Government College University

Department of Pharmaceutical
Sciences
MPhil pharmacy practice
Topic: Lab Data and Interpretation
Submitted to: Dr. Shahid Shah
Submitted by: Fiza Aslam

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Table of content

Sr. no Content
1 Introduction
2 Hematological test
3 Common serum enzyme test
4 Liver function test
5 Renal function test
6 Electrolytes
7 Iron test

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GENERAL PRINCIPLES

A. Laboratory tests are performed for multiple purposes, including to discover a disease, confirm or differentiate a
diagnosis, stage or classify a disease, and monitor effectiveness of therapy.

B. Laboratory tests are classified as screening or diagnostic.

• Screening tests are used in patients with no signs or symptoms of a disease (e.g., serum cholesterol for assessing
cardiovascular disease risk).

• Diagnostic tests are done in patients with signs and symptoms of disease or with an abnormal screening test.

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• Normal laboratory test results fall within a predetermined range of values, and abnormal values fall outside
that range. The normal range of a laboratory test is usually determined by applying statistical methods to results
from a representative sample of the general population. Usually, the mean 2 standard deviations is taken as the
normal range.
• Many factors (e.g., age, gender, time since last meal) must be taken into account when evaluating test results.

• Laboratory error must always be considered when test results do not correlate with expected results for a given
patient. If necessary, the test should be repeated. Common sources of laboratory error include spoiled specimens,
incomplete specimens, specimens taken at the wrong time, technical errors, incorrect procedures, and failure to
take diet or medication into account.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : . 4

E. Quantitative tests, qualitative tests
1. Tests with normal values reported in ranges (i.e., 3.5 to 5.0 mEq/L) are called quantitative
2. Tests with positive (+) or negative ( _ ) outcomes are called qualitative.

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HEMATOLOGICAL TESTS
Blood contains three types of formed elements: red blood cells (RBCs), white blood cells (WBCs), and platelets. A CBC
typically includes RBC count, total WBC count, hemoglobin (Hb), hematocrit (Hct), RBC indices (mean cell volume
[MCV], mean cell Hb [MCH], mean cell Hb concentration [MCHC]), reticulocyte count, and platelet count.

A. RBCs (erythrocytes)
1. The RBC count, which reports the number of RBCs found in a given volume of blood, provides an indirect estimate
of the blood’s Hb content. Values are often reported in cells/microliter ( L) or cells/liter and less commonly as
cells/cubic millimeter (mm3). Normal values are a. 4.3 to 5.9 b. 3.5 to 5.

Drugs that can increase the RBC count include:

• Erythropoietin.
• Gentamicin.
Decrease
• Chemotherapy drugs
• Chloramphenicol and certain antibiotics

Gallagher PG. Hemolytic anemias: red blood cell membrane and metabolic defects. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier;
2020:chap 152.

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2. The Hct or packed cell volume (PCV) measures the percentage by volume of packed RBCs in a whole blood
sample after centrifugation. The Hct value is usually three times the Hb value and is given as a percent or fraction
of 1 (42% to 52% or 0.42 to 0.52 for men; 37% to 47% or 0.37 to 0.47 for women).

a. Low Hct values indicate such conditions as anemia, overhydration, or blood loss.
b. High Hct values indicate such conditions as polycythemia vera or dehydration.

Drugs decrease hct value ACE inhibitors, aspirin

Drugs increase hct value empagliflozin, nor epinephrine, erythropoietin.

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3.The Hb test measures the grams of Hb contained in 100 mL (1 dL) or 1 L of whole blood and provides an
estimate of the oxygen-carrying capacity of the RBCs. The Hb value depends on the number of RBCs and the
amount of Hb in each RBC. a. Normal values are 14 to 18 g/dL for men and 12 to 16 g/dL for women. b. Low Hb
values indicate anemia.
Drugs increase ferrous sulphate injection
Drugs decrease NSAIDs ,methyldopa.

