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What is Endotracheal Intubation: Procedure, Steps, Complications


Endotracheal Intubation is an emergency procedure of introducing ET or Endotracheal Tube Insertion. It is one of the widely performed medical procedures in a casualty to establish respiration in those who are unable to breathe.

Our guide below will help you with its indications, procedure, complications, and a video of course.

What is Endotracheal Tube Insertion?

Endotracheal Tube Insertion or Endotracheal Intubation (EI) is an emergency procedure most often performed in patients who are unconscious or who cannot breathe on their own. EI helps to prevent suffocation or obstruction of the passage of air.

In a typical EI, a patient is first given a heavy anesthetic. Then, a flexible plastic tube is placed into the trachea (windpipe) through the mouth or sometimes the nose to help the patient with breathing.

The trachea, also known as the windpipe, is a cylindrical tube that is about four inches long and one inch in diameter. It begins just under the voice box, descends behind the breastbone, and then divides into two smaller tubes. Each tube connects to one of your lungs.

The windpipe is made from discs of tough cartilage, muscle, and connective tissue. Its lining is composed of smooth tissue. Each time you breathe in, the windpipe gets slightly longer and wider—then returns to its normal size as you breathe out.


Basically, Endotracheal Tube Insertion is used for:

  • Provide airway for mechanical ventilatory support. Administration of surfactants or other medications directly into the lungs.
  • Relieve critical upper airway obstruction.
  • Provide a route for selective bronchial ventilation.
  • Assist in pulmonary hygiene when secretions cannot be otherwise cleared.
  • Obtain direct tracheal cultures.

Specifically, endotracheal tube insertion is used for the following conditions:

  • Respiratory arrest
  • Respiratory failure
  • Airway obstruction
  • Need for prolonged ventilatory support
  • Class III or IV hemorrhage with poor perfusion
  • Severe flail chest or pulmonary contusion
  • Multiple trauma, head injury, and abnormal mental status
  • Inhalation injury with erythema/edema of the vocal cords
  • Protection from aspiration


Endotracheal Intubation is an invasive procedure and can cause considerable discomfort. For this reason, general anesthesia and muscle-relaxing medication are usually administered so that you do not feel anything.

However, if necessary, the procedure can be performed while the patient is awake, with local anesthesia or with no anesthesia at all.

Procedure Steps

To begin the procedure steps, an anesthesiologist opens the patient’s mouth by separating the lips and pulling on the upper jaw with the index finger.

Holding a laryngoscope in the left hand, he or she inserts it into the mouth of the patient with the blade directed to the right tonsil. Once the right tonsil is reached, the laryngoscope is swept to the midline, keeping the tongue on the left to bring the epiglottis into view.

The laryngoscope blade is then advanced until it reaches the angle between the base of the tongue and the epiglottis. Next, the laryngoscope is lifted upwards towards the chest and away from the nose to bring the vocal cords into view.

Often during endotracheal intubation, an assistant has to press on the trachea to provide a direct view of the larynx. The anesthesiologist then takes the endotracheal tube, made of flexible plastic, in the right hand and starts inserting it through the mouth opening.

The tube is inserted through the cords to the point that the cuff rests just below the cords. Finally, the cuff is inflated to provide a minimal leak when the bag is squeezed.

Using a stethoscope, the anesthesiologist listens for breathing sounds to ensure the correct placement of the tube.


Waking Up While Under Anesthesia

According to the Mayo Clinic, about one or two people in every 1,000 wake up briefly while under the effects of general anesthesia. If this happens, usually you will be aware of your surroundings but will feel no pain.

On rare occasions of endotracheal intubation, people feel severe pain. This can lead to long-term psychological problems. Factors that may increase the risk of this happening include:

  • Emergency surgery
  • Heart or lung problems
  • Long-term use of opiates, tranquilizers, or cocaine
  • Daily alcohol use


There are some risks related to endotracheal intubation. To prevent these from occurring, you will be evaluated by the anesthesiologist (or ambulance personnel in an emergency situation) before the procedure and will be monitored throughout for potential complications such as:

  • Buildup of excess water in your tissues
  • Bleeding
  • Collapsed lung

Sleep Paralysis: Demon vs Medical | Sleep Apnoea

Have you ever wake up to find you cannot move or speak but you can feel everything and hear everything near you? Have you ever felt that a ghost or something is trying to stop you from getting up? The phenomenon you just suffered is called Sleep Paralysis or Sleep Apnoea. This guide will explain the medical causes as well as uncover what are the mythological creatures supposed for Sleep Apnoea in different countries and culture.

Then certainly you are reading the right blog. We will be explaining what just happened with you. Read throughout what just caught you!

Two way approach

The two-way approach says either you will take it as medical condition or stick to the old theory-“A ghost struck me!” So, we are gonna explain everything according to the two-way approach for sleep apnoea or the sleep paralysis.

Where the medical approach defines parameters for sleep apnoea, the spiritual theory says you will call demons to this world if you recite the prayers backwards!

Sleep Paralysis: A Medical Approach

Sleep paralysis or Sleep Apnoea is a feeling of being conscious but unable to move. It occurs when a person passes between stages of wakefulness and sleep. During these transitions, you may be unable to move or speak for a few seconds up to a few minutes.

Some people may also feel pressure or a sense of choking. Sleep paralysis may accompany other sleep disorders such as narcolepsy. Narcolepsy is an overpowering need to sleep caused by a problem with the brain’s ability to regulate sleep.

When it occurs?

Sleep paralysis can occur either when you are asleep or when you are awake.

When asleep: If it occurs while you are falling asleep, it’s called hypnagogic or predormital sleep apnoea.

Mechanism: As you fall asleep, your body slowly relaxes. Usually you become less aware, so you do not notice the change. However, if you remain or become aware while falling asleep, you may notice that you cannot move or speak.

When awake: If it happens as you are waking up, it’s called hypnopompic or postdormital sleep paralysis.

Mechanism: During sleep, your body alternates between REM (rapid eye movement) and NREM (non-rapid eye movement) sleep. One cycle of REM and NREM sleep lasts about 90 minutes. NREM sleep occurs first and takes up to 75% of your overall sleep time. During NREM sleep, your body relaxes and restores itself. At the end of NREM, your sleep shifts to REM. Your eyes move quickly and dreams occur, but the rest of your body remains very relaxed. Your muscles are “turned off” during REM sleep. If you become aware before the REM cycle has finished, you may notice that you cannot move or speak.


Many theories have been put up for the causes like hormones or neurological, but the more casual approach just defines the simple causes:

  1. Teenage
  2. Lack of sleep
  3. Changing sleep schedule
  4. Sleeping on the back
  5. Other sleep problems like narcolepsy or nighttime leg cramps
  6. Use of meds like for ADHD
  7. Substance abuse


If you find yourself unable to move or speak for a few seconds or minutes when falling asleep or waking up, then it is likely you have isolated recurrent sleep paralysis. Often, there is no need to treat this condition.

More symptoms include:

  1. Anxiety
  2. Tiredness
  3. Insomnia or sleepless at nights


Most people need no treatment for sleep apnoea. Treating any underlying conditions such as narcolepsy may help if you are anxious or unable to sleep well. These treatments may include the following:

  • Improving sleep habits — such as making sure you get six to eight hours of sleep each night
  • Using antidepressant medication if it is prescribed to help regulate sleep cycles
  • Treating any mental health problems that may contribute to sleep paralysis
  • Treating any other sleep disorders, such as narcolepsy or leg cramps

The Demon- Paranormal Theories

Some people deny the fact of medical thing, because the feeling of demon is so strong, that they can actually feel like a ghost is sitting on the chest! They may also report like someone or something was preventing them from moving while they were trying to move from the bed.

In such a case, we have got a collection of cultural beliefs of different countries which define sleep paralysis with supernatural powers in their own languages. These are Cultural beliefs of sleep apnoea.

Scandinavian folklore

Mare, a supernatural creature which is related to incubi and succubi, is a cursed woman and her body is carried mysteriously during sleep and without her noticing. In this state, she visits villagers to sit on their rib cages while they are asleep, causing them to experience nightmares. Watch the movie Marianne for epic fun.


Pinyin: guǐ yā shēn is translated as “ghost pressing on body” or “ghost pressing on bed.”


Kanashibari, meaning Bound in metal (Kana: Metal, Shibari: To bind)


The term sleep paralysis is called gawi nulim, literally meaning “being pressed down by something scary in a dream.” It is often associated with a belief that a ghost or spirit is lying on top of or pressing down on the sufferer.


Nightmares in general as well as sleep apnoea is referred to by the verb-phrase khar darakh meaning “to be pressed by the Black” or “when the Dark presses.”


Sleep paralysis is often known as dip-non or dip-phok which translates roughly as “oppressed/struck by dip”; dip, literally meaning shadow, refers to a kind of spiritual pollution.


Sleep paralysis is called phǐǐ am and khmout sukkhot. It is described as an event in which the person is sleeping and dreams that one or more ghostly figures are nearby or even holding him or her down. The sufferer is unable to move or make any noises. This is not to be confused with pee khao and khmout jool, ghost possession.


Sleep paralysis is called phǐǐ am and khmout sukkhot. It is described as an event in which the person is sleeping and dreams that one or more ghostly figures are nearby or even holding him or her down. The sufferer is unable to move or make any noises.


Sleep paralysis is called ma đè, meaning “held down by a ghost,” or bóng đè, meaning “held down by a shadow.”


Bangungut has traditionally been attributed to nightmares.

New Guinea

People refer to this phenomenon as Suk Ninmyo, believed to originate from sacred trees that use human essence to sustain its life. The trees are said to feed on human essence during night as to not disturb the human’s daily life, but sometimes people wake unnaturally during the feeding, resulting in the paralysis.

Malay Peninsula

Sleep paralysis is known as kena tindih (or ketindihan in Indonesia), which means “being pressed.” Incidents are commonly considered the work of a malign agency; occurring in what are explained as blind spots in the field of vision, they are reported as demonic figures.

India Kashmir

In Kashmiri mythology, sleep apnoea is caused by an invisible creature called a pasikdhar or a saayaa. Some people believe that a pasikdhar lives in every house and attacks somebody if the house has not been cleaned or if god is not being worshiped in the house. One also experiences this if one has been doing something evil or derives pleasure from the misfortunes of others.

India Tamil Nadu

The sleep paralysis phenomenon is referred to as Amuku Be or Amuku Pei meaning “the ghost that forces one down.”


