Question about lab values and what they mean

[believeallispossible]

Hello.

I am doing a concept map on a 2 month old diagnosed with Failure to Thrive. Not gaining weight and vomits after most feedings. Had an ultrasound of the pylorus and it indicated patient has Pyloric Stenosis.

Here are the labs and i'm trying to indicate what the patient's labs mean or what it could indicate. Here's what I think.

Potassium 5.9 (High) -----I think it could indicate Hemolysis, Infection, Acidosis, and Dehydration.

Creatinine 0.4 (Low)------I think it could indicate Debiltation(weakening), Decreased muscle mass

Calcium 10.2 (High)---------could indicate hypercalcemia

HGB 9.3 (Low)---------could indicate Anemia, Hemorrhage, Dietary Def

HCT 25.4 (Low)

RDW 16.4 (high)--------could indicate Iron-Def anemia, b12 vitamin anemia, Hemolytc anemia

Platelet count 555 (high)--------could indicate thrombocytosis, iron-def anemia, malignant disorders

MPV 7.0 (Low)--------could indicate Aplastic Anemia

* The ones I'm really unsure of are:

Total Protein 6.0 (Low)

Alkaline Phosphatase 290 (high)

AST 50 (high)

Any help would be great. I'm just kinda want to make sure i'm on the right track.

[Muffy5]

Those labs indicate the child has liver damage. Increased ALT and AST indicate the actual liver damage. The liver synthesizes proteins, therefore, if there is damage, this would affect protein synthesis and cause the low lab value.

[PetiteOpRN]

These labs can be explained by vomiting (which causes F/E imbalance and alkalosis), and FTT/dietary def (dehydration, low muscle mass -- which is why creatinine is low, breast fed babies don't get any iron, so there's your anemia).

Protein low = inadequate intake.

ALT and AST could be indicative of dehydration. They are not high enough to worry about. My child's ran the same when he had rotavirus and no one batted an eye.

BTW, I had pyloric stenosis as a baby. Back then, they didn't think girls could get it!

[wooh, BSN, RN]

Yep, it's all dehydration, not enough intake (that's staying down.)

When you look at labs, it's not just "high" or "low" that you look at. You look at are they significantly high or low. (It's very rare to see lab values on a patient, even a healthy person getting a routine workup, where all the values are "normal.") There's always going to be a few that are a point up or down and really in the grand scheme of things don't mean anything.

Then think about the patho. Vomiting=dehydration and in the end, not enough intake. Sure, this lab could mean infection, that lab could mean liver damage. The beauty of pediatrics though, you don't tend to have all the comorbidity that you see in adults and especially in geriatrics. An old lady comes in because one disease process is acting up, but more than likely, she's got a bunch of other things wrong too. Babies (unless we're talking NICU, and to a point, even then), if you've got one diagnosis, more than likely, that is all that's wrong with them (unless that diagnosis causes other things.) If they've got pyloric stenosis, more than likely, that's ALL they have. So your labs are more than likely going to all be related to that.

[bunsterj]

Mildly elevated calcium could also be from dehydration. I don't know what a normal level is for a 2 month old, and I am too lazy to look it up.

[Redhead28]

All d/t dehydration and not getting his feedings thus nutrition. Fix the pylorus fix the problem. Don't over think the labs. Peds rarely have a whole host of problems.

[Redhead28]

Sorry forgot to add. Alk Phos always elevated in growing children.