Differential diagnosis of abnormal lab values
Posted by dkwinter

**Incomplete: This is a work in progress**

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     Arterial Blood Gases: pH,PaCO2, PaO2, HCO3, BE, COHb

     Hemogram: ESR, Hct, Hb, MCH, MCHC, MCV, MPV, Platelets, RBC count, RDW, Retic count

     White Blood Cell Differential: WBC, ANC, ABC, AEC, ALC, AMC

     Coagulation: Bleeding time, aPTT, PT/INR

     Iron Studies: Ferritin, Total iron, TIBC, Transferrin, Trans. sat.

     Thyroid: TPO, TSH, Free T4, Free T3

     Chemistry: ACTH, AlbuminAldosterone, ALP, ALT, ASTGGT, Ammonia, Amylase, Anion Gap, HCO3, D. Bili, I. BiliBNP, C-peptide, CRP, Ca, CA-125, CA-19-9, Carbamazepine, CEA, Cl, Cortisol, CK, Creatinine, D-dimer, eGFR, EtOH, Folate

     Lipids

     Urinalysis: Urine bili

     24-hour Urine Specimen Analysis

     Reproductive Hormones

     Semen analysis

     Stool

 

 

Arterial Blood Gases

Value Perturbation Differential Diagnosis Associated Findings
pH Increased
  • Hyperventilation (emotions, pain, respiratory overventilation)
  • Nasogastric drainage
  • Prolonged vomiting
  • Sodium bicarbonate overdose
 
Decreased
  • Diabetes
  • Shock
  • Renal failure
  • Intestinal fistula
  • Respiratory depression (drugs, CNS trauma)
  • Pulmonary disease (pneumonia, chronic obstructive pulmonary disease, respiratory underventilation)
 
PaCO2 Increased
  • Primary respiratory acidosis
  • Respiratory depression (drugs, CNS trauma)
  • Pulmonary disease (pneumonia, chronic obstructive pulmonary disease, respiratory underventilation)
 
Decreased
  • Primary respiratory alkalosis
  • Hyperventilation (emotions, pain, respiratory overventilation)
 
PaO2 Increased
  • Oxygen poisoning
 
Decreased
  • Pneumonia
  • Shock lung
  • Congestive heart failure
  • Congenital heart disease
  • Significant atelectasis
  • Pickwickian syndrome/Obesity-hypoventilation syndrome (OHS)
 
Bicarbonate (HCO3) Increased
  • Metabolic alkalosis
  • Sodium bicarbonate overdose
  • Prolonged vomiting
  • Nasogastric drainage
 
Decreased
  • Metabolic acidosis
  • Diabetes
  • Shock
  • Renal failure
  • Intestinal fistula
 
Base Excess (BE) Positive
  • Metabolic alkalosis
  • Compensation to prolonged respiratory acidosis
 
Negative
  • Metabolic acidosis (e.g. lactic acidosis)
 
Carboxyhemoglobin (COHb) Increased Carbon monomoxide poisoning
  • Dyspnea
  • Headache
  • Irritability
  • Disturbed judgement
  • Memory loss
  • Confusion
  • Weakness
  • Dimmness of vision
  • Fainting
  • Ataxia
  • Coma
  • Death