Sleep paralysis is considered an encounter with Shaitan (Satan), evil jinns or demons who have taken over one’s body. Like Iran, this ghoul is known as bakhtak or ‘ifrit’. It is also assumed that it is caused by the black magic performed by enemies and jealous persons. People, especially children and young girls, wear Ta’wiz (Amulet) to ward off evil eye. Spells, incantations and curses could also result in ghouls haunting a person. Some homes and places are also believed to be haunted by evil ghosts, satanic or other supernatural beings and they could haunt people living there especially during the night. Muslim holy persons (Imams, Maulvis, Sufis, Mullahs, Faqirs) perform exorcism on individuals who are believed to be possessed. The homes, houses, buildings and grounds are blessed and consecrated by Mullahs or Imams by reciting Qur’an and Adhan, the Islamic call to prayer, recited by the muezzin.


The phenomenon of sleep apnoea is referred to as boba (“speechless”).

Sri Lanka

This particular phenomenon is referred to as Amuku Be or Amuku Pei meaning “the ghost that forces one down.”


Especially Newari culture,it is also known as Khyaak, after a ghost-like figure believed to reside in the darkness under the staircases of a house.


Sleep paralysis is often referred to as Ja-thoom, literally “What sits heavily on something”. In folklore across Arab countries, the Ja-thoom is believed to be a shayṭān or a ‘ifrīt sitting on top of the person or is also choking him. It is said that it can be prevented by sleeping on your right side and reading the Throne Verse of the Quran.


Sleep apnoea is often referred to as karabasan (“the dark presser/assailer”). It is believed to be a creature that attacks people in their sleep, pressing on their chest and stealing their breath. However, folk legends do not provide a reason why the devil or ifrit does that.


It is known as bakhtak, which is a ghost-like creature that sits on the dreamer’s chest, making breathing hard for him/her.


Ogun Oru is a traditional explanation for nocturnal disturbances among the Yoruba of Southwest Nigeria; ogun oru (“nocturnal warfare”) involves an acute night-time disturbance that is culturally attributed to demonic infiltration of the body and psyche during dreaming.

Ogun oru is characterized by its occurrence, a female preponderance, the perception of an underlying feud between the sufferer’s earthly spouse and a “spiritual” spouse, and the event of bewitchment through eating while dreaming. The condition is believed to be treatable through Christian prayers or elaborate traditional rituals designed to exorcise the imbibed demonic elements.


The word Madzikirira is used to refer something strongly pressing one down. This mostly refers to the spiritual world in which some spirit—especially an evil one—tries to use its victim for some evil purpose. The people believe that witches can only be people of close relations to be effective, and hence a witches often try to use one’s spirit to bewitch one’s relatives.


The word dukak (“depression”) is used, which is believed to be an evil spirit that possesses people during their sleep. Some people believe this experience is a symptom of withdrawal from the stimulant khat. The evil spirit dukak is an anthropomorphic personification of the depression that often results from the act of quitting chewing khat. ‘Dukak’ often appears in hallucinations of the quitters and metes out punishments to its victims for offending him by quitting. The punishments are often in the form of implausible physical punishments (e.g., the dukak puts the victim in a bottle and shakes the bottle vigorously) or outrageous tasks the victim must perform (e.g., swallow a bag of gravel).


Sleep paralysis is called unihalvaus (dream paralysis), but the Finnish word for nightmare, painajainen, is believed to originally have meant sleep apnoea, as it’s formed from the word painaja, which translates to pusher or presser, and the diminutive suffix -nen.


Sleep paralysis is called lidércnyomás (lidérc pressing) and can be attributed to a number of supernatural entities like lidérc (wraith), boszorkány (witch), tündér (fairy) or ördögszerető (demon lover).[17] The word boszorkány itself stems from the Turkish root bas-, meaning “to press.”


Sleep apnoea is generally called having a Mara. A goblin or a succubus (since it is generally female) believed to cause nightmares (the origin of the word ‘Nightmare’ itself is derived from an English cognate of her name). Other European cultures share variants of the same folklore, calling her under different names; Proto-Germanic: marōn; Old English: mære; German: Mahr; Dutch: nachtmerrie; Icelandic, Old Norse, Faroese, and Swedish: mara; Danish: mare; Norwegian: mare; Old Irish: morrigain; Croatian, Bosnian, Serbian, Slovene: môra; Bulgarian, Polish: mara; French: cauchemar; Romanian: moroi; Czech: můra; Slovak: mora. The origin of the belief itself is much older, back to the reconstructed Proto Indo-European root mora-, an incubus, from the root mer- “to rub away” or “to harm.”


Sleep apnoea attributes a sleep paralysis incident to an attack by the Haddiela, who is the wife of the Hares, an entity in Maltese folk culture that haunts the individual in ways similar to a poltergeist. As believed in folk culture, to get rid of the Haddiela, one must place a piece of silverware or a knife under the pillow prior to sleep.


It is believed that sleep paralysis occurs when a ghost-like creature or Demon named Mora, Vrahnas or Varypnas (Greek: Μόρα, Βραχνάς, Βαρυπνάς) tries to steal the victim’s speech or sits on the victim’s chest causing asphyxiation.


Salem witch trials

During the Salem witch trials several people reported night-time attacks by various alleged witches, including Bridget Bishop, that may have been caused by sleep paralysis.


It is believed that this is caused by the spirit of a dead person. This ghost lies down upon the body of the sleeper, rendering him unable to move. People refer to this as “subirse el muerto” (dead person on you).


Sleep apnoea is known as the ‘Old Hag’. In island folklore, the Hag can be summoned to attack a third party, like a curse.


There is a legend about a mythological being called the pisadeira (“she who steps”). She is described as a tall, skinny old woman, with long dirty nails in dried toes, white tangled hair, a long nose, staring red eyes, and greenish teeth on her evil laugh. She lives over the roofs, waiting to step on the chest of those who sleep with a full stomach.

Alien abduction

Some people also report that alien took them away and did experiments on them and returned them back.

This was all about Sleep Apnoea- The way you think is the one which will decide what it does to you. The best solution to get rid of it is SLEEP!

Goosebumps Medical Term Meaning


Ever had the hair on the skin suddenly stand up? Of course, you had. But all you know about it is either “Oh I’m getting chills” or “OMG that’s hilarious”. Walk through our blog that explains the minutes of Goosebumps or the Piloerection. Featuring Trivia also that will really answer some weird questions of yours.


Goosebumps (medical term “Cutis anserine“) is a physiological process of the human body in response to cold (hypothermia) or strong emotions which causes involuntary erection of hairs.

The other term used for the same is “Piloerection” or “Horripilation“. Goosebumps are also referred to as Goose flesh or Goose pimples.

Origin of word

Origin of word “Goose bumps”
Goose + Bumps, is simple, isn’t it?

It’s not like someone plucked feathers from the goose, and the goose skin got protrusions exactly where the feathers were, but hey, it exactly is!

The word “Goosebumps” originates from the goose protrusions on goose skin after a feather had been plucked from it. Human skin is just like that goose who faced the feather plucking, and hence the term for humans too.


The reflex of producing goose bumps is known as horripilation, piloerection, or the pilomotor reflex. This causes contraction of the base muscles which are present at the hair follicle. These muscles are controlled by Autonomic Nervous System (ANS).

If you are not familiar with ANS, it is responsible for spontaneous functions in our body without our consciousness.

The reasons why we get goosebumps to include:

  1. Emotional Trigger
  2. Hypothermia
  3. Music
  4. Diseases

1. Emotional Triggers

These can include intense emotions such as excitement, fear, nostalgia, awe, euphoria, admiration, sexual arousal, and pleasure.

The simplest explanation is that the Autonomic Nervous System is involved with the processing of emotions too.

2. Hypothermia

Sudden changes in temperature, such as a cold breeze or extreme chill can cause these goosebumps.

3. Music

Although many people state this is related to the music evoking strong emotions, there are these weird causes involved when hearing plastic or metal being scratched. Indeed weird!

4. Diseases

Rarely, Goosebumps may be included as a symptom of some diseases, such as temporal lobe epilepsy, some brain tumors, and autonomic hyperreflexia.

“Cutis Anserine” can also be caused by heroin withdrawal. A skin condition that mimics piloerection in appearance is keratosis pilaris.

Science behind Goosebumps

Any of the mentioned stimuli can initiate a pilomotor reflex through the sympathetic nervous system. This causes the tiny muscles at the base of each hair, known as “arrector pili muscles“, to contract and pull the hair erect.

Causes of Goose bumps
Maybe the Goose did bump?

An important point to add is that Goose bumps can occur only in mammals since other animals do not have hair. The term “goose bumps” is therefore misleading: the bumps on the skin of a plucked goose technically do not qualify as piloerection. Birds do however have a similar reflex of raising their feathers in order to keep warm.

Diseases in which Goose bumps can occur
As a Doctor, you should know everything


Mechanism of Goose bumps
Arrector Pili causes the erection of hairs

In response to the stimuli explained in the section Causes of Goosebumps, the basics of piloerection can be better understood by the following:

Somatomotor and Sympathetic Nervous System
Somatomotor and Sympathetic Nervous System
Detailed Diagram of Goosbumps cause
Detailed Diagram of Goosebumps: Cause


Where goose bumps occur
Goosebumps occurring on thigh and legs

In humans, goose bumps are strongest on the forearms, but also occur on the legs, back, and other areas of the skin that have hair. In some people, they even occur in the face or on the head.

In animals, these can occur throughout parts of skin covered by hair. The most important example may include Porcupines! Have a look at what they look after goosebumps-

porcupine goosebumps
Exaggerated response perhaps


Piloerection as a response to cold or fear is vestigial in humans; as humans retain only very little body hair, the reflex (in humans) now serves no known purpose.

In animals, this may serve as heat preservation (more hairs=more insulation) or for defense as in porcupines or maybe someone else.

Goosebumps on kitties can definitely be scary sometimes


Q1- Why not on the face?

Ans- Piloerection (the muscular reflex that causes goosebumps) is found throughout the animal kingdom and is usually put to use by angry or scared animals. The piloerection causes hair to stand on its end making animals appear larger to predators and rivals.

goose bumps human body
You don’t get goosebumps on your beard, do you?

Humans, through the course of evolution, have retained comparatively very little body hair, so piloerection no longer serves much of a purpose. As such, it functions to varying degrees among people; a genetic variation similar to hair color or nose length. That’s the long way of saying, while most people do not get goosebumps on their faces as it has not assisted in human evolutionary survival for quite some time, some people still do.

