BODY FLUIDS

Body fluids, total volume : 50 percent (in obese) to 70 percent (lean) of body weight    Intracellular : 0.3 - 0.4 of body weight    Extracellular : 0.2 - 0.3 of body weight

Blood    Total volume    Males : 69 ml/kg body weight    Females : 65 ml/kg body weight

Plasma volume    Males : 39 ml/kg body weight    Females : 40 ml/kg body weight

Red blood cell volume    Males : 30 ml/kg body weight (1.15 - 1.21 L/m2 body surface area)    Females : 25 ml/kg body weight (0.95 - 1.00 L/m2 body surface area)

Blood acid-base

Normal rangeArterial Venous

Actual pH 7.35 - 7.45 7.32 - 7.42PCO2 (mmHg) 35 - 45 41 - 51Base excess (mmol/L blood) 0 ± 2.5 —Total CO2 (mmol/L plasma) 23 - 27 26 - 30Actual bicarbonate (mmol/L plasma)   22 - 26 24 - 28Standard bicarbonate(mmol/L plasma) 22- 26 —Oxygen saturation (%) 96 - 97 40 - 70Oxygen tension PO2 (mmHg) 80 - 100 25 - 40

CEREBROSPINAL FLUID

Cells < 5/mm3, all lymphocytesChloride 600 - 700 mg/dlGlucose 45- 75 mg/dl or

60% of serum glucosepH 7.34 - 7.43Pressure 50-180 mm H2OProtein, lumbar 15 - 45 mg/dlAlbumin 58%a1-globulins 9%a2-globulins 8%b-globulins 10%g-globulins 10% (5-12%)Protein, cisternal 15 - 25 mg/dlProtein, ventricular 5 - 15 mg/dl

CHEMICAL CONSITUTENTS OF BLOOD

Antistreptolysin titre 150 - 200 units/mlAcetoacetate 0.2 - 2.0 mg/dlAcid phosphatase 0.5 - 12.0 Bodansky units/dlAcid phosphatase, prostatic 2.5 - 12.0 IU/L

Aldolase 1.0 - 6.0 IU/LAlkaline phosphataseChild 5 - 12 Bodansky units/dlAdult 1.4 - 4 Bodansky units/dlAlpha - 1 antitrypsin 200 - 500 mg/dlAmmonia 10-80 µg/dlAmylase 3 - 10 Wohlgemuth units/dlAscorbic acid 0.4 - 1.5 mg/dlBilirubinAdult 0.3 - 1.1 mg/dlNewborn 0.4 - 4.0 mg/dl  At 3 days 1.0 - 10.0 mg/dlCarbon dioxide, total 18 ± 3.0 mEq/LCaeruloplasminMales 36.0 ± 5.6 mg/dlFemales 40.9 ± 6.8 mg/dlCopper 75 - 160 µg/dlCreatinine phosphokinase, total 0 - 3.4 micromoles/dl

(Duma modification of Hughes method)Creatinine phosphokinase isoenzymes

MM fraction 94-95%MB fraction 0-5%BB fraction 0-2%Creatinine 0.6 - 1.4 mg/dlDelta amino laevulinic acid 200 µg/dlElectrolytes (ISE Analyser)Potassium 3.5 - 4.5 mEq/LSodium 135 - 140 mEq/LChlorides 98-110 mEq/LCalcium 9-10.5 mg/dl(Delhi and Ellingboe)

Phosphorus (Fiskee and Subbarow)

Child 1.1 - 1.65 mmol (2.2 - 3.3 mEq)/L3-4.5 mg/dl

Adult 0.55 - 1.1 mmol (1.1 - 2.2 mEq)/L

Gamma glutamyl transpeptidase (Rosalki's method)

Male 45 U/LFemale 35 U/LGastrin 60 - 200 pg/mlGlucose, fasting 70 - 110 mg/dl (GOD-POD method)Glucose 6-phosphate  dehydrogenase 5-10 IU/g HbG6-PD screen, qualitative NegativeImmunoglobulin, quantitative (adults)

