Table of Available Analyses

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DIAGNOSTICS DIRECTORATE

DEPARTMENT OF BIOCHEMISTRY, YORKHILL

HOSPITAL

NOTES FOR GUIDANCE OF STAFF USING THE Laboratory Hours BIOCHEMICAL SERVICES Weekdays______08.45-17.00 (Specimens received 08.45-17.00) Saturday______NON-METABOLIC08.45-12.00 (Specimens INVESTIGATIONS received 08.45-12.00)

Routine Collection (of non-urgent specimens from wards and out-patient clinics)

Mondays to Friday:_08:00, 10:00, 13:30, 15:00 Saturdays:______09:00, 10:00

Address Department of Biochemistry, Royal Hospital for Sick Children, Dalnair St, Glasgow G3 8SJ. Internal Phone Numbers Enquiries (Reporting Room) incl. Clinical enquires______80339 (Outwith normal hours contact BMS (Page 8000) and/or Senior Staff via switchboard) Urgent requests, add-ons and supplies______80341 Medical Consultant Biochemist (Dr. Peter Galloway)______80345 Consultant Clinical Scientist (Dr. John Fyffe)______80335 Principal Biochemist (Dr. G.B. MacPhee)______80344 (For direct access, dial 0141 201 and final 4 digits only) Nov 2007 NOTE: A separate document “Specialised Metabolic Investigation” gives detailed information and clinical guidance on the investigation and diagnosis of

metabolic disease. Valid until Jan 2009 Royal Hospital for Children, Glasgow Department of Biochemistry Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations

CONTENTS______PAGE General Information Routine determinations______3 Specimens Urgent Requests Emergency Services Responsibility for Requesting Phlebotomy service Request forms Patient Details Clinical Details Safety Hazards Small Volume Samples Age-Related Reference Ranges ______4 Scope of Out of Hours Service Pneumatic Tube System HISS Requesting Computer Downtime Drugs of Abuse Screening______5 General Information on Pre-Analytical Problems ______6 Clinical Advice and Interpretation Table of Most Common Analyses Blood______7 Urine______10 Amniotic Fluid, Blood Spot, CSF, Faeces, Stone, Saliva and Sweat______11 Appendix A A guide to reference ranges______12

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General Information The following information is not comprehensive. Any matter not mentioned can be discussed by contacting the Biochemistry department on ext. 80339. Metabolic investigations are covered in more detail in a separate handbook. Routine Requests: All specimens for routine tests on in-patients should be prepared for the first collection each day. Routine specimens received after 15:30 on weekdays (11:30 on Saturday) may not be analysed until the following day. Specimens: Heparinised blood is usually suitable - but see accompanying table. All specimens must be manually labelled with surname, forename, and date of birth +/- hospital number. Ideally do not use addressograph labels on sample tubes; if used ensure ‘window’ for separating still present. All urine samples should be in a plain universal container unless table indicates preservative required. Ideally all antibodies and RAST should be performed on serum. Specimens MUST be placed in a sealed plastic bag with a form in the separate wallet. Urgent Requests: Requests considered urgent by clinicians should be notified to ext. 80341. These tests will be performed at any time during normal working hours and a porter will, if necessary be sent by the laboratory to collect the sample and appropriate request form. Please use the pneumatic tube transport system wherever possible. Emergency Services: Outside normal working hours, the services of a Consultant and BMS are always available. When an emergency biochemical determination is required, the person requesting the analysis should contact (via the telephone operator) the BMS staff member on call, to whom details of the request should be given. A request form must accompany the specimen. Responsibility for Requesting: Those requesting tests should be in a position to act on the results directly; or be able to tell the reporting room or on-call BMS who will be acting on the results. Phlebotomy Service: A limited phlebotomy service - staffed by part-time phlebotomists and managed by Nan MacIntosh Schiehallion Ward - is available to selected wards on Monday to Saturday mornings. Completing non-HISS request forms: Any request forms sent to the Department which are non-HISS orders, should contain the following information at a minimum: hospital, CHI number, hospital number, patient’s surname, forename, Date of Birth, sex, ward, date and time of sampling, plus clinical details, specimen type and examination required. Patient Details: Full details regarding the patient e.g. (Hospital number, CHI number and date of birth) must be given on the request form to aid computerised accumulation of results. The initials of the phlebotomist / blood collector and date / time of withdrawal of specimen should be handwritten. For small volume samples, please state priorities on the request form in handwriting. CHI NUMBER IS ESSENTIAL FOR ALL NON YORKHILL SAMPLES. Clinical Details: Symptoms, working diagnosis are essential because they enable the Biochemist to check result validation and interpretation. In some instances the laboratory may initiate further tests on the same specimen(s) to assist diagnosis. Important points might include (for example): fasting status, height and weight (for clearances), time of last drug dose, gestation.