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Hemogram

Value Perturbation Differential diagnosis
Erythrocyte Sedimentation Rate (ESR) Increased
  • Chronic renal failure (e.g. nephritis, nephrosis)
  • Malignant diseases
  • Inflammatory diseases (e.g. temporal arteritis, polymyalgia rheumatica (PMR), rheumatoid arthritis (RA), rheumatic fever, systemic lupus erythematosus (SLE)
  • Necrotic diseases (e.g. acute myocardia infarction, necrotic tumor, gangrene of an extremity)
  • Diseases associated with increased protein levels (e.g. hyperfibrinogenemia, macroglobulinemia)
  • Severe anemias (e.g. iron deficiency or Vitamin B12 deficiency)
Decreased
  • Sickle cell disease
  • Spherocytosis
  • Hypofibrinogenemia
  • Polycythemia vera
Hematocrit (Hct) Increased
  • Erythrocytosis
  • Congenital/cyanotic heart disease
  • Polycythemia vera
  • Severe chronic obstructive pulmonary disease (COPD)
  • Severe dehydration (e.g. severe diarrhea, burns)
Decreased
  • Anemia
  • Hemoglobinopathy
  • Cirrhosis (due to chronic fluid overload)
  • Hemolytic anemia (e.g. erythroblastosis fetalis, hemoglobinopathies, drug-induced hemolytic anemias, paroxysmal nocturnal hemoglobinuria)
  • Hemorrhage
  • Dietary deficiency (e.g. iron)
  • Bone marrow failure
  • Prosthetic valves
  • Renal disease (reduced erythropoietin)
  • Normal pregnancy (due to increased blood volume)
  • Rheumatoid/collagen-vascular diseases (e.g. rheumatoid arthritis, lupus due to decreased production of RBCs)
  • Lymphoma
  • Multiple myeloma
  • Leukemia
  • Hodgkin disease (due to bone marrow failure)
Hemoglobin (Hb) Increased
  • Erythrocytosis
  • Congenital/cyanotic heart disease
  • Polycythemia vera
  • Severe chronic obstructive pulmonary disease (COPD)
  • Severe dehydration (e.g. severe diarrhea, burns)
Decreased
  • Anemia
  • Hemoglobinopathy
  • Cirrhosis (due to chronic fluid overload)
  • Hemolytic anemia (e.g. erythroblastosis fetalis, hemoglobinopathies, drug-induced hemolytic anemias, paroxysmal nocturnal hemoglobinuria)
  • Hemorrhage
  • Dietary deficiency (e.g. iron)
  • Bone marrow failure
  • Prosthetic valves
  • Renal disease (reduced erythropoietin)
  • Normal pregnancy (due to increased blood volume)
  • Rheumatoid/collagen-vascular diseases (e.g. rheumatoid arthritis, lupus due to decreased production of RBCs)
  • Lymphoma
  • Multiple myeloma
  • Neoplasia
  • Leukemia
  • Hodgkin disease (due to bone marrow failure)
  • Splenomegaly
Mean Corpuscular Hemoglobin (MCH) Increased
  • Macrocytic anemias
Decreased
  • Microcytic anemia
  • Hypochromic anemia
Mean Corpuscular Hemoglobin Concentration (MCHC) Increased
  • Spherocytosis
  • Intravascular hemolysis
  • Cold agglutinins (a misperception by automated analyzer of increased MCV and decreased hematocrit)
Decreased
  • Iron-deficiency anemia
  • Thalassemia
Mean Corpuscular Volume (MCV) Increased
  • Pernicious anemia (Vitamin B12 deficiency)
  • Folate deficiency
  • Antimetabolite therapy
  • Alcoholism
  • Chronic liver disease
Decreased
  • Iron-deficiency anemia
  • Thalassemia
  • Anemia of chronic disease
Mean Platelet Volume (MPV) Increased
  • Valvular heart disease
  • Immune thrombocytopenia (e.g. idiopathic thrombocytopenia, neonatal, posttransfusion, or drug induced-thrombocytopenia)
  • Massive hemorrhage
  • Vitamin B12 deficiency
  • Folate deficiency
  • Myelogenous leukemia
Decreased
  • Aplastic anemia
  • Chemotherapty-induced myelosuppression
  • Wiskott-Aldrich syndrome (eczema, immune deficiency, thrombocytopenia, and small platelets)
Platelet Count (Thrombocyte count) Increased (thrombocytosis)
  • Malignant disorders (leukemia, lymphoma, solid tumors such as of the colon)
  • Polycythemia vera
  • Postsplenectomy syndrome
  • Rheumatoid arthritis
  • Iron-deficiency anemia
  • Posthemorrhagic anemias
Decreased (thrombocytopenia)
  • Hypersplenism
  • Hemorrhage
  • HELLP syndrome (hemolysis, elevated liver enzymes, low platelet count)
  • Immune thrombocytopenia
  • Leukemia and other myelofibrosis disorders
  • Thrombotic thrombocytopenia
  • Graves' disease
  • Inherited disorders (e.g. Wiskott-Aldrich, Bernard-Soulier, Zieve syndromes)
  • DIC (Disseminated Intravascular Coagulation)
  • Systemic Lupus Erythematosus
  • Pernicious anemia
  • Hemolytic anemia
  • Cancer chemotherapy
  • Infection
Red Blood Cell (RBC) count Increased
  • Erythrocytosis
  • Congenital heart disease
  • Severe chronic obstructive pulmonary disease
  • Polycythemia vera
  • Severe dehydration (e.g. severe diarrhea or burns)
  • Hemoglobinopathies
  • Thalassemia trait (due to reduced oxygen carrying capacity of each RBC)
Decreased
  • Anemia
  • Hemoglobinopathy
  • Cirrhosis
  • Hemolytic anemia
  • Hemorrhage
  • Dietary deficiency
  • Bone marrow failure
  • Prosthetic valves
  • Renal disease
  • Normal pregnancy
  • Rheumatoid/collagen-vascular diseases (e.g. rheumatoid arthritis, lupus, sarcoidosis)
  • Lymphoma
  • Multiple myeloma
  • Leukemia
  • Hodgkin disease
Red Cell Distribution Width (RDW) Increased
  • Iron-deficiency anemia
  • Vitamin B12 deficiency anemia
  • Folate-deficiency anemia
  • Hemoglobinopathies (e.g. sickle cell disease or protein C disease)
  • Hemolytic anemias
  • Posthemorrhagic anemias
Decreased
  • n/a
Reticulocyte Count Increased
  • Hemolytic anemia
  • Hemorrhage (3 to 4 days later)
  • Hemolytic disease of the newborn
  • Treatment for anemia (e.g. iron, B12 or folate)
Decreased
  • Pernicious anemia
  • Folate deficiency
  • Iron-deficiency anemia
  • Aplastic anemia
  • Radiation therapy
  • Malignancy
  • Marrow failure
  • Adrenocortical hypofunction
  • Anterior pituitary hypofunction
  • Chronic diseases