4. RBC indices provide important information regarding RBC size, Hb concentration, and Hb weight. They are
used primarily to categorize anemias, although they may be affected by average cell measurements.
• MCV is the ratio of the Hct to the RBC count. It essentially assesses average RBC size.
• (1) Low MCV indicates microcytic (undersize) RBCs, as occurs in iron deficiency.
• (2) High MCV indicates macrocytic (oversize) RBCs, as occurs in a vitamin B12 or folic acid deficiency.
• (3) Normal range for MCV is 90-100fl.

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• Mean cell hemoglobin (MCH) assesses the amount of Hb in an average RBC.

• Mean cell hemoglobin concentration (MCHC) represents the average concentration of Hb in an average RBC (2)
Low MCHC indicates hypochromia (pale RBCs resulting from decreased Hb content), as occurs in iron deficiency.

• Red blood cell distribution width (RDW) is a relatively new index of RBCs. Normally, most RBCs are
approximately equal in size, so that only one bell-shaped histogram peak is generated. Disease may change the size
of some RBCs—for example, the gradual change in size of newly produced RBCs in folic acid or iron deficiency.

• The reticulocyte count provides a measure of immature RBCs (reticulocytes)

Increased reticulocyte count occurs with such conditions as hemolytic anemia, and response to the treatment of a
factor deficiency (e.g., an iron, vitamin B12, or folate deficiency)
Decreased reticulocyte count occurs with such conditions as drug-induced aplastic anemia.

• erythrocyte sedimentation rate (ESR) measures the rate of RBC settling of whole, uncoagulated blood over time.
a. Normal ESR rates range from 0 to 20 mm/hr for males and from 0 to 30 mm/hr for females.
b. ESR values increase with acute or chronic infection, tissue necrosis or infarction.

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Drugs affecting the RBCs indices
Drug decrease
• chemotherapeutics
• hydontions.
Drugs increase
• Anabolic steroids.
• Erythropoietin.
• Gentamicin.
• Testosterone.

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B. WBCs (leukocytes)

1. The WBC count reports the number of leukocytes in a given volume of whole blood.
a. Normal values range from 4,000 to 11,000 103 cells/mm3 (or 109 cells/L)
b. Increased WBC count (leukocytosis) usually signals infection; it may also result from leukemia, tissue necrosis. It is
most often found with bacterial infection.
c. Decreased WBC count (leukopenia) indicates bone marrow depression, which may result from metastatic carcinoma,
lymphoma, or toxic reactions to substances such as antineoplastic agents.

NORMAL PERCENTAGE VALUES FOR WHITE BLOOD CELL (WBC) DIFFERENTIAL

Cell Type Normal Range of Values (%)
Polymorphonuclear leukocytes 50–70
Lymphocytes 20–40
Monocytes 0–7
Eosinophils 0–5
Basophils 0–1

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Neutrophils may be mature or immature.
(1) Chemotaxis. Neutrophils that phagocytize and degrade many types of particles serve as the body’s first line of
defense when tissue is damaged or foreign material gains entry.
Neutrophilic leukocytosis. This describes a response to an appropriate stimulus in which the total neutrophil count
increases.
Neutropenia, a decreased number of neutrophils, certain viral infections (e.g., mumps, measles), with idiosyncratic drug
reactions.
Drugs increase the level

b. Basophils stain deeply with blue basic dye. Their function in the circulation is not clearly understood; in the tissues,
they are referred to as mast cells.
(2) Basophilia, an increased number of basophils, may occur with chronic myelogenous leukemia (CML) as well as
other conditions. Like infection, allergic reactions.
(2) A decrease in basophils is generally not apparent because of the small numbers of these cells in the blood. But in
blood cancer it may reduce.

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Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). :
• Eosinophils stain deep red with acid dye and are classically associated with immune reactions.
• Eosinophilia, an increased number of eosinophils, may occur with such conditions as acute allergic reactions
(e.g., asthma, hay fever, drug allergy) and parasitic infestations (e.g., trichinosis, amebiasis).
• Low eosinophil numbers may indicate excessive stress, alcohol misuse, or the presence of an underlying
condition.

