INTERPRETATION OF LAB DATA

Reference values

Analyte Normal range

Haemoglobin 12-16 g/dl

Blood urea 20-40 mg/dl
S.Creatinine 0.6-1.1mg/dl
Glucose (Fasting) 70-110mg/dl
(Postprandial) <140mg/dl
HbA1c < 5.5% of total (>6.5 %: Diabetes)
S.Cholesterol <200 mg/dl
LDL 70-180mg/dl
Triglycerides <150mg/dl
HDL 40-59mg/dl
S.Uric acid 3.5-7mg/dl
Total Protein 6-8 g/dl
Albumin 3.5-5g/dl
Globulin 2-3.5g/dl
Total bilirubin 0.2-1.0mg/dl
SGOT/AST <35 IU/L
SGPT/ALT <35 IU/L
Alkaline Phosphatase 40-125 IU/L
Total T3 120-190 ng/dl
Total T4 5-12 µg/dl
TSH 0.5-5µU/ml
Serum Sodium 136-145 mEq/L
Serum Potassium 3.5-5 mEq/L

Reference: Textbook of Biochemistry for medical students DM Vasudevan, Sreekumari.S 8th edn
Lab reference values Amala Institute of Medical Sciences
Please note : This is a practical exercise. Please read the related theory portions for
each of the following main questions. The values and subquestions may differ when
asked for examination (interactive session for practical examination).

Dose Calculation & Interpretation of lab data should be copied on to your fair
record before your practical examination.
Qn 1. Mr George, a 45 year old male who has recovered from myocardial infarction, came to the OPD
with the following lab report. Lab investigations show

▪ FBS-90mg/dl

▪ PPBS- 110mg/dl

▪ S Cholesterol- 270mg/dl

▪ LDL- 160mg%

▪ TG-150mg%

▪ HDL-40mg%

a. What abnormality do you note in the lab investigations ? Is this a cause for concern ?
b. What are the secondary causes of hyperlipidaemia which should be ruled out before starting
lipid lowering therapy ?
c. How will you manage this patient ?
d. Write the starting dose, time of administration, adverse effects and contraindications of HMG
CoA reductase inhibitors.

Ans: a. Hyperlipidaemia.Yes.

b. Rule out secondary causes like dietary excess, uncontrolled DM,hypothyroidism, alcoholism,
nephrotic syndrome, chronic renal failure and drugs :etretinate, glucocorticoids for prolonged periods,
protease inhibitors.

c. Lifestyle modification-Dietary modification, Reduction of body weight to the ideal level, graded
exercise, Stress reduction, abstinence from alcohol and smoking.

Prescribe HMG CoA reductase inhibitors like Statins.

d. Statins: Starting dose

Atorvastatin : 10 mg/day

Rosuvastatin :2.5 mg/day

Time of administration: Most cholesterol synthesis occurs at night-so short t1/2 compounds like
Pravastatin & Fluvastatin are best administered at night as a single dose.

Atorvastatin & Rosuvastatin have long t1/2-can be taken at anytime of the day.

Others with evening meal.

Adverse effects: Rise in hepatic aminotransferase, creatine kinase,myositis,myopathy,Rhabdomyolysis,
increased risk of new onset diabetes,drug interactions etc.

Contra indications: Pregnancy,lactation,children,severe liver disease.

Qn 2. A 50 year old male comes to the OP with complaints of gross pedal oedema, and decreased
urine output. Lab investigations show

▪ Hb- 10gm%

▪ Blood urea-70mg/dl

▪ S .Creatinine-2.8mg/dl

▪ Random Blood Sugar- 126mg/dl

1. What abnormality do you note in the lab investigations ?

2. Which drug will you choose to treat the oedema ? Why ?

3. What should you monitor very closely once you start this drug ?

Ans 1. Raised blood urea and creatinine.Impaired renal function.

2. Furosemide.

Highly effective: Natriuretic effect is much greater than others.

High ceiling: Diuretic response increases with increasing dose

Active even in patients with severe renal failure.

Rapidly acting:IV ( 2-5 minutes) Oral (20-40 minutes)

No tolerance.

Thiazide diuretics are ineffective in the presence of elevated serum creatinine.

3.Closely monitor therapeutic response and watch for allergic reactions,

hypovolaemia,hyponatraemia,hypokalemia and acid base disturbances.