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White Blood Cell Differential

Value Perturbation Differential Diagnosis
White Blood Cells (WBC) Increased (leukcytosis)
  • Infection
  • Leukemic neoplasia
  • Other (non-bone marrow) malignancy
  • Trauma, stress or hemorrhage
  • Tissue necrosis
  • Inflammation
  • Dehydration
  • Thyroid storm
  • Pregnancy
  • Steroid use
Decreased (leukopenia)
  • Drug toxicity
  • Bone marrow failure
  • Overwhelming infections
  • Dietary deficiency (e.g. vitamin B12, iron)
  • Congential bone marrow aplasia
  • Bone marrow infiltration (e.g. myelofibrosis)
  • Autoimmune disease
  • Hypersplenism
Absolute Neutrophil Count (ANC) Elevated (neurophilia)
  • Physical or emotional stress
  • Acute suppurative infection
  • Myelocytic leukemia
  • Trauma
  • Cushing's syndrome
  • Inflammatory disorders (e.g. rheumatic fever, thyroiditis, rheumatoid arthritis)
  • Metabolic disorders (e.g. ketoacidosis, gout, eclampsia)
Decreased (neutropenia)
  • Aplastic anemia
  • Dietary deficiency
  • Overwhelming bacterial infection (especially in older adults)
  • Viral infections (e.g. hepatitis, influenza, measles)
  • Radiation therapy
  • Addison's disease
  • Drug therapy: myelotoxic drugs (as in chemotherapy)
Absolute Basophil Count (ABC) Increased (basophilia)
  • Myeloproliferative disease (e.g. myelofibrosis, polycythemia rubra vera)
  • Leukemia
Decreased (basopenia)
  • Acute allergic reactions
  • Hyperthyroidism
  • Stress reactions
Absolute Eosinophil Count (AEC) Increased (eosinophilia)
  • Parasitic infections
  • Allergic reactions
  • Eczema
  • Leukemia
  • Autoimmune diseases
Decreased (eosinopenia)
  • Increased adrenosteroid production
Absolute Lymphocyte Count (ALC) Increased (lymphocytosis)
  • Chronic bacterial infection
  • Viral infection (e.g. mumps, rubella)
  • Lymphocytic leukemia
  • Multiple myeloma
  • Infectious mononucleosis
  • Radiation
  • Infectious hepatitis
Decreased (lymphocytopenia)
  • Leukemia
  • Sepsis
  • Immunodeficiency diseases
  • Lupus erythematosus
  • Later stages of human immunodeficiency virus infection
  • Drug therapy: adrenocorticosteroids, antineoplastics
  • Radiation therapy
Absolute Monocyte Count (AMC) Increased (monocytosis)
  • Chronic inflammatory disorders
  • Viral infections (e.g. infectious mononucleosis)
  • Tuberculosis
  • Chronic ulcerative colitis
  • Parasites (e.g. malaria)
Decreased (monocytopenia)
  • Aplastic anemia
  • Hairy cell leukemia
  • Drug therapy: prednisone

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Coagulation

Value Perturbation Differential Diagnosis
Bleeding Time Increased
  • von Willebrand disease (vWD)
  • Glanzmann's thrombasthenia (HP IIb/IIIa deficiency)
  • Bernard-Soulier syndrome (GP1blX-X deficiency)
  • Connective-tissue diseases (Ehlers-Danlos syndrome, Wiskott-Aldrich syndrome, Chediak-Higashi syndrome, hereditary hemorrhagic telangiectasia (HHT))
  • Disseminated Intravascular Coagulation (DIC)
  • Vitamin C deficiency
  • Alcohol intoxication
  • Uremia
  • Liver failure
  • Leukemias
  • Myelodysplastic syndrome
  • Amyloidosis
  • Thrombocytopenia
  • Platelet Function Inhibiting Medications (e.g. aspirin, clopidogrel, ticagrelor, etc.)
  • Coagulation factor inhibiting medications (e.g. warfarin, rivaroxaban, apixaban, dabigatran, etc.)
Decreased
  • n/a
Activated Partial Thromboplastin Time (APTT) Increased
  • Congenital clotting factor deficiencies (e.g. von Willebrand's disease, hemophilia, hypofibrinogenemia)
  • Cirrhosis of liver
  • Vitamin K deficiency
  • Disseminated intravascular coagulation (DIC)
  • Heparin administration
  • Coumarin administration
Decreased
  • Early stages of Disseminated intravascular coagulation (DIC)
  • Extensive cancer (e.g. ovarian, pancreatic, colon)
Prothrombin Time (PT)

and

International Normalized Ratio (INR)

