Common Lab Values and Nursing Implications

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Calcium Normal Value
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10
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What does calcium do in the body?
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Clotting, bones, muscle
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Hypocalcemia symptoms
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Chvostek’s sign, Trousseau’s Sign
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How do you check Chvostek’s sign, and what is a positive sign?
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Tap the persons cheek. Positive sign = facial spasm
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Hypercalcemia symptoms
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muscle weakness
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What does potassium do in the body?
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Muscle contractions
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Potassium Normal Value
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3.5-5
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Hypokalemia symptoms
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PVCs with widened QRS wave and no P waves
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Hyperkalemia symptoms
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peaked t waves (~5.5 K), then QRS widens (~6.5), then asystole (~7)
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Hyperkalemia Fix
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CBIGKDie: 1) Calcium (Gluconate if IV, Chloride if Central Line) 2) Bicarb 3) Insulin & Glucose 4) Kayexalate 5) Dialysis
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What does Sodium do in the body?
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Fluid balance
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Sodium Normal Value
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135-145
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Hyponatremia symptoms
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Change in Mental status, seizures, death.
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Life threatening Hyponatremia
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<120
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Emergent Hyponatremia treatment
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Wean onto hypernatremic IVF (to avoid hypervolemia)
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Non-Urgent Hyponatremia treatment
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Saltines! No water.
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Hypernatremia symptoms
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fluid retention
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What does PT stand for? What does it measure?
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Prothrombin Time. Extrinsic coagulation pathway
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Normal PT
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10-15 seconds
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What is PTT/aPTT?
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Partial Thromboplastin Time/activated Partial Thromboplastin Time. Intrinsic and Common coagulation pathways.
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Normal PTT/aPTT
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30-45 seconds
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What is INR?
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International Normalized Ratio. Measures extrinsic coagulation pathway. Based on PT
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Normal INR
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1
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Therapeutic Effect of Warfarin on Labs
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1.5-2x baseline PT, 2-3 INR
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Therapeutic Effect of Heparin on Labs
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1.5-2x baseline PTT
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Normal Platelet Level
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300,000
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By lab results alone, when do you give PBRCs?
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Hct 20
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By lab results alone, when do you give Platelets?
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20,000 platelets
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By lab results alone, when do you give WBCs?
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You don’t really.
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By lab results alone, when do you give FFP?
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Low albumin, High PT, PTT/aPTT, INR
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What is FSP/FDP/d Dimer?
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Fibrin Split Products/Fibrin Degradation Product. Helps to diagnose thrombosis.
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Normal FSP/FDP/d Dimer
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Normal WBC Count
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8,000
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Normal Absolute Neutrophil Count
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Over 500
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What is Hematocrit?
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The percentage of blood volume taken up by RBCs
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Normal Hematocrit
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35-45
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What is Hemoglobin?
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The amount of available O2 carrying RBCs
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Normal Hemoglobin
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13
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What is CK-MB?
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Creatinine Kinase – Myocardial Banding. Byproduct of cell death specific to heart.
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Normal CK-MB
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What is Tryponin?
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Byproduct of cell death specific to heart. Test of choice because it takes less time for infarct to show in lab values.
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Normal Tryponin
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<0.4
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What is BUN?
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Blood Urea Nitrogen, measurement of kidney function.
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Normal BUN
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20-30
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BUN with low Creatinine?
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Dehydration
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What is Creatinine?
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Product of muscle breakdown, measurement of kidney function
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Normal Creatinine
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0.8-1.2
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High Creatinine
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Kidney Failure
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pH
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acidosis 7.35-7.45 alkalosis
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PaCO2
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35-45 mm Hg CO2 is an acid the partial pressure of CO2 in arterial blood
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HCO3
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22-26 mEq/L bicarb is a base
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PaO2
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80-100 mmHg arterial partial pressure of oxygen
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BUN
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10-20 mg/dL -measures the amount of nitrogen in the blood that comes from urea. (Urea is produced by the liver as a waste product of the digestion of protein and is also removed from the blood by the kidneys.)
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Serum Creatinine
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normal 0.5-1.5mg/dl -product of muscle metabolism, excreted entirely by the kidney. not affected by hepatic function.
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Serum Glucose
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70-110 mg/dL
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Hb A1C
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4% – 6% -glycosylated hemoglobin: a measure of the average glucose levels over the past 3 months
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WBC
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4-11 K/µ
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RBC
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4.5-5.5 mil/µL male: 4.5-6.2 mil/µL female: 4.2-5.4 mil/µL
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Hgb
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13.1-17.1 g/dL males: 13.5-18 g/dL females: 12-16 g/dL total amount of hemoglobin in a sample of blood
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Hct
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40-45% males: 40-54% females: 38-47% % of packed RBC in whole blood
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Plt
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150-400 K/µL or 150,000-400,000 mm3 platelet count
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Bleeding time
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3.0-9.5 minutes time required for blood to stop flowing from a tiny puncture wound
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PT (prothrombin time)
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10-14 secs prothrombin is a protein that acts in blood clotting and is dependent on the intake and absorption of vitamin K. Prothrombin time measures clotting factors II,V,VII,X and fibrinogen, and the time it takes these factors to clot blood via the extrinsic pathway
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INR (international normalized ratio)
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0.9-11 seconds -a more accurate way to determine the PT. It is a ratio of the PT to Thromboplastin activity. This is standardized with all laboratories.
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aPTT (Activated partial thromboplastin time)
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24-36 seconds • Monitor heparin • Measures intrinsic and common pathways • Measures the time needed for citrated plasma to clot in the presence of kaolin (activates XII), phospholipid, and Ca
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Na
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135-145 mEq/L
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K
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3.5 – 5.0 mEq/L
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Ca
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9-11 mg/dL
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Mg
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1.5-2.5 mEq/L
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Phosphorus, inorganic
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2.8-4.5 mg/dL
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Cl
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95-105 mEq/L
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Carbon dioxide
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20-30 mEq/L
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Total Cholesterol
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140-200 mg/dL
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HDL
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male: >45mg/dL female: >55 mg/dL high-density lipoprotein
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LDL
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<130 mg/dL low-density lipoprotein
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Triglycerides
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40-150 mg/dL
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Albumin
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3.5-5.0 g/dL liver enzyme test
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ALT/SGPT
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5-36 U/L Alanine aminotransferase: liver enzyme test
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AST/SGOT
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7-40 U/L Aspartate aminotransferase: liver enzyme test
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Ammonia
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30-70 mcg/dL liver enzyme test
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Total bilirubin
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0.2-1.3 mg/dL liver enzyme test
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Alkaline phosphatase
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30-120 U/L liver enzyme test
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Total protein
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6-8 g/dL
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Neutrophils
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43-70% -phagocytic granulocytes -first responders to acute infections, particularly of bacteria and fungi
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lymphocytes
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20-40% -agranulocytes -B and T lympocytes, assist in immune response
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monocytes
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4-8% -second response to infection
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eosinophils
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0-4% -granulocytes -response to allergic and parasite infection
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basophils
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0-2% -granulocytes -promote healing
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ESR: erythrocyte sedimentation rate
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15-30mm/hr: age and gender dependent
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digoxin (therapeutic blood level)
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0.8-2 ng/mL -antiarrhythmics, used for HF, a-fib, a-fltr, paroxysmal atrial tachycardia -increased cardiac output: positive inotropic effect, -slowing of the HR: negative inotropic effect
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lithium (therapeutic blood level)
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0.6-1.2 mEq/L
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Urine pH
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4-8
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urine specific gravity
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1.003-1.030

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