To the Editor:
In the Clinical Outlook column "Tips on Promoting Food and Fluid Intake in the Elderly" by Dolores M. Alford, PhD, RN, FAAN (1991; 17(11):4446), in the first column, it states ". . . serum cholesterol (if value is allowed to go below 160 mg/dL, death may ensue). . . ." Then, in the Table on page 46, the values of normal for "cholesterol, total serum" are listed as 150 to 200 mg/ dL.
Is this an error? If we look at the Table's norms and compare them with the sentence, there is a contradiction. Another source I checked agreed with the Table - the norms for serum cholesterol are 150 to 200 mg/dL. Therefore, should the sentence on page 46 read "below 150 mg/dL"?
Kathy Walker, LPN
Buffalo, New York
The Author Responds:
Thank you for your letter; you were very astute in your questions concerning cholesterol values.
One of the important considerations nurses must address in reading and interpreting lab values is to use the normal reference values (NRV) of the lab doing the testing and generating the report.
Therefore, the information you question is correct, based on the lab whose NRVs I was using.
Verdery, in his article, was using the NRVs from the clinical lab at his facility, as were Collingsworth et al in their article. Do read these references for they are superb.
In determining cholesterol values as an indicator in starvation, one should start with values below 160 mg/dL and compute the values from there - after reading the current literature on starvation to get an idea of the ranges of lab values. In my practice, I see cholesterol values of 50 to 80 mg/dL with other abnormal tests and findings that indicate starvation. The real secret to understanding starvation is not just one lab value, but a whole array of deranged physiological mechanisms.
I do hope that this explanation helps you. Again, thank you for taking the time to make your inquiry.
Dolores M. Alford, PhD, RN,
Gerontic Nursing Consultant