IgG 570 - 1920 mg/dlIgE < 0.025 mg/dlIgA 70 - 400 mg/dlIgM

Males 30 - 250 mg/dlFemales 30 - 300 mg/dl

IgD 0 - 40 mg/dl(Ramsay's method)Insulin, fasting 6 - 25 µU/ml

Iron 60 - 140 µg/dlIron binding capacity 250 - 450 µg/dl(Ramsay's method)Lactic acid 5-15 mg/dlLipidogramCholesterol 140 - 220 mg/dlTriglycerides 10 - 160 mg/dlPhospholipids 150 - 350 mg/dlFree fatty acids < 18 mg/dlChylomicrons AbsentBeta lipoprotein 60 - 75%Pre-beta lipoprotein 8 - 20%Alpha lipoprotein 13 - 24%LDH 70 - 240 IU/L

LDH isoenzymes (Colorimetric method of King)

LDH1 20 - 34%LDH2 28 - 41%LDH3 15 - 25%LDH4 8-16%LDH5 6-15%

Lipase 0-160 U/LMagnesium 1.7 - 2.6 mg/dlOsmolality 278 - 305 Osm/kg serum water

Phenosulphonphthalein25% excreted within 15 min after injection of 1 ml dye

Phenylalanine 3 mg/dlProtein, total 6.3 - 7.9 g/dl

Albumin 3.5 - 5.3 g/dlGlobulin 1.8 - 3.6 g/dl

Protein electrophoresisAlpha - 1 0.2 - 0.4 g/dlAlpha - 2 0.5 - 0.9 g/dlBeta 0.6 - 1.2 g/dlGamma 0.7 - 1.7 g/dl

SGOT (AST) 8 - 40 Karmen units/dlSGPT (ALT) 0 - 40 Karmen units/dlSulphate 0.5 - 1.5 mg/dlUrea 15 - 45 mg/dlUrea nitrogen 7 - 21 mg/dlUric acid 2.5 - 7.0 mg/dlViscosity 1.4 - 1.8 mg/dl(Serum compared to H2O)Vitamin A 0.15 - 0.60 µg/dlVitamin B12 200 - 850 µg/dl

FUNCTION TESTS

Circulation

Arteriovenus oxygen difference: 30-50 ml/LCardiac output (Fick) : 2.5-3.6 L/m2 body surface area per minContractility indexes

Maximum left ventricular dp/dt: 1650 ± 300 mmHg/sMaximum (dp/dt)/p : 44 + 8.4s-1

(dp/dt)/DP at DP = 40 mmHg : 37.6 ± 12.2s-1 (DP = diastolic pressure)Mean normalised systolic ejection rate (angiography) : 3.32 ± 0.84 end-diastolic volumes per secondMean velocity of circumferential fibre shortening (angiography) : 1.66 ± 0.42 circumferences per second

Ejection fraction, stroke volume/end-diastolic volume (SV/EDV): Normal range : 0.55-0.78; average : 0.67End-diastolic volume : 75 ± 15 ml/m2

End-systolic volume : 25 ± 8 ml/m2

Left ventricular workStroke work index : 30-110 (g.m)/m2

Left ventricular minute work index : 1.8-6.6 (kg.m)/m2/minOxygen consumption index : 110-150 ml

Pressures, intracardiac and intraarterialPulmonary vascular resistance : 2-12 (kPa.s)/L (20-120 (dyn.s/cm2)Systemic vascular resistance : 77-150 (kPa.s)/L (770-1500 dyn.s)/cm2)

Gastrointestinal

Absorption tests

D-xylose absorption test : After an overnight fast, 25 g xylose is given in aqueous solution by mouth. Urine collected for the following 5 h should contain 33-53 mmol (5-8 g) (or > 20 percent of ingested dose). Serum xylose should be 1.7-2.7 mmol/L l h after the oral dose (25-40 mg per 100 ml).