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d. Lymphocytes play a dominant role in immunological activity and appear to produce antibodies.
(1) Lymphocytosis, an increased number of lymphocytes, usually accompanies a normal or decreased total WBC count
and is most commonly caused by viral infection.
(2) Lymphopenia, a decreased number of lymphocytes, may result from severe debilitating illness, immunodeficiency, or
from AIDS, which has a propensity to attack TH4 cells.

•drugs that may increase WBC counts include:

• Epinephrine
• Allopurinol
• Aspirin
• Chloroform
Drugs that decrease WBCs include
• Diuretics
• Sulfonamides
• Captopril.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : .

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C. Platelets (thrombocytes).
These are the smallest formed elements in the blood, and they are involved in blood clotting and vital to the
formation of a hemostatic plug after vascular injury.
1. Normal values for a platelet count are 150,000 to 300,000/mm3 (1.5 to 3.0 1011/L).
2. Thrombocytopenia, a decreased platelet count, can occur with a variety of conditions, such as idiopathic
thrombocytopenic purpura( trigerred by viral infection) or, occasionally, from such drugs as quinidine and
sulfonamides.
Inflammatory conditions like autoimmune diseases, cancer or trauma, as well as certain infections and iron
deficiency, increase platelets. Iron deficiency induces thrombocytosis and enhances platelet aggregation.

Drugs increase platelet level

• Corticosteriods
• Immunogloblin
That decrease
• Aspirin
• Vancomycin
• Linezolid
• lovastatin

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Many drugs can cause hematological disorders, including anemia, thrombocytopenia, and aplastic anemia:
•Cephalosporins: A class of antibiotics that are a common cause of drug-induced immune hemolytic anemia.
Stopping the cephalosporin, Red blood cell transfusion.
•Levofloxacin: Can cause thrombocytopenia, pancytopenia, and hemolytic anemia.
Stopping the medication and starting steroids can help stabilize the patient's blood.
•Isoniazid: Can cause sideroblastic anemia . Pyridoxine (vitamin B6)
NSAIDs: Can cause aplastic anemia.
Blood transfusions
Bone marrow transplant
Immunosuppressants
Erythropoietin: Can cause pure red cell aplasia . immunosuppressive therapy can help treat.
Although hematological disorders are less common than liver or pulmonary disorders, they can be serious and require
monitoring.

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III. COMMON SERUM ENZYME TESTS.

Small amounts of enzymes (catalysts) circulate in the blood at all times and are released into the blood in larger quantities
when tissue damage occurs. Thus, serum enzyme levels can be used to aid in the diagnosis of certain diseases.
A. Creatine kinase (CK)
1. Creatine kinase—formerly known as creatine phosphokinase (CPK)—is found primarily in heart muscle, skeletal
muscle, and brain tissue.
2. CK levels are used primarily to aid in the diagnosis of acute myocardial or skeletal muscle damage. However, vigorous
exercise, a fall, or deep intramuscular injections can cause significant increases in CK levels.
Increase in CK-MB levels provides a sensitive indicator of myocardial necrosis.
Drugs that decrease trimethoprim, sulphamethoxazole and cimetidine.
Drugs that increase antipsyscotic, NSAIDs.

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B. Lactate dehydrogenase (LDH)
1. LDH catalyzes the interconversion of lactate and pyruvate and represents a group of enzymes present in almost all
metabolizing cells.
The distribution pattern of LDH isoenzymes may aid in diagnosing myocardial infarction, hepatic disease, and lung
disease.
Drugs increase the level of LDH aspirin,cocaine.
Drugs decrease the level of LDH pentoxtfylline.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition).

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C. Alkaline phosphatase (ALP)
1. ALP is produced primarily in the liver and bones.
2. Serum ALP levels are particularly sensitive to partial or mild biliary obstruction—either extrahepatic (e.g., caused
by a stone in the bile duct) or intrahepatic, both of which cause levels to increase.
3. Increased osteoblastic activity, as occurs in Paget disease, hyperparathyroidism, osteomalacia,
Decrease by oral contraceptive and vitamin D.
Increase by cardiovascular drugs and antiepileptic drugs.