Increased
  • Liver disease (e.g. cirrhosis, hepatitis)
  • Hereditary factor deficiency
  • Vitamin K deficiency
  • Bile duct obstruction (due to decreased absorption of Vitamin K)
  • Coumadin ingestion
  • Diseminated intravascular coagulation
  • Massive blood transfusion
  • Salicylate intoxication
Decreased
  • n/a

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Iron Studies

Value Perturbation Differential Diagnosis
Ferritin Increased
  • Hemochromatosis
  • Hemosiderosis
  • Megaloblastic anemia
  • Hemolytic anemia
  • Alcoholic/inflammatory hepatocellular disease
  • Inflammatory disease
  • Advanced cancers
  • Chronic illnesses such as leukemias, cirrhosis, chronic hepatitis, or collagen-vascular diseases
Decreased
  • Iron-deficiency anemia
  • Severe protein deficiency
  • Hemodialysis
Total Iron Increased
  • Hemosiderosis or hemochromatosis
  • Iron poisoning
  • Hemolytic anemia
  • Massive blood transfusions
  • Hepatitis or hepatic necrosis
  • Lead toxicity
Decreased
  • Insufficient dietary iron
  • Chronic blood loss (ateriovenous malformation, diverticulosis, gastrointestinal cancer, hemangioma, inflammatory bowel disease, irregular menses, urologic tract cancer, uterine cancer)
  • Inadequate intestinal absorption of iron (e.g. malabsorption, short-bowel syndrome)
  • Pregnancy (late)
  • Iron-deficiency anemia
  • Neoplasia

Total Iron Binding Capacity (TIBC)

or

Transferrin level

Increased
  • Estrogen therapy
  • Pregnancy (late)
  • Polycythemia vera
  • Iron-deficiency anemia
Decreased
  • Malnutrition
  • Hypoproteinemia
  • Inflammatory diseases
  • Cirrhosis
Transferrin Saturation Increased
  • Hemochromatosis or hemosiderosis
  • Increased iron intake (oral or parenteral)
  • Hemolytic anemias
Decreased
  • Iron-deficiency anemia
  • Chronic illnesses (e.g. malignancy, other chronic diseases)

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Thyroid

Solute Perturbation Differential Diagnosis
Thyroid Peroxidase Antibody

Increased

  • Chronic thyroiditis (Hashimoto thyroiditis)
  • Rheumatoid arthritis
  • Rheumatoid-collagen disease
  • Pernicious anemia
  • Thyrotoxicosis
  • Hypothyroidism
  • Thyroid carcinoma
  • Myxedema
Decreased
  • n/a
Thyrotropin/Thyroid Stimulating Hormone (TSH) Increased
  • Primary hypothyroidism
  • Thyroiditis
  • Thyroid agenesis
  • Congenital cretinism
  • Large doses of iodone
  • Radioactive iodine injection
  • Surgical ablation of thyroid
  • Severe and chronic illnesses
  • Pituitary TSH-secreting tumor
Decreased
  • Secondary hypothyroidism (pituitary or hypothalamus dysfunction)
  • Hyperthyroidism
  • Suppressive doses of thyroid medication
  • Factitious hyperthyroidism
Free Thyroxine (FT4) Increased
  • Primary hyperthyroid states (e.g. Grave's disease, Plummer disease, toxic thyroid adenoma)
  • Acute thyroiditis
  • Factitious hyperthyroidism
  • Struma ovarii
Decreased
  • Hypothyroid states (e.g. cretinism, surgical ablation, myxedema)
  • Pituitary insufficiency
  • Hypothalamic failure
  • Iodine insufficiency
  • Nonthyroid illness (e.g. renal failure, Cushing's disease, cirrhosis, surgery, advanced cancer)
Free Triiodothyronine (FT3) Increased
  • Primary hyperthyroid states (e.g. Grave's disease, Plummer disease, toxic thyroid adenoma)
  • Acute thyroiditis
  • Factitious hyperthyroidism
  • Struma ovarii
  • TBG increase (as occurs in pregnancy, hepatitis, congenital hyperproteinemia)
Decreased
  • Hypothyroid states (e.g. cretinism, surgical ablation, myxedema)
  • Pituitary insufficiency
  • Hypothalamic failure
  • Protein malnutrition and other protein-depleted states (e.g. nephrotic syndrome)
  • Iodine insufficiency
  • Nonthyroid illnesses (e.g. renal failure, Cushing's disease, cirrhosis, surgery, advanced cancer)
  • Hepatic diseases

