Skip to Content

HIV Biochemical Tests

← Back Return to Story

Laboratory Results

Flags: H High • L Low • N Within reference. 
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian assesses)
Anion Gap (8–16 mmol/L) 22 H 16 N 15 N 14 N Improves during admission
  • Acid–base context: Guides carbohydrate reintroduction speed (avoid worsening acidosis if severe).
  • Diarrhoea loss: Low HCO₃⁻ from GI losses explains early fatigue/poor intake.
Urea (3.0–8.5 mmol/L, adult male) 6.3 N — — — Serum urea within range.
  • Protein adequacy: Very low values can reflect low protein intake; rising with dehydration.
  • Trend with intake/hydration to judge response to nutrition plan.
Bicarbonate (HCO₃⁻) (22–29 mmol/L) 20 L 23 N 24 N — Improved with fluids.
  • Feeding tolerance: Low HCO₃⁻ → fatigue, dyspnoea; adjust meal size/timing.
  • ORS: Reinforces need for balanced oral rehydration when diarrhoea active.
Calcium, corrected (2.10–2.60 mmol/L) 2.10 N 2.20 N 2.20 N 2.10 N Low–normal / Improving.
  • Protein binding: Low albumin lowers total Ca — prioritise protein repletion.
  • Symptoms: Watch paresthesias/cramps if ionized Ca low.
Chloride (98–107 mmol/L) 88 L 91 L 95 L 97 L Persistent mild hypochloremia early.
  • GI losses: Supports chloride/sodium replacement priorities.
  • Palatability: Use broths/salty foods if acceptable to boost intake & Cl⁻.
Creatinine (60–110 µmol/L) 39 L 40 L — — Low from reduced muscle mass.
  • eGFR caveat: May overestimate renal function—be cautious with protein/Phos loads if true GFR lower.
  • Lean mass: Track with weight/functional status as nutrition improves.
Magnesium (0.75–1.00 mmol/L) 0.81 N — — —
  • Refeeding risk: Keep watching as intake increases; Mg drops can trigger cramps/arrhythmia.
  • Food sources: Nuts, beans, whole grains if tolerated.
Phosphate (0.80–1.50 mmol/L) 0.86 N — — —
  • Refeeding marker: Falling PO₄ after feeding needs rapid response.
  • Energy metabolism: Adequate PO₄ supports ATP—fatigue improves with repletion.
Potassium (3.5–5.1 mmol/L) 3.4 L 3.4 L 4.0 N 3.9 N
  • GI losses: Replace with diet (bananas, potatoes) as diarrhea settles; review meds (diuretics).
  • Feeding safely: Correct K with Mg to prevent refractory hypokalemia.
Sodium (135–145 mmol/L) 130 L 130 L 136 N 135 N
  • ORS strategy: Use iso-osmolar fluids; avoid excessive free water.
  • Appetite: Hyponatremia can worsen nausea—improves with balanced intake.
eGFR (≥90 mL/min/1.73 m²) 96 N — — —
  • Dosing context: Guides protein targets and supplement choice if renal disease present.
  • Low Cr caveat: Consider cystatin C if clinically indicated (not a diet order—context for MDT).
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian cares)
WCC (4.0–11.0 ×10⁹/L) 54 H 35 H 21 H —
  • Inflammation load: Higher protein/energy needs; small, frequent meals to meet demand.
  • Food safety: Immunosuppressed precautions during neutropenic periods if applicable.
RBC (4.5–6.0 ×10¹²/L, male) 3.1 L 3.2 L 3.6 L 3.6 L
  • Exercise tolerance: Plan meal timing around breathlessness/fatigue.
  • Micronutrients: Ensure iron, B12, folate evaluation (see profile).
MCV (80–100 fL) 77 L — — —
  • Iron deficiency signal: Supports iron-rich foods and timing with enhancers (vitamin C).
  • Avoid inhibitors: Separate tea/coffee, calcium from iron dosing/iron-rich meals.
MCH (27–33 pg) 22 L — — —
  • Hypochromia: Aligns with iron deficiency—reinforces education points above.
MCHC (320–360 g/L) 280 L — — —
  • Color index: Tracks hemoglobinization improvement with iron therapy.
Prothrombin Time (11.0–13.5 s) 13.0 N — — —
  • Fat-soluble vitamins: If prolonged later, consider vitamin K status/absorption with prolonged antibiotics/diarrhea.
Total Bilirubin (5–21 µmol/L) 11 N — — —
  • Liver handling: Normal now; continue gentle fat if nausea; monitor with TB/ART.
Conjugated Bilirubin (0–8 µmol/L) 7 N — — —
  • Cholestasis screen: Diet fat tolerance if rises; choose MCT if indicated by MDT.
Platelets (150–400 ×10⁹/L) 266 N — — —
  • Procedure safety: Adequate for enteral access if ever required.
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian cares)