General Information (contd.)

Safety Hazards: D:\Docs\2018-05-03\0127238c2907e31b32146dbd63371f2a.doc 3 of 16 Chris Hall Royal Hospital for Children, Glasgow Department of Biochemistry Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations

Specimens that present specific safety hazards must be clearly identified and submitted in accordance with established protocols as per the Trust Health and Safety Policy. All staff are required by the Health and Safety at Work Act to take reasonable care for their own safety and that of other people who may be affected by their actions. Laboratory work is hazardous and clinical staff are often in a position to warn staff when extra precautions are necessary for certain samples.(Appendix A) Age-Related Reference Ranges: Reference ranges appear where appropriate on the typed reports and HISS results screen. Help with interpretation is always available. A guide to commonly required analytes appears in Appendix A. Scope of Out of Hours Service: The laboratory is conscious of its requirements as a tertiary referral centre. It routinely offers Electrolytes, Urea and Creatinine, Liver Function Tests, CRP, Gases, Glucose, Lactate, Ammonia, Iron, Urate, Paracetamol, Salicylate and CSF Protein and Glucose. It can perform a far wider range of tests following discussion on the clinical nature of the request with either the BMS or senior staff. The collecting of critical samples is encouraged, particularly in possible metabolic disorders – though where possible samples should be collected and delivered during normal hours. If the BMS is concerned about the nature of a request, he/she must refer the request to the senior staff on-call and until then is not expected to perform the test. The out of hours service is staffed by one BMS at any given point of time so excessive, inappropriate demands have an adverse effect on the individual and on the quality of service offered to all other users. Pneumatic Tube Transfer System: Specimens may be sent to Biochemistry at any time using this system. All urgent requests must be notified to 80341 (within hours) and outwith hours by paging the on-call staff (Page 8000). Specimens must be placed and sealed within a specimen bag with a HISS request form in the adjoining pocket and then placed in a pod. Operating instructions and a list of destination codes are attached to each terminal. Care must be taken to ensure that the door is properly closed (push at the finger sign). The words “Selection OK” must be displayed in the LCD status window or the pod will not be dispatched. It should be noted that if the door is opened after a pod has been loaded, the position of the pod in the waiting list will be lost and will be at the end of the queue when it is replaced in the terminal. The receiving basket must be kept empty and checked regularly as reports etc. may be sent to you by this route. Power Failure: In the event of power failure the pneumatic tube should not be used because it takes an hour to purge itself after restoration of power. HISS Requesting: Due to the complex range of tests performed, the HISS system offers over 500 biochemical tests. The following tables are a summary of the common tests and their salient pre-analytical features. Most tests are performed on heparinised plasma. Immunological tests however are best performed on serum samples – and in some cases serum is essential (e.g. TRAB). The F9 function key will list available tests. Note that different specimen types for the same analyte may have a unique code. For example, the procedure GLU must only be used for Blood Glucose – GLU.U for Urine Glucose and GLU.C for CSF Glucose. The system allows user-specific order sets to be created. These can be found entering / in the ‘Category’ field - followed by F9. Further details are available from ext. 80339. HISS Failure - “Downtime Procedures”: ‘Downtime’ packs are available, containing request forms which should be used if the HISS goes down. These should be completed with full patient and request details. Written reports will be sent to the wards for 2pm and 6pm. Where results are required more urgently, please phone the laboratory (80341). Be aware that the loss of computing facilities impairs the routine flow of samples and that excessive requests for phoned results will reduce our ability to analyse all samples quickly.

Laboratory Computer Failure: The Biochemistry Laboratory relies heavily on I.T. systems to improve data transfer and failure of the computer system can have major effects on the flow of information:  Manual backup systems will be instituted and special written reports will be sent to the wards.

