh, what does CBC looks like? CVC is complete
blood count.
Um, so what I want to look at with the CVCS, I'm gonna look at several things. There are five, uh, one, two, three. There are four main things that you want to look at with the CPC. The first one is white blood cells. You wanna look at your red cells, you look at platelets, and then you want to look at this, which is also known as your h and h are the two. So one, two, three, four. This one is less important and I'll explain it in a second. So, uh, white blood cells with differential. There are four things that we look at with a differential, which I'll go into tomorrow. But the reason you look at a differential is they are, um, so let's say, let's look at this patient's white blood cell count, right? So let's say his, uh, let's see, he's 18. Oh my goodness. I cannot write. Do you have any Christmas? They're 18. So the 18,000 is his, uh, white cells and it flags. Now what does that tell me? How much information can I get from this? If I'm seeing that I get a CBC back? And it says his white cells or 18,000. Mine says infection.
Mary says infection.
Steve Says Cancer. Steve Snuck in here. Anything else? Pink says infection and it says HIV. Okay. What it tells you is that his white cells are count Eric, his white cell count is high. That's all it tells you. It doesn't really help us specify what's going on. It's kind of a trick question because what you need to do is look at the differential. The differential is going to help break it down. Let's say he's a trauma. Let's say for the, for the sake of me mis-gendering this person, it's a guy 20. So let's say it's 26. Let's see, 26 year old male involved in an NBC motor vehicle collision. So I to trauma, you get his, uh, let's see, you get his white count back and let's say his neutrophils are, how am I gonna do math?
80, 80%.
What does this now tell you? Because once your pills are not indicative, there it is. Brian's says inflammation neutrophils in the differential are a, are indicative of an inflammatory process. So real quick. Um, there are four things that you can get from a differential. The first one is infection. The second one is inflammation and inflammation. Uh, then you can get anemia. This is, I'm sorry, I don't want to misspeak here. Infection, inflammation and leukemia with the other. We'll talk about anemia in just a second. But with these, with these three things, infection, inflammation and leukemia you get from your differentials, you can also get a, now I guess I, this is an inflammatory process, but let's say you have a patient who has, um, let's say they have
Anna Filactic reaction. One of these might go up, your eosinophils and basophils and your neutrophils are going to go up, but your lymphocyte count would actually probably go down and your monocytes will probably go down. So this is why it's so important to pay attention to your patients history and also the paying attention to your patients. Um, this differential because the differential tells you so much more information than, hey, I got a patient. Um, I remember I had a patient one time, um, dude, he's a, what did he have? Oh, he had a trake, he was coughing. He had a ton of gross, nasty secretions. They were dark like Brown. I kept telling my providers, I'm like, look, I think it's got an infection. He started becoming febrile. We did a CBC on him and sure enough, and I told her, I said, hey, look, I think this does not, um, like, uh, like a blood infection.
We did cultures just as a, as a formality, but for the most part I said, look, this guy is symptomatically. He's has fixed pecans aggressions. His white count's going up. Sure enough, they cultured it and his lymphocytes had gone up. Uh, I think his monocytes were moderately elevated and his neutrophils were not that high. So I can tell that because he had the lymphocytes, the, uh, lymphocytosis, he had an elevated white count and his, he was symptomatically, uh, producing these thick respiratory secretions. I knew it was pneumonia. Sure enough, they took an x ray. They started on my antibiotics. All of these things I knew, I knew my patient. Hey, you know, one of the things here that I want to tell you about this is it's attention to your gut. If your gut is telling you that you really think something is and you have the data to back it up, bring it to your provider's attention because they may not be looking at the PA, the patient the same way that you are.
Um, let's move on to the next one. Sorry, I soapbox for a second. Red Blood cells, hemoglobin and hematocrit. Now these are really important for a, this is your anemia portion. This is what I'm on right here, this guy. So you've got anemia. And then down here you're h and h, sorry, there's a lot of writing on the screen. So bear with me. Uh, let's see. So red cells with the red cells. This is really important because you can have like a patient that has sickle cell anemia, so your red counts are normal. But because of the, uh, let's say d, The abnormal shape of the, the cell itself, the hemoglobin, uh, values can change. Hematocrit is a percentage. You can tell me why Hermatocrit is actually a percentage. I know it takes a second to type.
Okay.