Q2- Why do we get Goosebumps in scratching sounds?

Ans- The mechanism of piloerection (Goosebumps) has to do with your natural reflexes to external stimuli.

Fear and temperature both have strong effects on piloerection (Goosebumps) through autonomic nervous systems feedback systems. These are mediated like other emotion-linked autonomic reflexes by routing through the limbic system.

These other emotion-linked autonomic reflexes include blushing, blanching, and butterflies in the stomach.

The limbic system is the site of primitive drives: sex, fear, rage, aggression, and hunger. Anatomical sites for the limbic system include the amygdala, parahippocampal gyrus, uncus, subcallosal gyrus, cingulate gyrus, fornix, dentate gyrus, hypothalamus, and hippocampus.

These are found around a major structure called the thalamus which receives virtually all sensory input. The medial forebrain bundle is a bidirectional communication with the brainstem which then directly mediates autonomic reflexes.

A second method of invoking the autonomic reflexes is through the hypothalamus which also sends nerve projections to the brainstem.

Specifically, direct stimulation of the amygdala and hypothalamus evokes the piloerection pathway. It’s in these physical structures that emotional stimulation by music or the reading of poetry, etc. can result in piloerection. So also non-pleasant and/or unexpected sounds may elicit a fight or flight reaction, which may include piloerection (goosebumps).

Q3- Can it be controlled?

Ans- Medical term clearly says- “Involuntary action”, so indeed no. But the news has been that some people do control it!

Indian Penal Code 233 IPC

Indian Penal Code 233 or IPC 233 became viral as news messages started to spread across social media. According to news, the new law passed will grant women the right to kill or injure the sex organs of attackers. However, the truth about it is totally different.

The latest news went viral on social media about a new Anti-rape law being passed named Indian penal code 233 or IPC 233 which stated the following:

“A new law has been passed and under section Indian penal code 233, if a girl is suspected to be raped or getting raped, she has a right to kill the man, injure his sexual organ or harm the person within ipc 233. In such a situation, the girl would not be charged with murder.”

And the original message was:-

“If a girl is suspected to be raped or gettin raped , then she has the supreme ryt to kill the man, injure his sexual part or harm that person as dangerously under ipc 233 by modi govt.. that girl wont be blamed fr murder ……..tell as many as u can .. its your power .. create awareness …. Finally…”

This clearly doesn’t sound like a statement from Supreme Court, right? To add, one of the Supreme Court lawyers stated the following about Indian Penal Code 233:

“The act of rape is punishable under the IPC section 376, not under IPC 233 and punishment starts from 10 years to life imprisonment. There is no bill in the parliament about any amendments to the laws relating to rape currently. However, in certain cases judges have increased life imprisonment and have ordered that the accused will live and die in jail.”

There is no word of IPC 233! Adding to the following, he also said-

“The existing laws in the country are good enough if the prosecution can establish that there was a case of rape. We just need an active and efficient investigation agency, a brilliant prosecution and a dispassionate judge to decide based on facts presented. Further, under the current judicial system and based on the various statutes of the IPC, judges have the power to order that the sentence cannot be reduced and there will be no commutation of imprisonment.”

Answer to Hoax or Truth about Indian Penal Code 233

So this has been declared a False statement being viral all around on social media like WhatsApp and Facebook. So far, the real accused of the false statement is out of reach, but the main question is, “What is IPC 233 or Indian Penal Code 233” and “What is the anti-rape law then?”

We have got all answers as you go through this article. Just make sure you spread to your friends that this is indeed a hoax. But before that, have a look at something really interesting!

Gun For Indian Women

Nirbheek (Nirbhaya) – A 500gm Gun worth 1.22 lakhs for Women is out now! India has launched a new handgun for women, named after a student who was gang-raped in Delhi in December 2012 and later died of her injuries. Officials say it will help women defend themselves, but critics say it’s an insult to the victim’s memory. Let’s see how far it can beat IPC 233 then.

Coming back to the original topic, let’s have a look at the answers-

What is IPC 233 or the Indian penal code 233?

Central Government Act,
Section 233 in the Indian Penal Code

Real Indian Penal Code 233 states:

“Making or selling instrument for counterfeiting coin.—Whoever makes or mends, or performs any part of the process of making or mending, or buys, sells or disposes of, any die or instrument, for the purpose of being used, or knowing or having reason to believe that it is intended to be used, for the purpose of counterfeiting coin, shall be punished with imprisonment of either description for a term which may extend to three years, and shall also be liable to fine.”

So now you know what exactly is Indian Penal Code 233 is. If IPC 233 is not anti-rape, then what is? Let’s have a look at it.

The Real Anti-Rape laws

IPC Section 375

It states the definition of Rape and IPC Section 376 states the Punishment of rape. IPC 233 is completely irrelevant.

IPC Section 375

It states the definition of Rape. The new definition of rape was amended on Jan 1, 2013.

Old Rape Definition

“Sexual intercourse with a woman against her will is called rape.”

New definition as of January 1, 2013

“Penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim.”

IPC Section 376

It states the punishment for rape as follows

The punishment for committing rape is generally decided under rape laws – IPC section 376, punishing with a maximum sentence of life imprisonment and a minimum of seven years, where the rape accused is also liable to fine unless the woman raped is his wife and is not under twelve years of age. So, you see, no IPC 233 yet!

Additional Laws of Self-defense

There are other laws as well that explain Private Defense. But an important requirement goes as follows for the laws below:

“The right of private defense is only available when there is a reasonable apprehension of receiving injury/sexual assault. Also, the victim needs to provide the necessary evidence of sexual assault/rape either by herself or from the witnesses.”

IPC Section 79

Nothing is an offense that is done by any person who is justified by law, or who by reason of a mistake of fact and not by reason of a mistake of law in good faith, believes himself to be justified by law, in doing it.

IPC Section 96

Things are done in private defense.—Nothing is an offense that is done in the exercise of the right of private defense.

IPC Section 97

Right of private defense of the body and of property.—Every person has a right, subject to the restrictions contained in section 99.

IPC Section 100

When the right of private defense of the body extends to causing death.

But wait, there’s another law that explains when the Right of self-defense is not applicable!

IPC Section 99

There is no right of private defense against an act that does not reasonably cause the apprehension of death or of grievous hurt.

Summary of Additional laws applicable to Women

According to the IPC section 100, about Private Defense, a person/woman has a right to defend his/her body when there is a physical assault, with the intention of committing rape or gratifying unnatural lust. And according to section 96, nothing is an offense that is done in the exercise of the right of private defense. In cases of sexual assault, the right of private defense of one’s body can extend to the voluntary causing of death or of any other harm to the assailant. But it is important to note that:

The right of private defence is only available when there is a reasonable apprehension of receiving injury/sexual assault. Also, the victim needs to provide the necessary evidence of sexual assault/rape either by herself or from the witnesses.

The conclusion is that when a woman is attacked and physically assaulted by a man with an intention of rape or lust, the woman has every right to defend herself (not under IPC 233 of course).

She can go to any extent to protect herself from the danger, she won’t be blamed or accused of murder – she will only need to prove the sexual assault.

Moreover, according to IPC section 97, during the assault, any person associated with the woman also has the legal right to defend her body and fight/kill the assailant.

So next time someone passes the message of new anti-rape law IPC 233, or says Indian Penal Code 233 has arrived as the savior, slap him with all the LAWS! Share the info now to let everyone know.

Chronic Kidney Disease – An Occasion of CKD Day

On the very special day for the beany kidneys, we are going to stir you up about the disease of kidney, especially the chronic kidney disease, with our latest blog.


Kidney, being one the most vital organ (of course all organs are vital but Kidney is close to topping the chart) most often gets neglected by common people. By the time patients realize the complications it can yield, the disease would have reached an advanced stage. March 12th -World Kidney Day did not get the attention it most certainly requires among the masses. So let’s get to know more about Chronic Kidney Diseases (CKD).

What is CKD?

Chronic Kidney Disease PathologyChronic Kidney Disease is defined as persistent kidney damage accompanied by a reduction in the glomerular filtration rate (GFR) and the presence of albuminuria.

Statistics and Etiology

According to World Health Organization (WHO) Global Burden of Disease Project, disease of the kidney and urinary tract contribute to approximately 8,50,000 deaths every year of which Chronic Kidney Disease (CKD) is the 12th leading cause of death and 17th leading cause of disability in the world.

The global increase in CKD is due to diabetes mellitus, hypertension, obesity, and aging. The two most common causes of kidney disease are diabetes and high blood pressure. People with a family history of any kind of kidney disease are also at high risk.

Diabetic Nephropathy

It is a progressive disease characterized by nephrotic syndrome and diffuse glomerulosclerosis. Initially it causes glomerular hyperfiltration which progresses to BM (Basement membrane)thickening which leads to microalbuminuria .This is the earliest detectable change in the course of diabetic nephropathy.

Proliferation of mesangium follows and finally nodular sclerosis occurs. The Armanni-Ebstein change or Armanni-Ebstein cells which are deposits of glycogen in the tubular epithelial cells are seen in the end stages of this disease.

Hypertension and CKD

The relationship between HTN and CKD is cyclic in nature. Uncontrolled HTN is a risk factor for developing CKD and is also associated with a more rapid progression of CKD. Primarily, there is impairment in the glomerular filtration causing microalbuminuria.

Other Causes

Autoimmune diseases (such as systemic lupus erythematosus and scleroderma),infection-related diseases, and sclerotic diseases may also cause CKD. Irrational use of NSAID’s can also lead to CKD by causing interstitial nephritis.

Signs and Symptoms

The patient usually presents with the following symptoms:-

  • Edema
  • Persistent fatigue or shortness of breath
  • Loss of appetite
  • Increasing blood pressure
  • Pale, itchy, dry skin
  • Odoor in breath


  • Staging can be done by the following investigations:
  • Glomerular filtration rate (GFR)
  • Urine albumin:

Staging of Chronic Kidney Disease

  • Blood Urea Nitrogen (BUN)
  • Kidney imaging
  • Kidney Biopsy


The kidneys make and release hormones and balance the minerals in the blood. When the kidneys stop working, most people develop conditions that affect the blood, bones, nerves, and skin. These complications can range from uncomfortable to damaging and potentially even life-threatening. Managing these complications may help prevent or slow further damage to your kidneys and help you stay as healthy as possible.

