What is hyperkalemia and how does it affect the body. What are normal potassium levels and when are they considered too high. Who is at risk for developing hyperkalemia. What causes potassium levels to become elevated in the blood.

What is Hyperkalemia and Why is it Concerning?

Hyperkalemia refers to abnormally high levels of potassium in the blood. While potassium is an essential nutrient that helps nerves and muscles function properly, having too much can be dangerous. Excess potassium in the bloodstream can interfere with normal heart rhythms, potentially leading to serious cardiac problems.

Normal potassium levels typically range from 3.5 to 5.0 millimoles per liter (mmol/L) in adults. Hyperkalemia is generally defined as a potassium level above 5.5 mmol/L. Levels exceeding 6.5 mmol/L are considered severe and require immediate medical attention due to the risk of heart arrhythmias and cardiac arrest.

Who is At Risk for Developing Hyperkalemia?

While hyperkalemia can affect anyone, certain groups are at higher risk:

• People with kidney disease or reduced kidney function
• Those taking certain medications, especially ACE inhibitors, ARBs, or potassium-sparing diuretics
• Individuals with Addison’s disease or other adrenal gland disorders
• Patients with severe burns or trauma
• People with uncontrolled diabetes
• Those consuming excessive amounts of potassium-rich foods or supplements

Understanding your risk factors is crucial for early detection and management of hyperkalemia.

What Causes Potassium Levels to Rise in the Blood?

Several factors can contribute to elevated potassium levels:

1. Kidney dysfunction: The kidneys play a vital role in regulating potassium levels. When they’re not functioning properly, excess potassium can accumulate in the blood.
2. Certain medications: Some drugs, particularly those used to treat high blood pressure or heart conditions, can interfere with potassium excretion.
3. Hormonal imbalances: Conditions affecting hormone production, like Addison’s disease, can disrupt potassium regulation.
4. Cell damage: When cells are damaged (e.g., from burns, trauma, or tumor lysis syndrome), they release potassium into the bloodstream.
5. Excessive intake: Consuming large amounts of potassium-rich foods or supplements can overwhelm the body’s ability to maintain balance.

Recognizing the Symptoms of Hyperkalemia

Hyperkalemia often develops gradually and may not cause noticeable symptoms in its early stages. However, as potassium levels rise, the following symptoms may occur:

• Muscle weakness or fatigue
• Tingling or numbness in the extremities
• Nausea or vomiting
• Irregular heartbeat or palpitations
• Shortness of breath
• Chest pain

In severe cases, hyperkalemia can lead to paralysis, respiratory failure, or cardiac arrest. It’s important to note that these symptoms can be subtle or absent, making regular blood tests crucial for those at risk.

Diagnosing Hyperkalemia: The Importance of Blood Tests

Hyperkalemia is typically diagnosed through a simple blood test called a serum potassium test. This test measures the amount of potassium in your blood serum. How often should you get your potassium levels checked? For individuals at high risk, such as those with kidney disease or taking certain medications, regular monitoring may be recommended by their healthcare provider.

In addition to blood tests, doctors may use electrocardiograms (ECGs) to assess the impact of high potassium levels on heart function. Characteristic changes in the ECG can provide valuable information about the severity of hyperkalemia.

When to Seek Medical Attention

If you’re experiencing symptoms of hyperkalemia, especially if you’re in a high-risk group, it’s crucial to seek medical attention promptly. Severe hyperkalemia is a medical emergency that requires immediate treatment to prevent life-threatening complications.

Treatment Options for Hyperkalemia

The treatment of hyperkalemia depends on its severity and underlying cause. Common approaches include:

1. Dietary modifications: Reducing intake of high-potassium foods
2. Medication adjustments: Changing or stopping medications that may be contributing to high potassium levels
3. Diuretics: Medications that help the body excrete excess potassium through urine
4. Potassium binders: Medications that bind to potassium in the digestive tract, preventing its absorption
5. Insulin and glucose: Intravenous administration to help shift potassium back into cells
6. Calcium gluconate: Used in emergency situations to protect the heart from the effects of high potassium
7. Dialysis: In severe cases or when other treatments are ineffective

The choice of treatment will be tailored to the individual’s specific situation and the urgency of lowering potassium levels.

Preventing Hyperkalemia: Lifestyle and Dietary Considerations

While not all cases of hyperkalemia can be prevented, certain lifestyle changes can help manage potassium levels:

• Follow a low-potassium diet as recommended by your healthcare provider
• Stay well-hydrated to support kidney function
• Take medications as prescribed and inform your doctor of any side effects
• Monitor your potassium levels regularly if you’re at high risk
• Manage underlying conditions like diabetes or kidney disease effectively

Working closely with your healthcare team is crucial in developing a personalized prevention plan.

Hyperkalemia in Special Populations: Considerations for Chronic Kidney Disease Patients

Individuals with chronic kidney disease (CKD) are particularly susceptible to hyperkalemia due to their reduced ability to excrete potassium. For these patients, managing potassium levels often involves a delicate balance between dietary restrictions, medication management, and sometimes dialysis.

Dietary Management in CKD

CKD patients may need to follow a strict low-potassium diet, which can be challenging. Common high-potassium foods to limit or avoid include:

• Bananas, oranges, and melons
• Potatoes, tomatoes, and avocados
• Leafy green vegetables like spinach and kale
• Beans and legumes
• Nuts and seeds

Working with a renal dietitian can help create a balanced meal plan that meets nutritional needs while controlling potassium intake.

Medication Considerations

Many medications commonly prescribed for CKD patients can affect potassium levels. These may include:

• ACE inhibitors and ARBs for blood pressure control
• Potassium-sparing diuretics
• Beta-blockers
• NSAIDs

Regular monitoring and medication adjustments are often necessary to maintain safe potassium levels in CKD patients.

The Role of Potassium in the Body: Understanding Its Importance

While we’ve focused on the dangers of excess potassium, it’s important to understand why this mineral is crucial for normal bodily functions:

• Nerve signal transmission: Potassium helps nerves send signals throughout the body
• Muscle contraction: It plays a key role in muscle function, including the heart muscle
• Blood pressure regulation: Potassium helps maintain healthy blood pressure levels
• Fluid balance: It works with sodium to regulate fluid balance in cells
• pH balance: Potassium helps maintain the proper acid-base balance in the body

Maintaining the right balance of potassium is essential for overall health and well-being. Too little potassium (hypokalemia) can also cause health problems, highlighting the importance of proper potassium management.

Emerging Research and Future Directions in Hyperkalemia Management

As our understanding of hyperkalemia grows, researchers are exploring new approaches to diagnosis, treatment, and prevention:

Novel Potassium Binders

New potassium-binding medications are being developed to offer more effective and better-tolerated options for managing chronic hyperkalemia. These drugs aim to reduce gastrointestinal side effects and improve long-term adherence.

Personalized Medicine Approaches

Genetic studies are uncovering individual variations that may affect potassium handling and response to treatments. This research could lead to more tailored management strategies based on a person’s genetic profile.

Improved Monitoring Technologies

Continuous potassium monitoring devices, similar to continuous glucose monitors used in diabetes management, are being explored. These could provide real-time data on potassium levels, allowing for more precise and timely interventions.

Dietary Interventions

Researchers are investigating how various dietary patterns and specific foods affect potassium levels in different populations. This could lead to more nuanced dietary recommendations for preventing and managing hyperkalemia.

As research progresses, our ability to prevent, detect, and treat hyperkalemia is likely to improve, offering better outcomes for those at risk of this potentially dangerous condition.

Low potassium (hypokalemia) – Mayo Clinic

Low potassium (hypokalemia) refers to a lower than normal potassium level in your bloodstream. Potassium helps carry electrical signals to cells in your body. It is critical to the proper functioning of nerve and muscles cells, particularly heart muscle cells.

Normally, your blood potassium level is 3.6 to 5.2 millimoles per liter (mmol/L). A very low potassium level (less than 2.5 mmol/L) can be life-threatening and requires urgent medical attention.

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Show references

1. Adams JG. Potassium. In: Emergency Medicine: Clinical Essentials. 2nd ed. Philadelphia, Pa.: Saunders Elsevier; 2013. https://www.clinicalkey.com. Accessed May 5, 2017.
2. Hypokalemia. The Merck Manuals: The Merck Manual for Health Care Professionals. http://www.merckmanuals.com/professional/endocrine_and_metabolic_disorders/electrolyte_disorders/hypokalemia.html. Accessed April 5, 2017.
3. Mount DB, et al. Causes of hypokalemia in adults. http://www.uptodate.com/home. Accessed April 5, 2017.
4. Mount DB, et al. Clinical manifestations and treatment of hypokalemia in adults. http://www.uptodate.com/home. Accessed April 5, 2017.
5. Potassium, serum. Mayo Medical Laboratories. http://www.mayomedicallaboratories.com/test-catalog/Clinical+and+Interpretive/81390. Accessed April 28, 2017.

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Hyperkalemia (High Blood Potassium): Symptoms, Causes & Treatment

Overview

What is hyperkalemia (high potassium)?

Hyperkalemia occurs when potassium levels in your blood get too high. Potassium is an essential nutrient found in foods. This nutrient helps your nerves and muscles function. But too much potassium in your blood can damage your heart and cause a heart attack. You can’t always tell when your potassium levels are high.

What is a safe or normal potassium level?

A typical potassium level for an adult falls between 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia occurs when levels go above 5.5 mmol/L. A reading above 6.5 mmol/L can cause heart problems that require immediate medical attention.

Who might have hyperkalemia (high potassium)?

Anyone can get hyperkalemia, even children. You may be more at risk if you have:

Symptoms and Causes

What causes hyperkalemia (high potassium)?

Your kidneys filter potassium from the foods and drinks you consume. Your body gets rid of excess potassium when you pee. With hyperkalemia, your body has too much potassium for your kidneys to remove. As a result, potassium builds up in your blood.

In addition to conditions like kidney disease, these factors also contribute to hyperkalemia:

• A high-potassium diet, which can result from potassium supplements and salt substitutes.
• Medications that contain potassium, such as certain high blood pressure medicines.

What are the symptoms of hyperkalemia (high potassium)?