D. Aspartate aminotransferase (AST)

2. Aspartate aminotransferase—formerly known as serum glutamic-oxaloacetic transaminase (SGOT)—is found in a
number of organs, primarily in heart and liver tissues and, to a lesser extent, in skeletal muscle, kidney tissue, and
pancreatic tissue.
2. Damage to the liver results in increased AST levels about 8 hrs after injury.
Increase by acetaminophen and statins.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : 19

E. Alanine aminotransferase (ALT)
1. Alanine aminotransferase—formerly known as serum glutamic-pyruvic transaminase (SGPT) —is found in the liver,
with lesser amounts in the heart, skeletal muscles, and kidney.
2. Although ALT values are relatively specific for liver cell damage, ALT is less sensitive than AST, and extensive or severe
liver damage is necessary before abnormally increased levels are produced.
Increase by carbemezapine and isoniazid.
Decrease by amoxicillin and sitagliptin.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : .

Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-Induced Hepatotoxicity: a Comprehensive Update. J Clin Transl Hepatol.
2016;4:131–142. doi: 10.14218/JCTH.2015.00052. [DOI] [PMC free article] [PubMed] [Google Scholar

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F. Cardiac troponins (I, T, and C)
1. Troponins are a relatively new method to identify myocardial cell injury and thus assist in the diagnosis of
acute myocardial infarction.
2. Troponin T is found in cardiac and skeletal muscle, troponin I is found only in cardiac muscle, and troponin C
is present in two isoforms found in skeletal and cardiac muscle. Troponin T has shown prognostic value in
unstable angina and in detecting minor myocardial cell injury with greater sensitivity than CK-MB.
3. The normal value for troponin T is smaller than 0.1 ng/mL and I is smaller than1.5 ng/mL.
Decrease by statins and B blockers.
Increase by cocaine and cholchicine.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : .

Yoon E, Babar A, Choudhary M, Kutner M, Pyrsopoulos N. Acetaminophen-Induced Hepatotoxicity: a
Comprehensive Update. J Clin Transl Hepatol. 2016;4:131–142. doi: 10.14218/JCTH.2015.00052. [DOI] [
PMC free article] [PubMed] [Google Scholar
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IV. LIVER FUNCTION TESTS

Levels of certain enzymes (e.g., LDH, ALP, AST, ALT) increase with liver dysfunction. 2. These enzyme tests indicate
only that the liver has been damaged. They do not assess the liver’s ability to function. Other tests provide indications of
liver dysfunction.

Serum bilirubin
1. Bilirubin, a breakdown product of Hb, is the predominant pigment in bile. Effective bilirubin conjugation and excretion
depend on hepatobiliary function.
2. Serum bilirubin levels are reported as total bilirubin (conjugated and unconjugated) and as direct bilirubin (conjugated
only).
3. Normal values of total serum bilirubin are 0.1 to 1.0 mg/dL (2 to 18 mmol/L); of direct bilirubin, 0.0 to 0.2 mg/dL (0 to 4
mmol/L)
4. An increase in serum bilirubin results in jaundice from bilirubin deposition in the tissues.

body breaks down too many red blood cells too fast. Blood disorder
Increase by anticonvulsant and oral cointraceptive.
Decrease by barbiturates and caffeine.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : 22

C. Serum proteins
1. Primary serum proteins measured are albumin and the globulins.
a. Albumin (4 to 6 g/dL) maintains serum oncotic pressure and serves as a transport agent. Because it is primarily
manufactured by the liver, liver disease can decrease albumin levels. Albumin can also be used to assess
nutritional status.
b. Globulin (23 to 35 g/L) relates to the total measurement of immunoglobins (antibodies) found in the serum and
function as transport agents and play a role in certain immunological mechanisms. A decrease in albumin levels
usually results in a compensatory increase in globulin production.
2. Normal values for total serum protein levels are 6 to 8 g/dL (60 to 80 g/L).
To check
nutrition
Screen for liver, kidney, or blood diseas
at risk for an infection
Decrease by ACE inhibitors, aspirin, ARB, diuretics.
Increase by anabolic steroids, androgens, corticosteroids, dextran, growth hormone, insulin, phenazopyridine,
and progesterone