 Tracking and finding samples and results in the system will be complex and laborious.  Please keep the requests for urgent results to those required only for true clinical emergencies. These requests must be made by a Registrar or Consultant.  Do not send “routine” screens, which could be collected the following day. Only by approaching the problem in a spirit of co-operation can the laboratories hope to cope with the loss of I.T. services and still offer a reliable service.

Urine Drugs of Abuse Screening: This term is a misnomer as the assays look for specific drugs or groups of drugs only. The commonly abused substances screened for at present are amphetamines (but not ecstasy), opiates, benzodiazepines and methadone. Where clinical suspicion is raised, specific requests for ecstasy, barbiturates, buprenorphine, tricyclics, cannabinoids and alcohol can be performed on urine. This range is limited by the costs involved in more detailed analysis such as that performed by forensic pathology. When a urine sample is obtained, please put it into a universal container. The sample may be left at room temperature, or in the refrigerator, and delivery to the laboratory within normal working hours.  Freezing the sample causes plasticisers in the universal container to enter the urine and interfere with analysis.  Note that organic acids are volatile and must be frozen. Upon receipt of the specimen, a biochemist will contact the Consultant Paediatrician (or his junior doctor) involved to discuss whether the analysis should be performed and whether drugs, other than amphetamines, opiates, benzodiazepines, or methadone should be specifically sought. If an analysis is urgently required out of hours, please discuss the case with the Consultant on call. He or she may be able to arrange for emergency analysis on a drug by drug basis - with the proviso that the result of the screening test performed would need confirming during normal working hours.

Sent out Samples: Due to the vast array of possible tests, the laboratory keeps a list of all referral centres used which is available in the reporting office. The identification is added to results being reported for all analysis analysed outwith Yorkhill Biochemistry

Add on Requests: The department keeps all non “high risk” samples for 10 days minimum. Requests for add-ons within 12 hours of receipt should be made to extension 80341. Longer term (< 1 month) should be discussed with the duty biochemist on extension 80339. Some metabolic samples are available for significantly longer and should be discussed with a biochemistry consultant.

Pre-analytical Problems: In the Biochemistry Department, quality control and assessment samples are used to check and maintain the accuracy of the analytical service but it must be remembered that errors can arise before specimens reach the laboratory

Some Common Sources of Pre-Analytical Error  Incorrect patient identification or details – see protocol  Incorrectly preparation (eg not fasted, not rested) or timing (eg interference from administered drugs, specimen collected at wrong time for eg therapeutic drugs)  Incorrect labelling in ward or wrong tube used  Specimen collection site inappropriate eg. vein near IV infusion site or capillary from area of poor peripheral circulation  Difficult specimen withdrawal (eg Haemolysis, upper arm occlusion)  Contaminated syringe or container or inappropriate anticoagulant (especially adding EDTA blood to a heparin tube)  Delay in transport to laboratory. eg. Potassium, Phosphate  Exposure to warmth or cold - some enzymes and potassium  affected  Exposure to light. __e.g. Bilirubin , Porphyrins  Urine collection - wrong bottle, preservative, wrong time on label, failure to empty bladder completely

Complaints: In the event of difficulties in obtaining the service expected, please discuss this in the first instance with Dr. John Fyffe or Dr. Peter Galloway. There is a user questionnaire on the departmental intranet site and users are encouraged to use it to rate their perception of the service.

Clinical Advice and interpretation: During normal laboratory hours the reporting room (ext. 80339) should be contacted for advice and results interpretation. Out of hours, the hospital switchboard (tel 01412010000) will be able to forward any calls concerning clinical queries to the on-call consultant.