Many people with mild hyperkalemia have no signs or ones that are easy to dismiss. Symptoms often come and go and may come on gradually over weeks or months. Dangerously high potassium levels affect the heart and cause a sudden onset of life-threatening problems. Hyperkalemia symptoms include:

Diagnosis and Tests

How is hyperkalemia (high potassium) diagnosed?

Because most people don’t have symptoms, you might not know you have high potassium until you get a routine blood test. A serum potassium test measures potassium levels in blood. Your healthcare provider may also order an electrocardiogram (EKG). This test shows changes in heart rhythm caused by hyperkalemia.

Management and Treatment

What are the complications of hyperkalemia (high potassium)?

Severe hyperkalemia can come on suddenly. It can cause life-threatening heart rhythm changes (arrhythmia) that cause a heart attack. Even mild hyperkalemia can damage your heart over time if you don’t get treatment.

How is hyperkalemia (high potassium) managed or treated?

Treatment varies depending on the potassium level. Options include:

• Diuretics: Also called water pills, these drugs make you pee more often. Your body gets rid of potassium mainly in urine.
• Intravenous (IV) therapy: Extremely high potassium levels need immediate treatment. You’ll receive an IV infusion of calcium to protect your heart. Next, you get an infusion of insulin that helps move potassium into the blood cells. You may also inhale an asthma medication called albuterol to further lower potassium levels.
• Medication management: Many people see improvement after stopping or changing certain blood pressure medications or other drugs that raise potassium levels. Your healthcare provider can determine what medication changes to make.
• Potassium binders: A daily medication binds to excess potassium in the intestines. You pass the potassium when you poop. Your provider may recommend binders if other treatments don’t lower potassium levels. Potassium binders come in oral and enema form.
• Dialysis: If potassium levels remain high, or you experience kidney failure, you may need dialysis. This treatment helps your kidneys remove excess potassium from blood.

Prevention

How can I prevent hyperkalemia (high potassium)?

If you’ve had hyperkalemia or are at risk for it, a low-potassium diet is the best way to protect your health. You may need to cut back on, or completely cut out, certain high-potassium foods, such as:

• Asparagus.
• Avocados.
• Bananas.
• Citrus fruits and juices, such as oranges and grapefruit.
• Cooked spinach.
• Melons like honeydew and cantaloupe.
• Nectarines.
• Potatoes.
• Prunes, raisins and other dried fruits.
• Pumpkin and winter squash.
• Salt substitutes that contain potassium.
• Tomatoes and tomato-based products like sauces and ketchup.

Outlook / Prognosis

What is the prognosis (outlook) for people who have hyperkalemia (high potassium)?

Changes to your diet and medication often resolve mild cases of hyperkalemia. With the right care, most people don’t have long-term complications from hyperkalemia. Your healthcare provider may order more frequent blood tests to ensure your potassium levels stay within a healthy range.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

• Difficulty breathing.
• Extreme muscle weakness or fatigue.
• Severe abdominal pain, vomiting or diarrhea.
• Weak pulse, chest pain or signs of a heart attack.

What questions should I ask my doctor?

If you have hyperkalemia (high potassium), you may want to ask your healthcare provider:

• Why did I get hyperkalemia?
• How often should I get blood tests to check for hyperkalemia?
• How much potassium should I get in my daily diet?
• What foods or supplements should I avoid?
• What, if any, salt substitutes can I use?
• What are the treatment risks and side effects?
• Am I at risk for kidney failure or other problems due to hyperkalemia?
• What follow-up care do I need after treatment?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Because hyperkalemia rarely causes symptoms, you may be surprised when a blood test shows that your potassium levels are high. A low-potassium diet can protect your health. Your healthcare provider can determine how much potassium you need or connect you with a dietitian, if needed. A dietitian can help you create meal plans that ensure you get just the right amount of potassium in your diet. Your provider may also change your medications. Potassium levels that reach a dangerously high level can be life-threatening. If you’re at risk for hyperkalemia, your provider will closely monitor your potassium levels.

Hyperkalemia (High Blood Potassium): Symptoms, Causes & Treatment

Overview

What is hyperkalemia (high potassium)?

Hyperkalemia occurs when potassium levels in your blood get too high. Potassium is an essential nutrient found in foods. This nutrient helps your nerves and muscles function. But too much potassium in your blood can damage your heart and cause a heart attack. You can’t always tell when your potassium levels are high.

What is a safe or normal potassium level?

A typical potassium level for an adult falls between 3.5 and 5.0 millimoles per liter (mmol/L). Hyperkalemia occurs when levels go above 5.5 mmol/L. A reading above 6.5 mmol/L can cause heart problems that require immediate medical attention.

Who might have hyperkalemia (high potassium)?

Anyone can get hyperkalemia, even children. You may be more at risk if you have:

Symptoms and Causes

What causes hyperkalemia (high potassium)?

Your kidneys filter potassium from the foods and drinks you consume. Your body gets rid of excess potassium when you pee. With hyperkalemia, your body has too much potassium for your kidneys to remove. As a result, potassium builds up in your blood.

In addition to conditions like kidney disease, these factors also contribute to hyperkalemia:

• A high-potassium diet, which can result from potassium supplements and salt substitutes.
• Medications that contain potassium, such as certain high blood pressure medicines.

What are the symptoms of hyperkalemia (high potassium)?

Many people with mild hyperkalemia have no signs or ones that are easy to dismiss. Symptoms often come and go and may come on gradually over weeks or months. Dangerously high potassium levels affect the heart and cause a sudden onset of life-threatening problems. Hyperkalemia symptoms include:

Diagnosis and Tests

How is hyperkalemia (high potassium) diagnosed?

Because most people don’t have symptoms, you might not know you have high potassium until you get a routine blood test. A serum potassium test measures potassium levels in blood. Your healthcare provider may also order an electrocardiogram (EKG). This test shows changes in heart rhythm caused by hyperkalemia.

Management and Treatment

What are the complications of hyperkalemia (high potassium)?

Severe hyperkalemia can come on suddenly. It can cause life-threatening heart rhythm changes (arrhythmia) that cause a heart attack. Even mild hyperkalemia can damage your heart over time if you don’t get treatment.

How is hyperkalemia (high potassium) managed or treated?

Treatment varies depending on the potassium level. Options include:

• Diuretics: Also called water pills, these drugs make you pee more often. Your body gets rid of potassium mainly in urine.
• Intravenous (IV) therapy: Extremely high potassium levels need immediate treatment. You’ll receive an IV infusion of calcium to protect your heart. Next, you get an infusion of insulin that helps move potassium into the blood cells. You may also inhale an asthma medication called albuterol to further lower potassium levels.
• Medication management: Many people see improvement after stopping or changing certain blood pressure medications or other drugs that raise potassium levels. Your healthcare provider can determine what medication changes to make.
• Potassium binders: A daily medication binds to excess potassium in the intestines. You pass the potassium when you poop. Your provider may recommend binders if other treatments don’t lower potassium levels. Potassium binders come in oral and enema form.
• Dialysis: If potassium levels remain high, or you experience kidney failure, you may need dialysis. This treatment helps your kidneys remove excess potassium from blood.

Prevention

How can I prevent hyperkalemia (high potassium)?

If you’ve had hyperkalemia or are at risk for it, a low-potassium diet is the best way to protect your health. You may need to cut back on, or completely cut out, certain high-potassium foods, such as:

• Asparagus.
• Avocados.
• Bananas.
• Citrus fruits and juices, such as oranges and grapefruit.
• Cooked spinach.
• Melons like honeydew and cantaloupe.
• Nectarines.
• Potatoes.
• Prunes, raisins and other dried fruits.
• Pumpkin and winter squash.
• Salt substitutes that contain potassium.
• Tomatoes and tomato-based products like sauces and ketchup.

Outlook / Prognosis

What is the prognosis (outlook) for people who have hyperkalemia (high potassium)?

Changes to your diet and medication often resolve mild cases of hyperkalemia. With the right care, most people don’t have long-term complications from hyperkalemia. Your healthcare provider may order more frequent blood tests to ensure your potassium levels stay within a healthy range.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

• Difficulty breathing.
• Extreme muscle weakness or fatigue.
• Severe abdominal pain, vomiting or diarrhea.
• Weak pulse, chest pain or signs of a heart attack.

What questions should I ask my doctor?

If you have hyperkalemia (high potassium), you may want to ask your healthcare provider:

• Why did I get hyperkalemia?
• How often should I get blood tests to check for hyperkalemia?
• How much potassium should I get in my daily diet?
• What foods or supplements should I avoid?
• What, if any, salt substitutes can I use?
• What are the treatment risks and side effects?
• Am I at risk for kidney failure or other problems due to hyperkalemia?
• What follow-up care do I need after treatment?
• Should I look out for signs of complications?

A note from Cleveland Clinic

Because hyperkalemia rarely causes symptoms, you may be surprised when a blood test shows that your potassium levels are high. A low-potassium diet can protect your health. Your healthcare provider can determine how much potassium you need or connect you with a dietitian, if needed. A dietitian can help you create meal plans that ensure you get just the right amount of potassium in your diet. Your provider may also change your medications. Potassium levels that reach a dangerously high level can be life-threatening. If you’re at risk for hyperkalemia, your provider will closely monitor your potassium levels.

Normal Potassium Levels | Range, Values & Effects of High Potassium – Video & Lesson Transcript

Hyperkalemia vs. Hypokalemia

When potassium levels are too high, this condition is referred to as hyperkalemia. This can be deciphered by understanding that “hyper” refers to “a lot,” while “kalemia” refers to “kalium,” meaning potassium. (Potassium is expressed as a “K” on the periodic table because it is derived from the word “kalium.”) Potassium levels are closely linked to blood pH level. When pH is low (during acidosis), hyperkalemia may occur. Hyperkalemia is considered to occur when serum concentrations are above 5.0 mEg/L.

Hypokalemia is the opposite of hyperkalemia; it refers to low potassium levels. In this instance, the prefix “hypo” refers to “a little.” Both hyperkalemia and hypokalemia can range from mild to moderate and can be life-threatening under certain circumstances. Hypokalemia may occur when the body has a high pH during alkalosis. Hypokalemia occurs when potassium levels are below 3.5 mEq/L.

