From the Guidelines
This 79-year-old male's lab results indicate a need for further investigation into the cause of his elevated alkaline phosphatase level, which may suggest liver or bone issues, and monitoring of his prediabetic state with lifestyle modifications. The patient's glucose level of 111 mg/dL suggests prediabetes, which should be monitored with regular follow-up testing and lifestyle modifications, including diet changes and increased physical activity, as indicated by 1. The elevated alkaline phosphatase at 184 suggests possible liver or bone issues, which warrants further investigation with additional testing, such as a liver ultrasound or bone density scan, as recommended by 1 and 1. The low A/G ratio of 1.00 may indicate chronic inflammation or liver dysfunction, though this is a mild abnormality. Kidney function appears normal with a GFR >60 and normal creatinine of 0.96. Some key points to consider in the management of this patient include:
- Monitoring and management of prediabetes to prevent progression to diabetes
- Further investigation into the cause of elevated alkaline phosphatase, which may include liver ultrasound, bone density scan, or other tests as indicated by 1 and 1
- Maintenance of adequate hydration and a low-glycemic diet
- Continuation of any prescribed medications and follow-up with the physician in 3 months for repeat testing of glucose and alkaline phosphatase. It is essential to prioritize the patient's morbidity, mortality, and quality of life when making management decisions, and to consider the potential risks and benefits of different diagnostic and therapeutic approaches, as informed by the highest quality and most recent evidence, such as 1.
From the Research
Laboratory Test Results
The patient's laboratory test results show the following abnormalities:
- Glucose: 111 (high)
- Alkaline phosphatase: 184 (high)
- A/G ratio: 1.00 (low)
Interpretation of Results
According to 2, laboratory test results are a valuable source of information, and nurses need to assess these results as part of the physical assessment of their patients. The patient's high glucose level may indicate impaired glucose regulation, which can be a concern in older adults 3. The high alkaline phosphatase level may indicate liver or bone disease, and further evaluation is needed to determine the cause 4, 5.
Liver Enzymes
The patient's liver enzyme levels are:
- AST/SGOT: 12
- ALT/SGPT: 14
- Alkaline phosphatase: 184 (high) According to 4 and 5, abnormal liver enzyme levels can be categorized into hepatocellular or cholestatic patterns. The patient's liver enzyme levels suggest a cholestatic pattern, which may indicate biliary pathology or other conditions with hyperbilirubinemia.
Electrolytes and Renal Function
The patient's electrolyte levels are:
- Sodium: 141
- Potassium: 3.8
- Chloride: 105
- CO2: 27 The patient's renal function is:
- BUN: 16
- Creatinine: 0.96
- BUN/creat: 17
- GFR: >60 According to 2 and 6, these results are generally within normal limits, but the patient's high BUN level may indicate dehydration or other conditions that affect renal function.
Further Evaluation
Further evaluation is needed to determine the cause of the patient's abnormal laboratory test results, particularly the high glucose and alkaline phosphatase levels. According to 4 and 5, this may involve additional laboratory tests, imaging studies, and medical history to guide the evaluation and treatment plan.