--- ### **CBC 정상 수치** | 항목 | 정상 범위 | 단위 | |---------------------|---------------------------|--------------| | **Hemoglobin (Hb)** | 남성: 13.0–17.0 <br> 여성: 12.0–16.0 | g/dL | | **Hematocrit (Hct)** | 남성: 40–50 <br> 여성: 36–46 | % | | **Red Blood Cell (RBC)** | 남성: 4.5–5.9 <br> 여성: 4.0–5.2 | ×10⁶/μL | | **White Blood Cell (WBC)** | 4,000–10,000 | /μL | | **Platelet (PLT)** | 150,000–450,000 | /μL | --- ### **WBC (백혈구) 구분** 백혈구 감별 계산은 WBC 내 각 세포 유형의 비율과 수를 제공합니다. | 백혈구 유형 | 정상 비율 (%) | 절대 수치 (μL) | |----------------------|---------------------------|-------------------| | **Neutrophils (중성구)** | 50–70 | 2,000–7,500 | | **Lymphocytes (림프구)** | 20–40 | 1,000–4,000 | | **Monocytes (단핵구)** | 2–8 | 100–800 | | **Eosinophils (호산구)** | 1–4 | 50–400 | | **Basophils (호염구)** | <1 | 0–100 | --- ### **RBC 관련 지표** | 항목 | 정상 범위 | 단위 | |-----------------------|---------------------------|--------------| | **Mean Corpuscular Volume (MCV)** | 80–100 | fL | | **Mean Corpuscular Hemoglobin (MCH)** | 27–33 | pg | | **Mean Corpuscular Hemoglobin Concentration (MCHC)** | 32–36 | g/dL | | **Red Cell Distribution Width (RDW)** | 11.5–14.5 | % | --- ### **Clinical Significance** - **Hemoglobin/Hematocrit 감소**: 빈혈, 출혈, 만성질환. - **WBC 증가**: 감염, 염증, 스트레스, 백혈병. - **Platelet 감소**: 혈소판 감소증 (예: ITP, DIC). - **Neutrophil 증가**: 세균 감염. - **Eosinophil 증가**: 알레르기, 기생충 감염. - **Basophil 증가**: 알레르기, 만성염증. --- ### **1. 기본 전해질 검사 (Electrolytes)** | 항목 | 정상 범위 | 단위 | |--------------------|--------------------|---------| | **Sodium (Na⁺)** | 135–145 | mmol/L | | **Potassium (K⁺)** | 3.5–5.0 | mmol/L | | **Chloride (Cl⁻)** | 98–106 | mmol/L | | **Calcium (Ca²⁺)** | 8.5–10.5 | mg/dL | | **Phosphate (PO₄³⁻)**| 2.5–4.5 | mg/dL | | **Magnesium (Mg²⁺)**| 1.6–2.6 | mg/dL | --- ### **2. 신장 기능 검사 (Renal Function Tests)** | 항목 | 정상 범위 | 단위 | |--------------------|--------------------|-------------| | **Blood Urea Nitrogen (BUN)** | 8–20 | mg/dL | | **Creatinine (Cr)** | 남성: 0.7–1.3 <br> 여성: 0.6–1.1 | mg/dL | | **Glomerular Filtration Rate (GFR)** | >90 | mL/min/1.73m² | --- ### **3. 간 기능 검사 (Liver Function Tests, LFTs)** | 항목 | 정상 범위 | 단위 | |--------------------------|--------------------|-------------| | **Aspartate Aminotransferase (AST)** | 10–40 | IU/L | | **Alanine Aminotransferase (ALT)** | 10–40 | IU/L | | **Alkaline Phosphatase (ALP)** | 30–120 | IU/L | | **Total Bilirubin** | 0.1–1.2 | mg/dL | | **Direct Bilirubin** | 0.0–0.3 | mg/dL | | **Albumin** | 3.5–5.5 | g/dL | | **Total Protein** | 6.0–8.3 | g/dL | --- ### **4. 당뇨 및 대사 검사 (Diabetes and Metabolic Tests)** | 항목 | 정상 범위 | 단위 | |--------------------|--------------------|---------| | **Fasting Glucose**| 70–100 | mg/dL | | **HbA1c** | <5.7% | % | | **Insulin** | 2–25 | μIU/mL | | **C-peptide** | 0.5–2.0 | ng/mL | --- ### **5. 지질 검사 (Lipid Panel)** | 항목 | 정상 범위 | 단위 | |----------------------|--------------------|---------| | **Total Cholesterol**| <200 | mg/dL | | **LDL Cholesterol** | <100 | mg/dL | | **HDL Cholesterol** | >40 (남성) <br> >50 (여성)| mg/dL | | **Triglycerides** | <150 | mg/dL | --- ### **6. 염증 및 면역 반응 검사 (Inflammation and Immunology)** | 항목 | 정상 범위 | 단위 | |--------------------------|--------------------|---------| | **C-reactive Protein (CRP)** | <1.0 | mg/dL | | **Erythrocyte Sedimentation Rate (ESR)** | 남성: 0–15 <br> 여성: 0–20 | mm/hr | | **Rheumatoid Factor (RF)** | <20 | IU/mL | | **Procalcitonin** | <0.05 | ng/mL | --- ### **7. 