The following image may shortly explain the complications of chronic kidney disease:-
Complications of Chronic Kidney Disease


For stages I- IV, the first line therapy is to not only lower BP, but also to reduce proteinuria. Such drugs are:

  • ACE Inhibitors
  • ARB’s
  • Thiazide/Loop diuretics
  • Aldosterone antagonists
  • Renin inhibitors
  • Calcium Channel Blockers
  • Beta blocker

Lifestyle modifications are also suggested:

Increase physical activity, weight loss, and dietary modifications. Patient should be advised not to smoke/consume alcohol, explaining his situation.

For Vth stage of the disease, RTT (Renal Replacement Therapy) is advised.
Renal replacement therapy includes kidney transplant, peritoneal dialysis & Hemodialysis. Renal replacement therapy is usually indicated in end stage renal disease.

MBBS Third Year Subjects, Books and Syllabus


Third year MBBS consists of one year which includes the Subjects– Ophthalmology, ENT and Community medicine. Ophthalmology refers to Eye, ENT is based on Ear Nose and Throat while Community Medicine is somewhat branch of Medicine but with detailed Epidemiology. Following are the best MBBS Books for Third Year and the syllabus for each subject. Don’t forget to check our Downloads Section to get the books in PDF Format.

If you are in other year, you can jump to the below sections:


Ophthalmology in Third Year MBBS deals with primary eye care and study of related diseases.


The Syllabus for Ophthalmology for Third Year MBBS has been listed below:


A) Conjunctiva

  • Symptomatic conditions: – Hyperemia, Sub conjunctival Haemorrhage
  • Diseases: – Classification of Conjunctivitis
  • > Mucopurulant Conjunctivitis
  • > Membranous Conjunctivitis Spring Catarrh
  • > Degenerations :- Pinguecula and Pterigium

B) Cornea

  • Corneal Ulcers: Bacterial, Fungal, Viral, Hypopyon
  • Interstitial Keratitis
  • Keratoconus
  • Pannus
  • Corneal Opacities
  • Keratoplasty

C) Sclera

  • Episcleritis
  • Scleritis
  • Staphyloma

D) Uvea

  • Classification of Uveitis
  • Gen. Etiology, Investigation and Principles Management of Uveitis
  • Acute & Chronic Iridocyclitis
  • Panophthalmitis
  • End Ophthalmitis
  • Choriditis

E) Lens

  • Cataract – Classification & surgical management of cataract
  • Including Preoperative Investigation
  • Aphakia
  • IOL Implant

F) Glaucoma

  • Aqueous Humor Dynamics
  • Tonometry
  • Factors controlling Normal I.O.P
  • Provocative Tests
  • Classifications of Glaucoma
  • Congenital Glaucoma
  • Angle closure Glaucoma
  • Open Angle Glaucoma
  • Secondary Glaucoma

G) Vitreous

  • Vitreous. Opacities
  • Vitreous. Haemorrhage

H) Intraocular Tumours

  • Retinoblastoma
  • Malignant Melanoma

I) Retina

  • Retinopathies : Diabetic, Hypertensive Toxaemia of Pregnancy
  • Retinal Detachment
  • Retinitis Pigmentosa, Retinoblastoma

J) Optic nerve

  • Optic Neuritis
  • Papilloedema
  • Optic Atrophy

K) Optics

  • Principles : V.A. testing Retinoscopy, Ophthalmoscopy
  • Refraction Errors
  • Refractive Keratoplasty
  • Contact lens, Spectacles

L) Orbit

  • Proptosis – Aetiology, Clinical Evaluation, Investigations & Principles of Management
  • Endocrinal Exophthalmos
  • Orbital Haemorrhage

M) Lids

  • Inflammations of Glands
  • Blepharitis
  • Trichiasis, Entropion
  • Ectropion
  • Symblepharon
  • Ptosis

N) Lacrimal System

  • Wet Eye
  • Dry Eye
  • Naso Lacrimal Duct Obstruction
  • Dacryocystitis

O) Ocular Mobility

  • Extrinsic Muscles
  • Movements of Eye Ball
  • Squint : Gen. Aetiology, Diagnosis and principles of Management
  • Paralytic and Non Paralytic Squint
  • Heterophoria
  • Diplopia

P) Miscellaneous

  • Color Blindness
  • Lasers in Ophthalmology – Principles

Q) Ocular Trauma

  • Blunt Trauma
  • Perforating Trauma
  • Chemical Burns
  • Sympathetic Ophthalmitis

2) Principles of Management of Major Opthalmic Emergencies

  • Acute Congestive Glaucoma
  • C. Ulcer
  • Intraocular Trauma
  • Chemical Burns
  • Sudden Loss of vision
  • Acute Iridocyclitis
  • Secondary Glaucomas

3) Main Systemic Diseases Affecting the Eye

  • Tuberculosis
  • Syphilis
  • Leprosy
  • Aids
  • Diabetes
  • Hypertension

4) Drugs

  • Antibiotics
  • Steroids
  • Glaucoma Drugs
  • Mydriatics
  • Visco elastics
  • Fluoresceue

5) Community Ophthalmology

  • Blindness : Definition Causes & Magnitude
  • N.P.C.B. – Integration of N.P.C.B. with other health
  • Preventable Blindness
  • Eye care
  • Role of PHC’s in Eye Camps
  • Eye Banking

6) Nutritional

  • Vitamin A Deficiency

Best Books

Following MBBS Books are recommended for Ophthalmology in Third year MBBS:


ENT (Ear Nose Throat)

ENT in Third Year MBBS deals with common disorders, emergencies in ENT, and basic principles of impaired hearing and rehabilitation.


The Syllabus for ENT for Third Year MBBS has been listed below:


  • Anatomy/physiology
  • Diseases of buccal cavity
  • Diseases of pharynx
  • Tonsils and adenoids
  • Pharyngeal tumours and related topics (trismus, Plummer .Vinson Syndrome etc.)
  • Anatomy /physiology/examination
  • Methods/symptomatology of larynx
  • Stridor /tracheostomy
  • Laryngitis /laryngeal trauma/ Laryngeal paralysis/ foreign body larynx/Bronchus, etc.
  • Laryngeal tumours

Nose and Paranasal sinuses

  • Anatomy /physiology/ exam.
  • Methods /symptomatology
  • Diseases of ext. nose/cong.
  • Conditions
  • • Trauma to nose/p.n.s/Foreign Body. / Rhinolith
  • • Epistaxis
  • • Diseases of nasal septum
  • • Rhinitis
  • • Nasal polyps/nasal allergy
  • • Sinusitis and its complications
  • • Tumours of nose and Para nasal sinuses


Study of Ear, including the basic anatomy, physiology and diseases related to ear.

  • Anatomy / Physiology
  • Methods / methods of examination
  • Congenital diseases / ext.ear /middle ear
  • Acute/chronic supp. otitis media – Aetiology, clinical features and its management/complications
  • Serous/adhesive otitis media
  • Mastoid/middle ear surgery
  • Otosclerosis/tumours of ear
  • Facial paralysis/Meniere’s disease
  • Tinnitus /ototoxicity
  • Deafness/hearing aids/rehabilitation
  • Audiometry

Best Books

Following MBBS Books are recommended for ENT in Third Year MBBS:


Community Medicine

Community Medicine in Third Year MBBS deals with Teachings of the community and general understanding.


The Syllabus for Community Medicine for Third Year MBBS has been listed below:

  • Basic concept of Health and disease
  • Sociology and health
  • Epidemiology
  • Communicable disease epidemiology
  • Non-communicable disease epidemiology
  • National Health Programmes of India
  • Environment and impact on health
  • Entomology
  • Occupational Medicine / occupational health
  • Genetics and health
  • Nutrition and health
  • Health care management India and International
  • Primary Health care
  • International Health and travelers health

Best Books

Following MBBS Books are recommended for Community Medicine in Third year MBBS:

  1. Text book of Community Medicine, Kulkarni A.P. and Baride J.P
  2. Park’s Textbook of Preventive and Social Medicine, Park
  3. Principles of Preventive and Social Medicine, K. Mahajan
  4. Textbook of Community Medicine, B. Shridhar Rao
  5. Essentials of Community Medicine, Suresh Chandra
  6. Textbook of Biostatistics, B. K. Mahajan
  7. Review in Community Medicine, V.R. Sheshu Babu
  8. Sociology and Health Niraj Pandit
  9. National Health Programme, J Kishor

Further Reading

  1. Epidemiology and Management for health care for all P.V. Sathe and A.P. Sathe
  2. Essentials of Preventive Medicine O.P. Ghai and Piyush Gupta

Blood Test Interpretation with Normal values

We’ve just prepared the best Blood Test Interpretation guide for you with normal values and ranges. It’s definitely going to help you a lot, if you like it, do save it in bookmarks for future reference. Use the tools to understand your lab results faster.

Before we proceed, what are the Four Ominous Signs in Blood work?

Four Ominous Signs of Blood Work

  1. Albumin 3.5 or below with a 1500 or less lymphocyte count
  2. Calcium levels higher than 2.7
  3. A/G ratio less than 1.0
  4. Cholesterol values below 140

Lab Results Interpretation

Through this guide, we will help you interpret your results from the lab which often includes CBC, LFT, KFT, INR, and more. Hope it helps you understand the importance of individual reports.


Glucose is the chief source of energy for all living organisms. A level greater than 105 in someone who has fasted for 12 hours suggests a diabetic tendency.

If this level is elevated even in a non-fasting setting one must be concerned that there is a risk of developing diabetes. This is an incredibly powerful test and can predict diabetes for ten years or more before one develops the strict definition of diabetes which is levels greater than 120.

  • Clinical Adult Range: 70-115 mg/dL
  • Optimal Adult Range: 85-100 mg/dL
  • Red Flag Range <50 or >250 mg/dL

Common Causes of Glucose Increase

Diabetes, poor carbohydrate utilization, syndrome X

Less Common Causes of Glucose Increase

Cerebral lesions, uremia, pregnancy, intracranial pressure, Cushing’s disease, hyperthyroidism, chronic nephritis, infections, first 24 hours after a severe burn, pancreatitis, cerebral lesions, uremia, early hypopituitarism.

Common Causes of Glucose Decrease

Fasting Hypoglycemia

Clinical Note: LDH will frequently be decreased or in the low normal with Fasting Hypoglycemia, however, LDH will almost ALWAYS be decreased with Reactive Hypoglycemia.

