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Lab Tests for Evaluating Fluid Status

Lab Test Serum osmolality Normal Value 275 to 295 mOsm/kg Significance Increases in dehydration Decreases with water excess Determined mainly by serum Na+ concentration; one of the most reliable measures of hydration. BUN (blood urea nitrogen) 10 to 20 mg/dL Reflects difference between rates of urea synthesis in liver and its excretion by the kidneys. (Urea is main end product of protein catabolism).

Increases with decreased renal blood flow or decreased urine production (causing reduced urea clearance), dehydration, some neoplasms, and certain antibiotics (less specific for renal failure than creatinine) Decreases in pregnancy, overhydration, severe liver disease and low protein intake. Increases in fluid volume deficit. Decreases with low RBCs or with normal hemoglobin in the presence of fluid volume excess. Elevated when 50% or more of the nephrons are destroyed

Hematocrit

Female: 37-47 ml/100 ml (%)

Measures portion of blood Male: 40-54 ml/100 ml (%) volume occupied by RBCs 0.5 to 1.5 mg/100 ml

Creatinine (serum) Product of muscle metabolism Serum glucose Urine osmolality

70-110 mg/dL

50 to 1200 mOsm/L (depends upon the circulating titer of ADH and the rate of urinary solute Measures number of solute particles per unit of excretion. water in urine; determines diluting and concentrating ability of kidneys. Urine Specific Gravity (S.G.) 1.010 to 1.030 Measures degree of concentration of urine; determined by number and weight of solute particles in urine.

Markedly elevated glucose in blood stream causes osmotic diuresis and fluid volume deficit. Reflects changes in urine contents more accurately than specific gravity, but depends on the prior state of hydration. It should be 12 times that of serum osmolality. Conc. urine has osmolality > 1000. Increases with any condition causing hypoperfusion of kidneys leading to oliguria, i.e., dehydration, shock. Decreases when renal tubules lose their ability to reabsorb water and concentrate urine as in early pyelonephritis.