Effects of High Potassium: Hyperkalemia

The effects of high potassium are dangerous and potentially life threatening. One of the most concerning effects of high potassium levels involves the role it plays within the cardiac system. Because potassium is needed to regulate the rhythm of the heart, high potassium levels can interrupt normal heart rate patterns. Because of this, too much potassium can lead to heart palpitations, irregular heartbeat, and heart attacks. Problems with the cardiac system are critical and potentially life threatening. For this reason, severe hyperkalemia should be addressed by a healthcare professional immediately.

Risk Factors and Causes of Hyperkalemia

High levels of potassium may occur because of issues involving potassium excretion. Like many solutes within the blood, potassium levels are monitored by the kidneys. Excess potassium is removed from the blood and excreted through urine. When the kidneys aren’t functioning properly, potassium may not be properly removed from the body. Thus, individuals with kidney disease may be at higher risk for developing hyperkalemia. Similarly, the hormone aldosterone signals the kidney to excrete potassium. A patient with Addison’s disease cannot produce enough aldosterone, which in turn may cause hyperkalemia.

Recall that potassium is brought into the body via food and drink. With a proper, balanced diet, potassium levels are typically well managed. However, a diet that contains too much potassium-rich food may lead to hyperkalemia. Similarly, dehydration may cause hyperkalemia. When there is little water taken into the body, blood volume decreases. When blood volume decreases, the ratio of solutes to liters of blood changes — solutes may remain the same while the liters of blood decrease.

Other common reasons for developing hyperkalemia include:

• Diabetes
• Various medications and supplements
• Underlying disease

Symptoms of Hyperkalemia

The dangers of high potassium levels can be detected through common symptoms of hyperkalemia. An individual experiencing hyperkalemia may:

• Feel lethargic/fatigued
• Experience nausea and stomach pains
• Have muscular cramps throughout the body
• Experience cardiac abnormalities such as chest pain or an irregular heartbeat
• Exhibit difficulty breathing.

If these symptoms are observed, an individual should seek help from a qualified medical professional.

Medical Treatment for Hyperkalemia

Fortunately, hyperkalemia is treatable in most circumstances. If experiencing an emergency brought on by high potassium levels, emergency medical technicians may administer a combination of bicarbonate, calcium, and insulin, which helps to drive potassium levels down. Once potassium levels are below emergency values, healthcare professionals can administer in-house treatment to continue to lower potassium into a healthy range.

Long-term, non-emergency hyperkalemia can be treated in two ways:

• Via medication
• Through dietary changes

Medications like potassium binders attract potassium in the blood and prevent uptake by the bloodstream. However, healthcare professionals may prefer patients to make lifestyle changes that work to healthily lower potassium levels over longer periods of time. This includes avoiding foods which are rich in potassium and discontinuing supplements that contain potassium. Patients on low potassium diets should also make sure that they are not consuming bottled water or flavored beverages that contain additional electrolytes.

Lesson Summary

Electrolytes are minerals that work in the body to ensure the proper function of multiple systems. Potassium is an important electrolyte taken in through food and drink that is needed to maintain proper function of the heart, muscles, digestive system, nervous system, and to maintain adequate blood pressure.

A normal potassium range is between 3.7 and 5.2 mmol/L. When potassium levels are low, this condition is referred to as hypokalemia. High potassium levels are referred to as hyperkalemia. Serum potassium levels can be monitored via a blood test.

Hyperkalemia can be life-threatening and may cause issues with the cardiovascular system. High levels of potassium may lead to irregular heartbeat, palpitations, or cardiac arrest. Because potassium is filtered out of the body by the kidneys, individuals with kidney disease are at high risk for developing hyperkalemia. Individuals with diabetes, dehydration, or an underlying disease, or individuals taking certain medications are also at risk for developing hyperkalemia.

Hyperkalemia may be treated in an emergency by administering drugs that lower blood potassium levels. Medications like potassium binders prevent potassium from being absorbed into the bloodstream and can be used long term to lower potassium levels. Changing to a low potassium diet is another way to prevent hyperkalemia in those who are at risk.

The association between normal-range admission potassium levels in Israeli patients with acute coronary syndrome and early and late outcomes

Abnormal serum potassium levels are associated with an increased risk of ventricular arrhythmias and mortality in patients with acute myocardial infarction (AMI). The aim of the present study was to evaluate whether different levels of serum potassium, within the normal range, are associated with worse outcomes. The present study comprised 1277 patients with AMI and normal-range admission potassium levels (3.5-5.2 mEq/L), who were enrolled and prospectively followed up in the Acute Coronary Syndrome Israeli Survey between 2010 and 2013. Patients were divided into 4 quartiles based on admission potassium levels; “normal-low” (K ≥ 3.5 and K ≤ 3.9), “normal-moderate” (K > 3.9 and K ≤ 4.18), “normal-high” (K > 4.18 and K ≤ 4.45), and “normal-very high” (K > 4.45 and K ≤ 5.2). We analyzed the association between admission serum potassium levels and 7 days in-hospital complication rates, and 30-day and 1-year all-cause mortality rates. Patients with “normal-very high” potassium displayed increased frequency of baseline clinical risk factors and experienced a higher rate of acute kidney injury during hospitalization compared with the “normal-low” group (7.7% vs 2.4%; P = 0.002). However, the rate of in-hospital ventricular arrhythmias was similar across the range of admission potassium levels (overall P = 0.26), Multivariate analysis showed that compared with “low-normal” potassium values, patients with “normal-very high” potassium levels experienced increased risk for 30-days (adjusted hazard ratio 2.88, 95% confidence interval 1.05-7.87, P = 0.039) and 1-year all-cause mortality (adjusted hazard ratio 1.98, 95% confidence interval 1.05-3.75, P = 0.034). In patients admitted with AMI, admission serum potassium levels of 4.45 to 5.2 mEq/L are not associated with in-hospital ventricular arrhythmias, but are associated with increased short and long-term mortality.

Low-normal serum potassium is associated with an increased risk of cardiovascular and all-cause death in community-based elderly

https://doi.org/10.1016/j.jfma.2015.01.001Get rights and content

Background/Purpose

Several studies have already reported that serum potassium (SK) correlated inversely with adverse events among patients with preexisting cardiovascular disease and impaired renal function; less is known about the prognostic value of SK at the normal range in community-based elderly individuals. This study aimed to examine whether low normal SK value was associated with cardiovascular and all-cause mortalities in elderly people.

Methods

A prospective study was conducted using two independent elderly Taiwanese community cohorts that included 2065 individuals with relatively normal SK values (2.8–5.6 mmol/L). The participants were grouped as follows: low (2.8–3.4 mmol/L), low-normal SK (3.5–3.8 mmol/L), normal (3.9–4.4 mmol/L), and high-normal SK (4.5–5.6 mmol/L). Proportional hazards model was applied to compare the association between SK concentration groups and mortality.

Results

The relationship between baseline SK and all-cause and cardiovascular mortality was U-shaped, with the lowest mortality rates observed in patients with SK levels of 3.9–4.4 mmol/L. The low-normal SK group had significantly higher risks of all-cause (hazard ratio, 1.3; 95% confidence interval, 1.0–1.6) and cardiovascular mortality (hazard ratio, 1.6; 95% confidence interval, 1.1–2.3) than the normal SK group. The high-normal SK group had higher but nonsignificant risk compared to the normal group.

Conclusion

Our findings suggest that low-normal SK may be used as a marker of poor survival for elderly outpatient cares.

Keywords

cardiovascular mortality

elderly

serum potassium

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Copyright © 2015 Published by Elsevier (Singapore) Pte Ltd.

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High potassium (hyperkalemia) – Causes, Prevention & Treatment

What is high potassium, or hyperkalemia?

Everyone needs potassium to survive. Potassium is a mineral and an electrolyte. It helps your muscles work, including the muscles that control your heartbeat and breathing. Potassium comes from the food you eat.

Your body uses the potassium it needs. The extra potassium that your body does not need is removed from your blood by your kidneys. When you have kidney disease, your kidneys cannot remove extra potassium in the right way, and too much potassium can stay in your blood.

When you have too much potassium in your blood, it is called high potassium, or hyperkalemia. Having too much potassium in your blood can be dangerous. High potassium can even cause a heart attack or death! Unfortunately, many people do not feel symptoms of high potassium until it’s too late and their heart health worsens.

Frequently asked questions about hyperkalemia

What causes high potassium?

The most common cause of high potassium is kidney disease.

Other causes of high potassium include:

• Dehydration
• Some medicines
• Uncontrolled diabetes
• Injuries that cause severe bleeding
• Some rare diseases

If you have kidney disease, you are at risk for high potassium because your kidneys cannot remove the extra potassium in your blood. Instead of leaving your body through your urine, the extra potassium in your blood travels through your kidneys and back into your bloodstream. Over time, more and more potassium can build up in your blood.

What are the symptoms of high potassium?

Many people do not feel symptoms of high potassium. Having too much potassium in your blood can be dangerous. It can even cause a heart attack.

If you do feel symptoms, some of the most common are:

• Feeling tired or weak
• Feeling sick to the stomach (nausea)
• Muscle pains or cramps
• Trouble breathing, unusual heartbeat, chest pains

If you have trouble breathing or think there could be a problem with your heart, call 911 for emergency help.

What are the complications of high potassium?

Having too much potassium in your blood can be dangerous. Potassium affects the way your heart’s muscles work. When you have too much potassium, your heart may beat irregularly, which in the worst cases, can cause heart attack.

If you think you are having a heart attack, call 911 for emergency help.

Some of the most common signs of heart attack are:

• Feelings of pressure, pain, or squeezing in your chest or arms
• Stomach pain or nausea
• Shortness of breath
• Breaking into a cold sweat
• Sudden feelings of dizziness

What are the tests for high potassium?

The only way to know for sure if your potassium level is healthy is to have a blood test. The test measures how much potassium is in your blood.

The blood test is like many other blood tests that you may be familiar with. A small needle is placed into a vein on your arm and your blood is drawn out into a tube. The blood is sent to lab to be tested.