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V. URINALYSIS.
Composed of chemical and microscopic tests of the urine used to provide basic information regarding renal function,
urinary tract disease, and the presence of certain systemic diseases. Components of a standard urinalysis include physical
(color, turbidity, odor, and osmolality), chemical (pH, Hb, glucose, protein, glucose, ketone, leukocyte esterase, nitrites,
bilirubin) and microscopic examination (RBC, WBC, epithelial cells, bacteria)

A. Appearance. Normal urine is clear and ranges in color from pale yellow to deep gold. Changes in color can result from
drugs, diet, or disease.

B. pH
1. Normal pH ranges from 4.5 to 9.0 but is typically acidic (around 6.0).
2. Alkaline pH may indicate such conditions as alkalosis, a Proteus infection, or acetazolamide use. It may also reflect
changes caused by leaving the urine sample at room temperature.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : . 24

C. Specific gravity
1. Normal range for specific gravity is 1.003 to 1.035; it is usually between 1.010 and 1.025.
2. Specific gravity is influenced by the number and nature of solute particles in the urine.

D. Protein
1. Normal values for urine protein are 50 to 80 mg per 24 hr because the glomerular membrane prevents most
protein molecules in the blood from entering the urine.
2. Proteinuria occurs with many conditions (e.g., renal disease, bladder infection, venous conges tion, fever).

E. Glucose
1. The normal renal threshold for glucose is a blood glucose level of about 180 mg/dL; glucose does not normally
appear in urine as detected by popular testing methods. 2. Glycosuria usually indicates diabetes mellitus (DM). There
are certain less common causes (e.g., a lowered renal threshold for glucose).

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F. Ketones
1. Ketones do not normally appear in urine. They are excreted when the body has used available glucose stores and
begins to metabolize fat stores
2. The three ketone bodies are -hydroxybutyric acid (80%), acetoacetic acid (about 20%), and acetone (a small
percentage). Some commercial tests (e.g., Ames products) measure only acetoacetic acid, but usually all three are
excreted in parallel proportions.
3. Ketonuria usually indicates uncontrolled DM, but it may also occur with starvation and with zero- or low-
carbohydrate diets.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : . 26

VI. COMMON RENAL FUNCTION TESTS

Introduction Renal function may be assessed by measuring blood urea nitrogen (BUN) and serum creatinine.
Renal function decreases with age, which must be taken into account when interpreting test values.
These tests primarily evaluate glomerular function by assessing the glomerular filtration rate (GFR).

BUN
Urea, an end product of protein metabolism, is produced in the liver. From there, it travels through the blood
and is excreted by the kidneys. Urea is filtered at the glomerulus, where the tubules reabsorb approximately
40%. Thus, under normal conditions, urea clearance is about 60% of the true GFR.
• Normal values for BUN range from 8 mg/dL to 18 mg/dL (3.0 to 6.5 mmol/L).
• Decreased BUN levels occur with significant liver disease.
• Increased BUN levels may indicate renal disease.

Shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition). : . 27

Serum creatinine
Creatinine is excreted by glomerular filtration and tubular secretion
Normal values for serum creatinine range from 0.6 to 1.2 mg/dL (50 to 110 mmol/L).
reatinine clearance
Creatinine clearance, which represents the rate at which creatinine is removed from the blood by the kidneys,
roughly approximates the GFR.
The value is given in units of milliliters per minute, representing the volume of blood cleared of creatinine by the
kidney per minute. Normal values for men range from 75 to 125 mL/min.
Determination of GFR
The modified diet in renal disease (MDRD) equation is considered a more accurate measurement of GFR than other
equations used to estimate renal function (e.g., Cockcroft –Gault) in patients with reduced GFR and is used in
staging renal disease. Patients must have a serum creatinine concentration. For females, multiply the result by 0.742;
for African Americans, multiply by 1.210.