Let me give you just one more second. Anybody. So the reason that hematocrit medic over hemoglobin? No, not necessarily. So hermatocrit is a, um, it's a percentage because if I take, I'm gonna draw over here. This is a test tube.
You're cool.
So the test tube of blood, right. And I feel as I fill this, uh, testing with blood and I spin it down and Ooh, I think I can change colors. Oh, I can, I normally don't change colors. So check this out. Red. Yay. Yeah, I'm sorry. It's, it's the little things in life, right? Cool. These are my red blood cells. Okay, then.
Sweet.
This is plasma
[inaudible].
Okay, that's fine. It now on my red cells are down at the bottom and this is plasma. This whole thing is known as you get this t v V or total blood volume. If I literally were to measure this out, this is about 45% of the total blood volume and plasma. It makes up about 55% of the total blood volume. So the reason what you can do is it actually gives you a quick snapshot, a quick, uh, like rule of thumb into whether your patients naming your patients like 44% English, okay. Not Likely anemic if your patients Sinai having difficulty breathing and looks Pale. Uh, and then you get your, their h and h back and you see their hemoglobin, you're like, oh, hemoglobin to four. And I can't remember what normal is, are, but I see that as, hey is like 20%. I know that that patient is then anemic.
That means that only 20% of his entire blood volume is red blood cells, which means, hey, we have a problem with red blood cells. We need a transfusion, right? So that's what the hemoglobin does. But Hemoglobin and hematocrit are actually tied to each other because hemoglobin is a concentration of the Fred's cells and the hemoglobin is that, that, um, that carrying capacity. So let's move on. So before I do real quick, I just want to come back to this. So anytime you see a CBC, what you want to do is you want to look at, uh, let's go with green. You looking at these four things, anemia, leukemia, infection and inflammation. That's what your CBC does.
Alright,
liver function panels. I'm also doing another, uh, more expounded, uh, tutoring session tomorrow. This one, we're going to get into this a lot more. Basically with these, you're looking at, hey, I want to look at alt, alk, phos and ASD. And then, uh, because Bilirubin is kind of a, a byproduct that should be filtered out, it should actually stay relatively low. So if we look right here, these are low values. I would expect this to be normal in this patient. However, Alanine, uh, Alanine, Trans Trans Nominees, uh, Auckland phosphatase and, uh, aspartates trans nominees is well, so many words. Um, but these are all your liver function tests and then your Bilirubin is tied to it. The other reason you need to pay attention to proteins in your liver, liver function panel is that albumin and other proteins are made in the liver. So if you have impaired, if your patient has impaired liver function, you're actually going to see decrease in the proteins.
Okay. One thing, uh, I want to mention real quick, if you can't come back tomorrow, but this is really important. AST is produced in several different locations in the body. Alt Is, uh, uh, produced in several different locations in the body and Alk phos. They're all, all of these are, uh, produced in the liver, but they're also produced in other areas. So in order to determine if it's an actual liver value problem or a liver problem, more than one of these have to be elevated. If your ASC is just totally is elevated and the other two are normal and your patient's asymptomatic, your Bilirubin is normal, uh, maybe you do an ultrasound on the liver that looks normal, then you very likely have some other problem other than liver. So just remember the big thing about the liver function panel and the liver function tests is that your LFTs all have to be elevated.
While I say all more than one has to be elevated and you'll start to see trends in the way that works. So just something to keep in mind when we're going through these. There's actually lessons on, on, on all of these. Let's see, here we go. Renal panel. We talked about this just a few minutes ago. So the big difference between these, so you've got the Bun and the creatinine. Oh, also one thing, don't call it Bun, never call it bun. The provider will look at you like you're silly. It's B u n cause it stands for blood urea nitrogen. So you're bun, creatine, and then you have your electrolytes and your GFR. GFR is specific to the kidney. You've got your lights, which is really important because we're talking about, um, the management of electrolytes and water and osmotic and autocratic pathways in the kidneys. But the other thing that's really important here is this guy right here.
Your analysis, um, with the, your analysis, we're looking at white cells, red cells, protein, glucose. Um, there should be a zero after this, sorry. Um, ketones, Ph in the bilirubin and euro blend engine. These are all really, these are always products is what we're looking for with a reason. We want protein is low because we don't want the kidneys actually spilling out protein, glucose. Um, we actually want to make sure that glucose and ketones are negative because there are certain syndromes like, um, so you can actually have a, it's called Fanconi Syndrome. You can't have it. Well, I mean you could theoretically, but if you had a patient that had a Fanconi Syndrome, they would actually produce ketones in the urine without producing glucose because for a variety of reasons, ketones are actually kicked out by the, uh, by the bladder. It's Kinda crazy, um, without Lucas because usually what happens is you have excess of glucose in the blood.