Table of Analyses (Blood) Turn- HISS Required Sample Notes Analysis (* 1ml heparinised (Deliver Within 2 Hours unless around Code unless stated) stated) (Days) 25-OH Cholecalciferol (Vit. D) 25HCC 2 ml heparinised 21 17Alpha-OH Progesterone 17AOHPP * 10 A.C.T.H. ACTH 2ml heparinised Deliver within 30 mins. 28 Aldosterone ALD 2ml heparinised 14 Alkaline Phosphatase LFT * 0.2

Table of Analyses (Blood) Turn- HISS Required Sample Notes Analysis (* 1ml heparinised (Deliver Within 2 Hours unless around Code unless stated) stated) (Days) Alpha-1-antitrypsin (Phenotype) AAT * 21 Alpha-Fetoprotein AFP * 7 Aluminium AL 1.5ml heparinised 7 Amino acids AMA * See appendix A of metabolic 5 handbook Ammonia AMMON * Deliver within 30 mins. 0.2 Amylase AMYL * 0.2 Anti-Tissue Transglutaminase AB.TTG 1 ml plain 28 Antibodies Anti-nuclear Factor AB.ANF 1 ml plain or 28 heparinised Ascorbic Acid (Plasma) VITC.P * Deliver within 30 mins. 21 B2-Microglobulin B2M.P * 10 Bile Acids BAC 1 ml plain 7 Bilirubin (Total and unconjugated) BIL * 0.2 Biotinidase BTDASE * Deliver within 30 mins. 10 Bromide BR * 7 Caeruloplasmin CAE * 10 Calcium UE * 0.2 Carbamazepine CAR * Immediately before or 6-8 hrs post 1 dose. Carboxyhaemoglobin COHB * 0.2 Carnitine CATN 2ml heparinised 30 Carotene CAROTN * Protect from light 15 Cholesterol CHO * 0.2 Complement levels COMP 2 ml plain or 14 heparinised Copper and Zinc COP * 7 Cortisol COR * 3 Creatine Kinase CK * 0.2 51Cr EDTA Clearance CRC 2ml heparinised As per protocol. 3 C.R.P. CRP 0.5 ml Heparinised 0.2 blood Cyclosporin CYCLOSP 1ml EDTA At least 12 hrs post-dose. Container 3 should be full. Cystine (Leucocyte) CYS.LEU 5ml heparinised 12 hr post dose. Monday-Thursday 60 before 1400. Digoxin DGXN * At least 6 hrs post-dose 1 Electrolytes UE * Sodium, Potassium, Chloride, CO2, 0.2 Urea, Creatinine, Calcium and Phosphate. Ethanol ALC 0.5 ml fluoridated 0.2 FK506 FK506 1 ml EDTA 12hrs post dose. Container must be 4 full F.S.H. FSH * 3 Galactose-1-Phosphate GAL1P 3ml heparinised To arrive by 14.30 hrs. 60 Galactose-1-P-U Transferase GAL1PUT 0.5ml heparinised 3 Gamma Glutamyl Transferase GGT * 0.2 Gases (Capillary) GAS Heparinised capillary Collected by lab staff. Phone to 0.2 tube (185 ul) arrange. Gases (Arterial) GAS Heparinised syringe Collected by ward staff. Deliver 0.2 within 1/2 hour. Glucose GLU 0.5ml fluoridated 0.2 Glucose Tolerance Test GTT 0.5ml fluoridated Glucose 45g/m2 in children. 1 Glucose 6-P Dehydrogenase GPD * 3