Glucose, random (3.0–7.7 mmol/L) 10.4 H 7.2 N 6.8 N 4.6 N
  • Stress hyperglycemia: Start with lower-sugar ONS while acutely unwell; liberalise as normalises.
  • Energy distribution: Even CHO across the day aids appetite and glycemic comfort.
HbA1c (<42 mmol/mol • <6.0%) — 5.2% N — —
  • No diabetes: No need for restrictive diabetic diet; focus on protein-energy density.
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian cares)
C-reactive protein (0–6 mg/L) 37 H 41 H 36 H 37 H
  • Acute-phase: Explains low albumin/pre-alb; don’t underfeed based on these alone.
  • ONS choice: Energy-dense, easy to swallow; antiemetic timing before meals.
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian cares)
Hemoglobin (male) (13.5–17.5 g/dL) 10.7 L 10.4 L — —
  • Fatigue/DOE: Offer smaller, softer meals; add liquid calories.
  • Iron plan: Food + supplements per MDT; vitamin C pairing improves absorption.
Hematocrit (male) (41–53 %) 25.4 L 28.2 L 28.6 L 29.6 L
  • Endurance: Schedule meals when least breathless; fortify foods.
Myoglobin (30–90 µg/L) 41 N — — —
  • Muscle injury screen: Normal—focus on rebuilding lean mass with adequate protein.
Folate (4–20 ng/mL) 6.2 N — — —
  • Balance: With B12 low, avoid masking neurological issues—treat B12 first if supplementing.
Ferritin (15–200 µg/L) — 11 L — —
  • Low iron stores: Supports iron-deficiency anemia dx in right clinical context.
  • Inflammation confounder: Low despite high CRP is strongly suggestive of true deficiency.
Iron (10–30 µmol/L) — 5.8 L — —
  • Circulating iron: Reinforces need for iron-rich foods and schedule with enhancers.
Vitamin B12 (200–900 pg/mL) — 107 L — —
  • Neurologic risk: Monitor paresthesias, glossitis, appetite impact.
  • Diet tips: Animal proteins, fortified foods; coordinate supplementation with MDT.
Transferrin Saturation (20–45 %) — 46% H — — Value “46” interpreted as % saturation for physiology; please confirm unit in LIS.
  • If % sat: Borderline high—can fluctuate; interpret alongside low ferritin/iron → still deficient.
  • If transferrin (g/L): Different meaning—await confirmation before acting.
CD4 Count (>500 cells/mm³) 333 L — — —
  • Opportunistic risk: Emphasise food safety; manage oral candidiasis impact on texture/taste.
  • Energy/protein: Higher needs during infections; gentle progression.
HIV Viral Load (<1000 copies/mL) 1776 H — — —
  • Adherence support: Simplify meal plans around ART timing; manage nausea/diarrhea triggers.
  • Weight loss risk: If VL persists, anticipate prolonged catabolism—fortify aggressively.
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian cares)
Triglycerides (<1.7 mmol/L) 1.33 N — — —
  • ONS selection: Choose formulas that won’t exacerbate hypertriglyceridemia if it appears while on ART.
Total Cholesterol (<5.2 mmol/L) 5.1 N — — —
  • Plan: Focus short-term on repletion; long-term fibre/unsaturated fats.
HDL-C (≥1.0 mmol/L, male) 1.0 N — — —
  • Activity: As recovery allows, encourage walking Plan: Focus short-term on repletion; long-term fibre/unsaturated fats..
LDL-C (<3.5 mmol/L) 2.5 N — — —
  • No restriction now: Do not limit energy density based on LDL during acute illness.
Test (Reference) ED Day 1 Day 3 Day 6 Comments (Why the dietitian cares)
ALT (5–45 U/L) 33 N — — —
  • Tolerances: If enzymes rise, pivot to lighter, lower-fat meals to reduce nausea.
AST (10–45 U/L) 42 N — — —
  • TB/ART overlap: Monitor with medications that can affect liver.
ALP (30–120 U/L) 101 N — — —
  • Cholestasis screen: If elevated with bili, consider MCT; currently not indicated.
GGT (10–60 U/L) 34 N — — —
  • Medication effect: Watch trends with TB therapy.
Albumin (35–50 g/L) 24 L 27 L 28 L 28 L
  • Not a calorie gauge: Low from inflammation; still feed adequately.
  • Edema: If present, focus on protein-dense foods within sodium plan.
Pre-albumin (18–38 mg/dL) — 9 L 11 L 13 L
  • Short half-life: Useful to see response over days as CRP falls.
  • Meal design: Add powdered milk, eggs, legumes, soft meats per tolerance.
Total Protein (60–80 g/L) 58 L — — —
  • Global status: Reinforces need for enriched meals and ONS.