Qn 3. A 35 year old female comes to the OP with complaints of fatigue , dyspnoea on exertion
 Lab investigation show

▪ FBS-106mg/dl

▪ PPBS-120mg/dl

▪ Hb-9gm%

▪ ESR-15 mm/hr

1. What abnormality do you note in the lab investigations ?

2.How will you manage this patient ?

3.Write any three preparations which you can administer orally. Write the dose of any one of
them.

4.What are the possible adverse effects ? How will you minimize them ?

5.When will you consider the response to therapy satisfactory ?

6.What dietary advice will you give to this patient ?

Ans:

1.Anaemia-possibly iron deficiency anaemia

2.Correct Haemoglobin and correct the underlying cause of anaemia such as blood loss due to
menorrhagia,GI loss and hookworm infestation.

3.Oral iron preparations-Ferrous sulphate, Ferrous gluconate, Ferrous fumarate

Ferrous sulphate 200 mg three times daily after food.

4.GI disturbances-give iron with food and increase dose gradually.

Constipation,metallic taste in the mouth.

Liquid form may combine with sulphide ions in mouth to form black iron sulphide which cause
blackening of teeth-avoid by using a straw for drinking.

Iron sulphide also makes the faeces black

5.Response to oral iron is considered satisfactory when Hb level increases by about 1.5 g/100 ml
of blood within 3 weeks.
6. To include iron rich foods like green leafy vegetables,rice bran,pulses, jaggery.,egg
yolk,meat,liver etc in diet

Qn 4. A 40 year old female comes to the OP with complaints of pain ,swelling and redness in

the big toe. She gives history of recurrent attacks of such episode in the past

Lab investigations show

▪ ESR-70mm/hr

▪ RA factor-negative

▪ Hb-12gm/dl

▪ S Uric acid-10 mg/dl

1. What abnormality do you note in the lab investigations ?

2.Which drugs will you give to reduce the symptoms of the patient ? How will you administer them

3.Which group of drugs will lower serum urate levels?

4.List the drugs which can cause hyperuricaemia.

Ans: 1.Hyperuricaemia

2. a.NSAIDs like Aceclofenac 100 mg BD / Diclofenac 25-50 mg BD

Indomethacin 25-50 mg tid x 5-7 days ( A/E: gastric intolerance)

Ibuprofen,Naproxen: equally effective,less toxic. Avoid salicylates (antiuricosuric and also blocks

uricosuric effect of other drugs)

b.Colchicine : Fastest acting,but highly toxic.Single dose of 1.2 mg orally followed by 0.6 mg 1

hr later.Do not repeat within 4 days to avoid cumulative toxicity.

c. Glucocorticoids if refractory to the above drugs.Prednisolone 20mg orally bd till the patient is

asymptomatic for 1 week.Then reduce by 5-10 mg everyday

3. (If uric acid level is <9mg% start only after acute joint inflammation subsides to prevent delay

in recovery)

a.Uric acid synthesis inhibitors-Febuxostat 40-80 mg /day

or Allopurinol 100 mg/day.Monitor serum uric acid level after 2 weeks .Increase dose gradually

every two weeks (max 800 mg/day) till Serum uric acid is <6mg%

b.Uricosuric drugs –Probenecid 0.5 g once daily orally.Interferes with excretion of many drugs.

4.Thiazides,loop diuretics, Cytotoxic drugs,Ethambutol,Pyrazinamide ,Levodopa,Isotretinoin etc

Qn 5.An obese 45 year old female comes to the OP with complaints of fatigue ,excessive thirst

Lab investigations show

▪ FBS-140mg/dl

▪ PPBS-250mg/dl

▪ ESR-18mm/hr

▪ Hb-12gm/dl

▪ HbA1c- 7%

1.What abnormality do you note in the lab investigations ?

2.How will you manage this patient ? Which drug will you prefer for monotherapy ? Why ?

3.Name two group of drugs to be used judiciously in this patient

Ans:
1.Raised bloodsugar and HbA1c-Diabetes mellitus

2.Dietary modification(amount of carbohydrate intake should be reduced, Include salads & dietary
fibres) and exercise

Monotherapy with Metformin-Start with dose of 500 mg 2-3 times a day with major meals.