Table of Analyses (Blood) Turn- HISS Required Sample Notes Analysis (* 1ml heparinised (Deliver Within 2 Hours unless around Code unless stated) stated) (Days) Growth Hormone HGH * 3 Haemoglobin A1c (HBA1c) HBA1C 0.5ml EDTA 3 H.C.G. HCG * 2 H.C.G. (tumour marker) HCG.T * 7 IgF1 IGF1 * 7 Immunoglobulins (IgA,IgG,IgM) IGS * 1 Insulin INS 2ml heparinised Deliver within 30 mins. 10 Iron / T.I.B.C. IRN * Iron as emergency only 0.2 Lactate LAC * See appendix A of metabolic 0.2 handbook Lead LEAD 1ml heparinised or 10 EDTA Leucocyte Enzymes CE.W >10ml heparinised Deliver by 14.30hrs. Discuss with 5-28 reporting room. L.H. LH * 3 Liver Function Tests LFT * Bilirubin,Total Protein, Albumin, 0.2 Alk Phos, AST,ALT. Magnesium MAG * 0.2 Methotrexate MTX * 1 Oestradiol OED 2ml heparinised 10 Osmolality OSM * 1 Paracetamol PARAC * Refer to treatment chart. 0.2 Parathormone PTH 2ml Consult HISS for current specimen 7 requirements Phenobarbitone PHB * 0.2 Phenytoin PHY * 0.2 Phosphate UE * 0.2 Porphyrin POR 2ml EDTA Discuss with Lab. Protect from 21 light. Full screen requires blood, urine & faeces. Progesterone PROGST * Record LMP. 7 Prolactin PRL * 2 Protein (Total/Albumin) LFT * 0.2 Pyruvate Kinase PK * 3 Rapamune / Sirolimus RAPA 1 ml EDTA 4 RAST / Total IgE RAST 2ml plain State requirements in additional info In House 7 field. Sent Out 30 100ul per test. Renin RENIN 1.5ml EDTA Deliver within 30 mins 21 Rheumatoid Factor AB.RF * 15 Salicylate SAL * 0.2 Selenium SEL * 10 Sex Hormone Binding Globulin SHBG * 7 Testosterone TESTOS * 15 Theophylline THE * 0.2 Thyroid Antibodies AB.TPO 1ml plain or For autoimmune Hypothyroidism. 7 heparinised Thyroid Function Tests TFT 1.5 ml heparinised 3 (Free T4, TSH) TRAB AB.TR 1ml PLAIN ONLY For investigation of Graves’ 28 Disease. Triglycerides TRG * Fasting / pre feed. 0.2 Urate URA * 0.2 Valproate VAL * 5 Vitamin A VITA * Protect from light 10

Table of Analyses (Blood) Turn- HISS Required Sample Notes Analysis (* 1ml heparinised (Deliver Within 2 Hours unless around Code unless stated) stated) (Days) Vitamin B screen VITB 2 ml Lithium Heparin Vitamin E VITE * 10 Zinc (with Copper) COP * 7

Table of Analyses (Urine)

NOTES Turn-around Analysis HISS Code (Plain container (10-25mls) suitable unless stated) (Days) Albumin ALB.U Random/overnight specimen 3 Albumin Excretion Rate AER Accurately timed collection. 3

Amino Acids AMA.U Random specimen 5

B-2 Microglobulin B2M.U Random specimen 21 Catecholamine Screen FULLC.U 14 Calcium / Creatinine Ratio CAL.U Random plain specimen; or 24hr collection in acid 2 containing bottle. Creatinine Clearance CCL Accurately timed collection and plasma sample. 3 Height and weight for surface area Drug Screen DRUGS Discuss with lab. in morning. See note above 10 Electrolyte ELECT.U Random specimen 1 Glucose GLU.U Random specimen 2 HMMA (VMA) PHE 24hr Acid container. Deliver promptly. Within 1/2 4 hour. OR fresh Random sample, deliver immediately, acidified in lab on receipt HVA PHE 24hr Acid container. Deliver promptly. Within 1/2 4 hour. OR fresh Random sample, deliver immediately, acidified in lab on receipt 5-Hydroxy Indole Acetic Acid 5HIAA Acid container. Deliver promptly. Within 1/2 hour. 21 Laxative Screen LXSCRN (+/- Liquid faeces for Osmolality/ Magnesium). (20 21 mls urine). Metabolic Bone Screen MBS Calcium, Phosphate, Creatinine, PEI and TRP. 2 Concurrent plasma required. Osmolality OSM.U 1 Phosphate PHOS.U Acid container or acidified on receipt. 1 Porphyrin POR Discuss with Lab. Protect from light. Full screen requires 21 blood, urine & faeces. Protein / Creatinine Ratio PRO.U 2 Sugar Chromatography SUG.U Random specimen 14 Urate URA.U 24hr collection or random specimen. 1

Urea + Creatinine Performed on all urine specimens received. 1 Urobilinogen UROBIL Random specimen 1

Table of Analyses (Miscellaneous fluids)