Sulphamethoxazole and trimethoprim cause nephrotoxicity.

Bird ST, Etminan M, Brophy JM, Hartzema AG, Delaney JAC. Risk of acute kidney injury associated with the use of fluoroquinolones. CMAJ.
2013;185(10):E475–E482.
shargel, L., Alan.H.Muthick, . (2004). Comprehensive pharmacy Review (Fifth edition)
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ELECTROLYTES
A. Sodium ( Na)
Sodium is the major cation of the extracellular fluid. Sodium, along with chloride (Cl), potassium (K), and
water, is important in the regulation of osmotic pressure and water balance between intracellular and
extracellular fluids.
Normal values are 135 to 147 mEq/L or mmol/L.
An increase in sodium concentration (hypernatremia) may indicate impaired sodium excretion or
dehydration. A decrease in sodium concentration (hyponatremia) may reflect overhydration, abnormal
sodium loss, or decreased sodium intake.
Patients with kidney, heart, or pulmonary disease may have difficulty with sodium and water balance.

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill
Livingstone, Edinburgh.
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Potassium
The total amount of potassium in the body, like sodium, is 3000mmol. About 10% of the body potassium is
bound in red blood cells (RBCs), bone and brain tissue and is not exchangeable.
Hypokalemia can occur. The kidneys are responsible for approximately 90% of the daily potassium loss.
Other losses occur mainly through the GI system. Even in states of no potassium intake, the kidneys still
excrete up to 20 mEq of potassium daily. Therefore, prolonged periods of potassium deprivation can result in
hypokalemia.

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill
Livingstone, Edinburgh.
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• Hyperkalaemiea may arise from excessive intake, decreased elimination or shift of potassium from cells to the
ECF. It is rare for excessive oral intake to be the sole cause of hyperkalaemia. The inappropriate use of parenteral
infusions containing potassium is probably the most common iatrogenic cause of excessive intake.
• Hyperkalaemia is a common problem in patients with renal failure due to their inability to excrete a potassium
load. The combined use of potassium-sparing diuretics such as amiloride, triamterene or spironolactone with an
angiotensin converting enzyme (ACE) inhibitor, which will lower aldosterone, is a recognised cause of
hyperkalaemia, particularly in the elderly.

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill Livingstone,
Edinburgh.
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Calcium
The body of an average man contains about 1kg of calcium and 99% of this is bound within bone. Calcium is present in
serum bound mainly to the albumin component of protein (46%), complexed with citrate and phosphate (7%), and as
free ions (47%). Only the free ions of calcium are physiologically active.
Calcium metabolism is regulated by 1,25-dihydroxycholecalciferol (vitamin D) which, when serum calcium is low, is
secreted to promote gastro-intestinal absorption of calcium, and by parathyroid hormone (PTH) which is inhibited by
increased serum concentrations of calcium ions.
• Hypercalcaemia may be caused by a variety of disorders, the most common being primary hyperparathyroidism in
which there is autonomous growth of PTH-producing cells and malignancy.
• diuretics, lithium, tamoxifen and calcium supplements used in the management of osteoporosis are examples of some
of the drugs which can cause hypercalcaemia.
• Hypocalcaemia can be caused by a variety of disorders including severe malnutrition, hypoalbuminaemia,
hypoparathyroidism and those that cause vitamin D deficiency, for example, malabsorption, reduced exposure to
sunlight, liver disease and renal disease.

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill Livingstone,
Edinburgh.
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Phosphate
About 85% of body phosphate is in bone, 15% in ICF and only 0.1% in ECF. Its major function is in energy
metabolism. Serum levels are regulated by absorption from the diet, which is partly under the control of
vitamin D, and PTH which controls its excretion by the kidney and resorption from bone.
• Hypophosphataemia Clinical features.
Severe hypophosphataemia can cause general debility, anorexia, anaemia, muscle weakness and wasting and
some bone pain and skeletal wasting.
diabetic ketoacidosis, without adequate provision of phophorus, can precipitate hypophosphataemia.
• Hyperphosphataemia
Hyperphosphataemia occurs in chronic renal failure. Less common causes are secondary to rhabdomyolysis,
tumour lysis or severe haemolysis.