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Chemistry

Value Perturbation Differential Diagnosis Associated Findings
Adrenocorticotropic hormone (ACTH) Increased
  • Addison's disease (primary adrenal insufficiency)
  • Adrenogenital syndrome (congenital adrenal hyperplasia)
  • Cushing's disease (pituitary-dependent adrenal hyperplasia)
  • Ectopic ACTH syndrome
  • Stress
 
Decreased
  • Secondary adrenal insufficiency (pituitary insufficiency)
  • Hypopituitarism
  • Adrenal adenoma or carcinoma
  • Cushing's syndrome
  • Exogenous steroid administration
 
Albumin Increased
  • Dehydration
 
Decreased
  • Malnutrition
  • Pregnancy
  • Liver disease (e.g. hepatitis, extensive metastatic tumor, cirrhosis, hepatocellular necrosis)
  • Protein-losing enteropathies (e.g. malabsorption syndromes such as Crohn's disease, sprue, Whipple's disease)
  • Protein-losing nephropathies (e.g. nephrotic syndrome, nephrosis)
  • Third-space losses (e.g. ascites, third-degree burns)
  • Overhydration
  • Increased capillary permeability (e.g. collagen-vascular diseases such as systemic lupus erythematosus)
  • Inflammatory disease
  • Familial idiopathic dysproteinemia
 
Aldosterone Increased
  • Aldosterone-producing adrenal adenoma (Conn's disease)
  • Adrenal cortical nodular hyperplasia
  • Bartter syndrome (renal wasting of potassium associated with poor sodium tubule absorption)
  • Hyponatremia
  • Hyperkalemia
  • Diuretic ingestion resulting in hypovolemia and hyponatremia
  • Laxative abuse
  • Stress
  • Malignant hypertension
  • Poor perfusion states (e.g. congestive heart failure)
  • Decreased intravascular volume (e.g. cirrhosis, nephrotic syndrome)
  • Renal arterial stenosis
  • Pregnancy and oral contraceptives
  • Hypovlemia or hemorrhage
  • Cushing's disease
 
Decreased
  • Renin deficiency
  • Steroid therapy
  • Addison's disease
  • Patients on a high-sodium diet
  • Hypernatremia
  • Aldosterone-inhibiting antihypertensive therapy
  • Aldosterone deficiency
  • Toxemia of pregnancy
 
Alkaline phosphatase (ALP) Increased
  • Primary cirrhosis
  • Intrahepatic or extrahepatic biliary obstruction
  • Primary or metastatic liver tumor
  • Metastatic tumor to the bone
  • Healing fracture
  • Hyperparathyroidism
  • Osteomalacia
  • Paget's disease
  • Rheumatoid arthritis
  • Rickets
  • Intestinal ischemia or infarction
  • Myocardial infarction
  • Sarcoidosis
 
Decreased
  • Hypophosphatemia
  • Hypophosphatasia
  • Malnutrition
  • Milk-alkali syndrome
  • Pernicious anemia
  • Scurvy (vitamin C deficiency)
 
Alananine aminotransferase (ALT) Increased
  • Hepatitis
  • Hepatic necrosis
  • Hepatic ischemia
  • Cirrhosis
  • Hepatic tumor
  • Hepatotoxic drugs
  • Obstructive jaundice
  • Severe burns
  • Trauma to striated muscle
  • Myositis
  • Pancreatitis
  • Myocardial infarction
  • Infectious mononucleosis
  • Shock
 
Decreased
  • n/a
 
Aspartate aminotransferase (AST) Increased
  • Hepatitis
  • Hepatic cirrhosis
  • Drug-induced liver injury
  • Hepatic metastasis
  • Hepatic necrosis 
  • Hepatic surgery
  • Infectious mononucleosis with hepatitis
  • Hepatic infiltrative process
  • Skeletal muscle trauma
  • Recent noncardiac surgery
  • Multiple traumas
  • Severe, deep burns
  • Progressive musclular dystrophy
  • Recent convulsions
  • Heat stroke
  • Primary muscle diseases (e.g. myopathy, myositis)
  • Acute hemolytic anemia
  • Acute pancreatitis
 
Decreased
  • Acute renal disease
  • Beriberi
  • Diabetic ketoacidosis
  • Pregnancy
  • Chronic renal dialysis
 
Gamma-Glutamyltransferase (GGT) Increased
  • Liver diseases (e.g. hepatitis, cirrhosis, hepatic necrosis, hepatic tumor or metastasis, hepatotoxic drugs, cholestasis, jaundice)
  • Myocardal infarction
  • Alcohol ingestion
  • Pancreatic diseases (e.g. pancreatitis, pancreatic cancer)
  • Epstein-Barr virus (infectious mononucleosis)
  • Cytomegalovirus (CMV) infection
  • Reye syndrome
 
Decreased
  • n/a
 
Ammonia Increased
  • Primary hepatocellular disease
  • Reye syndrome
  • Asparagine intoxication
  • Portal hypertension
  • Severe heart failure with congestive hepatomegaly
  • Hemolytic disease of the newborn (erythroblastosis fetalis)
  • Gastrointestinal bleeding with mild liver disease
  • Gastrointestinal obstruction with mild liver disease
  • Hepatic encephalopathy and hepatic coma
  • Genetic metabolic disorder or urea cycle
 