Less Common Causes of Glucose Decrease

Liver damage, pancreatic adenoma, Addison’s disease (adrenal insufficiency), starvation, late hypopituitarism Carcinoma of islet tissue
Clinical Notes: Order Glycohemoglobin (HGB A1C) with serum glucose values above 160 and to monitor diabetics under therapy

Nutrition Tip: Thiamine Deficiency has been linked to increases in glucose levels.


Sodium plays an important role in salt and water balance in your body. A low level in the blood can be caused by too much water intake, heart failure, or kidney failure.

A low level can also be caused by loss of sodium in diarrhea, fluid, or vomiting. A high level can be caused by too much intake of salt or by not enough intake of water.

  • Clinical Adult Range: 135-145 mmol/L
  • Optimal Adult Range: 140-144 mmol/L
  • Red Flag Range <125 or >155 mmol/L

Common Causes of Sodium Increase

Nephritis (kidney problems), dehydration, hyper-cortico-adrenalism (increased adrenal function)

Clinical Notes: Water Softeners have been linked to causing an increase in sodium.

Common Causes of Sodium Decrease

Reduced kidney filtration, diarrhea, Addison’s disease, adrenal hypo-function


Potassium element is found primarily inside the cells of the body. Low levels in the blood may indicate severe diarrhea, alcoholism, or excessive use of water pills. Low potassium levels can cause muscle weakness and heart problems.

  • Clinical Adult Range: 3.5-5.0 mmol/L
  • Optimal Adult Range: 4.0-4.6 mmol/L
  • Red Flag Range <3.0 or >6.0 mmol/L

Common Causes of Potassium Increase

Adrenal hypo-function, cortisol resistance, acidosis, ongoing tissue destruction

Common Causes of Potassium Decrease

Diarrhea, diuretic use, kidney problems, adrenal hyperfunction

Less Common Causes of Potassium Decrease

Anemia, overdosage of testosterone, hereditary periodic paralysis, and hypertension

Nutrition Tip: Excessive licorice consumption has been linked to lower potassium levels.


Magnesium is an important element that is found in the arteries, heart, bone, muscles, nerves, and teeth.

  • Clinical Adult Range: 1.7-2.4 mg/dL
  • Optimal Adult Range: 2.2-2.6 mg/dL
  • Red Flag Range <1.2 mg/dL

Common Causes of Magnesium Increase

Kidney problems

Common Symptoms of Magnesium Deficiency

Anxiety, aching muscles, disorientation, low body temperature, easily angered, hyperactivity, insomnia, muscle tremors, nervousness, rapid pulse, sensitivity to noise and loud sounds, epilepsy

Clinical Note: Magnesium should be evaluated in all patients suffering from heart disease.
Clinical Note: Patient suffering from fibromyalgia may have low serum magnesium accompanied by a low C02 and an increased anion gap.
Nutrition Tip: Excessive use of antacids containing magnesium may increase magnesium levels.
Clinical Note: If your magnesium is less than 2.0, it is strongly recommended to have an erythrocyte magnesium test or a magnesium loading test.


Chloride is an electrolyte controlled by the kidneys and can sometimes be affected by diet. An electrolyte is involved in maintaining acid-base balance and helps to regulate blood volume and artery pressure.

Elevated levels are related to acidosis as well as too much water crossing the cell membrane.

  • Clinical Adult Range: 96-110 mmol/L
  • Optimal Adult Range: 100-106 mmol/L
  • Red Flag Range <90 or >115 mmol/L

Common Causes of Chloride Increase

Renal (kidney) problems, metabolic acidosis

Common Causes of Chloride Decrease

Kidney problems, metabolic alkalosis, hypochlorhydria (too little acid in the stomach)

Less Common Causes of Chloride Increase

Hyperventilation, anemia, prostate problems, salicylate poisoning, excess intake of salt, dehydration

Less Common Causes of Chloride Decrease

Diabetes, pneumonia, intestinal obstruction, and pyloric spasm. Adrenal hypo-function

Clinical Note: Suspect hypochlorhydria if chloride is below 100, the total globulin is less than 2.4 and serum phosphorus is less than 3.0.
Clinical Note: Chloride is required for the production of HCL by the chief cells of the stomach.


Blood Urea Nitrogen or BUN is a waste product derived from protein breakdown in the liver.

Increases can be caused by excessive protein intake, kidney damage, certain drugs, low fluid intake, intestinal bleeding, exercise, heart failure, or decreased digestive enzyme production by the pancreas.

Decreased levels are most commonly due to inadequate protein intake, malabsorption, or liver damage.

  • Clinical Adult Range: 10-26 mg/dL
  • Optimal Adult Range: 13-18 mg/dL
  • Red Flag Range <5 or >50 mg/dL

Common Causes of BUN Increase

Renal disease, gout, drug diuretics

Common Causes of BUN Decrease

Pregnancy, protein malnutrition

Less Common Causes of BUN Increase

Metallic poisoning, pneumonia, ulcers, Addison’s disease, increased protein catabolism, dysbiosis, congestive heart failure

Less Common Causes of BUN Decrease

Acute liver destruction, dysbiosis, celiac sprue

Clinical Note: Decreased BUN of less than 8 with a decreased urinary specific gravity may indicate posterior pituitary dysfunction.
Clinical Note: Increased BUN above 25 usually indicates kidney disease. However, if Creatinine is not above 1.1, then kidney disease may not be the problem. Instead consider anterior pituitary dysfunction, dehydration or hypochlorhydria.
Nutrition Tip: Increased BUN may indicate a Boron deficiency.


Creatinine is also a protein breakdown product. Its level is a reflection of the body’s muscle mass.

Low levels are commonly seen in inadequate protein intake, liver disease, kidney damage, or pregnancy.

Elevated levels are generally reflective of kidney damage and need to be monitored very carefully.

  • Clinical Adult Range: 0.7-1.5 mg/dL
  • Optimal Adult Range: 0.7-1.0 mg/dL
  • Red Flag Range >1.6 mg/dL

Common Causes of Creatinine Increase

Kidney Problems, Gout

Clinical Note: If Creatinine is 1.2 or higher in a male over the age of 40, Prostate Hypertrophy MUST be ruled out.

Less Common Causes of Creatinine Increase

Renal Hypertension, uncontrolled diabetes, congestive heart failure, urinary tract infection, dehydration

Clinical Note: Suspect early nephritis ( kidney disease) if creatinine is between 2-4 mg/dL. Suspect severe nephritis is creatinine is between 4-35 mg/dL.

Common Causes of Creatinine Decrease

Amyotonia congenital


Increased values of the BUN/Creatinine Ratio may indicate catabolic states, dehydration, circulatory failure leading to declining renal blood flow, congestive heart failure, acute and chronic renal (kidney) failure, urinary tract obstruction, prostatic enlargement, and high protein diet.

Decreased values may indicate overhydration, low protein/high carbohydrate diet, pregnancy

  • Clinical Adult Range: 6-10
  • Optimal Adult Range: 10-16
  • Red Flag Range <5 or >30

Common Causes of BUN/Creatinine Ratio Increase

Kidney problems

Less Common Causes of BUN/Creatinine Ratio Increase

Catabolic states, prostatic hypertrophy, high protein diet, dehydration, shock

Common Causes of BUN/Creatinine Ratio Decrease

Low protein/high carbohydrate diet, pregnancy


Uric acid is the end product of purine metabolism. High levels are seen in gout, infections, high protein diets, and kidney disease. Low levels generally indicate protein and molybdenum (trace mineral) deficiency, liver damage, or an overly acidic kidney.

  • Clinical Female Range: 2.4-6.0 mg/dL
  • Clinical Male Range: 3.4-7.0 mg/dL
  • Optimal Female Range: 3.0-5.5 mg/dL
  • Optimal Male Adult Range: 3.5-5.9 mg/dL
  • Red Flag Range <2 mg/dL or >9.0 mg/dL

Common Causes of Uric Acid Increase

Gout, kidney problems, arteriosclerosis, arthritis

Less Common Causes of Uric Acid Increase

Metallic poisoning (mercury, lead), intestinal obstruction, leukemia, polycythemia, malignant tumors, drug diuretics

Common Causes of Uric Acid Decrease

Chronic B-12 or folate anemia, pregnancy

Less Common Causes of Uric Acid Increase

Salicylate and atropine therapy

Nutrition Tip: If the uric acid is low with a normal MCV and MCH, a molybdenum deficiency may be present.


Phosphorus is closely associated with calcium in bone development. Therefore most of the phosphate in the body is found in the bones. But the phosphorus level in the blood is very important for muscle and nerve function.

Very low levels of phosphorus in the blood can be associated with starvation or malnutrition and this can lead to muscle weakness. High levels in the blood are usually associated with kidney disease.

However, the blood must be drawn carefully as improper handling may falsely increase the reading.

  • Clinical Adult Range: 2.5-4.5 mg/dL
  • Optimal Adult Range: 3.2-3.9 mg/dL
  • Red Flag Range <2.0 mg/dL or >5.0 mg/dL

Common Causes of Phosphorus Increase

Parathyroid dysfunction, kidney dysfunction, and excessive phosphoric acid in soft drinks.

Important Fact: Children will have an increase in Phosphorus due to normal bone growth. In addition, people with fractures will usually reveal an increase.

Less Common Causes of Phosphorus Increase:

Bone tumors, edema, ovarian hyper-function, diabetes, excess intake of vitamin D

Common Causes of Phosphorus Decrease

Parathyroid Hyper-function, osteomalacia, rickets

Less Common Causes of Phosphorus Decrease

Diabetes, liver dysfunction, protein malnutrition, neurofibromatosis, myxedema

Nutrition Tip: Phosphorus is frequently decreased with diets high in refined sugars.
Clinical Note: Suspect Vitamin D deficiency with low levels of calcium, phosphorus and increased levels of alkaline phosphorus.
Clinical Note: Phosphorus is a general indicator of digestive function. Consider hypochlorhydria when phosphorus is below 3.0 and total serum globulin is greater than 3.0 or less than 2.4.


Calcium is the most abundant mineral in the body. It is involved in bone metabolism, protein absorption, fat transfer, muscular contraction, the transmission of nerve impulses, blood clotting, and heart function.

It is highly sensitive to elements such as magnesium, iron, and phosphorous as well as hormonal activity, vitamin D levels, CO2 levels, and many drugs.

Diet or even the presence of calcium in the diet has a lot to do with “calcium balance” – how much calcium you take in and how much you lose from your body.