Vitamin A absorption test : A fasting blood specimen is obtained and 200,000 units of vitamin A in oil is given by mouth. Serum vitamin A levels should rise to twice fasting level in 3-5 h.

Bentiromide test (pancreatic function): 500 mg bentiromide (Chymex) orally; p-aminobenzoic acid (PABA) measured in plasma and/or urine.

Plasma : 3.6 (± 1.1) mg/L at 90 min   Urine : 50 percent recovered in 6 h

Gastric juice

Volume

24 h : 2-3 L

Nocturnal : 600-700 ml

Basal fasting : 30-70 ml/hConversion factor for SI

ReactionpH : 1.6-1.8Titratable acidity of fasting juice : 4.9 µmol/s (15-35 mEq/h) 0.261

Acid output

 

 

BasalFemales (mean ± 1 SD) : 0.6 ± 0.5 µmol/s (2.0 ± 1.8 mEq/h) 0.2778Maximal (after subcutaneous histamine acid phosphate 0.004 mg/kg body weight and preceded by 50 mg promethazine or after betazole 1.7 mg/kg body weight or pentagastrin 6 µg/kg body weight):Females (mean ± 1 SD) : 4.4 ± 1.4 µmol/s 0.2778(16 ± 5 mEq/h)Males (mean ± 1 SD) : 6.4 ± 1.4 µmol/s 0.2778(23 ± 5 mEq/h)

Basal acid output/maximal acid output ratio : 0.6 or lessGastrin, serum : 40-200 ng/L (40-200 pg/ml)Secretin test (pancreatic exocrine function ) : 1 unit per kg body weight, intravenously —

Volume (pancreatic juice): 2.0 ml/kg in 80 min —Bicarbonate concentration : 80 mmol/L (80 mEq/L) —Bicarbonate output : 10 mmol in 30 min (10 mEq in 30 min) —

Haematology

Haemogram

Total erythrocyte count

Males 4.5 - 5.5 millions/cmmFemales 4.1 - 4.8 millions/cmm

HaemoglobinMales 14.5 - 16.5 g/dLFemales 12.0 - 14.5 g/dL

Packed cell volumeMales 38 - 50%Females 34 - 43%

Mean corpuscular volume 78 - 94 cµMean corpuscular haemoglobin 24 - 33 µgMean corpuscular haemoglobinconcentration 30-35% Total leucocyte count 4000 - 11000/cmmDifferential count

Neutrophils 60 - 70%Eosinophils 1 - 7%Lymphocytes 20 - 30%Monocytes 1- 6%

Platelets 150, 000 - 450,000/cmmReticulocyte count 0.5 - 2% of erythrocytesErythrocyte sedimentation rate(Westergen)

Male 0 - 15 mm at end of 1 hFemale 0 - 20 mm end of 1 h

Blood volumeAverage plasma volume 45 ± 5 ml/kg body weight

1487 ± 112 ml/sq meter body surface

Erythrocyte osmotic fragility testIncreased fragility Lysis of RBCs seen with over

0.5% of sodium chloride; haemolysis incomplete in 0.3% sodium chloride

Coagulation studiesBleeding time (Ivy’s method) 1.7 minCoagulation time (Lee and White) 4 - 8 minOne-stage prothrombin time (Quick) Control ± 1 secClot retraction 40 - 65%Euglobulin lysis time 120 - 240 minFibrin degradation products 10 µg/dlFibrinogen 200 - 400 mg/dlActivated partial thromboplastinTime (PTT) 24 - 35 secThrombin time 9 - 10 sec (control + 3 sec)Whole blood clot lysis time < 24 hours

Bone marrow study Normal percentage (range)

WBC reticulum cells 0.2 (0.1 - 2.0)Blasts 2.0 (0.3 - 5.0)Promyelocytes 5.0 (1.0 - 8.0)Myel-neutro 12.0 (5.0 - 21.0)Myel-eosino 1.5 (0.5 - 3.0)Myel-baso 0.3 (0.0 - 0.5)

