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Blood Test : SMAC-25This test is a useful combination of electrolyte, kidney profile, and liver profile data. Additional tests found in the SMAC-25 (tests can differ from lab to lab) screen for levels of calcium, magnesium, phosphate, cholesterol, triglycerides, and others. The SMAC-25 is useful as a general screening tool and is performed on a yearly basis by many internists. This test is usually cheaper to run as a "SMAC" then as a sum total of the separate lab tests. The SMAC is occasionally used as a preoperative screening test. This test is run on a venipuncture specimen. See values below. SMAC 25 NORMAL VALUES GLUCOSE 70-110 mg/dl BUN (urea nitrogen) 8-23 mg/dl NA (sodium) 136-142 meq/l K (potassium) 3.8-5.0 meq/l CL (chloride) 95-103 meq/l CO2 (carbon dioxide) 22-38 millimoles/l CR (creatinine) .6-1.5 mg/dl URC (uric acid) 2-8 mg/dl CA (calcium) 8.5-10.5 mg/dl PHOS (phosphorus) 2.5-4.5 mg/dl TP (total protein) 6.0-8.0 g/dl ALB (albumin) 3.5-5.0 g/dl TBILI (total bilirubin) 0.1-1.2 mg/dl ALP (alkaline phosphatase) 20-90 IU/dl GT (gama glutamyl transpeptidase) 0-45 IU/dl SGPT (ALT) 0-30 IU/dl LDH (lactate dehydrogenase) 60-200 IU/dl SGOT (AST) 10-40 IU/dl CK (creatine phosphokinase) 30-150 IU/dl CHOL (cholesterol) see test file chart TRIG (triglycerides) 10-150 mg/dl AMYL (amylase) 60-160 SU/dl LAC (lactic acid) 3-24 meq/dl MG (magnesium) 3-2.4 mg/dl * NOTE: The above normal values can vary slightly from lab to lab. THE VALUES AND WHAT THEY MEANGlucose: Elevations of the blood glucose level must be interpreted in relation to the last meal. A fasting blood glucose measurement will be interpreted differently from that of a level that was drawn soon after eating. Abnormal elevations in the blood glucose can as the result of diabetes or medication side effects (e.g. thiazide diuretics, steroids). BUN (blood urea nitrogen): This is a normal metabolic byproduct that occurs as the result of the breakdown of blood, muscle, and protein. Abnormal elevations are seen in dehydration, starvation, fever, kidney diease, high protein diets, drug side effects, kidney stone with obstruction, acute urinary retention, and gastrointestinal bleeding. Abnormally low values can be seen in liver disease, malnutrition, and excessive fluid intake. NA (sodium): Elevations can be seen in some cases of dehydration, drug side effects, excessive dietary salt, and some glandular disorders (Cushing's disease). Low Na levels can also be seen in some cases of dehydration (vomiting), CHF, glandular disorders (Addison's disease), drug side effects, kidney disease, and severe lung disease. K (potassium): Abnormal elevations in potassium can be seen in kidney disease, diabetic ketoacidosis, Addison's disease, liver disease, drug side effects, severe burns, crush injuries, electrical injuries, or excessive use of potassium supplements (or salt substitutes). Abnormally low potassium levels can be seen in Cushing's disease, diarrhea, diuretic use, excessive vomiting, and inadequate dietary intake. C02 (carbon dioxide): Abnormal elevations in C02 can be seen in cases of severe COPD, Cushing's disease, excessive antacid use, and drug side effects (steroid and diuretic use). Low levels can be seen with diabetic ketoacidosis, kidney failure, severe diarrhea, aspirin overdose, sepsis (bacteria in the bloodstream) and shock. CR (creatinine): Abnormal elevation in the CR can be secondary to kidney disease, dehydration, and diabetic ketoacidosis. Abnormally low levels can be seen with malnutrition. URC (uric acid): An abnormal elevation in the uric acid level in the bloodstream can be seen in some (but not all) patients with gout. Not all patients with elevated uric acid levels will suffer from gout. Elevations can also be seen in leukemia, multiple myeloma, chemotherapy or radiation therapy for cancer, metabolic defects, toxemia of pregnancy, or fever. Some medications (thiazide diuretics, furosemide, ethacrynic acid, probenecid, corticosteroids, aspirin) can also cause increased blood uric acid levels. Low uric acid levels can be found in some forms of kidney disease and as a drug side effect (allopurinol). CA (calcium): Elevations can be seen with hyperparathyroidism, multiple myeloma, cancers with spread to bone, excessive vitamin D intake, excessive use of antacids which contain calcium (e.g. Rolaids), drug side effects, and prolonged bedrest. Abnormally low calcium levels can be seen with low levels of serum albumin (see below), hypoparathyroidism, low vitamin D intake, pregnancy, osteomalacia, and certain kidney diseases. Phosphorus: Abnormal elevations in phosphorus can be seen in kidney disease, hypoparathyroidism, healing fractures, and excessive vitamin D intake. Abnormally low levels can be seen in hyperparathyroidism, vitamin D deficiency, and alcoholism. Total protein: Abnormal elevations can be seen in multiple myeloma, dehydration, and vomiting or diarrhea. Low levels can be seen with malnutrition, CHF, and toxemia of pregnancy. Albumin: Decreased levels can be seen in liver disease and some forms of kidney disease. Total bilirubin: Elevations can be seen with gallbladder disease, obstructive jaundice (blockage of the common bile duct), pancreatic cancer, hemolytic anemia, hepatitis, mononucleosis, and drug side effects. Creatine phosphokinase: Elevations can be seen after sustaining a crush injury to muscle tissue, after strenuous exercise, myocardial infarction (see cardiac enzymes), rhabdomyolysis (from an electrical injury or alcohol abuse), polymyositis (inflammatory muscle disease), and polymyalgia rheumatica. Magnesium: Elevations can be seen in cases of kidney failure, and dehydration. Low levels can be seen with alcoholism, malnutrition, drug side effects, pancreatitis, hyperthyroidism, and hyperparathyroidism. Lactate dehydrogenase: This enzyme is present in brain, liver, muscle, heart, bone, and lung. Disease processes in any of these organs can lead to elevation in the blood LDH. Spread of cancer to the bones or liver can result in the elevation of the LDH.
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