Analysis Hiss Code Required Sample Notes Turnaround (Days) Bloodspot 17-OH Progesterone 17AOHPB Bloodspot card 90 Immunoreactive Trypsin IRT Bloodspot card Sent to Medical Genetics 4 CSF Glucose GLU.C 0.5ml fluoridated 0.2 Protein PRO.C 0.5ml plain 0.2 Lactate LAC.C 0.5ml plain 0.2 Faeces Alpha-1-antitrypsin AAT.F plain universal Random specimen 10 Chymotrypsin CHYM plain universal Random specimen 7 Fat FAT Container from lab. 3-5 day 5 collection. Fat Microscopy FATMIC plain universal Random specimen 7 Occult Blood FOB Smeared on Hema- Random specimen 3 screen cards pH Reducing Substances REDS plain universal Random specimen Ensure 5 liquid portion is submitted. Porphyrin POR plain universal Random specimen. Discuss 21 with Lab. Protect from light. Full screen requires blood, urine & faeces. Saliva Cortisol COR.F 2ml in plain universal 60 Stone Stone STONE plain universal 28 Sweat Sweat Test SWT Arranged via Respiratory 1 Lab.

Prepared by Peter Galloway Medical Consultant November, 2007

Appendix A: A GUIDE TO CLINICAL CHEMISTRY VALUES The values given are a guide to the normal range. For simplicity, exact data for tight age ranges are not given although are produced on reports. When interpreting an analyte, the pathophysiological processes need to be considered; in particular inflammation and acute phase response, such that analytes increase (e.g. copper, -1- antitrypsin) or decrease (e.g. iron, zinc). Those where large differences occur when compared to adult reference ranges are highlighted.

Acid-base [H+]______38-45 nmol/l pH 7.35-7.42 (Neonates especially premature pH 7.2 – 7.5) pCO2 ______4.5-6.0 kPa (32-45 mmHg) pO2 ______11-14 kPa (78-105 mmHg)

- Bicarbonate [HCO3 ]______22-27 mmol/l (Preterm/<1 month______17-25 mmol/l) Base excess______-4 to +3 mmol/l

Plasma: electrolytes and minerals

Sodium______135-145_____mmol/l Potassium______Newborns 4.3-7.0______mmol/l ______Older Children 3.5-5.0______mmol/l Chloride______95-105______mmol/l Calcium______Preterm 1.5-2.5______mmol/l ______First year 2.25-2.75____mmol/l ______Children 2.25-2.70____mmol/l Phosphate (lower in breast fed) Preterm 1.4-3.0 ______mmol/l ______First year 1.2-2.5______mmol/l ______Children 0.9-1.8 ______mmol/l Magnesium______Children 0.7-1.0 ______mmol/l Copper______Birth to 4 weeks 5.0-12.0_____mol/l ______17-24 weeks 5.0-17.0_____mol/l ______25-52 weeks 8.0-21.0_____mol/l ______>1 year 12.0-24.0____mol/l Zinc______9.0-18.0_____mol/l

Iron______< 3 years 5.0-30.0_____mol/l ______>3 years 15.0-45.0____mol/l Ceruloplasmin______Newborn 0.05-0.26____g/l ______Children 0.25-0.45____g/l

Plasma: other analytes

Acetoacetate (incl. acetone)_ <30______mg/l AFP______< 6 months (Very high levels especially if premature – rapid fall over a week expected) ______> 6 months < 10______U/ml Alkaline phosphatase______Newborn <800______U/l ______Children 100-500_____U/l Alanine aminotransferase (ALT) Infants 10-60______U/l ______Children 10-40______U/l Ammonia______1 – 4 months <60 ______mol/l ______> 4 months 20-45______mol/l ______Term neonate <100______mol/l ______Preterm neonate <180______mol/l Amylase______<200______U/l Ascorbic acid______15-90______mol/l Aspartate aminotransferase (AST) <4 weeks 40-120______U/l ______>4 weeks 10-50______U/l

Bilirubin total______Cord blood <50______mol/l ______Term Day1 <100______mol/l ______(pre-term greater) ______Term days 2 -5 <200mol/l ______>1 month <20______mol/l Cholesterol______Cord blood 1.0-3.0______mmol/l ______Newborn 2.0-4.8______mmol/l ______Infants and children 2.8-5.7______mmol.l Cortisol______Neonates use synacthen test ______Diurnal variation after 10 weeks post-term

Creatine kinase (CK)______Newborn <600______U/l ______Infants <300______U/l D:\Docs\2018-05-03\0127238c2907e31b32146dbd63371f2a.doc 13 of 16 Chris Hall Royal Hospital for Children, Glasgow Department of Biochemistry Notes for Guidance of Staff using the Biochemical Services Non Metabolic Investigations

