B-Hydroxybutyrate

Centralized Core Laboratory : Chemistry

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. B-Hydroxybutyrate
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

BHB1 ACHM1

Specimen Type:

Blood

Tube Type:

Green top (lithium heparin)tube

Collection Volume:

1 mL

Cause for Rejection:

Gross hemolysis

Storage:

Refrigerate, stable one week at 2-8 Celsius

Methodology:

Colorimetric

Lab/Phone:

330-543-8417

TAT:

1 hour

Additional Info:

Reference range:

<0.4 mmol/L

Critical >4.0 mmol/L

CPT Code:

82010

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B-Hydroxybutyrate

Centralized Core Laboratory : Chemistry

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