A few weeks ago a patient I was seeing in the office asked me to look at a copy of his lab work he’d received from an alternate medicine provider. It was the usual chemistry screen and all looked great, to me at least. But two figures were circled, a slightly low creatinine level and a slightly high BUN/creatinine ratio, and yes, the lab printout had those in the out-of-normal range. His provider had asked that he come back in several weeks and have them rechecked. The retest would cost around $150.
This jogged my memory of some wise advice one of my medical school professors taught: Doing a medical test is useless if you have no idea what you’re going to do with the results.
And you’re not going to do much if there’s no danger from a slight abnormality. This goes for everyday situations and survival ones.
Thinking It Through
Creatinine is one sign of how well your kidneys are working. Every day your body breaks down a small portion of your muscle, and creatinine is a byproduct. It’s excreted out your kidneys. The higher above normal your creatinine level is, the less well your kidneys are probably working. But a slightly low creatinine reading in an otherwise healthy person basically indicates nothing. I mention otherwise healthy because it could rarely mean someone isn’t getting enough protein in their diet. I mean, like starving low.
The BUN/creatinine listing in the lab results indicates the ratio of BUN to creatinine. BUN stands for blood urea nitrogen. When the liver breaks down protein, urea is a byproduct, and it’s excreted in the kidneys, so high means possible kidney function problems. High can also indicate dehydration. Or, as in this man’s case, it can mean … let’s see.
OK, so he has a slightly low creatinine. He looks healthy and eats a varied diet. His BUN is actually normal, but his BUN/creatinine ratio is slightly high but it’s only because his creatinine is a little low.
According to these figures, should he be worried? Should he be retested to see if these figures have changed?
In my opinion the answer is no to both. Sure the numbers are slightly out of range, but if anything, his kidneys are working better than normal.
Here’s the point. If you do a test, know what to do with it. If a provider tests you, ask for a quick explanation of why. What’s it going to show? How’s it going to help in treatment? If something’s deemed abnormal, then dig a little deeper and do some research on your own.
Emergency Example 1: Low Blood Pressure
My best example of when “abnormal” may be OK in an emergency situation is a somewhat low blood pressure. Now, sometimes this can be a red flag that something bad is going on—blood loss, dehydration, heart problems, or maybe a medicine is doing it—but many extremely healthy people have blood pressures that normally run on the low side, and this is actually considered very healthy.
So if you check a blood pressure and it’s a little low, find out, if you can, what pressure they usually run. An everyday BP of less than 120/80 can actually be healthier. Also, usually if the low blood pressure means something ominous, the person is going to be dizzy, feel faint, or at least feel weak.
Know some of the common reasons for an abnormally low pressure, as mentioned above. And look for other signs or symptoms of those reasons. But if the person is doing just fine and is alert, there’s no reason to worry solely on the basis that the blood pressure is a little “low.”
One caveat: Very few healthy people are going to have high number (systolic) reading below 90. If it’s below that, even if you can’t find a reason, it’s best to have it checked out.
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Emergency Example 2: Slightly Nonaverage Body Temperature
Body temperature is another example. Actually no one runs an oral 98.6 F. all the time. In fact, a study done about 10 years ago showed that on average, an oral temperature taken under the tongue is 98.2. And in everyone the temperature fluctuates up and down by as much as 1 degree each way each day.
Also remember we’re talking averages here. For an average we add up a bunch of people’s numbers and divide by the number of people. So some people’s normal temperature may reach 97 or lower, or up to 99.5.
The bottom line here is don’t assume something bad is going on if the person feels OK but has a temperature not quite the average.
My Tips for What to Do
Now, while it’s true that in everyday life, something like a really high cholesterol level or blood pressure may be your only clue that you need to start treatment to prevent bad things, in emergency situations, look at the overall patient.
If you can’t find a pulse or blood pressure but the person is sitting up talking to you, don’t start chest compressions. Rather, you might want to check again or make sure your equipment is in order. If your findings are still abnormal, start looking for the why or get the person to someone who can figure it out as soon as you can. Because in the end, a test is useless if you don’t know what to do with the results.
What about you? Have you ever had tests that came back “better than normal?” If you were assessing someone in distress, until medical help arrived or if was inaccessible, would you know what to do with your results of the assessment?
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