Metamyelocytes 11.0 (6.0 - 17.0)Stab forms 11.0 (7.0 - 15.0)PMN neutrophils 20.0 (7.0 - 15.0)PMN eosinophils 20.0 (0.5 - 4.0)PMN basophils 0.2 (0.0 - 0.7)Lymphocytes 10.0 (3.0 - 17.0)Plasma cells 0.4 (0.0 - 2.0)Monocytes 2.0 (0.5 - 5.0)Megakaryocytes 0.4 (0.03 - 3.0)RBC : Pronormoblasts 4.0 (1.0 - 8.0)

NormoblastsBasophilic 1.4 (0.5 - 2.4)Polychromatophilic 18.0 (7.0 - 32.0)Orthochromatic 2.0 (0.4 - 4.6)

Unclassified cells 0.3 (0.0 - 0.9)M : E ratio 3.5 : 1Haemoglobin studies (normal and abnormal)

Haemoglobin A1 0.5% of total HbHaemoglobin A1C Up to 6% of total HbHaemoglobin A2 1.5 - 3.5% of total HbHaemoglobin, foetal 0-2% of total HbHaemoglobin, plasma 0-5% of total HbHaemoglobin, serum 2-3 mg/dl

Methaemoglobin < 1.8%Haptoglobin, serum 100 - 300 mg/dlHaemochromogens, plasma 3-5 mg/dlHaemolysis test

Acid haemolysis test (Ham) No haemolysisCold haemolysis test(Donath - Landsteiner) No haemolysis

Erythrocyte life-spanNormal 120 days51Cr - labeled half-life 28 daysIron turnover rate (plasma) 29 - 42 mg/24 hOsmotic fragilityHaemolysis begins 0.45 - 0.38 NaClHaemolysis completed 0.33 - 0.30 NaCl

Reticulocyte index =Corrected rate

2Reticulocyte index correction factorCorrected rate =

Observed rate x patient’s haematocritNormal haematocrit (45)

Haematocrit Correction factor45 1.0040 0.7135 0.5230 0.3825 0.2820 0.2015 0.13

Note : Reticulocyte index = percent reticulocytes x correction factor haematocrit and early bone marrow releaseSchilling test : 7-40% of orally administered radiolabelled vitamin B12 excreted in urine after ‘flushing’ with intramuscular injection of B12

Hormones and metabolites

Adrenocorticortropin (ACTH), serum 15 - 70 pg/mlAldosterone, serum210 mEq/day sodium diet

Supine 48 ± 29 pg/dlUpright (2 h) 65 ± 23 pg/dl

110 mEq/day sodium dietSupine 107 ± 45 pg/dlUpright (2 h) 532 ± 228 pg/dl

Urine 5 - 19 µg/24 hCalcitonin, serum None detectableCatecholamines, free urinary 110 ug/24 hCortisol, serum

8 AM 5 - 25 µg/dl8 PM 5 - 25 ug/dl

Cosyntropin stimulation(30-90 min after 0.25 mg cosyntropin intramuscularly or intravenously)

10 µg/dL rise over baseline

Overnight suppression (8 AM) (serum cortisol after 1 mg dexamethasone orally at 11 pm)

5 µg/dl

Urine 20 - 70 µg/24 h11-deoxycortisol, serum, basal < 0 - 1.4 µg/dlMetyrapone stimulation (30 mg/dl orally 8 h prior) > 1.5 µg/dlOestrogens, urine (increased during pregnancy, decreased after menopause)

Males FemalesTotal 4 - 25 µg/24 h 5 - 100 µg/24 hOestriol 1 - 11 µg/24 h 0 - 65 µg/24 hOestradiol 0 - 6 µg/24 h 0 - 14 µg/24 hOestrone 3 - 8 µg/ 24 h 4 - 31 µg/24 hOestriocholanolone, serum 1.2 µg/24 h