Excessive glucose gets filtered out through the kidneys, like in diabetic patients, diabetic Ketoacidosis, Keto acidotic patients. What happens is that glucose gets kicked out and then finally the body starts to break down ketones as a means of, uh, as a means of energy, trying to find a ways to get energy. And what happens is there's ketone bodies build up and then they get kicked out. So your, your DKA patients are gonna have like glucose and ketones in there and then their Ph could change. But you want to look at all of these collectively together with, um, with the, these other values and this specific gravity. So 10 20 is normal, 10, 10 to 10 30. The thing about this is this side is extremely dilute.
Okay?
And this is extremely concentrated. So if there's a way for you guys to remember, so concentrate is that way. Dilute is that way. So the lower the number, the more dilute, which means there's more water in it. So there's a less constant, there's less, uh, saw use in it and more water. Next one. You have questions about that one? I'm kind of blowing through that one. If you don't, we're good.
Okay,
let's move to the next one. Cool. Alright, next. Lipid panels. Lipids. Who can tell me in one word why we do live in panels or two words? I'll take two words.
Cool. All right. We'll play hangman for a second. Yep. We could play hangman.
The panels look at risk. Yeah. So Roxie says atherosclerosis. So what? Yeah. So della rams, stroke, we're looking with lipid panels. We are looking actual, um, we're at, oh my goodness. It feels like Friday. It's only to say, here we go, uh, lipid panels, assess for risk. We look for things like triglycerides, cholesterol, HDL, LDL. So if I have a patient that has t I a briefly tell me what a tia is. Anybody. Oh my goodness. Jane's in it. Jane's Ain't wet. Lulu says transient something.
Okay.
Transient ischemic attack. Mini-Stroke exactly. So if I have a patient, imagine this. Imagine I have a patient that presents, they have a Tia, right? All of a sudden you do their triglycerides. Let's see. Let's see you do this lipid panel. Let's say these are their values.
Uh, [inaudible]
just making up numbers here. And these probably wouldn't be too far off from somebody who's normal. What does this tell me about this patient's risk? Exactly. They are a high, they are now a higher risk for stroke. They already have kind of like the, uh, like the predeterminations to habit because they've already had a tia. Like they're already at risk. So the triglycerides are high and the cholesterol is high, the HDL is low, and their LDL is high. Where do we want to keep these values real quick? HDL and LDL. HDL, we want high or low.
Okay.
Okay. LDL, we want higher. Low. Brian says, hi,
LDL low HDL. We want to keep that high. If you look over here at this range, this is kind of the goal. We want to above 60 milligrams per deciliter and LDL, we want to keep it, uh, less than a hundred milligrams per deciliter because what happens with HDL and LDL, basically HDL attaches to the LDL and kicks it out of the body. Says, Hey, you're not supposed to be here. We're going to travel. We're going to leave. That's exactly this kind of in a nutshell what you want to do. So the higher you have your HDL, the higher you have your good fats. In the lower you have your lower fats, the less likely you are that you're going to, you're going to have your cholesterol and your triglycerides go up.
Cool.
All right. I think I've got one more. Oh no, that's it. I've been nursing. Yay. Cool. Alright, I'm gonna turn screen share off so we can talk like humans. Uh, bear with me.
Cool.
