Lab values master card III: cardiac, hepatic, endocrine, drug levels
Upper half, two cardiac marker curves rising and falling on a shared time axis with no numeric vertical scale; lower half, four narrow therapeutic channels drawn at true relative narrowness, divided by a rule labeled DIAGNOSTIC above and THERAPEUTIC below.
Strip 1 · Cardiac markers Troponin is the specific one. It rises within hours of myocardial injury and stays elevated for days. A conventional reference sits under 0.04 nanograms per milliliter, with cutoffs assay-specific. Serial draws matter more than any single result.
Strip 2 · B-type natriuretic peptide Under 100 picograms per milliliter is normal. A markedly elevated result points to volume overload rather than to a lung problem. In a dyspnea stem, this is the value that separates heart failure from pneumonia.
Strip 3 · Hepatic enzymes Alanine aminotransferase 4 to 36 units per liter. Aspartate aminotransferase 0 to 35 units per liter. Alkaline phosphatase 30 to 120 units per liter.
Strip 4 · Hepatic function Total bilirubin 0.3 to 1 milligrams per deciliter. Albumin 3.5 to 5 grams per deciliter. Ammonia 15 to 45 micrograms per deciliter. Rising ammonia tracks encephalopathy, and the nursing consequence is a neurologic assessment.
Strip 5 · Glycemic control Glycated hemoglobin, reported as a percentage, reflects glycemic control over roughly three months; under 5.7 percent is normal. The general adult treatment target is individualized and is cited to the current ADA Standards of Care rather than fixed here.
Strip 6 · Thyroid Thyroid stimulating hormone 0.4 to 4 milli-international units per liter. It moves inversely to free thyroxine: a high stimulating hormone with low thyroxine is hypothyroidism.
Strip 7 · Therapeutic levels, narrow Digoxin 0.5 to 2 nanograms per milliliter. Lithium 0.6 to 1.2 milliequivalents per liter for maintenance. Both sit in channels so narrow that a small excess is toxic.
Strip 8 · Therapeutic levels, monitored Phenytoin 10 to 20 micrograms per milliliter. Vancomycin monitoring follows current consensus guidance, which favors exposure-based monitoring over a trough value alone for serious infections.
Margin notea therapeutic level is a leash, not a target.
Watch outlow potassium raises digoxin toxicity risk even when the digoxin level has not changed.
Takeawaya therapeutic drug level is only interpretable alongside the electrolytes and renal function on the previous card.
Full monitoring page → BOOK 07 · P7. Toxicity presentation → BOOK 05 · P11.