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill
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Magnesium
Magnesium is an essential cation, found primarily in bone, muscle and soft tissue. About 1% of the total body
content is in the ECF. As an important cofactor for numerous enzymes and ATP, it is critical in energy requiring
metabolic processes, protein synthesis, membrane integrity, nervous tissue conduction, neuromuscular
excitability, muscle contraction, hormone secretion and in intermediary metabolism. Serum magnesium levels are
usually maintained within a tight range (0.7–1.0mmol/L).

Hypomagnesaemia is frequently seen in critically ill patients. Causes include excessive gastro-intestinal losses,
renal losses, surgery, trauma, infection, malnutrition and sepsis. The drugs most likely to induce significant
hypomagnesaemia are cisplatin, amphotericin B and ciclosporin.

Hypermagnesaemia is most commonly caused by renal insufficiency and excess iatrogenic magnesium .

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill Livingstone,
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Bicarbonate and acid–base Bicarbonate acts as part of the carbonic acid–bicarbonate buffer system, which is
important to maintain acid–base balance and thus the pH of the blood. pH homeostasis is accomplished
through the interaction of lungs, kidneys and blood buffers.
metabolic acidosis such as that which occurs in renal failure, diabetic ketoacidosis or salicylate poisoning,
bicarbonate levels fall. In metabolic alkalosis, the plasma bicarbonate concentration is high.
Vinca alkaloids
Vincristine and, less often, vinblastine
Monoclonal antibodies

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill
Livingstone, Edinburgh.
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Vitamin B12 and folate

• B12 refers not only to cyanocobalamin but also to several other cobalamins with identical nutritional
properties. Folic acid, which can designate a specific compound, pteroylgutamic acid, is also more
commonly used as a general term for the folates. Deficiency of cobalamin can result both in anaemia,
usually macrocytic, and neurological disease, including neuropathies, dementia and psychosis. Folate
deficiency produces anaemia, macrocytosis, depression, dementia and neural tube defects.

• Liver disease tends to increase B12 levels, and they may be reduced in folate deficient patients:
malabsorption of B12 may result from long-term ingestion of antacids such as protonpump inhibitors or
H2 -receptor antagonists or biguanides (metformin).

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill
Livingstone, Edinburgh.
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Iron, transferrin and iron binding
• Iron is necessary for the functioning of all mammalian cells, but is particularly important in cells producing
haemoglobin and myoglobin. Iron circulating in the serum is bound to transferrin. It leaves the serum pool
and enters the bone marrow where it becomes incorporated into haemoglobin in developing red cells.
• Transferrin a simple polypeptide chain with two iron binding sites, is the plasma iron binding protein
which facilitates its delivery to cells bearing transferrin receptors.Saturation of 16% or lower is usually taken
to indicate an iron deficiency.
• Ferritin is an iron storage protein found in cell cytosol. It acts as a depot, accepting excess iron and allowing
for mobilisation of iron when needed. Serum ferritin measurement is the test of choice in patients suspected
of having iron deficiency anaemia.
• Antibiotics: Tetracyclines, such as doxycycline (Vibramycin) and minocycline (Minocin), and quinolones,
such as ciprofloxacin (Cipro) and norfloxacin (Noroxin), can decrease iron absorption

R Walker · 2007 · Cited by 725 — Walker, R., & Whittlesea, C. (2007). Clinical Pharmacy and Therapeutics . (4th edition ed.) Churchill
Livingstone, Edinburgh.
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Typhiod test

Body fluid or tissue culture

A sample of your blood, stool, urine or bone marrow is used. The sample is placed in an environment where bacteria
grow easily. The growth, called a culture, is checked under a microscope for the typhoid bacteria. A bone marrow
culture often is the most sensitive test for Salmonella typhi.
A culture test is the most common diagnostic test. But other testing may be used to confirm typhoid fever. One is a test
to detect antibodies to typhoid bacteria in your blood. Another test checks for typhoid DNA in your blood.