Decreased
  • Essential or malignant hypertension
  • Hyperornithinemia
 
Amylase Increased
  • Acute pancreatitis
  • Chronic relapsing pancreatitis
  • Peptic ulcer disease penetrating into the pancreas
  • Gastrointestinal disease (with necrotic bowel, perforated bowel, or duodenal obstruction amylase leaks into peritoneal cavity and is absorbed via blood and lymphatics)
  • Acute cholecystitis
  • Parotitis(mumps)
  • Ruptured ectopic pregnancy
  • Renal failure
  • Diabetic ketoacidosis
  • Pulmonary infarction
  • After endoscopic retrograde pancreatography
 
Decreased
  • n/a
 
Anion gap Increased
  • Lactic acidosis
  • Diabetic ketoacidosis
  • Alcoholic ketoacidosis
  • Alcohol intoxication
  • Starvation
  • Renal failure
  • Increased gastrointestinal losses of bicarbonate (e.g. diarrhea or fistulae)
  • Hypoaldosteronism
 
Decreased
  • Excess alkali ingestion
  • Multiple myeloma
  • Chronic vomiting or gastric suction
  • Hyperaldosteronism
  • Hypoproteinemia
  • Lithium toxicity
 
Bicarbonate (HCO3) Increased
  • Severe vomiting
  • High-volume gastric suction
  • Aldosteronism
  • Use of mercurial diuretics
  • Chronic obstructive pulmonary disease
  • Metabolic alkalosis
 
Decreased
  • Chronic diarrhea
  • Chronic use of loop diuretics
  • Renal failure
  • Diabetic ketoacidosis
  • Starvation
  • Metabolic acidosis
  • Shock
 
Direct Bilirubin Increased
  • Gallstones
  • Extrahepatic duct obstruction (tumor, inflammation, gallstone, scarring, surgical trauma)
  • Extensive liver metastasis
  • Cholestasis from drugs
  • Dubin-Johnson syndrome
  • Rotor syndrome
 
Decreased
  • n/a
 
Indirect Bilirubin Increased
  • Erythroblastosis fetalis
  • Transfusion reaction
  • Sickle cell anemia
  • Hemolytic jaundice
  • Hemolytic anemia
  • Pernicious anemia
  • Large-volume blood transfusion
  • Resolution of large hematoma
  • Hepatitis
  • Cirrhosis
  • Sepsis
  • Neonatal hyperbilirubinemia
  • Crigler-Najjar syndrome
  • Gilbert syndrome
 
Decreased
  • n/a
 
Brain-type natriuretic peptide (BNP) Increased
  • Congestive heart failure
  • Myocardial infarction
  • Systemic hypertension
  • Heart transplant rejection
  • Cor pulmonale
 
Decreased
  • n/a
 
N-terminal pro-brain-type natriuretic peptide (NT-proBNP)      
CD4 T-cell count      
C-peptide Increased
  • Insulinoma
  • Pancreas transplant
  • Renal failure
  • Administration of oral hypoglycemic agents
 
Decreased
  • Factitious hypoglycemia
  • Diabetes mellitus
  • Total pancreatectomy
 
C Reactive Protein (CRP) Increased
  • Acute, noninfectious inflammatory reactions (e.g. arthritis, acute rheumatic fever, Reiter's syndrome, Crohn's disease)
  • Collagen-vascular diseases (e.g. vasculitis syndrome, systemic lupus erythematosus)
  • Tissue infarction or damage (e.g. acute myocardial infarction, pulmonary infarction, kidney or bone marrow transplantation rejection, soft-tissue trauma)
  • Bacterial infections such as postoperative wound infection, urinary tract infection or tuberculosis
  • Malignant disease
  • Bacterial infection (e.g. tuberculosis, meningitis
  • Increased risk for cardiovascular ischemic events
 
Decreased
  • n/a
 
Total/Ionized Calcium Increased
  • Hyperparathyroidism
  • Nonparathyroid PTH-producing tumor (e.g. PTHrP from lung or renal carcinoma)
  • Metastatic tumor to bone
  • Prolonged immobilization
  • Milk-alkali syndrome
  • Witamin D intoxication
  • Lymphoma
  • Granulomatous infections such as sarcoidosis and tuberculosis
  • Addison's disease
  • Acromegaly
  • Hyperthyroidism
 
Decreased
  • Hypoparathyroidism
  • Renal failure
  • Hyperphosphatemia secondary to renal failure
  • Rickets
  • Vitamin D deficiency
  • Osteomalacia
  • Hypoalbuminemia
  • Malabsorption
  • Pancreatitis
  • Fat embolism
  • Alkalosis
 