Follicle-stimulating hormone, serum

Males 6 - 18 µU/dlFemalesFollicular phase 5 - 20 µU/dlPeak midcycle 12 - 30 µU/dlLuteal phase 5 - 15 µU/dlPostmenopausal 50 µU/dl

Free thyroxine index, serum

Adult, fasting 5 ng/dlGlucose load (100 g orally) < 5 ng/dl

Levodopa stimulation (500 mg orally in a fasting state) baseline within 2 h

17-hydroxycorticosteroids, urine

Males 2 - 12 mg/24 hFemales 2 - 8 mg/24 h

5-hydroxyindoleacetic acid

(5-HIAA), urine 2- 9 mg/24 hInsulin, plasma

Fasting 6 - 126 µU/mlHypoglycaemia < 5 µU/ml

17-ketogenic steroids, urineUnder 8 years 0-2 mg/24 hAdolescent 0-18 mg/24 hAdult males 8-18 mg/24 h

females 5-15 mg/24 hMetanephrine, urine 1.3 mg/24 hNorepinephrine, urine 100 mg/24 hParathyroid hormone, serum 150-300 pg/ml

(varies with serum calcium)

Radioactive iodine 131I uptake (RAIU)

5-25% at 24 h (varies with iodine intake)

Renin activity, plasmaNormal diet

Supine 1.1 ± 0.8 mg/dlUpright 1.9 ± 1.7 mg/dl

Low-sodium dietSupine 2.7 ± 1.8 mg/dlUpright 6.6 ± 2.5 mg/dlDiuretics and low-sodium diet

10.0 ± 3.7 mg/dl

TestosteroneTotal plasma bound  Adolescent males 100 mg/dl  Adult males 300 - 100 mg/dl   Females 25 - 90mg/dlUnboundAdult males 3 - 24 mg/dl   Females 0.09 - 1.30

mg/dlThyroid-stimulating hormone, serum

< 10 µU/ml

Thyroxine (T4), serumTotal 4.5 - 11.5 µg/dlFree 0.8 - 2.4 µ/dlThyroxine-binding globulin capacity, serum 15 - 25 µg T4/dlThyroxine index, free 1-4 mg/dlTri-iodothyronine (T3), serum 70-190 mg/dlT3 resin uptake 25 - 45%Vanillyl mandelic acid (VMA), urine

1-8 µg/24 h

Renal function tests

Anion gapNa+ - (HCO-3 + Cl-) 10± 2 mEq/dLOsmolalityOsmolality (serum) = 2 Na+ (mEq/L) +

BUN (mg/dl)2.8

+Glucose (mg/dl)

18Bicarbonate deficitHCO-3 deficit = body weight (kg) x 0.4 (desired HCO-3 - observed HCO-3)

Creatinine clearance Ucr x V

Pcr  = 130 ± 20 ml/min in males  = 120 ± 15 ml/min in femaleswhereUcr = Urine creatinine (mg/dl)

Pcr = Plasma creatinine (mg/dl)V = Urine volume/(ml) 24 hRenal plasma flow

RPF =Upah X V

ppah  = 700 ± 100 ml/min in males  = 600 ± 100 ml/min in femaleswhereUpah = Urine para-aminohippuric acidV = Urine volume/24 hppah = Plasma para-aminohippuric acid

Summary of values useful in pulmonary physiology

Pulmonary mechanics Normal valuesSpirometry : volume-time curves

Forced vital capacity 4.0 litresForced expiratory volume 3.0 litresin 1 sFEV1/FVC 75%Maximal midexpiratory flow 4.0 litres per secondMaximal expiratory flow rate 8.0 litres per second

Spirometry: flow-volume curvesMaximal expiratory flow 5.5 litres per secondat 50% of expired vital capacityMaximal expiratory flow 3.0 litres per secondat 75% of expired vital capacity