Potassium may be called something else in your test results. If you do not see ‘potassium’, look for either:

A potassium of higher than 5.2 millimoles per liter (mmol/L) is usually considered high but your doctor or lab might use slightly different numbers. Talk to your doctor about what your test results mean.

Because very high potassium (higher than 6.0 mmol/L) can be dangerous, your doctor or nurse may contact you first if your results are unusually high. In this case, they may ask you to go to an emergency room or hospital.

What are the treatments for high potassium?

There are two ways to treat high potassium, through diet and/or medicine.

Potassium binders

Medicines for high potassium are called potassium binders. A potassium binder works by sticking to the potassium in your body and preventing some of it from being taken into your bloodstream. This helps to keep potassium from building up in your blood. The medicine is a powder, which you can take by mixing it with water and drinking. Talk to your doctor about whether a potassium binder could be an option for you.

Follow these tips to keep your potassium at the right level:

• Avoid salt substitutes because they are usually high in potassium.
• Do not forget about drinks. Many fruit juices, like orange and tomato, have high potassium. Potassium can also be found in other drinks including coconut water.
• Pay attention to serving sizes. Use measuring cups and measuring spoons to make sure you know how many servings you are eating or drinking. Remember that if you eat two servings of a food with potassium, you are eating twice as much potassium!

To manage your potassium intake, you need to know how much potassium is in your food and drinks.

• Packaged foods must have nutrition labels, but potassium is not always listed on the label. If you do not see potassium listed on the nutrition label, check the list of ingredients on the package. If the word potassium or an abbreviation for potassium (K, KCl or K+) is listed, there is potassium in the food.
• Starting in July 2020, potassium values will be listed on food nutrition labels. You can read more about these changes here.
• Fresh fruits, vegetables, meats, and some dairy products do not have nutrition labels. Ask your dietitian for a list of high-potassium foods and lower potassium options.

Plan ahead if you know you will be eating a meal that is high in potassium. For example, if you are going out for dinner and you know your meal will be higher in potassium, or you know that it will be hard to measure how much potassium is in your meal, plan to eat meals that are low in potassium for breakfast and lunch.

When eating out, choose a restaurant that will make changes or substitutions in their dishes. Bring a list of low potassium foods with you that the restaurant can substitute out for other items. Use this sample potassium log to start tracking how much potassium you eat at each meal.

90,000 The doctor explained how to decipher their tests for antibodies to COVID-19

As the coronavirus situation worsens, more and more people are gripped by anxiety. Some are beginning to take various means – there is already official data that sales in pharmacies have grown significantly. Others check for signs of coronavirus. Many take tests, including for antibodies to COVID-19. And having received a form with the results of the study, they begin to worry even more.

With the results of such analyzes, the “Rossiyskaya Gazeta” correspondent turned to Leonid Dyakov, a certified specialist in physical rehabilitation, a member of the European Association for Outpatient Rehabilitation.

Antibodies: immune response

Rehabilitation physician Leonid Dyakov advises walking more in the fresh air and enjoying life. Photo: From the family archive of Leonid Dyakov.

Leonid Leonidovich, in the laboratory people receive research results, naturally, without any comments. They are sent to doctors. But it’s not easy to get through to them now, and not everyone risks sitting in lines. As a result, a person painfully peers into incomprehensible designations, thinks whether this is good or bad.Tell us what it means: “Antibodies detected”.

Leonid Dyakov : After the virus enters the body, the human immune system begins to produce antibodies specific to this virus – immunoglobulins (Ig).

An antibody test can show if a person has encountered coronavirus, even if they did not have symptoms of COVID-19. If antibodies are detected, it means that the body has reacted to the encountered virus. They can persist even if the virus itself is no longer in the body.This test only says that some kind of immune response has occurred.

Thus, the detection of antibodies in the blood is informative evidence of the current or past infectious process and helps to identify the stage of development of the infection.

In conclusion, we see two types of antibodies – IgM and IgG. What’s this?

Leonid Dyakov : Immoglobulin M are young, fresh antibodies that the immune system begins to produce in response to SARS-CoV-2 infection.

Detection of IgM indicates recent infection with SARS-CoV-2. They appear immediately after contact with the carrier of the virus, on the third or fourth day. After seven to ten days, they are already definitely present in the blood.

That is, the presence of immunoglobulin M is an indicator that you are sick right now. With or without clinical manifestations. These are fresh antibodies.

Then do they “age”?

Leonid Dyakov : The total period of probable detection of class M antibodies does not exceed two months.During this time, IgM antibodies are gradually completely replaced by IgG. The latter begin to form on average on the 21st day.

If there is still IgM, and class G immunoglobulins have already appeared, then this means a late infection. It’s just that IgM hasn’t faded yet.

Two antibodies – on the mend

It turns out that the presence of IgM does not necessarily indicate an active infection?

Leonid Dyakov : Yes. These antibodies can also be detected during the convalescent stage.

Moreover, the level of antibodies and the dynamics of the antibody response can vary individually. IgM is stronger – they attack the virus, prevent it from developing and “poisoning” the body. IgG is already weaker. They also fight the virus, but to a lesser extent.

When only IgG is detected in the blood, this indicates that the patient has recovered and has developed immunity to SARS-CoV-2. If the IgG level is high enough, then you can become an immunocompetent plasma donor. For example, IgG is greater than 40 and IgM is greater than 1.5, or IgG is greater than 80 and IgM is zero.

That is, if both groups of antibodies are detected in the blood, this means that the person is already recovering?

Leonid Dyakov : Quite right. I repeat once again: immunoglobulins M indicate that a person is currently suffering from coronavirus. These are not necessarily severe; the condition may be asymptomatic. And immunoglobulins G indicate whether he has had a coronavirus infection in the past.

Further, in the “Additional information” column, there is generally incomprehensible encryption.And the more incomprehensible, the worse it is. For example, here are the results in front of me, transmitted by one patient: “OPsiv 0.0338; CP 1.45”. What is behind this?

Leonid Dyakov : And then there is a column “Reference values”, and it says “not found”. This means that the quantitative characteristics of the identified antibodies are negligible – they do not even reach the reference values, which can be, for example, 17 units. And here – 0.03 …

What determines the amount of antibodies in the body?

Leonid Dyakov : From the amount of the virus that entered.It is one thing to be in a room or in a ward with a person actively ill with coronavirus, another is to ride a bus where someone sneezed. The dose of the resulting virus affects the severity of the disease.

Better not to get sick

Is the person whose analysis we decipher is contagious?

Leonid Dyakov : This test cannot determine whether a person is still contagious. Basically, with the metrics you provided, the patient is not contagious.

But in order to reliably know this, you still need to pass another smear.It is he who will show whether the virus is released into the external environment. If it is negative, then the person is not one hundred percent infectious. Without this confidence, I would recommend observing social distance measures and personal protection even if only IgG antibodies are detected.

Do you believe that everyone should get sick, and then the epidemic will be over?

Leonid Dyakov : There is, of course, logic in this. But the problem is that the virus causes serious complications.And not everyone gets sick in a mild or asymptomatic form.

People who find out that they have antibodies start to think when and where they got the infection. They remember when they were sick. Can this test show antibodies not only for COVID-19, but also for other acute respiratory infections or acute respiratory viral infections?

Leonid Dyakov : Deleted. This is a specific test specifically for antibodies to coronavirus infection.

The man recalled that he was very ill in February, he was very ill.Could there have been a coronavirus then?

Leonid Dyakov : Immunoglobulin G would not have survived since then.

That is, carriers of antibodies can, in principle, be glad that they have had coronavirus, practically not noticing it?

Leonid Dyakov : Those who have had a mild or asymptomatic illness develop low levels of immunoglobulin G and can get sick again.

The more severe the disease progresses, the more antibodies will be produced by the immune system, and the longer they will live in the blood after the disease.

Therefore, if the disease was mild, then perhaps the defense will also weaken rather quickly. IgG antibodies disappear after three to four months – as soon as the body defeats the infection, it stops synthesizing them.

However, there is information that the so-called memory cells are stored. The body remembers how to produce these antibodies, under what conditions and in what quantity. And in case of repeated contact with the virus, the body begins to synthesize IgG antibodies much faster, not in 21 days, but in three.And they are able to “soften” the course of the disease, to prevent the development of severe complications.

Breathe deeper

It turns out that in principle it is not absolutely necessary to take an antibody test. What difference does it make if a person was sick or not, if he didn’t notice this, and the presence of antibodies does not give any such advantages. You still need to protect yourself from infection …

Leonid Dyakov : My personal opinion, if a person feels well, there is no particular need for testing.After all, you can just as well look for the herpes virus and others.

In any laboratory there is a price list of hundreds of names of analyzes for the presence of viruses, which you can search for and, moreover, find. And half my life to be treated. Indeed, the maximum that he learns is whether he was sick with coronavirus or not, and if he was sick, then how long ago. And, of course, if the test turns out to be positive, this does not mean that he can now neglect his safety measures.

However, testing will help solve the problem on a more global scale, develop a strategy to combat the coronavirus, since the number of immune people can predict when the epidemic will decline.

What to do for those who have found IgM antibodies?

Leonid Dyakov : If there are no obvious signs of illness, you need to move more, walk in the fresh air, breathe deeply so that the lungs work and oxygen circulates in the blood.

Ventilate the premises, humidify the air. Now, of course, it is necessary to include vitamins in the diet, especially C and D, trace elements – selenium, zinc. And enjoy life.

All materials of the plot “COVID-19.We can handle it! “Read here .

Comprehensive diagnostics of the coronavirus COVID-19

The coronavirus infection COVID-19 is caused by a new strain of the SARS-CoV-2 virus, which was identified in December 2019. The transmission of infection occurs by airborne droplets and by contact. Comprehensive laboratory examination includes: 1) a study for the RNA of the virus by PCR; 2) determination of specific antibodies to coronavirus in the blood.

Composition of the complex:

• Antibodies to coronavirus SARS-CoV-2 (COVID-19), IgM, qualitatively
• Antibodies to coronavirus SARS-CoV-2 (COVID-19), IgG, quantitative
• Coronavirus SARS-CoV-2, RNA

Synonyms Russian

Covid, antibodies to coronavirus, coronavirus infection.

