Comprehensive Laboratory Reference Chart

Essential Laboratory Values for Clinical Practice with Psychiatric Applications

Test Reference Range Clinical Notes
Hemoglobin A1c
%		 < 5.7%
Clinical Significance: Reflects average blood glucose over 2-3 months
Prediabetes: 5.7-6.4%
Diabetes: ≥6.5%
🧠 Psychiatric Relevance:
Antipsychotic medications, particularly atypicals, increase diabetes risk. Regular A1c monitoring essential for patients on olanzapine, clozapine, risperidone, and quetiapine.
TSH with Reflex to Free T4
mIU/L		 21+ years: 0.550 - 4.780
13-20 years: 0.480 - 4.170
2-12 years: 0.670 - 4.160
0-1 year: 0.870 - 6.150
Hyperthyroidism: TSH <0.5 mIU/L
Hypothyroidism: TSH >5.0 mIU/L
Subclinical dysfunction: Abnormal TSH with normal Free T4
🧠 Psychiatric Relevance:
Thyroid dysfunction can mimic psychiatric disorders. Lithium therapy may cause hypothyroidism. Monitor TSH every 6-12 months in lithium-treated patients.
Cortisol
mcg/dL		 7-9 AM: 5.3 - 22.5
4-6 PM: 3.4 - 16.8
Circadian Rhythm: Late afternoon levels fall to approximately half of morning levels
Collection: Morning sample preferred for screening
🧠 Psychiatric Relevance:
Elevated cortisol associated with depression and anxiety. Consider dexamethasone suppression test for suspected Cushing's syndrome in treatment-resistant depression.

Estimated Glomerular Filtration Rate (eGFR)

The eGFR provides an estimate of kidney function based on serum creatinine levels. Understanding eGFR is crucial for medication dosing and identifying chronic kidney disease.

Age Group Normal eGFR (mL/min/1.73m²) Clinical Interpretation
20-29 years 116 mL/min/1.73m² Normal: ≥60 mL/min/1.73m²
Mild CKD (Stage 2): 60-89 mL/min/1.73m²
Moderate CKD (Stage 3a): 45-59 mL/min/1.73m²
Moderate CKD (Stage 3b): 30-44 mL/min/1.73m²
Severe CKD (Stage 4): 15-29 mL/min/1.73m²
Kidney Failure (Stage 5): <15 mL/min/1.73m²
30-39 years 107 mL/min/1.73m²
40-49 years 99 mL/min/1.73m²
50-59 years 93 mL/min/1.73m²
60-69 years 85 mL/min/1.73m²
70+ years 75 mL/min/1.73m²

eGFR Calculation Methods

The transition from MDRD to the 2021 CKD-EPI equation eliminates race-based adjustments while maintaining clinical accuracy.

2021 CKD-EPI Equation (Race-Neutral):
142 × min(Scr/κ, 1)^α × max(Scr/κ, 1)^-1.200 × 0.9938^Age × 1.012 [if female]

Where:
• Scr = standardized serum creatinine in mg/dL
• κ = 0.7 (females) or 0.9 (males)
• α = -0.241 (female) or -0.302 (male)
Important: eGFR will not calculate if the patient is under age 18 or if patient sex is not specified as male or female.

eGFR vs mGFR: Understanding the Differences

Aspect Estimated GFR (eGFR) Measured GFR (mGFR)
Method Calculation using creatinine or cystatin C Direct measurement using inulin or iohexol
Accuracy May yield less accurate estimates of GFR in certain populations or clinical conditions Accurate measures of GFR, including early stages of kidney disease
Precision Can miss early GFR changes Can identify early GFR changes, such as rapid decreases
🧠 Clinical Application in Psychiatry:

In psychiatry, routine monitoring of eGFR is essential for patients on medications such as lithium, where renal impairment may alter drug metabolism and toxicity risk. Dose adjustments are required when eGFR falls below 60 mL/min/1.73m². Additionally, psychiatric disorders, including depression and anxiety, are prevalent in individuals with CKD, with prevalence rates of depression up to 22.8% in advanced CKD and anxiety up to 34.3%. Lower eGFR correlates with increased psychiatric symptom burden and poorer mental health outcomes (Dalal et al., 2022).