  • Clinical Adult Range: 8.5-10.8 mg/dL
  • Optimal Adult Range: 9.7-10.1 mg/dL
  • Red Flag Range <7.0 mg/dL or >12.0 mg/dL

Common Causes of Calcium Increase


Less Common Causes of Calcium Increase

Tumors of the thyroid, hypervitaminosis (excess Vitamin D), multiple myeloma, neurofibromatosis, osteoporosis, ovarian hypo-function, adrenal hypo-function

Clinical Note: Serum protein influences calcium levels. Calcium goes up with increased protein and goes down with decreased protein.

Common Causes of Calcium Decrease

Hypoparathyroidism, pregnancy, hypochlorhydria, kidney dysfunction

Less Common Causes of Calcium Decrease

Vitamin D deficiency, diarrhea, celiac disease, protein malnutrition, chemical/heavy metal toxicity, HPA-axis dysfunction

Clinical Fact: Poor intestinal fat absorption may be suspected with low levels of calcium, bilirubin, and phosphorus.
Nutrition Note: Pancreatic enzyme deficiency may be suspected with low levels of calcium, triglycerides and increased levels of LDH.
Clinical Note: Circadian rhythm abnormality should be a primary consideration with calcium levels either above or below normal.


Albumin is the most abundant protein in the blood, it is made in the liver and is an antioxidant that protects your tissues from free radicals. It binds waste products, toxins, and dangerous drugs that might damage the body.

It also is a significant buffer in the body and plays a role in controlling the precise amount of water in our tissues. It serves to transport vitamins, minerals, and hormones.

Lower levels are seen in poor diets, diarrhea, fever, infections, liver disease, kidney disease, third-degree burns, edemas, or hypocalcemia.

  • Clinical Adult Range: 3.0-5.5 g/dL
  • Optimal Adult Range: 4.0-4.4 g/dL
  • Red Flag Range <4.0 g/dL

Common Causes of Albumin Increase


Less Common Causes of Albumin Increase

Thyroid and adrenal hypo-function

Common Causes of Albumin Decrease

Liver Disease

Less Common Causes of Albumin Decrease

Acute Nephritis, malnutrition, acute cholecystitis (gall bladder), multiple sclerosis, vitamin B-12 or folic acid anemia

Clinical Note: Albumin 3.5 or below with a 1500 or less lymphocyte count is one of the four OMINOUS signs.
Nutrition Tip: Decreased albumin with decreased serum phosphorus may indicate digestive inflammation.

Calcium/Albumin Ratio

It is elevated in malnutrition or visceral protein loss. Levels higher than 2.7 is one of the four OMINOUS signs.


Globulins have many diverse functions such as the carrier of some hormones, lipids, metals, and antibodies.

High levels are found in chronic infections, liver disease, rheumatoid arthritis, myelomas, and lupus.

Lower levels may be seen in immune-compromised patients, with poor dietary habits, malabsorption, and liver and kidney disease.

  • Clinical Adult Range: 2.0-4.0 g/dL
  • Optimal Adult Range: 2.8-3.5 g/dL
  • Red Flag Range <2.0 g/dL or >3.5 g/100ml

Common Causes of Globulin Increase

Hypochlorhydria, liver disease (infection)

Less Common Causes of Globulin Increase

Liver parasites, multiple myeloma, rheumatoid arthritis, typhoid fever

Common Causes of Globulin Decrease

Anemia, hemorrhage

Clinical Note: Anytime the total globulin is less than 2.0 or greater than 3.5 a Serum Protein Electrophoresis.


A/G Ratio is an important indicator of disease states. A low ratio suggests ulcerative colitis, burns, kidney disease, cirrhosis, and multiple myeloma.

A/G ratio less than 1.0 is one of the four OMINOUS signs.

  • Clinical Adult Range: 1.1-2.5
  • Optimal Adult Range:1.2-1.5
  • Red Flag Range <1.0
Nutrition Note: Elevated A/G ratio, elevated protein, and elevated cholesterol may indicate too high protein consumption.


ALP or Alkaline phosphatase is an enzyme that is found in all body tissue, but the most important sites are bone, liver, bile ducts, and the gut.

A high level of alkaline phosphatase in your blood may indicate bone, liver, or bile duct disease. Certain drugs may also cause high levels. Growing children, because of bone growth, normally have a higher level than adults do.

Low levels indicate low-functioning adrenal glands, protein deficiency, malnutrition, or more commonly, a deficiency in zinc.

  • Clinical Adult Range: 30-115 U/L
  • Optimal Adult Range: 60-80 U/L
  • Red Flag Range <30 U/L or >Laboratory range

Common Causes of Alkaline Phosphatase Increase

A primary bone lesion, invasive liver lesion, biliary duct (liver) obstruction, osteomalacia, Paget’s disease, rheumatoid arthritis

Less Common Causes of Alkaline Phosphatase Increase

Excess ingestion of Vitamin D, rickets, Cirrhosis of the liver, adrenal hyper-function, shingles, Hodgkin’s disease, osteogenic sarcoma, alcoholism, multiple myeloma, jaundice

Common Causes of Alkaline Phosphatase Decrease

Anemia, Hypothyroidism, celiac disease

Less Common Causes of Alkaline Phosphatase Decrease

Adrenal hypo-function, vitamin C deficiency, progesterone deficiency

Nutrition Note: Alkaline Phosphatase levels below 70 U/L may indicate a Zinc Deficiency.
Clinical Note: Any patient having a significant increase in Alkaline Phosphatase should have an ALP isoenzyme.
Clinical Note: It is considered “NORMAL” for Alkaline Phosphatase to be elevated in children under 18 and people with bone fractures.


Transaminases (SGPT/ALT) & (SGOT/AST) are enzymes that are primarily found in the liver.

Drinking too much alcohol, certain drugs, liver disease and bile duct disease can cause high levels in the blood. Hepatitis is another problem that can raise these levels.

Low levels of GGT may indicate a magnesium deficiency. Low levels of SGPT and SGOT may indicate a deficiency of vitamin B6.

  • Clinical Adult Range: 0-41 U/L
  • Optimal Adult Range: 18-26 U/L
  • Red Flag Range >100 U/L

SGOT/AST is found in the heart, skeletal muscles, brain, liver, and kidneys.

Clinical Note: In acute congestive heart failure and/or myocardial infarction, the SGOT/AST will significantly increase. However, these values will slowly return to normal. SGPT/ALT will also increase in these cardiac heart emergencies, however, SGOT/AST normally will not return to normal as quickly as SGPT.

Common Causes of SGOT/AST Increase

Myocardial Infarction, pulmonary embolism, congestive heart failure, myocarditis

Other Common Causes of SGOT/AST Increase

Hepatitis, liver cirrhosis, liver disease, pancreatitis

Less Common Causes of SGOT/AST Increase

Liver neoplasm

Nutrition Note: Low levels of SGOT/AST and SGPT/ALT may indicate a B-6 deficiency.

Common Causes of SGPT/ALT Increase

Acute hepatitis, cirrhosis of the liver, mononucleosis

Less Common Causes of SGPT/ALT Increase

Pancreatitis, biliary dysfunction, diabetes

Clinical Note: SGPT values are greater than SGOT in liver obstruction, and toxic hepatitis. SGOT values are greater than SGPT in cirrhosis of the liver, liver neoplasms and jaundice.

GGT (Gamma-Glutamyl transerase)

Gamma-Glutamyl Transferase (GGT) is believed to be involved in the transport of amino acids into cells as well as glutathione metabolism. Found in the liver and will rise with alcohol use, liver disease, or excess magnesium.

  • Clinical Adult Range: 0-55 U/L
  • Optimal Adult Range: 10-30 U/L
  • Red Flag Range >90 U/L

Common Causes of GGT Increase

Biliary obstruction, alcoholism, cholangitis/cholecystitis (bile duct and gall bladder inflammation)

Clinical Note: If GGT is greater than 150 U/L with a serum bilirubin of over 2.8 mg/dL, strongly suspect a biliary obstruction. Seek immediate medical attention.
Clinical Note: If GGT values are five times higher than the clinical range suspect pancreatitis.

Less Common Causes of GGT Increase

Brucellosis, hepatitis, mononucleosis, bacterial and viral infection, malignancy, congestive heart failure biliary.

Nutrition Note: Low levels of GGT may indicate a B-6 deficiency.
Additional Clinical Notes: Food allergy/sensitivity is a very common finding with biliary dysfunction.


Lactate Dehydrogenase or LDH is an enzyme found in all tissues of the body.

A high level in the blood can result from a number of different diseases such as hepatitis, anemia, etc.

Also, slightly elevated levels in the blood are common and usually do not indicate disease. The most common sources of LDH are the heart, liver, muscles, and red blood cells.

  • Clinical Adult Range: 60-225 U/L
  • Optimal Adult Range: 140-200 U/L
  • Red Flag Range >250 U/L

Common Causes of LDH Increase

Liver/biliary dysfunction, pulmonary embolism, myocardial infarction, tissue inflammation, tissue destruction, malignancy anywhere in the body, several types of anemias

Clinical Note: LDH will frequently increase with low thyroid function.
Clinical Note: LDH is frequently increased with birth control usage.
Nutrition Note: Decreased LDH may indicate reactive hypoglycemia (check glucose).


Total Protein: This is a measure of the total amount of protein in your blood. The total protein is the combination of albumin and total globulin and is affected by albumin and total globulin.

A low or high total protein does not indicate a specific disease, but it does indicate that some additional tests may be required to determine if there is a problem.

  • Clinical Adult Range: 6.0-8.5 g/dL
  • Optimal Adult Range: 7.1-7.6 g/dL
  • Red Flag Range <5.9 g/dL or > 8.5 g/dL

Common Causes of Protein Increase

Dehydration, “early” carcinoma, and multiple myeloma (should be correlated with serum protein electrophoresis).

Less Common Causes of Protein Increase

Malignancy, diabetes, rheumatoid arthritis

Common Causes of Protein Decrease

Protein malnutrition, digestive inflammation (colitis, gastritis)

Less Common Causes of Protein Decrease

Hypothyroidism, leukemia, adrenal hyper-function, congestive heart failure

Nutrition Note: If protein and calcium are found to be on the low side of the Optimal range suspect poor protein absorption.
Additional Nutrition Notes: Decreased protein, cholesterol, and SGPT may indicate fatty liver congestion.


The body must have iron to make hemoglobin and to help transfer oxygen to the muscle.

If the body is low in iron, all body cells, particularly muscles in adults and brain cells in children, do not function up to par.