______Children <200______U/l Creatinine ______Newborn 40-100______mol/l ______Reflects Maternal level and declines over first month ______1-2 years 20-45______mol/l ______7-9 years 30-65______mol/l Creatinine clearance______0-3 months 30-70______ml/min/m2 ______12-24 months 50-100______ml/min/m2 ______Older children 90-120______ml/min/m2 C-reactive protein (CRP)___ <7______mg/l Follicle-stimulating hormone (FSH) <3______U/l Gammaglutamyltransferase (GT) Newborn <200______U/l ______1-6 months <120______U/l ______>6 months <40______U/l Glucose______Newborn (<48h) 2.2-5.0______mmol/l ______Infants and children 3.0-5.0______mmol/l Glycosated haemoglobin___ 4.1-6.1______% ______(DCCT aligned) 17 OH Progesterone _____>4 days <13 nmol/l ______>60 confirms CAH Insulin______Fasting <13______mU/l ______(Always measure glucose) Lactate (blood)______Newborn <3.0______mmol/l ______Infants and Children 1.0-1.8______mmol/l ______Adult 0.7-2.1 Lactate dehydrogenase (LDH) <1 month 550-2100____U/L ______1-12 months 400-1200____U/l ______1-6 years 470-920_____U/l ______6-9 years 420-750_____U/l ______>9 years 300-500_____U/l Lipids – Triglycerides_____Fasting 0.3-1.5 ______mmol/l Luteinising hormone (LH)__ <1.9______U/l Osmolality______275-295_____mmol/kg

Protein – Total______Newborn 45-70______g/l ______Infants 50-70______g/l ______Children 60-80______g/l - Albumin______Newborn 25-35______g/l ______Infants and Children 35-50______g/l

Immunoglobulins (g/l) IgG IgA IgM Newborn 2.8-6.8 0-0.5 0-0.7 Infants 3.0-10.0 0.2-1.3 0.3-1.5 Children >3 years 5.0-15.0 0.4-2.5 0.4-1.8

Pyruvate (blood)______50-80______mol/l ______(Ratio Lactate/Pyruvate > 20 abnormal)

Free Thyroxine (T4)______<1 month 6-30______pmol/l ______>1 month 9-26______pmol/l

Thyroid-stimulating hormone (TSH) 1-30 days 0.5-16______mU/l ______1 month – 5 years 0.5-8______mU/l ______5 years - 0.4-6______mU/l

Tri-iodthyronine(T3)______Newborn 0.5-6.0______nmol/l ______Infants and children 0.9-2.8______nmol/l

Urea______2.5-6.0______mmol/l ______(Neonates often 1.0-5.0 mmol/l) Uric acid______<9 years 0.11-0.3_____mmol/l Vitamin A______Preterm 0.09.1.7_____mol/l ______<1year 0.5-1.5______mol/l ______1 year-6 years 0.7-1.7______mol/l ______Older 0.9-2.5______mol/l 25 Hydroxyvitamin D______>15 ______nmol/l ______Ideally > 25 + <100 nmol/l Vitamin E (-tocopherol)___<2month 2-8______mol/l ______1-6 months 5-14______mol/l ______2 years 13-24______mol/l

The kidney develops rapidly over the first year of life. Its handling of many filtered compounds is substantially different, e.g. Urine calcium Birth – 6 months < 2.4 mmol/mmol Creatinine 6-12 months 0.09 – 2.2 mmol/mmol Creatinine, 1-3 years 0.06 – 1.4 mmol/mmol Creatinine, 3-5 years 0.05-1.1 mmol/mmol Creatinine, 7 years to adult 0.04-0.7 mmol/mmol Creatinine Urine Phosphate 7-12 months 1.2-19 mmol/mmol Creatinine 1-3 years 1.2-12 mmol/mmol Creatinine 3-6 years 1.2-8 mmol/mmol Creatinine Adult__ 0.8-2.7 mmol/mmol Creatinine

CSF Protein ______<1 month 0.26-1.2 _____g/l ______1-3 months 0.1-0.8 ______g/l ______>3months 0.1-0.5 ______g/l

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