Vitals & Weights

Item Shift ED Day 1 Day 2 Day 3
Pulse (bpm) 07:00–15:00 114 112 108 101
Pulse 15:00–23:00 111 110 108 99
Pulse 23:00–07:00 90 89 85 92
SpO₂ (%) • Target 94–98% 07:00–15:00 89 88 87 89
Temperature (°C) 07:00–15:00 39.2 38.1 38.4 37.5
Blood Pressure (mmHg) 07:00–15:00 190/99 144/91 140/89 142/90
Blood Pressure 15:00–23:00 156/98 150/93 147/88 141/86
Blood Pressure 23:00–07:00 — 139/88 134/85 131/83
Oral Fluid Intake (mL/24 h) 24 h — 750 1000 1100
IV Fluid (NaCl 0.9%) (mL/24 h) 24 h — 3600 3400 3000
Urine Output (mL/24 h) 24 h — 1800 2100 2200
Stool Output — — Watery Watery Soft
Pain (0–5) (0=no pain, 5=severe) — 3 3 2 2
Related — Intake–Output Chart

Respiratory Rate Charts (linked images)

Dates presented as DD/MM/YYYY to avoid ambiguity.
ED • 10/09/2023 — Open ED RR chart
Day 1 AM • 11/09/2023 — Open Day-1 AM RR chart

Imaging & Procedures

Date Study Author Notes / Source
10/09/2023 Bacterial Pneumonia CXR O’Shane, MD Bacterial pneumonia (R middle lobe). Source: Medscape
10/09/2023 Bronchopneumonia CXR O’Shane, MD Bronchopneumonia with scattered nodular opacities involving more than one lobe. Source: Radiopaedia
10/09/2023 Bronchopneumonia lateral O’Shane, MD Bronchopneumonia lateral view (multi-lobar involvement). Source: Radiopaedia
10/09/2023 Pleural effusion AP O’Shane, MD Patchy R lung airspace opacity (bronchopneumonia). L lung clear. No pleural effusion. Source: Radiopaedia
10/09/2023 Pleural effusion lateral O’Shane, MD R bronchopneumonia, L lung clear; no effusion on this view. Source: Radiopaedia
Date & Time Study Author Notes / Source
10/09/2023 CT axial delayed O’Shane, MD LLL consolidation with atelectasis; moderate L pleural effusion extending to oblique fissure; tiny R effusion. Source: Radiopaedia
10/09/2023 CT axial lung window O’Shane, MD LLL consolidation/atelectasis with moderate L effusion; very small R effusion. Source: Radiopaedia

Teaching Video

For student review (external)

Dietitian's Rationale

Marker Key Takeaways 
Nutritional Status Inflammation + low albumin/pre-alb → replete without waiting for labs to rise; energy-dense, high-protein small meals/snacks; continue ONS; texture-soft if oral discomfort.
Iron & RBC Indices Low ferritin/iron with microcytosis → iron food strategy + vitamin C pairing;
coordinate supplementation with MDT.
B12/Folate B12 deficiency likely contributing to fatigue/appetite; implement repletion plan and reinforce dietary sources; treat B12 before high-dose folate.
Electrolytes/Fluids Early hypo-Na/K with watery stools → balanced ORS; potassium/Mg-rich foods as GI settles; monitor PO₄/Mg during refeeding.
Respiratory/Infection Low SpO₂ and high CRP → high energy cost of breathing; short, frequent meals; time meals after physio/nebulizers; consider supplements when most comfortable.
Glucose Transient stress hyperglycemia only; avoid unnecessary sugar restriction but choose balanced ONS in acute phase.
ART/Drug–Nutrition Align meals with ART timing; manage nausea/dysgeusia; monitor liver profile with TB therapy; sustain adherence by simplifying food routines.
 
← Back Return to Story
 
Updated October 23, 2025
Exit Full Screen