Cancer antigen 125 (CA-125) Increased
  • Ovarian cancer
  • Pancreatic cancer
  • Colon cancer
  • Lung cancer
  • Peritoneal carcinomatosis
  • Cancer of the nonovarian female genital tract
  • Breast cancer
  • Lymphoma
  • Cirrhosis
  • Peritonitis
  • Pregnancy
  • Endometriosis
  • Pancreatitis
  • Pelvic inflammatory disease
 
Decreased
  • n/a
 
Cancer antigen 19-9 (CA-19-9) Increased
  • Pancreatic carcinoma
  • Cholecystitis
  • Colorectal cancer
  • Hepatobiliary carcinoma
  • Cirrhosis
  • Gallstones
  • Pancreatitis
  • Gastric cancer
  • Lung cancer
  • Inflammatory bowel disease
  • Rheumatoid diseases
 
Decreased
  • n/a
 
Carbamazepine Increased
  • Supratherapeutic dosing
 
Decreased
  • n/a
 
Carcinoembryonic antigen (CEA) Increased
  • Cancer (GI, breast, lung, pancreatic, hepatobiliary)
  • Inflammation (colitis, cholecystitis, pancreatitis, diverticulitis)
  • Cirrhosis
  • Crohn's disease
  • Peptic ulcer
 
Decreased
  • n/a
 
Chloride (Cl) Increased
  • Dehydration
  • Excessive infusion of normal saline solution
  • Metabolic acidosis
  • Renal tubular acidosis
  • Cushing's syndrome
  • Kidney dysfunction
  • Hyperparathyroidism
  • Eclampsia
  • Respitatory alkalosis
 
Decreased
  • Overhydration
  • Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) (Chloride is diluted)
  • Congestive heart failure (Chloride is retained with sodium then diluted with total body water)
  • Vomiting or prolonged gastric suction
  • Chronic diarrhea or high-output gastrointestinal fistula
  • Chronic respiratory acidosis
  • Metabolic alkalosis (Chloride is driven into cells to compensate for the bicarbonate leaving cells to buffer blood pH)
  • Salt-losing nephritis
  • Addison's disease
  • Diuretic therapy
  • Hypokalemia
  • Aldosteronism (Chloride excretion is increased)
  • Burns
 
Cortisol Increased  
  • Cushing's disease
  • Ectopic ACTH-producing tumors
  • Stress
  • Cushing's syndrome (adrenal adenoma or carcinoma)
  • Hyperthyroidism
  • Obesity
 
Decreased
  • Adrenal hyperplasia
  • Addison's disease
  • Hypopituitarism
  • Hypothyroidism (normal cortisol levels are not required to maintain the reduced metabolic rate of hypothyroid patients)
 
Creatine kinase (CK) Increased
  • Electroconvulsive therapy
  • Adenocarcinoma (especially breast and lung)
  • Pulmonary infarction
  • Disases that affect the central nervous system (e.g. brain injury, brain cancer, cerebrovascular accident, subarachnoid hemorrhage, seizures, shock, Reye syndrome)
  • Acute myocardial infarction
  • Cardiac aneurysm surgery
  • Cardiac defibrillation
  • Myocarditis
  • Ventricular arrhythmias
  • Cardiac ischemia
  • Rhamdomyolysis
  • Muscular dystrophy
  • Myositis
  • Recent surgery
  • Electromyography
  • Intramuscular injections
  • Trauma
  • Crush injuries
  • Delirium tremens
  • Malignant hyperthermia
  • Recent convulsions
  • Shock (anoxic injury to muscle)
  • Hypokalemia
  • Hypothyroidism
 
Decreased
  • n/a
 
Creatinine Increased
  • Glomerulonephritis
  • Pyelonephritis
  • Acute tubular necrosis
  • Urinary tract obstruction
  • Reduced renal blood flow (e.g. shock, dehydration, CHF, atherosclerosis)
  • Diabetic nephropathy
  • Nephritis
  • Rhabdomyolysis
  • Acromegaly
  • Gigantism
 
Decreased
  • Debilitation
  • Decreased muscle mass (e.g. muscular dystrophy, myasthenia gravis)
 
D-dimer Increased
  • DIC
  • Primary fibrinolysis
  • During thrombolytic or defibrination therapy
  • Deep vein thrombosis
  • Pulmonary embolism
  • Arterial thromboembolism
  • Sickle cell anemia with or without vasoocclusive crisis
  • Pregnancy
  • Malignancy
  • Surgery
 
Decreased
  • n/a
 
Estimated glomerular filtration rate (eGFR) Increased
  • Exercise
  • Pregnancy
  • High cardiac output syndromes
 
Decreased
  • Renal artery atherosclerosis
  • Glomerulonephritis
  • Acute tubular necrosis
  • Congestive heart failure
  • Cirrhosis with ascites
  • Shock
  • Dehyration
 