English synonyms

Comprehensive laboratory diagnosis of coronavirus COVID-19.

Which biomaterial can be used for research?

Venous blood, oropharyngeal and nasopharyngeal smear.

Research method

Reverse transcription polymerase chain reaction (RT-PCR), immunochemiluminescence analysis.

How to properly prepare for the study?

• At least 1 hour before taking oropharyngeal (pharyngeal) swabs, do not eat, drink, brush your teeth, rinse your mouth / throat, chew gum, do not smoke.
• Do not instill drops / sprays or rinse the nose 3-4 hours before taking nasal / nasopharyngeal swabs.
• Do not eat for 2-3 hours before the study, you can drink clean still water.
• Do not smoke within 30 minutes prior to examination.
• The survey is not performed anonymously, a passport is required.

General information about the study

Coronavirus infection COVID-19 – is an infectious disease caused by a new strain of the SARS-CoV-2 virus, which was identified in December 2019.The transmission of infection occurs by airborne droplets and by contact.

After entering the body, the virus multiplies in the epithelium of the upper and lower respiratory tract with diffuse damage to alveocytes and the development of pneumonia. At the same time, it increases the permeability of cell membranes, which ultimately leads to the development of interstitial and alveolar edema and the collapse of the alveoli. The normal process of gas exchange is disrupted, and acute respiratory distress syndrome can develop.

Variants of the course of the disease:

• asymptomatic course;
• mild form of the disease affecting only the upper respiratory tract;
• moderately severe with the development of pneumonia without respiratory failure;
• severe, in which respiratory failure develops against the background of pneumonia;
• is an extremely severe form with the addition of multiple organ failure.

According to published data, 80-85% of patients suffer the disease in a mild form, 14-16% develop a severe form of the disease requiring hospitalization, and 5% have an extremely severe course of infection.

The risk group for a severe course of the disease includes people over 60 years of age, patients with diabetes mellitus, respiratory diseases, cardiovascular diseases and cancer.

The average incubation period is 5-6 days, but it can take up to 14 days, and according to some sources, up to 24 days.
Comprehensive laboratory examination includes:

• study for virus RNA by PCR;
• determination of specific antibodies to coronavirus in the blood.

With the help of PCR, the genetic material of the virus in the human body is detected several days after infection, which makes it possible to identify cases, including those with an asymptomatic course of the disease.

Antibodies, or immunoglobulins, are produced by the immune system in response to the introduction of the virus into the body.IgM are produced on the 5-7th day from the onset of the disease. Their detection in the blood indicates the presence of a disease at the moment. As you recover, the level of these antibodies will decrease. The production of IgG antibodies begins later, reaching a maximum 10-14 days after the infection. Detection of IgG to the pathogen COVID-19 indicates that a person is in the recovery stage or has already had a coronavirus infection.

If a person simultaneously detects IgG and IgM antibodies, then, most likely, he has an asymptomatic course of the disease, and the infection occurred about 10-14 days ago.During this period, there is a high risk of transmission of infection to others, therefore isolation is required.

If IgG and IgM antibodies are not detected, this may mean that the person has not yet been infected, or the infection has occurred recently and the immune system has not yet had time to develop antibodies of class M. In this case, a positive PCR test will allow the infected person to be verified at an early stage of the disease.

What is the research used for?

• To identify people with asymptomatic coronavirus infection.
• To determine the stage of the disease.
• To identify patients with coronavirus infection COVID-19.

When is the study scheduled?

• For the diagnosis of a recent coronavirus infection, including the asymptomatic course of the disease.

What do the results mean?

Coronavirus COVID-19 (SARS-CoV-2, RNA [real-time PCR])

Reference values: negative.

Reasons for a positive result:

Reasons for negative result:

• absence of coronavirus infection.

Antibodies to coronavirus SARS-CoV-2 (COVID-19), IgG, quantitative

Reference values ​​

Interpretation

Antibodies to coronavirus SARS-CoV-2 (COVID-19), IgM

Reference values ​​

The result is negative.

KP: 0.00 – 0.80.

Positive

• Acute phase of coronavirus infection COVID-19.

Negative

• With negative PCR for SARS-CoV-2 – no infection;
• with a positive PCR for SARS-CoV-2 – the late phase of the infection, the acute phase has passed, more than 5-7 days have passed since the development of the infection.

Questionable result

• It is recommended to repeat the analysis after 2-5 days.

Technologies

Reference values ​​are the medical term used in the conduct and evaluation of laboratory tests; is defined as the average value of a certain laboratory indicator, which was obtained as a result of mass examinations of a healthy population. The term reference meanings is also used synonymously.

The results of any research must be considered in conjunction with all the characteristics and indicators of the patient, that is, in combination with .For example, let’s take one of the simplest medical indicators – heart rate. You can measure your heart rate right now by placing your fingers on your pulse and counting the beats for a minute. Most people know that the “average” heart rate is around 70 beats per minute. But how do you know what a “normal” heart rate is? Scientists have concluded that the heart rate is normal based on numerous measurements over time.

You probably also know that if you exercise regularly or are generally in good physical condition, your heart rate can be significantly lower – 55 beats per minute, and this will still be “normal”.

Or, say, you are going for a walk, and on your way there is a mountain or a hill. In this situation, the heart rate will already be 120 beats per minute. This will be a fairly high figure, but still “normal”, taking into account this load.

Thus, you are convinced that even the heart rate, like any medical indicator, should be considered in an integrated manner and taking into account the context. Without considering the influencing factors, any research and its results are meaningless. To understand whether certain test results are normal for you, your doctor must know and take into account what is normal for most other patients of your gender and age, and what was your condition before and during the examination.

Reference ranges

The results of some studies are given to the patient in the form of “yes” or “no” concepts.This type of research is called qualitative. For example, positive tests for antibodies to a certain infection, indicating that these antibodies are present in the patient’s blood.

There is also a quantitative type of research. In this case, the laboratory will issue the results in the form of a digital value, to which the same reference intervals of will be indicated. For example, the results of a thyroid-stimulating hormone (TSH) test may look like this: 2.0 μIU / ml, reference values: 0.5 – 5.0 μIU / ml.In this example, we see that the result falls within the reference values.

How is this reference range determined? In general, you can give the same answer: by observing and measuring the indicators of a large number of healthy people.

The first step in determining the range of reference values ​​is to sample the population: for example, healthy women between 20 and 30 years of age are selected. Then most of this category undergo special clinical trials.The results of these studies are adjusted to the mean, and thus the reference range is calculated (plus or minus 2 standard units of deviation from the mean).

Why may the reference ranges differ from laboratory to laboratory?

The fact is that the reference intervals depend on the used analysis method and measuring instruments, that is, laboratory equipment.

Different laboratories use different types of equipment and different research methods.Therefore, each laboratory establishes its own reference ranges depending on the equipment used and the method of analysis. Accordingly, when issuing a result, each laboratory must indicate on the results form the reference interval approved by that laboratory.

This is why there is no such thing as a single reference range. When assessing the results of laboratory tests, your doctor should refer to the reference range provided by the laboratory in which you were examined.

How to evaluate test results outside the reference range?

There are several reasons why test results may fall outside the established reference range, even if you are completely healthy:

• Out of range values ​​are associated with the physiological characteristics of the human body. If your doctor advises you to take the same test several times, there is a certain chance that the result will fall outside the reference range.For biological reasons, your indicators may change from day to day. That is why the doctor may ask you to take the test again in order to compare the results. In most cases, diagnostic conclusions are made not on the basis of single measurements, but on the dynamics of changes in results over time.

• Your body’s personality can also affect your results. Reference values ​​are usually calculated from experimental clinical studies of a large number of people in certain categories, then the data are reduced to the mean, taking into account the mean standard deviations.This is just statistical data, not a biological law. Therefore, it happens that in healthy people, certain indicators, which are the “norm” for them, are not, in the end, the “norm” for the majority of the population and do not fall into the range of generally accepted reference values.

As a rule, such cases imply only small deviations from the reference values.

However, indicators that go beyond the reference values ​​can signal problems in the body and indicate the need for further examination.Your doctor will evaluate the test results, taking into account your medical history, physical condition and other relevant factors, to determine if something means a serious deviation in your test result from the generally accepted reference values. He may order a retest or order additional tests. it is important to compare the results of current and previous studies when it comes to a situation where you passed the same test in order to find out what is “normal” for you.

If you know of any special circumstances that could affect the test results, please inform your doctor. One should not think that the doctor could guess about them on his own.

Other factors influencing research results

Laboratories usually share your test results with reference values ​​for your age and gender, and your doctor will then interpret the results for you based on your personal knowledge of your health and the medication used.It should be borne in mind that the results of the study can be influenced by many additional factors: the use of coffee, tobacco, alcohol, vitamins, natural and artificial colors, etc .; your diet (for example, vegetarian or meat), stress or pregnancy. Even your postures, when the biomaterial is taken from you, can affect some of the results, as well as the physical activity that preceded the test.

For example, albumin and calcium levels may increase when the prone position is shifted to an upright position.

Intensive exercise can affect the activity of the enzymes creatine phosphokinase (CPK), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH). Therefore, visiting the gym on the eve of the test can lead to an increase in CPK. In addition, the level of testosterone, luteinizing hormone (LH) and platelets can be increased in people who are actively involved in sports for several months or years, for example, jogging. or weightlifting.

All these factors underline the importance of adhering to the rules of preparation for analyzes. It is also important to follow your doctor’s instructions when preparing for research. Compliance with these simple rules will give you even more confidence in the correctness and accuracy of the results obtained.

Common misconceptions

There are two main misconceptions about research results and reference values:

Misconception: “An abnormal test result is a sign (signal) of a disease.”

Reality: A test result that is outside the reference range only indicates to your doctor that he needs to schedule further examination or re-examination. An abnormal result does not necessarily indicate a problem in your body, but your doctor should understand the cause of the result.