Advantages of Metformin : it reduces HbA 1C by 1-2 %, decreases LDL-C & triglycerides,causes

less weight gain,low risk of hypoglycaemia,low cost, decreases total mortality

3.Corticosteroids-increase gluconeogenesis,reduce glucose uptake-cause hyperglycaemia

Betablockers like Propranolol-mask the signs of hypoglycaemia

Qn 6.A 70 year old male diabetic patient on insulin misses a few doses of insulin and is brought
to the casualty in a comatose state,dehydrated and hyperventilating

Lab Investigations show

▪ Random blood sugar-480 mg%

▪ Urine sugar-2 %

▪ Urine- acetone+++

1.What is your diagnosis ?

2.How will you manage this patient ?

Ans:

1. Diabetic ketoacidosis

2. a.Correction of dehydration

Normal saline infusion: 1.5 L in the first hour.IL per hour for the next 3-4 hours.IL every 4 hours
thereafter.

When blood glucose reaches 250 mg% glucose and potassium should be added to the saline
infusion.

b. Insulin: If serum Potassium is normal, give bolus dose of Regular Insulin 0.1-0.2 U/kg IV

followed by Continuous low dose insulin infusion

Administer 5-10 U (0.1 unit/kg) of REGULAR INSULIN per hour by continuous IV infusion
(maintains plasma insulin at about 100-200 microunits/ml which is effective in correcting
ketoacidosis)

Add 100 units of regular insulin to 1000 ml of a isotonic saline solution. Start a drip through a
needle inserted into a forearm vein.Infuse at the rate of 40-50 ml/hour (10 drops/minute)-ie, 5-6
units/hour

Fall in blood glucose level by 10%/hour can be considered as adequate response.

If blood glucose shows no response at the end of 2 hours,double the rate of insulin infusion

When blood glucose comes down to 300 mg%,decrease insulin to 2-3 units/hour. Add 50g of
glucose and 20mEq of potassium to each litre of infusion fluid

Continue the infusion till the patient starts eating normally.Then start subcutaneous insulin 30
minutes before discontinuing infusion

c. Correction of acidosis : if blood Ph less than 7,correct by 50 meq IV sodium bicarbonate.

d.Potassium & Phosphorus: As soon as urine output is satisfactory,20 meq of potassium per
hour is started through the drip (2g KCl =26 meq K)

As soon as patient can take orally,milk can be given as arich source of phosphorus and fruit juice
& soups can provide potassium.

e.Treatment of precipitating cause like infection with antibiotics

f.Nursing care-skin,mouth,position and bladder care

Qn 7 .A 45 year old obese female comes to the OP with complaints of fatigue, facial puffiness
and constipation

Lab investigatons show

▪ T4- 2.2µg/dl

▪ T3- 45ng/dl

▪ TSH- 30mU/L

1.What is your interpretation ?

2.How will you manage this patient ?

Ans: 1.Hypothyroidism

2.Thyroxine supplement-Levothyroxine- start with 50-100 mcg/day (12.5-25 mcg in elderly & IHD
).Entire dose given once daily with a glass of water on an empty stomach in the morning followed
by tea/breakfast ½ hour later.

Increase daily dose by 25-50 mcg every 3-4 weeks until plasma TSH becomes normal.Monitor
therapy clinically and by plasma TSH every 6-12 months. Therapy must be continued lifelong in
most patients

Dietary modification-avoid goitrogenic foods like cabbage.

Qn 8. A 35 old female with an enlarged neck swelling, tremor and exopthalmos comes to the OP

Lab investigations show

▪ T4- 20 µg/dl

▪ T3- 220 ng/dl

▪ TSH- 0.1mU/L

1.What is your interpretation?

2.How will you manage this patient ?

Ans:1. Hyperthyroidism

2.Antithyroid drugs-Propyl thiouracil 300-600 mg/day in divided doses.

Or Carbimazole 30-60 mg/day for control

Rapidly effective & well tolerated by most patients.Benefits apparent in about 2 weeks,becomes
euthyroid in about 2-3 months.

Ask the patient to report if sorethroat, fever and oral ulceration occurs during therapy-to rule out
agranulocytosis.

b)For goitre-Thyroidectomy, Radioactive iodine (absolute contra indication-pregnancy)

c)Tremor,Palpitation- Betablocker-Propranolol 30-120 mg/day

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