혈액 응고 검사 (Coagulation Tests)** | 항목 | 정상 범위 | 단위 | |--------------------------|--------------------|-------------| | **Prothrombin Time (PT)**| 11–14 | seconds | | **INR (International Normalized Ratio)** | 0.8–1.2 | ratio | | **Activated Partial Thromboplastin Time (aPTT)** | 25–35 | seconds | | **Fibrinogen** | 200–400 | mg/dL | | **D-dimer** | <0.5 | μg/mL | --- ### **8. 갑상선 기능 검사 (Thyroid Function Tests)** | 항목 | 정상 범위 | 단위 | |--------------------------|--------------------|-------------| | **TSH (Thyroid Stimulating Hormone)** | 0.4–4.2 | μIU/mL | | **Free T4** | 0.8–1.8 | ng/dL | | **Free T3** | 2.3–4.1 | pg/mL | --- ### **9. ABGA (Arterial Blood Gas Analysis)** | 항목 | 정상 범위 | 단위 | |--------------------|--------------------|-------------| | **pH** | 7.35–7.45 | - | | **PaCO₂** | 35–45 | mmHg | | **PaO₂** | 80–100 | mmHg | | **HCO₃⁻** | 22–26 | mmol/L | | **SaO₂** | 94–100 | % | --- ### **10. 종양 표지자 (Tumor Markers)** | 항목 | 정상 범위 | 단위 | |--------------------------|--------------------|---------| | **Alpha-Fetoprotein (AFP)** | <10 | ng/mL | | **Carcinoembryonic Antigen (CEA)** | <5.0 | ng/mL | | **CA-125** | <35 | U/mL | | **CA-19-9** | <37 | U/mL | | **PSA (Prostate-Specific Antigen)** | <4.0 | ng/mL | --- ### **11. 기타 검사** | 항목 | 정상 범위 | 단위 | |--------------------------|--------------------|-------------| | **Amylase** | 25–125 | IU/L | | **Lipase** | 10–140 | IU/L | | **Lactate** | 0.5–2.2 | mmol/L | | **Ferritin** | 남성: 20–250 <br> 여성: 15–150 | ng/mL | | **Vitamin B12** | 200–900 | pg/mL | | **Folate** | 2–20 | ng/mL | --- # **Organized Summary of Antibiotics** Antibiotics are grouped based on their **mechanism of action**, **target microorganisms**, and **chemical structure**. --- ### **1. Classification by Mechanism of Action** #### **A. Inhibitors of Cell Wall Synthesis** - **Beta-Lactams**: - Bind to penicillin-binding proteins (PBPs), inhibiting peptidoglycan cross-linking. - Includes: - **Penicillins**: - Narrow-spectrum: Penicillin G, Penicillin V. - Anti-staphylococcal: Nafcillin, Oxacillin. - Broad-spectrum: Amoxicillin, Ampicillin. - Anti-pseudomonal: Piperacillin, Ticarcillin. - **Cephalosporins**: - Classified by generation (1st to 5th): - 1st: Cefazolin, Cephalexin (Gram-positive focus). - 2nd: Cefuroxime, Cefoxitin (enhanced Gram-negative). - 3rd: Ceftriaxone, Ceftazidime (broad Gram-negative). - 4th: Cefepime (anti-pseudomonal). - 5th: Ceftaroline (MRSA coverage). - **Carbapenems**: - Imipenem, Meropenem, Ertapenem (broad spectrum, resistant to beta-lactamase). - **Monobactams**: - Aztreonam (Gram-negative only, including Pseudomonas). - **Glycopeptides**: - Vancomycin: Inhibits peptidoglycan polymerization (Gram-positive, including MRSA). - Teicoplanin: Similar to vancomycin. --- #### **B. Inhibitors of Protein Synthesis** - Bind to bacterial ribosomes (30S or 50S subunit). - **30S Inhibitors**: - **Aminoglycosides**: - Gentamicin, Amikacin, Tobramycin. - Bactericidal; effective for Gram-negative aerobes. - Synergistic with beta-lactams. - **Tetracyclines**: - Tetracycline, Doxycycline, Minocycline. - Broad-spectrum, used for atypicals (e.g., Rickettsia, Chlamydia). - **50S Inhibitors**: - **Macrolides**: - Erythromycin, Azithromycin, Clarithromycin. - Broad-spectrum, especially for respiratory infections and atypicals. - **Clindamycin**: - Covers Gram-positive and anaerobes. - **Chloramphenicol**: - Broad-spectrum; risk of aplastic anemia. - **Linezolid**: - Covers Gram-positive, including MRSA and VRE. --- #### **C. Inhibitors of DNA or RNA Synthesis** - **Fluoroquinolones**: - Inhibit DNA gyrase (topoisomerase II). - Ciprofloxacin (Gram-negative, including Pseudomonas). - Levofloxacin, Moxifloxacin (Gram-negative and Gram-positive). - **Rifamycins**: - Rifampin: Inhibits RNA polymerase; used for TB and prophylaxis for meningitis. - **Metronidazole**: - Produces free radicals; effective against anaerobes and protozoa (e.g., Giardia, Trichomonas). --- #### **D. Inhibitors of Folate Synthesis** - **Sulfonamides**: - Sulfamethoxazole: Competes with PABA, inhibiting dihydropteroate synthase. - **Trimethoprim**: - Inhibits dihydrofolate reductase. - **Combination**: - TMP-SMX (trimethoprim-sulfamethoxazole): Broad-spectrum; used for UTIs, PCP pneumonia. --- #### **E. Disruptors of Cell Membrane Integrity** - **Polymyxins**: - Colistin (Polymyxin E): Effective for multidrug-resistant Gram-negative bacteria. - **Daptomycin**: - Effective for Gram-positive, including MRSA and VRE. --- ### **2. Classification by Target Microorganisms** | **Antibiotic Class** | **Target Microorganisms** | |--------------------------|-------------------------------------------------| | **Beta-Lactams** | Broad-spectrum; effective for Gram-positive/negative. | | **Vancomycin** | Gram-positive, including MRSA. | | **Aminoglycosides** | Gram-negative aerobes. | | **Macrolides** | Atypicals (Legionella, Mycoplasma, Chlamydia). | | **Fluoroquinolones** | Gram-negative, some Gram-positive, atypicals. | | **Metronidazole** | Anaerobes and protozoa. | | **TMP-SMX** | Broad-spectrum; PCP, UTIs. | | **Daptomycin** | Gram-positive (MRSA, VRE). | | **Polymyxins** | Gram-negative (MDR organisms). | --- ### **3. Common Clinical Uses** | **Condition** | **First-Line Antibiotics** | |--------------------------------|-----------------------------------------------------| | **Community-Acquired Pneumonia** | Amoxicillin, Azithromycin, Doxycycline. | | **Hospital-Acquired Pneumonia** | Piperacillin-Tazobactam, Cefepime, Meropenem. | | **Urinary Tract Infections (UTIs)** | Nitrofurantoin, TMP-SMX, Ciprofloxacin. | | **Skin and Soft Tissue Infections** | Cefazolin, Vancomycin (MRSA). | | **Sepsis** | Broad-spectrum (Piperacillin-Tazobactam, Meropenem). | | **Tuberculosis** | Rifampin, Isoniazid, Pyrazinamide, Ethambutol. | | **C. difficile Colitis** | Vancomycin (oral), Fidaxomicin. | --- ### **4. Adverse Effects by Antibiotic Class** | **Class** | **Common Adverse Effects** | |---------------------|-------------------------------------------------------------------------| | **Beta-Lactams** | Allergic reactions, anaphylaxis, rash, diarrhea. | | **Aminoglycosides** | Nephrotoxicity, ototoxicity. | | **Tetracyclines** | Photosensitivity, GI upset, teeth discoloration in children. | | **Macrolides** | GI upset, QT prolongation. | | **Fluoroquinolones**| Tendonitis, QT prolongation, CNS effects. | | **Vancomycin** | Red man syndrome, nephrotoxicity. | | **Rifampin** | Hepatotoxicity, orange discoloration of body fluids. | | **TMP-SMX** | Rash, hyperkalemia, bone marrow suppression. | | **Metronidazole** | Metallic taste, disulfiram-like reaction with alcohol. | --- ### **5. Antibiotic Resistance Concerns** - Overuse and misuse have led to resistance: - **MRSA**: Resistant to beta-lactams; treated with vancomycin or linezolid. - **ESBL-Producing Bacteria**: Treated with carbapenems. - **VRE**: Treated with daptomycin or linezolid. - **MDR Gram-Negatives**: Polymyxins, tigecycline. --- ### **Key Takeaways** 1. Antibiotics are categorized by their **mechanism of action** and **target pathogens**. 2. Selection depends on the **site of infection**, **pathogen susceptibility**, and **patient factors**. 3. Resistance is a growing concern, requiring judicious antibiotic use and stewardship programs.