It is possible that your result falls within that very 5%, when even in healthy people the indicators go outside the reference range.In addition, there are many factors that may have influenced the test result, which may not necessarily signal a problem in the body. For example: high blood sugar, which may be due to diet rather than diabetes. Lipid levels can also be high due to the fact that you did not take the test on an empty stomach. High levels of liver enzymes may be the result of alcohol consumption just before testing, and not a sign of liver cirrhosis. In addition, new drugs are constantly appearing on the market.This is happening faster than laboratories can assess how much they could influence research results. And it is not uncommon when a particular drug, entering into certain reactions during the study, affects the final indicators of the test results.

Sometimes some abnormal results of one or another study can come back to normal by themselves, especially if before that these indicators were on the border of the reference values.

Therefore, in most cases, the key point in making a decision will be to assess the degree of deviation of the results of your analysis from the reference values.As noted earlier, there are few diseases that can be detected with just one single study.

If, nevertheless, these research results really signal a problem in the body, your doctor will definitely point you to this. However, there are very few diseases that can be detected with just one single study.

Misconception: “If all my test results are normal, I have nothing to worry about.”

Reality: This is, of course, a good sign, but a set of studies alone is not a guarantee that there will be no problems in the body. This can sometimes accompany an unnoticed problem.

The fact is that in the statistical processing of the reference intervals, there is always a partial coincidence between the results of healthy people and people with diseases (those same 5% of the boundaries of the reference interval). This means that the results of some healthy people may fall outside the reference range, as well as laboratory values ​​in some people with diseases may be within the normal range.

If the result of your analysis, which did not fall into the reference interval, normalized over time, this is good news for you. However, your doctor may retest after a few days, weeks, or months to make sure you are still healthy, or to record any important changes.

And in conclusion, we would like to remind you that laboratory diagnostics does not pretend to be your doctor, but only helps him to make the right medical decisions. Your doctor should always interpret the test results, taking into account your medical history.It is the doctor who will take into account all the factors that could affect the results of your tests, and will make the correct conclusion about the state of your body.

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decryption of the IgG and IgM test

https://ria.ru/20210730/antitela-1743500762.html

Antibodies to COVID-19: what is it, decoding the test, is vaccination needed

Antibodies to coronavirus: decoding the IgG test and IgM

Antibodies to COVID-19: what is it, decoding the test, is it necessary to vaccinate

Antibodies to coronavirus are proteins produced by the body that neutralize the infection.About how their level is determined using analysis, what is … RIA Novosti, 30.07.2021

2021-07-30T10: 31

2021-07-30T10: 31

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MOSCOW, July 30 – RIA Novosti. Coronavirus antibodies are proteins made by the body that neutralize infection. About how their level is determined using the analysis, what is the value of different types of antibodies, what indicators indicate the presence of an immune response, how to decipher the test results – in the material of RIA Novosti. What are antibodies to coronavirus Antibodies (immunoglobulins) to coronavirus are special proteins, which are produced in the body by the immune system to neutralize the causative agent of the infection.They arise to neutralize not only SARS-CoV-2, but also other viruses, as well as bacteria, fungi, multicellular parasites. Immunoglobulins allow you to recognize the coronavirus, neutralize it in time and “remember” information about it in case of a new meeting. Antibodies refer to humoral immunity, but there is also T-cell immunity. It is represented by lymphocytes, which destroy infected cells. How antibodies are formed According to the candidate of medical sciences, clinical pharmacologist Andrei Kondrakhin, antibodies are formed in the body in response to the penetration of antigens – any foreign substances that are considered potentially dangerous.As a result, each immunoglobulin recognizes an antigen, binds to it on the surface of pathogens, including viruses, and neutralizes it. Antigens that trigger an immune response are also called immunogens. What determines the amount of antibodies Many experts note that the level of antibodies in the human body depends on how much virus has got into it and to what extent the patient has suffered an infection. However, according to one of the latest scientific studies conducted by British and Italian scientists, those infected with the coronavirus retained high levels of antibodies for nine months, regardless of whether they suffered from a severe, mild or asymptomatic form.To obtain such results, experts tested for infection with the SARS-CoV-2 virus and antibodies to it 86 percent of the inhabitants of the Italian town of Vaud, whose population is about three thousand people. It is noted that the data may differ depending on the type of test. Two types of IgM and IgG antibodies When the body has just got an infection, in the first seven days of the disease, immunoglobulins M (IgM) begin to be synthesized. They are the first to reflect coronavirus infection and are considered markers of the acute phase of the disease, but they can also be detected at the stage of recovery.They usually disappear 1-3 months after infection. 5-6 weeks after the pathogen of the coronavirus has entered the body, IgG immunoglobulins are synthesized. They form slowly, but they are able to store information about COVID-19 and remain in the body for more than six months. It is their number that shows that a person has had a coronavirus and has developed a strong immune response to the pathogen. In addition, there are other types of antibodies: Which antibody test is better? There are several types of antibody tests.Unlike PCR analysis, which shows whether a person is infected or not, antibody tests allow you to find out the stage of development of the coronavirus, the amount of immunoglobulins, or whether a person has already suffered a disease. For example: In addition, tests are qualitative and quantitative. The former show whether there are antibodies in the body or not, while the latter allow you to find out their concentration in the blood. During illness, it is better to take an IgM antibody test in order to understand what stage of the disease the patient is in. When the study is shown Why do they take antibody tests? Antibody tests are taken both during and after the illness, and also, if a person wants to find out, he has been ill whether he has a mild coronavirus.Such an analysis helps to determine the degree of development of the disease, to find out what immune response the body provides some time after recovery from the coronavirus, to analyze the incidence in the population when the disease could not be detected. to better understand how the disease progresses. Also, a person can independently pass an analysis in a public or private clinic. Deciphering the results With a qualitative analysis, it is indicated as a result of the test whether antibodies are detected or not.In quantitative terms, how many of them were formed. As a rule, the interpretation of the units of measurement is in the help. Method of investigation For the test for antibodies, the ELISA method is used – enzyme immunoassay and immunochemiluminescence analysis. It is based on a specific antigen-antibody reaction. Units of Measurement Different antibody test systems use different units of measurement. For example, the World Health Organization (WHO) has approved the BAU / ml unit of measurement, so if the analysis results in a & lt; 10.0 BAU / ml, then it is negative, there are no antibodies.If the indicator is ≥ 150.0 BAU / ml, then the person has developed a sufficient protective barrier. Units AU / ml, U / ml, OU / ml can also be used. Usually, the analysis indicates how to interpret them. If the units of measurement are OU / ml, then 0.0 – 12.0 OU / ml indicates the absence or low level of antibodies, 12.0 – 15.0 OU / ml – the result is doubtful, need to donate blood again, ≥ 15.0 EU / ml – immunity has developed What can influence the result There are factors that can distort the test results for antibody levels, which may lead to a retake of the test.How to take and how to prepare Special preparation for taking the test is not required. To detect antibodies, blood is donated from a vein, usually in the morning on an empty stomach or in the afternoon 3 hours after the last meal. A few days before the procedure, it is better to give up fatty foods, do not consume alcohol a day before the procedure, while you can drink clean water without gas, excluding coffee and tea. If a person is taking prescription drugs, then the doctor can be told about this, because some of them can affect the test results.Before taking blood, it is advisable to have a good sleep and not to be nervous. Do you need to get vaccinated against COVID-19 if there are antibodies? The World Health Organization recommends getting vaccinated against coronavirus for everyone, even those people who have antibodies. Russian Minister of Health Mikhail Murashko said about this: The vaccination should be done six months after recovery. What test can be used to check antibodies after vaccination against coronavirus? An analysis to determine the amount of antibodies should be taken no earlier than 42 days after the first vaccination, but it is better to do this after 2-3 months.The test should be for antibodies of the IgG type to the S-protein. At the same time, the analysis for the presence of immunoglobulins to the N-protein of the coronavirus is not suitable for testing the immune response. Do you need to retest? Kondrakhin. – In order to understand if he has a coronavirus, he should take an immunoglobulin test. It happens that the first study does not show anything, but the person gets worse and worse.This is because there is not enough virus in the body to form antibodies. After some time, a second test may be required to see if the acute stage immunoglobulins are growing or not, then a test can be done to determine the level of IgG antibodies showing the degree of the immune response. ”About coronavirus infection continues to this day, is a viral disease that affects the respiratory system.It is transmitted by contact or airborne droplets, like other respiratory diseases. Among the main symptoms of the disease: high fever, shortness of breath, nasal congestion, dry cough, body aches, etc. To date, there are over 15 registered or approved coronavirus vaccines. Among them are domestic “Sputnik V”, “EpiVacCorona”, “KoviVak”, “Sputnik Light”, as well as Pfizer / BioNTech, Moderna, AstraZeneca, etc. Over the entire time of the COVID-19 pandemic, 194 million people have been infected, of which 4.16 million have died.In Russia, 6.09 million cases of the disease were registered, while 153 thousand people died. To protect yourself from infection, you should be vaccinated and observe personal protective measures.

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MOSCOW, July 30 – RIA Novosti. Antibodies to coronavirus are proteins produced by the body that neutralize infection. About how their level is determined using analysis, what is the value of different types of antibodies, what indicators indicate the presence of an immune response, how to decipher the test results – in the material of RIA Novosti.

What are antibodies to coronavirus

Antibodies (immunoglobulins) to coronavirus are special proteins that are produced in the body by the immune system to neutralize the pathogen.They arise to neutralize not only SARS-CoV-2, but also other viruses, as well as bacteria, fungi, multicellular parasites. Immunoglobulins allow you to recognize the coronavirus, neutralize it in time and “remember” information about it in case of a new meeting. It is represented by lymphocytes, which destroy infected cells.

How antibodies are formed

According to the candidate of medical sciences, clinical pharmacologist Andrei Kondrakhin, antibodies are formed in the body in response to the penetration of antigens – any foreign substances that are considered potentially dangerous. As a result, each immunoglobulin recognizes an antigen, binds to it on the surface of pathogens, including viruses, and neutralizes it. Antigens that trigger an immune response are also called immunogens.