Resistance to airflow

Pulmonary resistance< 3.0 cm H2O/s per litre

Airway resistance< 2.5 cm H2O/s per litre

Specific conductance > 0.13 cm H2O/sPulmonary compliance

Static recoil pressure 25 ± 5 cm H2Oat total lung capacityCompliance of lungs (static) 0.2 L/cm H2OCompliance of lungs 0.1 L/cm H2Oand thoraxDynamic compliance of 0.25 ± 0.05 litres20 breaths per minute per cm H2O

Maximal static respiratory pressuresMaximal inspiratory pressure > 90 cm H2OMaximal expiratory pressure > 150 cm H3O

Lung volumes

Total lung capacity 6-7 litresFunctional residual capacity 2-3 litresResidual volume 1-2 litresInspiratory capacity 4.5 litresExpiratory reserve volume 3.2 litresVital capacity 4-5 litres

Gas exchange (sea level)

Arterial O2 tension 95 ± 5 mmHgArterial CO2 tension 40 ± 2 mmHgArterial O2 saturation 97 ± 2%

Arterial blood pH 7.40 ± 0.02Arterial bicarbonate 24 ± 2 mmol/LBase excess 0 ± 2 mmol/LDiffusing capacity for 25 ml co/min/mmHgcarbon monoxide (single breath)Dead space volume 50 ± 25 mlPhysiologic dead space : dead space- £ 35% VTtidal volume ratio (rest) (exercise) £ 20% VTAlveolar-arterial difference for O2 £ 20 mmHg

Semen

Liquefaction Complete in 15 minMorphology 60% normal formsMotility 75% motile formspH 7.2 - 8.0Spermatocrit 10%Spermatocyte count 50 million/dlVolume 2.0 - 6.6 ml

Stool

BulkWet weight < 197 g/24 hDry weight < 66.4 g/24 h

Coproporphyrin 12 - 832 mg/24 hFat (on a diet containing < 7.2 g/24 h or 30%30 g fat/day) dry weightNitrogen < 2.2 g/24 hUrobilinogen 40 - 280 mg/24 hWater Approximately 65%

Synovial fluid

Cells 200 cells/mm3

Polymorphonuclear cells 25%Crystals NoneFibrin clot NoneGlucose Same as serumHyaluronic acid 2.45 - 3.97 g/LpH 7.32 - 7.64Protein 2.5 g/dL

Albumin 63%a1-globulins 7%a2-globulins 7%b-globulins 9%g-globulins 14%

Relative viscosity 300Uric acid Same as serum

Urine

Acidity, titrable 20-40 mEq/24 hAmmonia 20 - 50 mEq/24 hAmylase 25 - 260 Somogyi unit/hBence-Jones protein None detectedBilirubin None detected

Calcium : Normal diet 0.05 - 0.31 mEq/kg body weight/24 hLow-calcium diet 150 mg/24 h

Chloride 120 - 240 mEq/24 h (varies with dietary intake)

Copper 0-32 µg/24 hCreatinine

Adults 0 - 200 mg in 24 hChildren 7 - 11 mg in 24 h

Creatinine 1.0 - 1.6 g/24 h or 15-25 mg/kg body weight/24 h

GlucoseQualitative None detectedQuantitative 16-300 mg/24 hHaemoglobin None detectedHomogentisic acid None detectedIron 40 - 140 µg/24 hLead 0 - 120 µg/24 hMyoglobin None detectedOsmolality 50 - 1200 mOsm/LpH 4.6 - 8.0Phenylpyruvic acid, quantitative None detectedPhosphorus 0.8 - 2.0 g/24 hPorphobilinogen

Qualitative None detectedQuantitative 0-2.4 mg/24 h

PorphyrinCoproporphyrin 50 - 250 µg/24 hUroporphyrin 10 - 30 µg/24 h

Potassium 25 - 100 mEq/24 hProtein

Qualitative Non detectedQuantitative 10 - 150 mg/24 h

Sodium 10 - 150 mEq/24 h (varies with dietary sodium intake)

Specific gravity 1.003 - 1.030Uric acid 600 - 700 mg/24 hUrobilinogen 1.0 Enrich units/24 h