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Commonly prescribed antibiotics
These medicines may be used alone or together. Antibiotics that may be given for typhoid fever are:
Fluoroquinolones.
Cephalosporins.
Other treatments
Other treatments include:
Drinking fluids. This helps prevent the dehydration caused by a long fever and diarrhea. If you're very dehydrated,
you may need to receive fluids through a vein.
Surgery. If the intestines are damaged, you may need surgery to repair them.

mayoclinic.org/diseases-conditions/typhoid-fever/diagnosis-treatment/drc
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Malaria
Review medical history and recent travel, conduct a physical exam, and order blood tests. Blood tests can indicate:
•The presence of the parasite in the blood, to confirm that you have malaria
•Which type of malaria parasite is causing your symptoms
•If your infection is caused by a parasite resistant to certain drugs
•Whether the disease is causing any serious complications

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Medications
The most common antimalarial drugs include:

Chloroquine phosphate. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug. But in
many parts of the world, parasites are resistant to chloroquine, and the drug is no longer an effective treatment.

Artemisinin-based combination therapies (ACTs). artemisinin-based combination therapy (ACT) is a

combination of two or more drugs that work against the malaria parasite in different ways. This is usually the
preferred treatment for chloroquine-resistant malaria. Examples include artemether-lumefantrine (Coartem) and
artesunate-mefloquine.
Other common antimalarial drugs include:
Atovaquone-proguanil (Malarone)
Quinine sulfate (Qualaquin) with doxycycline (Oracea, Vibramycin, others)
Primaquine phosphate

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CVD test
Blood tests. Certain heart proteins slowly leak into the blood after heart damage from a heart attack. Blood tests can
be done to check for these proteins. A high-sensitivity C-reactive protein (CRP) test checks for a protein linked to
inflammation of the arteries. Other blood tests may be done to check cholesterol and blood sugar levels.

medlineplus.gov/lab-tests/heart-disease-risk-assessment
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•DENGUE TEST
•The dengue MAC-ELISA is used for the qualitative detection of IgM antibodies against dengue virus.
•The MAC-ELISA is based on capturing human IgM antibodies on a microtiter plate using anti-human-IgM
antibody, followed by the addition of dengue virus antigens. The antigens used for this assay are derived from
the envelope proteins of the four dengue virus serotypes (DENV-1-4).

Specimen types
• Serum
• Cerebrospinal fluid (CSF)

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Interpretation of results

Positive IgM: Patients with a positive IgM test result in a single sample are classified as presumptive, recent
dengue virus infections.
Negative IgM:
Patients with a negative IgM result between days 0–7 of illness, and absent or negative NAAT or NS1
results, are considered unconfirmed cases. For these cases, a second sample should be obtained after day
7 of symptoms for additional serologic testing.
Patients with negative IgM results after 7 days of symptoms, and absent or negative NAAT or NS1
(dengue virus antigen detection), are classified as negative for recent infection.
Patients with a change from negative to positive IgM results in paired samples (first sample collected
during the first 7 days of illness, and second sample collected after symptoms subside) are classified as
current dengue infections.

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Role of pharmacist
Pharmacists play a key role in interpreting laboratory results to help patients and other
health professionals make informed decisions about drug therapy:
•Selecting tests
•Pharmacists can recommend appropriate laboratory tests to monitor a patient's drug
therapy. They can also help determine if a test is necessary, and if so, what type of test to
order.
•Interpreting results
•Pharmacists use their knowledge of drugs, metabolism, and how the body functions to
interpret laboratory results. They can use this information to determine if a drug is working
as intended, and if any adjustments need to be made to the patient's therapy.
•Making recommendations
•Pharmacists can use their interpretation of laboratory results to make recommendations
about a patient's drug therapy. For example, they might recommend reducing a patient's
dosage, stopping a drug, or ordering additional tests.

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