Burn laboratory findings
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eman Alademi, M.D.[2]
Overview
Laboratory Findings
Most nutrition laboratory testing relies on serum concentrations of ingested nutrients, their coenzymes, proteins, or lipids. Alternatively, functional tests measure a specific physiological process or biochemical reaction. We compared these two approaches to nutritional assessment in intensive-care burn patients, in whom the serum concentrations of transthyretin (prealbumin), albumin, transferrin, carotene, retinol, ascorbic acid, copper, cholesterol, iron, and calcium were all below established reference ranges. In contrast, serum triglyceride concentrations were often above the reference range. Functional tests for thiamin, riboflavin, pyridoxine, and iron (by zinc protoporphyrin/heme ratio) in these patients all showed normal values. Dietary intake, weight trends, and nitrogen balances all indicated that these patients' estimated caloric and protein needs had been met. These findings suggest that static measurements of serum concentrations may be unreliable indicators of nutritional status in burn patients.[1]
CBC
- White Blood Cells are abnormally high. White cells in the blood are elevated during inflammation and trauma. Under the differential results we see the type of white cells that are high are neutrophils. Neutrophils help fight infection and are the first to the site with inflammation.
- Red Blood Cells are slightly low as is the Hemoglobin due to the trauma of the burn.
- The hematocrit (Hct) is the percentage of of the volume of the whole blood that is made up of red blood cells. In burns, the patient has lost a lot of fluid from leaky blood vessels (see Systemic Effects of Burns in the Case Study Workbook). There are more red cells than fluid so the hematocrit is high. You can think about this if you make up a packet of Kool Aid. If you dilute the Kool Aid with 2 qts of water, it tastes about right; it's normal. If I dilute the Kool Aid with 1 cup of water, it's very concentrated. Think of the hematocrit as describing how concentrated the Kool Aid is, only in this case we're talking about how concentrated the blood is. If there's not a lot of fluid in the vessels, the blood is very concentrated. The hematocrit goes up.
Chemistry Panel
- The glucose value is elevated. The body is under extreme stress. Glucose stores are released from the liver and new glucose is made. This extra glucose is needed as energy for the body to heal.
- Creatine Kinase is very high. Creatine is a breakdown product from muscles. Because of the damage to the muscles from the burn, creatine kinase is released into the bloodstream.
- BUN (Blood Urea Nitrogen). This is a breakdown product from protein and also reflects kidney damage.
- Total Protein, albumin, and globulin values. The patient's total protein is low because proteins have been lost through damaged blood vessels (see Systemic Effects of Burns in the workbook). Albumin is the major blood protein and globulins reflect the rest of the blood proteins.
Basic laboratory tests include the following:
- Complete blood count (CBC) and Arterial blood gas (ABG) analysis,
- Urea and Electrolytes (U&E),
- Sputum Culture and Sensitivity,
- Creatine Kinase (CK) and C-reactive protine (CRP),
- Human chorionic gonadotropin (B-HCG): if the patient is female,
- Albumin test.
References
- ↑ Heimbach, D M; Labbé, R F; Williamson, J C; Rettmer, R L (1992). "Laboratory Monitoring of Nutritional Status in Burn Patients". Clinical Chemistry. 38 (3): 334–337. doi:10.1093/clinchem/38.3.334. ISSN 0009-9147.
- ↑ "Treatment of burns in the first 24 hours: simple and practical guide by answering 10 questions in a step-by-step form".