Ethanol Increased
  • Alcohol intoxication or overdose
 
Decreased
  • n/a
 
Alpha-1-Fetoprotein      
Folate (folic acid) Increased
  • Pernicious anemia
  • Vegetarianism
  • Recent masive blood transfusion
 
Decreased
  • Malnutrition
  • Malabsorption syndrome (e.g. celiac disease)
  • Pregnancy
  • Folic acid deficiency (megaloblastic) anemia
  • Hemolytic anemia
  • Malignancy
  • Liver disease
  • Chronic renal disease
 
Glucose      
Glycohemoglobin (Hemoglobin A1c)      
Hepatitis A IgM antibody      
Hepatitis A IgG antibody      
Hepatitis B surface antibodies      
Hepatitis C antibody      
HIV viral load      
Lactate      
Lactate dehydrogenase (LDH)      
Lipase      
Lithium (Li)      
Magnesium (Mg)      
Osmolality      
Parathyroid hormone (PTH)      
Phosphate (PO4)      
Potassium (K) Increased (Hyperkalemia)
  • Excessive dietary intake
  • Excessive intravenous intake
  • Acute or chronic renal failure
  • Addison's disease
  • Hypoaldosteronism
  • Potassium-sparing diuretics
  • Crush injuries to tissues
  • Hemolysis
  • Transfusion of hemolyzed blood
  • Infection (cell injury)
  • Acidosis (proton exchange with cells)
  • Dehydration (through volume concentration)
  • Irritability, nausea, vomiting, intestinal colic, diarrhea
  • Peaked T waves
  • Wide QRS
  • Depressed ST segment
Decreased (Hypokalemia)
  • Deficient dietary intake
  • Burns/trauma/surgery (can trigger secretion of aldosterone)
  • Gastrointestinal disorders (e.g. diarrhea, vomiting)
  • Diuretics
  • Hyperaldosteronism
  • Cushing's syndrome
  • Renal tubular acidosis
  • Licorice ingestion (aldosterone-like effect)
  • Alkalosis (proton exchange with cells)
  • Insulin administration (glucose and potassium are taken up by cells)
  • Glucose administration
  • Ascites (can trigger secretion of aldosterone)
  • Renal artery stenosis (can trigger secretion of aldosterone)
  • Cystic fibrosis
  • Weakness
  • Paralysis
  • Hyporeflexia
  • Ileus
  • Arrhythmias
  • Flattened T waves
  • Prominent U waves
  • Increased sensitivity to digitalis-like drugs (increased arrythmia risk)
Prostate-specific antigen (PSA)      
Total protein      
Rheumatoid factor      
Sodium (Na)      
Troponin I      
Troponin T (TnT)      
Urate (Uric acid)      
Urea      
Valproic acid      
Vitamin B12      
Vitamin D (25-OH vitamin D)      

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Lipids

Solute Perturbation Differential diagnosis Associated findings
Total Cholesterol      
High-density Lipoprotein (HDL) Cholesterol      
Low-density Lipoprotein (LDL) Cholesterol      
Non-high-density lipoprotein (Non-HDL) Cholesterol      
Triglycerides      

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Urinalysis

Value Perturbation Differential diagnosis Associated findings
Bilirubin Increased
  • Gallstones
  • Extrahepatic duct obstruction (tumor, inflammation, gallstone, scarring, surgical trauma)
  • Extensive liver metastasis
  • Cholestasis from drugs
  • Dubin-Johnson syndrome
  • Rotor syndrome
 
Decreased
  • n/a
 
Eosinophils      
Glucose      
pH      
Ketones      
Specific gravity      
Urobilinogen      
Albumin to creatinine ratio (ACR)      
Leukocyte esterase      
Osmolality      
Protein      
Sodium      
Nitrite      
Urine Red Blood Cells (RBCs)      
Urine White Blood Cells (WBCs)      

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24-hour Urine Specimen Analysis

Solute Perturbation Differential Diagnosis Associated findings
Urine calcium (Ca)      
Urine chloride (Cl)      
Urine creatinine      
Urine metanephrine      
Urine protein      
Urine potassium (K)      
Urinary free cortisol      
Urine sodium (Na)      

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Reproductive Hormones

Solute Perturbation Differential Diagnosis Associated findings
Dehydroepiandrosterone sulfate (DHEA-S)      
Total estrogens      
Estradiol (E2)      
Follicle-stimulating hormone (FSH)      
Human chorionic gonadotropin (beta-hCG)      
Luteinizing hormone (LH)      
Progesterone      
Prolactin      
Testosterone      

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Semen analysis

Value Perturbation Differential diagnosis Associated findings
Ejaculate volume      
pH      
Sperm concentration      
Total sperm number      
Motility      
Forward progression      
Normal morphology      
Sperm agglutination      
Viscosity      

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Stool

Value Perturbation Differential diagnosis Associated findings
Fecal fat      
Stool culture      

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