If this test is low you should consider getting a Ferritin test, especially if you are a female who still has menstrual cycles.

  • Clinical Adult Range: 40-150 ug/ml
  • Optimal Adult Range: 50-100 ug/ml
  • Red Flag Range <25 ug/ml or >200 ug/ml

Common Causes of Iron Increase

Hemochromatosis, liver dysfunction, iron therapy, pernicious and hemolytic anemia

Less Common Causes of Iron Increase

Cooking with iron utensils

Common Causes of Iron Decrease

Pathologic bleeding (especially in the geriatric population), iron deficiency anemia

Less Common Causes of Protein Decrease

Chronic infections, kidney and liver problems

Nutrition Note: Increased iron with decreased hematocrit (HCT) suggests intrinsic factor deficiency.
Clinical Notes: An iron evaluation is not complete without ordering Ferritin (see below).


The Ferritin test is considered the “gold standard” in documenting iron deficiency anemia.

Low levels below 25 indicate a need for iron. In contrast, high levels may an inflammatory disorder, infections, rheumatoid arthritis, and chronic kidney disease.

  • Clinical Male Adult Range: 33-236 ng/mL
  • Clinical Female Adult Range (before menopause): 11-122 ng/mL
  • Clinical Female Adult Range (after menopause): 12-263 ng/mL
  • Optimal Male Adult Range: 20-200 ng/mL
  • Optimal Female Adult Range (before menopause): 10-110 ng/mL
  • Optimal Female Adult Range(after menopause): 20-200 ng/mL
  • Red Flag Range <8 ng/mL or >500 ng/mL

Common Causes of Ferritin Increase

Iron overload, hemochromatosis

Less Common Causes of Ferritin Increase

Inflammation, liver disease, rheumatoid arthritis

Common Causes of Ferritin Decrease

Iron deficiency anemia

Less Common Causes of Ferritin Decrease

Free radical pathology

Clinical Notes: If serum ferritin is greater than 1000, suspect hemochromatosis.
Clinical Notes: Iron overload and/or hemochromatosis are silent and can result in cirrhosis of the liver, bacterial infections, dementia, arteriosclerosis, diabetes, and stroke.
Nutrition Note: Doctors specializing in chelation have found a correlation between increased iron and arteriosclerosis.


Triglycerides are fats used as fuel by the body, and as an energy source for metabolism.

Increased levels are almost always a sign of too much carbohydrate intake and hyperlipidism. On the other hand, decreased levels are seen in hyperthyroidism, malnutrition, and malabsorption.

  • Clinical Adult Range: 50-150 mg/dL
  • Optimal Adult Range: 70-110 mg/dL
  • Red Flag Range <35 mg/dL or >350 mg/dL

Common Causes of Triglycerides Increase

Hyperlipidism, diabetes, alcoholism

Less Common Causes of Triglycerides Increase

Hypothyroidism, early stages of fatty liver

Common Causes of Triglycerides Decrease

Chemical/heavy metal overload, liver dysfunction, hyperthyroid function

Clinical Notes: Resistive exercise training has been found to be effective in lowering elevated triglycerides.


Cholesterol is a group of fats vital to cell membranes, nerve fibers, and bile salts, and a necessary precursor for the sex hormones.

High levels indicate a diet high in carbohydrates/sugars.

Low levels indicate a low-fat diet, malabsorption, anemia, liver disorders, and carbohydrate sensitivity.

Cholesterol values below 140 are considered one of the four OMINOUS signs.

  • Clinical Adult Range: 120-200 mg/dL
  • Optimal Adult Range: 150-180 mg/dL
  • Red Flag Range <50 mg/dL or >400 mg/dL

Common Causes of Cholesterol Increase

Early stages of diabetes, fatty liver, arteriosclerosis, hypothyroidism

Less Common Causes of Cholesterol Increase

Biliary obstruction, multiple sclerosis, pregnancy

Common Causes of Cholesterol Decrease

Liver dysfunction, chemical/heavy metal overload, hyperthyroidism, viral hepatitis, free radical pathology

Nutrition Note: Increased cholesterol levels have been found to be lowered by the amino acid methionine.
Clinical Notes: A cholesterol level below 130 is considered one of Four Ominous signs.
Clinical Notes: If cholesterol is above 220 with an SGPT below 10 suspect liver congestion/fatty liver


LDL is the cholesterol-rich remnants of the lipid transport vehicle VLDL (very-low-density lipoproteins) there have been many studies to correlate the association between high levels of LDL and arterial arteriosclerosis.

  • Clinical Adult Range: <130 mg/dL
  • Optimal Adult Range: <120 mg/dL
  • Red Flag Range >180 mg/dL

Common Causes of Cholesterol LDL Increase

Arteriosclerosis, diabetes, Syndrome X

Nutrition Note: Increased cholesterol levels have been found to be lowered by the amino acid methionine


HDL or High-density lipoprotein is the cholesterol carried by the alpha lipoproteins.

A high level of HDL is an indication of a healthy metabolic system if there is no sign of liver disease or intoxication.

The two mechanisms that explain how HDL offers protection against chronic heart disease are that HDL inhibits cellular uptake of LDL and serves as a carrier that removes cholesterol from the peripheral tissues and transports it back to the liver for catabolism.

  • Clinical Adult Males Range: >50 mg/dL
  • Clinical Adult Female Range: >55 mg/dL
  • Optimal Adult Male Range: >55 mg/dL
  • Optimal Adult Male Range: >60 mg/dL
  • Red Flag Range <35 mg/dL

Common Causes of HDL Cholesterol Decrease

Arteriosclerosis, diabetes, Syndrome X

Less Common Causes of HDL Cholesterol Decrease

Cigarette smoking, steroids, beta-blockers

Nutrition Note: Diets high in refined carbohydrates, lack of exercise, and genetic predisposition have been found to lower HDL.
Clinical Notes: If HDL is decreased, triglycerides are greater than 50% of the cholesterol value, LDL is increased and uric acid is increased rule out arteriosclerosis.


The Cholesterol/HDL ratio is an important marker of cardiovascular health. A ratio of <4.0 is considered adequate. A ratio of <3.1 is ideal.

Carbon Dioxide (CO2)

The CO2 level is related to the respiratory exchange of carbon dioxide in the lungs and is part of the body’s buffering system.

Generally, when used with the other electrolytes, carbon dioxide levels indicate pH or acid/alkaline balance in the tissues. This is one of the most important tests that we measure.

Most people have too much acid in their bodies. If you garden you will know that it is very difficult to grow plants in the soil where the pH is incorrect.

Our blood is similar to soil in many respects and it will be difficult to be healthy if our body’s pH is not well balanced. An ABG helps understand the results better.

  • Clinical Adult Range: 24-32 mmol/L
  • Optimal Adult Range: 26-30 mmol/L
  • Red Flag Range <18 mmol/L or >38 mmol/L

Common Causes of CO2 Increase

Alkalosis, hypochlorhydria

Less Common Causes of CO2 Increase

Acute vomiting, fever, adrenal hyper-function, emphysema (respiratory distress)

Common Causes of CO2 Decrease


Less Common Causes of CO2 Decrease

Diabetes, sleep apnea, severe diarrhea

Nutrition Note: Low levels of CO2 may indicate a need for thiamine (a B vitamin).
Clinical Notes: If CO2 is above 32mmol/L, a Pulmonary Function Test should is warranted.


WBC or White blood count measures the total number of white blood cells in a given volume of blood. Since WBCs kill bacteria, this count is a measure of the body’s response to infection.

  • Clinical Adult Range: 4,500-11,000 cubic mm
  • Optimal Adult Range: 5,000-8,000 cubic mm
  • Red Flag Range <3,000 cubic mm or >13,000 cubic mm

Common Causes of WBC Increase

Active Infections, Leukemia, Childhood diseases (measles, mumps, chicken-pox, rubella, etc.

Less Common Causes of WBC Increase

Asthma, emphysema, adrenal dysfunction, intestinal parasites, severe emotional stress

Common Causes of WBC Decrease

Chronic Viral or Bacterial Infections, Lupus (SLE)

Less Common Causes of WBC Decrease

Hepatitis, Immune dysfunction, Chemical/Heavy metal toxicity

Nutrition Note: Decreased WBC may indicate a need for Vitamin B-12, B-6, and folic acid.
Clinical Notes: An increase or decrease in total WBC in conjunction with a lymphocyte count below 20 and serum albumin below 4.0 is a pattern frequently seen in a developing neoplasm (tumor).


Neutrophils are typically elevated in acute infection.

  • Clinical Adult Range: 35-65 percent of total WBC
  • Optimal Adult Range: 40-60 percent of total WBC
  • Red Flag Range <30 percent of total WBC or >80 percent of total WBC

Common Causes of Neutrophils Increase


Common Causes of WBC Decrease


Clinical Notes: Neutrophils tend to increase with chronic bacterial infections and decrease with chronic viral infections.


Monocytes are elevated in bacterial infections and protozoal infections.

  • Clinical Adult Range: 0-10 percent of total WBC
  • Optimal Adult Range: <7 percent of total WBC
  • Red Flag Range >15 percent of total WBC

Common Causes of Monocytes Increase

Bacterial Infections, parasitic infections

Common Causes of WBC Decrease

High doses of corticosteroids will depress monocytes

Clinical Notes: Increased monocytes are frequently present with prostate hypertrophy, and ovarian and uterine dysfunction.
Clinical Notes: An increase in monocytes with an increase in the basophils (>1.0) and a mild increase of eosinophils (>3.0) may indicate intestinal parasites.


Lymphocytes are elevated in acute and chronic infections. Decreased in viral infection and immune deficiency.

  • Clinical Adult Range: 20-40 percent of total WBC
  • Optimal Adult Range: 25-40 percent of total WBC
  • Red Flag Range <20 percent of total WBC or >55 percent of total WBC

Common Causes of Lymphocytes Increase

Chronic viral or bacterial infection, Childhood diseases (measles, mumps, chicken-pox, rubella, etc.), HIV, Hepatitis

Less Common Causes of Lymphocytes Increase

Chemical/heavy metal toxicity

Common Causes of Lymphocytes Decrease

Active infections

Clinical Notes: Suspect viral infections when the lymphocytes increase to a point that either equals or exceeds the neutrophil level.


Eosinophils are elevated in allergic conditions, skin diseases, and parasitic diseases.