19 July, 14:27 Science Scientists have found out what determines the level of antibodies in those who have had COVID-19

What determines the number of antibodies

Many experts note that the level of antibodies in the human body depends on how much of the virus got into it and what the severity of the patient suffered an infection. However, according to one of the latest scientific studies conducted by British and Italian scientists, those infected with the coronavirus retained high levels of antibodies for nine months, regardless of whether they suffered from a severe, mild or asymptomatic form.To obtain such results, experts tested for infection with the SARS-CoV-2 virus and antibodies to it 86 percent of the inhabitants of the Italian town of Vaud, whose population is about three thousand people. However, it is noted that the data may vary depending on the type of test.

23 July, 18:51

Consequences of coronavirus: what are the complications and how are they dangerous

Two types of IgM and IgG antibodies

When an infection has just entered the body, immunoglobulins M (IgM) begin to be synthesized in the first seven days of the disease.They are the first to reflect coronavirus infection and are considered markers of the acute phase of the disease, but they can also be detected at the stage of recovery. They usually disappear 1-3 months after infection. 5-6 weeks after the pathogen of the coronavirus has entered the body, IgG immunoglobulins are synthesized. They form slowly, but they are able to store information about COVID-19 and remain in the body for more than six months. It is their number that shows that a person has been ill with a coronavirus and has developed a persistent immune response to the pathogen.

In addition, there are other types of antibodies:

• –

  IgA – prevent the penetration of the virus into the body through the mucous membranes;

• –

  IgE – destroy parasites;

• –

  IgD – while poorly understood by scientists, their purpose is not exactly known.

Which antibody test is better

There are several types of antibody tests. Unlike PCR analysis, which shows whether a person is infected or not, antibody tests allow you to find out the stage of development of the coronavirus, the amount of immunoglobulins, or whether a person has already suffered a disease.For example:

1. 1

   An IgM antibody test shows the body’s response to infection and the amount of antibodies that formed 7-14 days after infection with coronavirus. If there are many of them, this indicates an acute stage of the disease.

2. 2

   An IgG antibody test shows the level of the immune response. Such immunoglobulins are synthesized when a person is ill, and they are produced even if the person had an asymptomatic form.

In addition, tests are qualitative and quantitative.The former show whether there are antibodies in the body or not, while the latter allow you to find out their concentration in the blood. During illness, it is better to take an IgM antibody test in order to understand at what stage of the disease the patient is.

July 29, 04:00 How accurate are PCR tests for coronavirus?

When the study is shown

Why do they take antibody tests

Antibody tests are taken both during and after illness, and also if a person wants to find out if he has had a mild coronavirus.Such an analysis helps to determine the degree of development of the disease, to find out what immune response the body provides some time after recovery from the coronavirus, to analyze the incidence in the population when the disease could not be identified.

Who orders the study?

During an illness, a test for the level of antibodies can be prescribed by the attending physician in order to better understand how the illness progresses. Also, a person can independently take an analysis in a public or private clinic.

Interpretation of results

In a qualitative analysis, the test results indicate whether antibodies are detected or not. In quantitative terms, how many of them were formed. As a rule, the interpretation of the units of measurement is in the help.

July 27, 13:52 Science Scientists have assessed the role of cellular immunity in the fight against COVID-19

Research method

For an antibody test, an ELISA method is used – enzyme immunoassay and immunochemiluminescence analysis. It is based on a specific antigen-antibody reaction.

“As a result of the interaction of the antibody and the antigen, an immune-fluorescent reaction occurs, in which the antibodies seem to glow, which makes it possible to determine their quantity,” Andrei Kondrakhin told RIA Novosti. “ELISA is the clearest, best, most sensitive test for determining the level of immunoglobulins.”

Units

Different antibody test systems use different units of measure. For example, the World Health Organization (WHO) has approved the BAU / ml unit of measurement, therefore, if, as a result of the analysis, the indicator is <10.0 BAU / ml, then it is negative, there are no antibodies.If the indicator is ≥ 150.0 BAU / ml, then the person has developed a sufficient protective barrier. Units AU / ml, U / ml, OU / ml can also be used. Usually the analysis will tell you how to interpret them.

If the units of measurement are OU / ml, then 0.0 – 12.0 OU / ml indicates the absence or low level of antibodies, 12.0 – 15.0 OU / ml – the result is doubtful, you need to donate blood again, ≥ 15 , 0 OU / ml – immunity is formed.

13 July, 16:51

There are factors that can skew the antibody test results, which may require you to retake the test.

“The result of the analysis can be affected by improper collection of blood, if the blood clotted or inaccurately diagnosed, – explained the expert. – For example, if a person has a coronavirus, and he tests for influenza. Other factors: strong blood clotting, hemolysis – the destruction of red blood cells with the release of hemoglobin protein into the plasma. These are temporary restrictions, they do not say that research cannot be carried out, it is just that the patient’s condition needs to be corrected. If a person ate and immediately went for analysis, then the result will be small errors.Moreover, food intake for a qualitative test for antibodies will not matter, but for a quantitative test it will. The sensitivity of the method also plays an important role. If it has a high sensitivity, then it is better not to eat food before analysis ”.

How to take and how to prepare

No special preparation is required for taking the test. To detect antibodies, blood is donated from a vein, usually in the morning on an empty stomach or in the afternoon 3 hours after the last meal. A few days before the procedure, it is better to give up fatty foods, do not consume alcohol a day before the procedure, while you can drink clean water without gas, excluding coffee and tea.If a person is taking prescription drugs, then the doctor can be told about this, because some of them can affect the test results. Before taking blood, it is advisable to have a good sleep and not to be nervous.

28 July, 11:14Russian Minister of Health Mikhail Murashko said the same:

“According to international and Russian studies, a stable humoral and cellular immune response in people who have had coronavirus persists on average six months after the infection. After six months, the protection gradually weakens. Therefore, during an epidemic for to improve the effectiveness of the fight, including with new strains of coronavirus, it is recommended to be vaccinated after six months. This recommendation applies to both those who were previously vaccinated and those who have been ill, “the minister said.

Vaccination should be done six months after recovery.

29 July, 02:15 Spread of coronavirusThe doctor explained who needs revaccination against COVID-19

What test can be used to check antibodies after vaccination against coronavirus?

An analysis to determine the amount of antibodies should be taken no earlier than 42 days after the first vaccination, but it is better to do this after 2-3 months. The test should be for antibodies of the IgG type to the S-protein. At the same time, the analysis for the presence of immunoglobulins to the N-protein of the coronavirus is not suitable for testing the immune response.

Do you need repeated studies?

In some cases, the test for antibodies is taken several times.

“For example, a person got sick, and his temperature just started to rise,” explained Andrey Kondrakhin. – In order to understand if he has a coronavirus, he should take an immunoglobulin test. It happens that the first study does not show anything, but the person gets worse and worse. This is because there is not enough virus in the body to form antibodies.After some time, a re-analysis may be required to see if the acute stage immunoglobulins are growing or not, then a test can be done to determine the level of IgG antibodies, showing the degree of the immune response. ”

About coronavirus infection

The new coronavirus infection, the outbreak of which occurred in 2020 and continues to this day, is a viral disease that affects the respiratory system. It is transmitted by contact or airborne droplets, like other respiratory diseases.Among the main symptoms of the disease: high fever, shortness of breath, nasal congestion, dry cough, body aches, etc. To date, there are over 15 registered or approved coronavirus vaccines. Among them are domestic “Sputnik V”, “EpiVacCorona”, “KoviVak”, “Sputnik Light”, as well as Pfizer / BioNTech, Moderna, AstraZeneca, etc. Over the entire time of the COVID-19 pandemic, 194 million people have been infected, of which 4.16 million have died. In Russia, 6.09 million cases of the disease were registered, while 153 thousand died.Human. To protect yourself from infection, you should be vaccinated and observe personal protective measures.

July 27, 16:59

What to do after vaccination against COVID-19: basic prohibitions, revaccination

What are tumor markers and what their indicators testify to

Oncomarkers are special specific proteins / antigens formed in the blood. Normally, they are secreted by cells in small quantities and perform various functions in the body. However, in the presence of a malignant process, the concentration of these substances increases sharply – the tumor marker can be released both by the tumor cells themselves and by healthy tissues surrounding the neoplasm.

The value of the study of the level of tumor markers is the ability to detect a pathological process long before the appearance of the first manifestations of the disease. In addition, such an analysis often puts the final point in difficult diagnostic situations.

Blood tests for tumor markers are highly informative if the recommendations before delivery are followed:

• alcohol and smoking are not recommended before the analysis;
• the analysis is carried out in the morning on an empty stomach, food intake should be carried out 8-12 hours before blood sampling;
• you can drink liquid in unlimited quantities;
• you should refuse to take medications and various medical manipulations, and also notify your doctor about them;
• increased physical activity is also not recommended;
• when analyzing women, the menstrual cycle of a woman is also taken into account: the analysis is carried out on certain days.

Different markers characterize different tumors. In some cases, several markers characterize the same form of cancer, then, to increase the reliability of the results, several tumor markers are analyzed simultaneously. Also, the same tumor marker may indicate several forms of cancer.

• PSA or prostate-specific antigen. Produces a malignant tumor of the prostate. Normal content is up to 4 ng per ml.The amount of 4-10 ng per mg indicates a threat of developing prostate cancer, and exceeding 10 ng per ml is considered pathological.

  A significant increase in serum PSA levels is sometimes found in prostatic hypertrophy, as well as in inflammatory diseases. Also, it should be borne in mind that digital rectal examination, cystoscopy, colonoscopy, transurethral biopsy, laser therapy, urinary retention can cause a more or less pronounced and prolonged increase in PSA levels.The effect of these procedures on the PSA level is most pronounced on the next day after their implementation, and the most significant – in patients with prostatic hypertrophy. In such cases, the PSA study is recommended to be carried out no earlier than 7 days after the listed procedures. PSA levels are elevated in benign and malignant prostate diseases. At the same time, with prostate carcinoma, the proportion of the bound fraction increases more, therefore the ratio between free and total PSA decreases.

• CEA or cancer-embryonic antigen. The norm of a tumor marker is up to 5 ng / ml, 5-8 mg per ml is considered a borderline state, and the pathology is the content of this tumor marker in an amount higher than 8 ng / ml. In this case, the development of lung cancer, cancer of the rectum or colon, stomach, ovaries, breast, thyroid or pancreas cancer is possible.