So how can, okay, so Brian asked, how can l HDL be raised? Um, we're gonna we're to answer Brian's question first. So Brian says, how can HDL be raised? HDL can be raised by a variety of reasons. Number one, by lowering the amount of LDL, which means you have to make some diet changes, which means you have to be aware of the types of, um, fats you're taking in. So if you're taking in a trans fats, uh, if you're taking in a saturated fats, a fried foods,
um, one of the thing, like a quick way to assess your patient, especially if they're like, oh, hey, my LDL is low and main show is high. How Brian says, no pizza. Uh, everything in moderation, right? So with, um, you want to say, you want to say with healthy fats, fats aren't essential part of the Diet. Fats do a lot of really important things that are a part of hormone production. And there are part of um, storing excess energy if you need it. Um, they're part of installation. They're a part, they have a ton of different functions that are part of like cell formation. They're more warmth. Yeah. Especially when cold cause in Texas it gets ridiculous sometimes cause Texas is, Texas is something else with its weather right now. But um, with that, what you want to do is you want to make sure that, that you're patient and yourself, nothing wrong with self care is that you want to make sure that your patients, uh, they're getting a good solid, balanced, um, balance of, of good, healthy fats. So things like,
yeah,
Avocados, um, eggs and moderation. I'm going to say, I'm going to say eggs and moderation because there was a new study that came out and it was kind of iffy basically. So he was in rats and it was talking about excess eggs and um, but you want to make sure that they're good, getting good like, uh, nuts. Nuts are a good source of healthy fats. Like walnuts are extremely high in Omega threes and Omega sixes. So it's really important that when your patient says, oh, well I eat, you know, these fatty foods. Well, are you going to Carl's jr every day? Um, nothing against Carl's Jr. But, uh, that's what I mean. It's like I'm, I'm getting a good mix of healthy fats and I'm eating, uh, you know, I'm cooking with, you know, a minimal amount of olive oil or, um, I bake all my foods or I'm, I'm eating lean meats like you can get, you can get a certain amount of, um, of healthy fats from all those things. Uh, what you, by eating extremely high processed, uh, highly saturated fatty foods, um, that's, they're going to get a lot of that LDL build up. And if that LDL is too high, even if the HDL was normal, it's still kind of takes a toll on HDL production. So a delirium asks if someone has fatty liver and takes Lipitor. Is that okay?
The alarm, I'm going to ask you a question. Um, are you talking about a nonalcoholic fatty liver disease or syndrome? Ah, this one is a tricky one. And here's why. Um, in my personal quest for research, um, one of the best things, and it's weird and I don't know why and I'm not really like not a huge proponent of it, but it's something worth looking up. And, uh, I think there's needs to be more research in this area, but for fatty liver disease or I don't want to call it fatty liver disease, nonalcoholic Fatty Liver Syndrome, uh, the Keto Diet has actually shown. I have no idea why. Um, and I am not a proponent of the Keto Diet. Uh, I'm not, I let you know I'm going to go by where it's, let's look, see, and, uh, the majority of science says, um, and what research says, it's just some interesting research.
Um, and I'm not in any way advocating for, uh, the Keto Diet to be done. Um, I think the best answer for your question, if someone has fatty liver and takes the [inaudible], is that OK? Um, the, the question is, so liberatory is a, a fat binding or cholesterol binding agent. Um, and so what you want it, what it's designed to do is to bind to, uh, think free fat. I'd have to look up the pharmacokinetics of it, um, but it binds to the free fat in the blood and then helps to, uh, Tequila it essentially and, and excreta from the body. Um, so for patients that have atherosclerosis, arteriosclerosis or they have a previous history of, um, maybe high triglycerides and there's a lot more that goes into, um, nonalcoholic fatty liver disease, um, syndrome disease, then I know about, I would, I probably have to do like more specific specific information. There's also maybe some contraindications or some indications for a bad disease process pro plus Lipitor. I would have to look. I don't, I probably doesn't answer your question in any way, shape or form, but that's kind of what I know about it. You guys have any other questions?
Yeah.
Oh, you're welcome. Perfect. Okay. For those of you that were around earlier for, I think it was Nicole session, which she had some issues with, uh, some of the screen sharing, did you guys have any problems with screen sharing today?
Cool.
All right guys. Well, I'm gonna wrap it up here. Thanks for, uh, coming on and really cool. Excellent. All right guys. Um, I'll be back tomorrow. I'm doing two more. Tomorrow I'm doing, um, am I doing CDC and I'm doing, uh, LFTs. LFTs are gonna be my first one that I'm doing. So it should be interesting. Uh, Steve asked for the survey. Oh, Steve, you just wait. Steve knows. Uh, so one of the things, so Steve is asking about a survey. One of the things that we've actually done is we've implemented this, uh, this really cool thing at the end, if you guys, you're not obligated to stick around, a survey may pop up for you. If it does, uh, just throw it out. I'm not, you know, we try to make it a little bit easier for everybody and is a Oh, co who does he tutoring sessions? Who engages in that kind of stuff? So Steve's on the surveys, but yeah, if you guys, um, you know, just hang out for like two more seconds and then she'll pop up our guys. We'll see you tomorrow. I've been asking.