  • Clinical Adult Range: 0-7 percent of total WBC
  • Optimal Adult Range: 0-3 percent of total WBC
  • Red Flag Range <20 percent of total WBC or >55 percent of total WBC

Common Causes of Eosinophils Increase

Allergic condition (asthma), food sensitivities, parasitic infection

Less Common Causes of Eosinophils Increase

Chemical/heavy metal toxicity, Hodgkin’s disease, ovarian and bone tumors


Basophils are elevated in Infections.

  • Clinical Adult Range: 0-2 percent of total WBC
  • Optimal Adult Range: 0-1 percent of total WBC
  • Red Flag Range <5 percent of total WBC

Common Causes of Basophils Increase

Inflammation, Childhood diseases (measles, mumps, chicken-pox, rubella, etc.), acute trauma, and parasites

Less Common Causes of Basophils Increase

Chemical/heavy metal toxicity

Clinical Notes: Symptoms of inflammation in the absence of trauma may indicate a need to order C-Reactive Protein and/or a Sed rate.
Clinical Notes: Consider ordering a comprehensive stool and digestive test to rule out intestinal parasites if the basophils are increased with no sign of inflammation.


RBCs (Red Blood Cells) are made in the spleen. Reveals the oxygen-carrying ability of the blood.

  • Clinical Adult Male Range: 4.60-6.0 million cu/mm
  • Clinical Adult Female Range: 3.90-5.50 million cu/mm
  • Optimal Adult Male Range: 4.20-4.90 million cu/mm
  • Optimal Adult Female Range: 3.90-4.50 million cu/mm
  • Red Flag Range for Men <3.90 or >6.00 million cu/mm
  • Red Flag Range for Women <3.50 or >5.00 million cu/mm

Common Causes of RBC Increase

Polycythemia, dehydration, Respiratory Distress (asthma, emphysema)

Less Common Causes of RBC Increase

Acute poisoning, cystic fibrosis, adrenal hyperfunction

Common Causes of RBC Decrease

Iron deficiency anemia, internal bleeding

Less Common Causes of RBC Decrease

Excessive exercise, salicylate toxicity, lead poisoning

Nutrition Tip: Low levels of RBC may indicate a need for B-12, B-6, and folic acid.
Clinical Notes: Consider checking iron and ferritin levels with low levels of RBC.


Hemoglobin: Hemoglobin provides the main transport of oxygen and carbon in the blood. It is composed of “globin”, a group of amino acids that form a protein, and “heme”, which contains iron.

It is an important determinant of anemia (decreased hemoglobin) or poor diet/nutrition or malabsorption.

  • Clinical Adult Male Range: 13.5-18.0 g/dL
  • Clinical Adult Female Range: 12.5-16.0 g/dL
  • Optimal Adult Male Range: 14.0-15.0 g/dL
  • Optimal Adult Female Range: 13.5-14.5 g/dL
  • Red Flag Range <10.0 or >17 g/dL

Common Causes of Hemoglobin Increase

Polycythemia, dehydration, emphysema, asthma

Common Causes of Hemoglobin Decrease

Anemia, internal bleeding, digestive inflammation

Nutrition Tip: Low levels of Hemoglobin may indicate a need for B-12, folic acid, and thiamine.
Clinical Notes: Consider checking iron and ferritin levels with low levels of Hemoglobin.


Hematocrit is the measurement of the percentage of red blood cells in whole blood. It is an important determinant of anemia (decreased), dehydration (elevated), or possible overhydration (decreased).

  • Clinical Adult Male Range: 40.0-52.0 percent
  • Clinical Adult Female Range: 36.0-47.0 percent
  • Optimal Adult Male Range: 40.0-48.0 percent
  • Optimal Adult Female Range: 37.0-44.0 percent
  • Red Flag Range <32.0 or >55 percent

Common Causes of Hematocrit Increase

Same as hemoglobin

Common Causes of Hematocrit Decrease

Same as hemoglobin

Clinical Notes: Suspect Iron anemia if serum iron, hemoglobin, and hematocrit are all low.
Clinical Notes: Suspect B-6 anemia if MCT, hematocrit, and iron are low (also look for a low SGOT).
Clinical Notes: Suspect B12/folic acid anemia if you have a low hematocrit with a high MCH, MCV, and iron.
Clinical Notes: Consider getting a ferritin test.


Platelets are concerned with the clotting of the blood.

  • Clinical Adult Range: 150,000-450,000 cubic mm
  • Optimal Adult Range: 200,000-300,000 cubic mm
  • Red Flag Range <50,000 or >600,000 cubic mm

Common Causes of Platelets Increase

Polycythemia, inflammatory arthritis, several types of anemia, arteriosclerosis, and acute blood loss

Common Causes of Platelets Decrease

Leukemia, liver dysfunction

Less Common Causes of Platelets Decrease

Chemical/heavy metal toxicity

Nutrition Tip: Low levels of Platelets may indicate a B12, folic, selenium, and iron deficiency.
Clinical Notes: The following drugs have been found to lower Platelets: quinidine, heparin, gold salts, sulfas, digitoxin.


Reticulocyte Count is an excellent test to confirm chronic microscopic bleeding.

  • Clinical Adult Range: 0.5-1.5%
  • Optimal Adult Range: same as the clinical range
  • Red Flag Range >2.0%

Common Causes of Reticulocyte Count Increase

Internal bleeding

Common Causes of Reticulocyte Count Decrease

Vitamin b-12, B-6 and folic acid anemia


Mean Corpuscular Volume (MCV) indicates the volume occupied by the average red blood cell.

  • Clinical Adult Range: 81.0-99.0 cubic microns
  • Optimal Adult Range: 82.0-89.9 cubic microns
  • Red Flag Range <78.0 or >95.0 cubic microns

Common Causes of MCV Count Increase

Vitamin B-12/Folic Acid Anemia

Common Causes of MCV Count Decrease

Iron anemia, internal bleeding

Clinical Notes: If the MCV is >89.9 and the MCH is >31.9, suspect Vitamin B-12 or folic anemia. This should be confirmed with a serum or urinary methylmalonic (vitamin B-12) and a serum or urinary homocysteine (folic acid and vitamin B-6).
Clinical Notes: If iron and ferritin are normal and MCV, MCH, Hemoglobin, and Hematocrit are all decreased, suspect a toxic metal body burden.


Mean Corpuscular Hemoglobin (MCH) indicates the volume occupied by the average red blood cell.

  • Clinical Adult Range: 26.0-33.0 micrograms
  • Optimal Adult Range: 27.0-31.9 micrograms
  • Red Flag Range <24.0 or >34.0 micrograms

Common Causes of MCV Count Increase:

Vitamin B-12/Folic Acid Anemia

Common Causes of MCV Count Decrease

Iron anemia, internal bleeding

Clinical Notes: If the MCV is >89.9 and the MCH is >31.9, suspect Vitamin B-12 or folic anemia. This should be confirmed with a serum or urinary methylmalonic (vitamin B-12) and serum or urinary homocysteine (folic acid and vitamin B-6).
Clinical Notes: If iron and ferritin are normal and MCV, MCH, Hemoglobin, and Hematocrit are all decreased, suspect a toxic metal body burden


T3 (Tri-Iodothyronine) is a thyroid hormone produced mainly from the peripheral conversion of thyroxine (T-4).

  • Clinical Adult Range: 22-33%
  • Optimal Adult Range: 26-30%

Common Causes of T3 Increase


Common Causes of T3 Decrease



T-4 (Tetra-Iodothyronine) is the major hormone secreted by the thyroid gland.

  • Clinical Adult Range: 4.0-12.0 mcg/dL
  • Optimal Adult Range: 7.0-8.5 mcg/dL

Common Causes of T4 Increase


Common Causes of T3 Decrease

Hypothyroidism, anterior pituitary hypo-function


T7 (FTI-Free Thyroxine Index) is an estimate, calculated from T-4 and T-3 uptake.

  • Clinical Adult Range: 4.0-12.0 mcg/dL
  • Optimal Adult Range: 7.0-8.5 mcg/dL

Common Causes of T7 Increase

See T-3 uptake

Common Causes of T3 Decrease

See T-3 uptake


T-3 Uptake measures the unsaturated binding sites on the thyroid binding proteins.

  • Clinical Adult Range: 22-36%
  • Optimal Adult Range: 27-37%
  • Red Flag Range <20 percent of uptake or >39 percent of uptake

Common Causes of T-3 Uptake Increase

Thyroid hyperfunction

Less Common Causes of T-3 Uptake Increase

Kidney dysfunction, salicylates toxicity, and protein malnutrition

Common Causes of T3 Decrease

Thyroid hypo-function


TSH (Thyroid Stimulating Hormone) is used to confirm or rule out suspected hypothyroidism when T3, T4, and T7 are essentially normal and clinical signs suggest hypothyroidism.

  • Clinical Adult Range: 0.4-4.4 mlU/L
  • Optimal Adult Range: 2.0-4.0 mlU/L
  • Red Flag Range <0.3 mlU/L or >10.0 mlU/L

Common Causes of TSH Increase

Thyroid hypofunction

Less Common Causes of TSH Increase

Liver dysfunction

Common Causes of TSH Decrease

Thyroid hyper-function, anterior hypo-function

Clinical Notes: The axillary temperature (underarm) will frequently be <97.8 with thyroid hypo-function. The axillary temperature should be taken for 10 minutes before leaving the bed and ideally should be taken for five days in a row and averaged. Reduced axillary temperature is common with adrenal stress, thiamine deficiency, diets low in essential fatty acids, and protein malnutrition.
Clinical Notes: Difficulty losing weight, fatigue, lack of motivation, sensitivity to cold, dry or scaly skin, ringing in ears, low blood pressure, impaired hearing, constipation, difficulty working under pressure, and headaches that start in the morning but improve during the day.

ESR (Erythrocyte Sedimentation Rate)

ESR (Erythrocyte Sedimentation Rate) documents if the organic disease is truly present in patients with vague symptoms. Monitors the course of chronic inflammatory conditions. Elevated in patients with a breakdown of tissue.

  • Clinical Adult Male <50 Range: 0-15mm/hour
  • Clinical Adult Male >50 Range: 0-20mm/hour
  • Clinical Adult Male <50 Range: 0-25mm/hour
  • Clinical Adult Female >50 Range: 0-30mm/hour
  • Optimal Adult Male Range: <5mm/hour
  • Optimal Adult Female Range: <10mm/hour
  • Red Flag Range >45 mm/hour

Common Causes of ESR Increase

Tissue Inflammation