  Determination of CEA content in human blood serum is of diagnostic value and can be used to monitor therapy, detect relapses and undiagnosed metastases of cancer of various localizations and organ specificity.

• Oncomarker CA-125 is produced by ovarian cancer. Norm – up to 30 IU / ml. A level of 30-40 IU / ml means a high risk of developing cancer, with the content of this tumor marker in an amount of more than 40 IU / ml, the doctor already assumes the presence of an ovarian cancer.

  Determination of the content of CA-125 in human blood serum can be used for the diagnosis of ovarian cancer and dynamic control of its level in order to assess the effectiveness of therapy, early detection of metastases, and predict the course of the disease.Non-oncological pathology: an increase in the level of CA-125 in the blood is observed when serous membranes are involved in the process – peritonitis, pericarditis, pleurisy of various etiologies. A higher increase in the level of CA-125 in the blood is sometimes observed in various benign gynecological tumors (ovarian cysts), as well as in inflammatory processes involving the appendages, and benign endometrial hyperplasia.

• CA-19-9 – is produced during the development of pancreatic cancer. Norm – up to 30 IU / ml, dangerous values ​​- 30-40 IU / ml, above 40 IU / ml – a cancerous neoplasm develops.

  The level of CA 19-9 is increased in malignant neoplasms: pancreatic cancer; cancer of the gallbladder and biliary tract; bladder cancer; primary liver cancer; stomach cancer; rectal cancer; sigmoid colon cancer; mammary cancer; ovarian cancer; uterine cancer. Non-oncological pathology, which is accompanied by an increase in the level of CA 19-9: cirrhosis of the liver; cholecystitis; cystic fibrosis; hepatitis; cholelithiasis.

• CA-15-3 is a tumor marker for breast cancer. Norm – no more than 38 IU / ml.

  An increase in the level of CA 15-3 is observed in malignant neoplasms: breast cancer; bronchogenic cancer; stomach cancer; liver cancer; pancreas cancer; ovarian cancer; cervical cancer; uterine cancer; endometrial cancer. Non-oncological pathology: benign diseases of the mammary glands; cirrhosis of the liver; pregnancy in the third trimester; autoimmune diseases.

Important to remember! Deviation of results from the norm is not always an indicator of oncology. The level of many indicator compounds can increase in inflammatory processes, organ trauma, hormonal disruptions. In this case, the medical specialist takes into account not only the direct increase in the level of tumor markers, but also the degree of this increase, clinical symptoms, the relationship with the results of other research methods and analyzes. On the basis of all this diagnostic picture, the cause of the pathological changes is determined.

Pass a blood test for D-dimer

D-dimer is a fibrin breakdown product, formed in the process of thrombus lysis.When a blood vessel is damaged, a blood coagulation cascade is triggered in the body, a fibrin clot is formed, which stops bleeding. After the thrombus has performed its function, it must collapse in order to restore the patency of the vessel.

Lysis of a thrombus occurs under the influence of plasmin, fragments of destruction (degradation) of fibrin can be determined in the blood. D-dimer is one of the end products of fibrin breakdown. The level of D-dimer in the blood can increase when thrombus formation occurs in the body and the subsequent destruction of thrombotic masses, or the processes of restructuring of the vascular bed take place, when some vessels are empty and thrombosed, while others are re-formed.

Normal D-dimer values ​​indicate that the presence of a thrombus is unlikely.

In what cases is the D-dimer test usually prescribed?

The D-dimer test is used when thrombotic conditions are suspected (for example, deep vein thrombosis or pulmonary embolism), as well as in the diagnosis of such a serious condition as disseminated vascular coagulation syndrome.

What exactly is determined in the analysis process?

The amount of D-dimer in blood plasma is determined by the method of immunochemiluminescence analysis.

What do the test results mean?

Normal (within the reference values) result of the D-dimer indicates that the person who passed this test most likely does not have an acute condition associated with increased formation and disintegration of fibrin thrombi. This indicator has a negative prognostic value: with a normal D-dimer, the probability of thrombosis is low, with an increased one, additional examination of the patient is required.

An elevated D-dimer does not always indicate the presence of thrombus formation, because a number of other factors can lead to an increase in the level of D-dimer in the blood:

• recent surgery (early postoperative period)
• injury
• liver disease
• pregnancy

D-dimer has high sensitivity but insufficient specificity and should only be used to exclude thrombosis and not to confirm the diagnosis.Both elevated and normal D-dimer levels may require follow-up and may lead to further investigation in patients with possible signs of thrombosis. People with increased D-dimer values ​​and with a moderate to high risk of deep vein thrombosis (as assessed by the attending physician) require further study using other instrumental research methods.

Typical due date for test

Usually the result of D-dimer can be obtained within 1-2 days.

Do I need special preparation for the analysis?

Blood should be taken in the morning on an empty stomach. Inform the laboratory about all medications you are taking.

Description of Database Normalization – Office

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Original KB number: 283878

This article explains database normalization terminology for beginners. A basic understanding of this terminology is helpful when discussing relational database design.

Standardization description

Normalization is the process of organizing data in a database. This includes creating tables and establishing relationships between these tables in accordance with rules designed to both protect data and make the database more flexible by eliminating redundancy and inconsistent dependencies.

Redundant data wastes disk space and creates maintenance problems. If data that exists in multiple locations needs to be changed, the data needs to be changed in the same way in all locations. Changing the customer address is much easier to implement if this data is stored only in the Customers table and nowhere in the database.

What is inconsistent dependency? While it is intuitive for a user to search the Customers table for the address of a specific customer, it makes no sense to search there for the salary of the employee who is calling this customer.An employee’s salary is associated with or dependent on an employee and therefore should be overpopulated in the Employees table. Incompatible dependencies can make it difficult to access the data because the path to find the data can be skipped or broken.

There are several rules for normalizing a database. Each rule is called “normal form”. If the first rule is met, the database is reported to be in “first normal form”. If the first three rules are met, the database is treated as “third normal form”.While other levels of normalization are possible, third normal form is considered the highest level required for most applications.

As with many formal rules and specifications, real-world scenarios are not always ideal for meeting requirements. Normally, additional tables are required for normalization, and some clients find this cumbersome. If you choose to violate one of the first three rules of normalization, make sure your application anticipates potential problems such as redundant data and incompatible dependencies.

Examples are described below.

First normal form

• Exclude repeating groups in individual tables.
• Create a separate table for each set of related data.
• Define each set of related data using a primary key.

Do not use multiple fields in one table to store similar data. For example, to track an inventory item that might come from two possible sources, an inventory record might contain fields for Vendor ID 1 and Vendor ID 2.

What happens when a third provider is added? Adding a field is not an answer; it requires program and table changes, and does not allow for smoothly accommodating dynamic supplier counts. Instead, put all of the vendor information in a separate table called Vendors, and then link inventory to vendors with an item number key, or vendors for inventory with a vendor code key.

Second normal form

• Create separate tables for sets of values ​​that apply to multiple records.
• Correlate these tables with a foreign key.

Records must not depend on anything other than the primary key of the table (complex key if needed). For example, consider a customer’s address in an accounting system. The address is required in the Customers table, as well as in the Orders, Delivery, Invoices, Invoice Reports, and Collections tables. Instead of storing the customer address as a separate entry in each of these tables, store it in one place, in the Customers table or in a separate Address table.

Third normal form

• Eliminate key-independent fields.

Values ​​in a record that is not part of the key for that record are not relevant to the table. In general, at any time the contents of a field group may apply to more than one record in a table, consider placing these fields in a separate table.

For example, the recruitment table might include the name and address of the candidate’s university. But group mailing requires a complete list of universities.If university details are stored in the Candidates table, there is no way to list universities without current candidates. Create a separate university table and link it to the Applicants table with the university code key.

EXCEPTION: The use of the third common form, while desirable in theory, is not always practical. If you have a Customers table and want to eliminate all possible dependencies between fields, you need to create separate tables for cities, zip codes, sales representatives, customer classes, and any other factor that may be duplicated in multiple records.In theory, normalization is worth cleaning up. However, many small tables can degrade performance or exceed the capacity of the open file and memory.

It may be more appropriate to apply third normal form only to data that changes frequently. If some dependent fields remain, design the application to require the user to validate all related fields when changing them.

Other forms of normalization

A fourth normal form, also called Boyce Codd Normal Form (BCNF), and a fifth normal form exist but are rarely considered in practical design.Ignoring these rules may result in a less perfect database design, but should not affect functionality.

Normalization of the example table

These steps demonstrate the process of normalizing a dummy student table.

1. Non-normalized table:

   Student #	Advisor	Adv-Room	Class 1	Class2	Class3
   1022	Jones	412	101-07	143-01	159-02
   4123	Smith	216	101-07	143-01	179-04

2. First normal form: no repeating groups

   Tables should have only two dimensions.Since one student has multiple grades, these grades must be listed on a separate table. The fields Class1, Class2 and Class3 in the above entries indicate design issues.

   Tables often use the third dimension, but tables shouldn’t. Another way to look at this problem is the relationship between one and more, without putting one side and many sides in the same table. Instead, create another table in the first regular form by eliminating the duplicate group (Class #) as shown below:

   Student #	Advisor	Adv-Room	Grade #
   1022	Jones	412	101-07
   1022	Jones	412	143-01
   1022	Jones	412	159-02
   4123	Smith	216	101-07
   4123	Smith	216	143-01
   4123	Smith	216	179-04

3. Second Normal Form: Eliminate Redundant Data

   Note several Class # values ​​for each Student # value in the above table.Class # is functionally independent of student # (primary key), so this relationship is not in second normal form.

   The following tables show the second normal form:

   Students:

   Student #	Advisor	Adv-Room
   1022	Jones	412
   4123	Smith	216

   Registration:

   Student #	Grade #
   1022	101-07
   1022	143-01
   1022	159-02
   4123	101-07
   4123	143-01
   4123	179-04

4. Third Normal Form: Eliminate Key Independent Data

   In the last example, the Adv-Room (advisor office number) functionally depends on the Advisor attribute.