Pediatric Nutrition in Practice

24 Himes  Shulman

Test (specimen) Normal range^1 Function/description Deficiency Pitfalls to avoid

Albumin
(serum)

Infant: 29 – 55 g/l

Child: 37 – 55 g/l [2]

Most abundant serum

protein, half-life 20 days

Negative acute-phase reactant

↓ with hepatic synthetic

dysfunction

Changes with hydration status

and fluid shifts

Alkaline
phosphatase
(serum)

Infant: 150 – 420 U/l

2 – 10 years: 100 – 320 U/l

Adolescent boy: 100 – 390 U/l

Adolescent girl: 100 – 320 U/l

Adult: 30 – 120 U/l

Zinc-dependent metallo-

enzyme found in liver, bone,

biliary epithelium, kidney

and intestine

Low alkaline phosphatase

warrants consideration of zinc

deficiency

α 1 -Antitrypsin
(stool)

<6 months: <4.5 mg/g of stool

>6 months: <3 mg/g of stool [3]

Measure of protein loss from

the gut

Unstable at pH <3, unsuitable

to assess gastric protein loss [4]

Biotin
(serum)

214 – 246 pmol/l [5] Water-soluble vitamin,

cofactor for carboxylases

Dermatitis, glossitis, alopecia,

poor growth, ataxia, weakness,

depression and seizures

Anticonvulsants, hemodialysis

and parenteral nutrition may

give rise to deficiency

Calcium
(serum)

Preterm: 1.6 – 2.8 mmol/l

Term to 10 days: 1.9 – 2.6 mmol/l

10 days to 2 years: 2.3 – 2.8 mmol/l

2 – 12 years: 2.2 – 2.7 mmol/l

Adult: 2.2 – 2.5 mmol/l

Skeletal integrity, cofactor

in clotting cascade and

neuromuscular function

Fatigue, muscular irritability,

tetany and seizures

Factitious hypocalcemia caused

by low albumin (50% is bound

to albumin)

Ceruloplasmin
(serum)

Birth to 3 months: 40 – 160 mg/l

3 – 12 months: 290 – 380 mg/l

1 – 15 years: 230 – 490 mg/l [3]

Carries 90% of serum copper Positive acute-phase reactant

Copper
(serum)

11 – 22 μmol/l [2] Mineral cofactor for

superoxide dismutase and

enzymes of connective

tissue synthesis

Anemia, neutropenia,

depigmentation, characteristic

hair changes, weakened bone

and connective tissue [5]

Supraphysiologic doses of iron

or zinc may impair absorption

of copper [5]

Creatinine
(serum)

Neonate: 27 – 88 μmol/l

Infant: 18 – 35 μmol/l

Child: 27 – 62 μmol/l

Adolescent: 44 – 88 μmol/l

Adult male: 80 – 115 μmol/l

Adult female: 53 – 97 μmol/l

Product of muscle creatinine-

phosphate metabolism; level

parallels muscle mass

Diminished glomerular

filtration rate, cimetidine,

cephalosporins and

trimethoprim may increase

serum creatinine [6]

Elastase
(stool)

>200 μg/g of stool Indicator of exocrine

pancreas sufficiency

Sensitivity and specificity in

mild insufficiency unclear [8]

Fat
(stool)

<3 years: >85%

>3 years: >95%

(expressed as coefficient of

absorption)

Indicator of fat malabsorption Classically, a 72-hour stool

collection with diet diary and

adequate fat intake

Ferritin
(serum)

Neonate: 25 – 200 μg/l

1 months: 200 – 600 μg/l

2 – 5 months: 50 – 200 μg/l

6 months to 15 years: 7 – 140 μg/l

Adult male: 20 – 250 μg/l

Adult female: 10 – 120 μg/l

Major storage form of iron;

levels mirror body reserves

Early and sensitive indicator

of iron deficiency anemia

Positive acute-phase reactant

Folate (serum) Neonate: 16 – 72 nmol/l
Child: 4 – 20 nmol/l
Adult: 10 – 63 nmol/l

Water-soluble vitamin, role

in DNA/RNA synthesis and

amino acid metabolism

Macrocytic anemia,

hypersegmented neutrophils,

glossitis, stomatitis, poor

growth and fetal neural tube

defects

Deficiency may be clinically

indistinguishable from that of

B 12 , but the latter has

neurological signs

Methotrexate, phenytoin and

sulfasalazine antagonize folate

utilization

Ta b l e 1. Frequently used laboratory tests in the assessment of childhood nutrition

Koletzko B, et al. (eds): Pediatric Nutrition in Practice. World Rev Nutr Diet. Basel, Karger, 2015, vol 113, pp 23–28

DOI: 10.1159/000360314