Additional Renal Considerations in Psychiatric Care

Test Reference Range Psychiatric Relevance
Urine Protein/Creatinine Ratio (UPCR)
mg/g		 <150 mg/g (normal)
>300 mg/g (significant proteinuria)		 Elevated proteinuria is associated with increased risk of psychiatric comorbidities in chronic glomerular disease. Higher UPCR correlates with greater psychiatric symptom burden (Desmond et al., 2021).
Albumin
g/dL		 3.5 - 5.0 g/dL Low serum albumin in dialysis patients is associated with cognitive decline and impaired memory (Dalal et al., 2022). Monitor nutritional status and protein binding capacity, which affects psychotropic medication distribution.
Renal Function Panel
(Creatinine, BUN, Electrolytes)		 Laboratory-specific ranges Renal impairment alters metabolism and clearance of psychotropic medications. Interpret results in context of medication pharmacokinetics and psychiatric symptomatology (Dalal et al., 2022).
Test Reference Range Clinical Notes
Erythrocyte Sedimentation Rate (ESR)
mm/hr		 Male 0-50 years: 0-15
Male >50 years: 0-20
Female 0-50 years: 0-20
Female >50 years: 0-30
Elevated ESR: Infection, inflammation, malignancy, autoimmune disease
Very High ESR (>100): Consider multiple myeloma, temporal arteritis, severe infection
🧠 Psychiatric Relevance:
Elevated ESR may indicate underlying medical conditions contributing to psychiatric symptoms. Consider in workup of delirium or new-onset psychiatric symptoms in elderly patients.
C-Reactive Protein (CRP)
mg/dL		 0.0 - 0.5
Mild Elevation (0.6-1.0): Low-grade inflammation
Moderate Elevation (1.1-10.0): Active inflammation
Severe Elevation (>10.0): Severe bacterial infection, tissue necrosis
🧠 Psychiatric Relevance:
Emerging research links chronic inflammation to depression and cognitive disorders. CRP may be useful in treatment-resistant depression evaluation.
Test Reference Range Clinical Notes
Vitamin B12
pg/mL		 211 - 911
Deficiency: <200 pg/mL
Borderline: 200-300 pg/mL
Causes: Pernicious anemia, malabsorption, vegan diet
🧠 Psychiatric Relevance:
B12 deficiency can present with depression, cognitive impairment, and psychosis. Essential screening in elderly patients with new psychiatric symptoms.
Folate
ng/mL		 > 5.4
Deficiency: <3.0 ng/mL
Causes: Poor diet, malabsorption, alcohol use, medications
🧠 Psychiatric Relevance:
Folate deficiency associated with depression and cognitive impairment. Some antidepressants (e.g., lamotrigine) may affect folate metabolism.
Vitamin D, 25-Hydroxy
ng/mL		 Deficiency: <20
Insufficiency: 20-30
Sufficiency: 31-100
Toxicity: >100
Risk Factors: Limited sun exposure, dark skin, malabsorption
Symptoms: Bone pain, muscle weakness, fatigue
Supplementation Studies: Mixed results in improving mental health outcomes, though screening may be relevant in mood disorder management (Guzek et al., 2021)
🧠 Psychiatric Relevance:
Low serum 25(OH)D levels are associated with increased symptoms of depression and anxiety. Vitamin D plays a role in neuroinflammation and oxidative stress modulation, particularly relevant in psychiatric populations. Evaluate for potential contribution to mood and anxiety symptoms, especially in patients with limited sunlight exposure, chronic illness, or poor dietary intake (Akpınar & Gezmen Karadağ, 2022).

References

eGFR Calculations:

Inker, L. A., Eneanya, N. D., Coresh, J., Tighiouart, H., Wang, D., Sang, Y., Crews, D. C., Doria, A., Estrella, M. M., Froissart, M., Grams, M. E., Greene, T., Grubb, A., Gudnason, V., Gutiérrez, O. M., Kalil, R., Karger, A. B., Mauer, M., Navis, G., Nelson, R. G., ... Chronic Kidney Disease Epidemiology Collaboration. (2021). New creatinine- and cystatin C–based equations to estimate GFR without race. New England Journal of Medicine, 385(19), 1737–1749. https://doi.org/10.1056/NEJMoa2102953

National Kidney Foundation & American Society of Nephrology. (2021). Reassessing the inclusion of race in diagnosing kidney diseases. https://www.kidney.org/professionals/guidelines/gfr

Psychiatric Applications:

Akpınar, Ş., & Gezmen Karadağ, M. (2022). Is Vitamin D important in anxiety or depression? What is the truth? Current Nutrition Reports, 11(4), 675–681. https://doi.org/10.1007/s13668-022-00441-0

Dalal, P. K., Kar, S. K., & Agarwal, S. K. (2022). Management of psychiatric disorders in patients with chronic kidney diseases. Indian Journal of Psychiatry, 64(Supplement 2), S394–S401.

Desmond, H. E., Lindner, C., Troost, J. P., Held, Z., Callaway, A., Oh, G. J., Lafayette, R., O'Shaughnessy, M., Elliott, M., Adler, S. G., Kamil, E. S., Pesenson, A., Selewski, D. T., Gipson, P. E., Carlozzi, N. E., Gipson, D. S., & Massengill, S. F. (2021). Association between psychiatric disorders and glomerular disease. Glomerular Diseases, 1(3), 118–128. https://doi.org/10.1159/000516359

Guzek, D., Kołota, A., Lachowicz, K., Skolmowska, D., Stachoń, M., & Głąbska, D. (2021). Association between vitamin D supplementation and mental health in healthy adults: A systematic review. Journal of Clinical Medicine, 10(21), 5156. https://doi.org/10.3390/jcm10215156

Note: Reference intervals are laboratory-specific. Always refer to your local laboratory's established ranges for clinical decision-making. This chart provides commonly used reference intervals and should not replace clinical judgment or laboratory guidelines.

Disclaimer

The information provided in this Comprehensive Laboratory Reference Tool is intended solely for educational and informational purposes. It does not constitute medical advice, diagnosis, or treatment, nor does it establish a provider-patient relationship. While efforts have been made to ensure the accuracy and clinical relevance of the content, PsychConcierge PLLC and PsychConcierge.com make no warranties, express or implied, regarding the completeness, reliability, or applicability of the information presented. Users are strongly encouraged to consult their licensed healthcare provider or local clinical laboratory for interpretation of laboratory values and individualized medical decisions. Reference ranges may vary by lab and patient population. PsychConcierge PLLC assumes no responsibility for any outcomes arising from reliance on this tool.