BLOOD CHEMISTRIES

jacky

BLOOD CHEMISTRIES

Blood chemistries are often cheaper by the dozen. So, a blood report will have more types of blood chemistries than required to evaluate the client/patient for exercise. The components of the blood report include:

• Lipids
• Enzymes
• Electrolytes
• Sugars
• Cell Counts
• Others
  

The purposes of these reports for exercise testing and prescription include:

• Establish Risk
  The lipid panel gives values for Total Cholesterol, HDL Cholesterol and Triglycerides. LDL Cholesterol can be calculated from Total Cholesterol and Triglycerides.
  
  Fasting blood glucose provides information on impaired glucose as well as glucose control in diabetes.
• Effects of Medications
  Some medications, like diuretics, can affect potassium concentrations. Because low potassium can be fatal during exercise, screening the potassium is a safety issue. If the potassium is too low, refer the client/patient back to their physician for management.
• Further Screening
  Other blood chemistries may be abnormal and may require referral back to the primary physician.
• Nutritional Assessment
  The nutritionist observes the blood chemistries to see nutritional status.
  

Each health or disease condition requires a different blood work-up. The general work-up in apparently healthy adults is listed below. This would be from a simple Complete Metabolic Profile (CMP).

Chemistry	Normal Range	Source	Function	Abnormal High	Abnormal Low
Hemoglobin	Men 13.5-17.5g/dl Wo 11.5-15.5 g/dl	Red Blood Cell	Oxygen Transport	Thrombus formation	Anemia
Hematocrit	Men 40-52% Women 36-48%	Percent of Red Blood Cells
Red Cell Count	4.5-6.5 x 1012/L 3.9-5.6 x 1012/L	Number of Red Blood Cells
White Cell Count	4-11 x 109/L
Platelet Count	150-450 x 109/L
Fasting Glucose	60-110 mg/dL	Circulating in blood stream from diet or liver	Energy source for quick energy	Diabetes or Impaired Glucose	Hypoglycemia
BUN Blood Urea Nitrogen	4-24 mg/dL
Creatinine	0.3-1.4 mg/dL
BUN:Creatinine Ratio	7-27
Uric Acid	Men 4.0-8.9g/dL Wom 2.3-7.8 g/dL	Oxidation of purine bases		-Gout -Renal Insufficiency -Leukemias
Bilirubin	up to 1.5	Breakdown of hemoglobin		Jaundice Liver Disease
Sodium	135-150 mEq/L
Potassium	3.5-5.5 mEq/L			Tall T-Wave	Sudden Death in Exercise Interpretation of ST segment is compromised
Creatinine Kinase (CK)	Myocardial Band <5% of Total CK			Myocardial Infarction
CPK Creatinine Phosphokinase	Men 25-90 U/L Wom 10-70 U/L			Myocardial Infarction
Troponin 1	<0.5 ng/mL			Myocardial Infarction

The enzymes often have different sources. For example, Creatinine Kinase can come from muscle brain heart Therefore, specific fractions must be observed to determine whether the damage is from the heart or from skeletal muscle. Exercise can increase the muscle CK and some sports like boxing and football can increase the brain CK. Heart damage increases myocardial CK.

BLOOD PANELS FOR DISEASE STATES

Some disease states require a variation in the blood analysis:

• DIABETES
  
  • Glycosylated Hemoglobin - HbA1c
  • Glucose Tolerance Test
    

Elements of ExRx	Contraindications	Risk Stratification	Pulmonary Functions	Graded Exercise Testing Interpretation
Blood Chemistries	Body Composition	ECG	top

PULMONARY FUNCTIONS Of all the assessment activities, pulmonary function are often the least utilized. The assessment of pulmonary function is important in the diagnosis and evaluation of obstructive and restrictive pulmonary diseases.    Obstructive lung disease is clinically identified by a decrease in expiratory flow rates, the anatomical basis of which is airway narrowing.   Whereas, restrictive lung disease is clinically identified by decreased lung volumes.   Pulmonary functions utilized in the diagnosis and prognosis of these diseases include: Static Lung Volumes (VC) Flow Rate (FEV1) Flow-Volume Loops Maximal Ventilatory Volume (MVV) Pulmonary functions are not the only means of evaluating lung disease.  Other assessments include: Diffusion Capacity Arterial Blood Gases Right to Left Shunts

A spirometer is the equipment used for most pulmonary function tests.

Forced Vital Capacity:     Vital capacity maneuver measures dynamic and static lung volumes. Static lung volumes are single volumes whereas dynamic volumes or capacities are combinations of static lung volumes.     The graph to the right illustrates the vital capacity maneuver.  It starts with normal tidal breathing.  Then you see the complete inhalation followed by the complete and rapid exhalation.  Then normal tidal breathing continues.

Each component of the forced vital capacity maneuver is divided into different pulmonary functions. Dynamic pulmonary functions are: Inspiratory Capacity Vital Capacity Functional Reserve Capacity Total Lung capacity Whereas the static pulmonary functions are: Inspiratory Reserve Volume Expiratory Reserve Volume Tidal Volume Residual volume is a static lung volume, but cannot be measured by the Vital Capacity Maneuver Diagnostic criteria, based on pulmonary functions Diagnosis Restrictive Disease Obstructive Disease Normal Mild Moderate Severe      > 80% of predicted VC 60 to 75% of predicted VC 50 to 60% of predicted VC < 50% of predicted VC      > 80% of predicted FEV1 60 to 70% of predicted FEV1 40 to 59% of predicted FEV1 < 40% of predicted FEV1 FEV1 is the percent of the vital capacity that can be exhaled within the first second. A FEV1 <60% compromises the ability to exercise.

The forced vital capacity maneuver can be illustrated in a different way; as a flow-volume loop. Flow rate is plotted on the y axis whereas volume is plotted on the x axis. These values are plotted for every fraction of a second of the total inspiration and expiration. The expiration is above the x axis whereas the inspiration is below. The plot begins at total lung capacity; with the lungs filled as much as possible. Different pulmonary diseases exhibit distinct flow-volume loops. Flow rates are also broken down into fractions of the whole maneuver. That is: 25% 25-50% 25-75%

Maximal Ventilatory Volume (MVV):     MVV measures the capacity to move air in and out of the lungs.   MVV is illustrated in the figure to the right.   MVV measures the largest amount that can be moved in 10 or 20 seconds and corrects that volume to one minute. The MVV has been called the huff and puff test.   It is a series of rapid deep breaths for 10 to 20 seconds.

Relationships among Pulmonary Functions and Physical Work Capacity MVV = FEV1 x 35 VEmax = 72 (+ 15%) x MVV Pulmonary functions are assessed in pulmonary disease and are used in the exercise prescription. The only need for measuring pulmonary functions in the health & fitness setting would be for heavy smokers or incorporating exercise in a smoking cessation program.

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