BLOOD CHEMISTRY
VALUES FOR DIALYSIS PATIENTS
by Patricia Hansen, RN
Patricia Hansen, RN, is Administrator of the Dialysis Center and Director of Renal Nursing Services at Good Samaritan Hospital of Long Island, NY.
| Blood Chemistry | Normal Values | Accepted Normal for Dialysis Patients | Causes of Abnormals (I.E. of High Abnormals) | Signs and Symptoms Associated with Abnormal Levels |
| CALCIUM (Ca) |
8.5-10.5 | Same | LOW CALCIUM -- eating too many phosphorus foods. Not taking phosphorus binders. Will go down if phosphorus goes up. | LOW CALCIUM -- muscles twitching and cramping, seizures, varying degrees of depression, hair loss, cataracts and conjuctivitis. |
| HIGH CALCIUM -- medications such as Rocaltrol or Calderol may cause sharp increase if blood not checked regularly. | HIGH CALCIUM -- muscle weakness fatigue, constipa- tion, and abdominal cramps, nausea, vomiting, loss of apetite. If prolonged, calcification of blood vessels, including coronary arteries. | |||
| PHOSPHORUS (PO4) |
2.5-5.0 | Same | Not taking phosphate binders. Eating too many foods with phosphorus, e.g. milk, cheese, meats, beans. | Calcium deposits in blood vessels, leading to heart and eye problems. Breaking of bones without specific injury (spontaneous), continuous bone pain - especially hip, knees and ankles. Causes elevated parathyroid hormone. |
| MAGNESIUM | 1.7-2.3 | Same | Elevations due to taking phosphate binders contain-ing
magnesium or other medications, such as Milk of Magnesia or Citrate of Magnesia.
|
Decreased mental function ranging from drowsiness to insevere state coma. Decreased tendon reflex leading to paralysis. Nausea and vomiting. Hypotension due to dilation of blood vessels. |
| HEMATOCRIT (Hct) |
36-52 | Will be lower- varies with patient. Average is mild 20s. |
Decreased production of red blood cells. Blood loss during or after dialysis. | Fatigue, shortness of breath, chest pain on exertion. |
| GLUCOSE | 80-120 | Same | Diabetes, Recently eating very sweet foods | Excessive thirst. |
| BUN | 10-26 | Less than 100. | Eating too much protein food. | Fatigue, nausea, insomnia, dry and itching skin. Taste and smell affected, urine- like body odor and breath. |
| CO2 Bicarb |
21-30 | Not less than 12. | Eating too much protein food, creating a more acid blood-- lowering CO2 | Slow, shallow breathing. |
| SODIUM (Na) |
133-150 | Same | Eating too much salt, e.g., bacon, potato chips, canned vegetables. | Edema, elevated blood pressure, shortness of breath, elevated
tempera- ture, flushed skin color, rapid heartbeat. |
| CHLORIDE (Cl) |
95-108 | Same | Same as Na. | Same as Na. |
| CREATINE | Below .25 | 12-28 Varies with muscle mass. Should not change more. | Inadequate dialysis time. Breakdown of muscles (often given off by muscle after exercise. | |
| POTASSIUM (K) |
3.5-5.4 | Same | Eating too many foods with potassium, e.g., green leafy vegetables, fruit, meat, coffee, and nuts. | Heart stops, vague symptoms-- occasional weakness, numbness, irregular heartbeat. |
| ENZYMES SGOT |
10-50 | Same | Hepatitis fatigue. Pancreatitis Pericarditis |
Nausea, vomiting, abdominal cramping Nausea, severe abdominal pain. Chest pain on inspiration. |
| GGT | 30-115 | Same | Hepatitis Pancreatitis |
|
| ALKALINE PHOSPHATASE |
30-115 | Same | Not taking phosphate binders | Painful joints. Weakened bones, which could lead to severe pain and/or deteri- oration requiring surgery. |
| PARATHYROID HORMONE |
Intact 163-347 C-Terminal |
Same | Long-term imbalances of calcium and phosphorus | Same as elevated phosphorus. |