Trends and physiology of common serum biochemistries in children aged 0–18 years
Abstract
The aim of this study was to visually present and discuss in detail the physiological trends of 22 serum biochemistries in children aged 0-18.A data-mining, LMS (lambda, mu, and sigma) approach was employed to derive the smoothed continuous serum biochemistry centile charts, after application of stringent outlier exclusion criteria.Serum sodium and calculated osmolality are low in early life and rise with age due to maturing kidney and body water redistribution. Urea, creatinine and uric acid is high at birth, declines to reach a trough by 1 month of age and gradually rises again thereafter. Serum bicarbonate falls initially during the neonatal and toddler period, then rises with declining respiratory rate, further increasing sodium and suppressing chloride. Potassium, calcium and phosphate are required for somatic growth and are actively accrued during periods of rapid growth. Albumin increases until puberty while globulin rises to age 10 as a result of increased hepatic synthetic capacity and maturing immunity. Serum alkaline phosphatase activity peaks during bone growth spurts in infancy and adolescence due to osteoblast leakage, while creatinine increases with muscle mass. Serum gamma-glutamyl transferase, aspartate aminotransferase and lactate dehydrogenase activities are high at birth and decline with age. Serum alanine aminotransferase activity is low at birth and is induced by increased gluconeogenesis. Serum bilirubin increases continuously with age, mirroring haemoglobin concentration. Serum total cholesterol declines more markedly in boys than girls during puberty due to the combined effects of free testosterone (lowering high-density lipoprotein cholesterol in boys) and oestradiol (lowering low-density lipoprotein cholesterol in boys and girls).It is important to understand trends and biological variation when interpreting results since partitioned reference intervals may mask this information.
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The highest serum albumin levels in men are reached in adulthood after age 20, when growth and muscle accretion have stopped.
“The highest serum albumin levels in men are only reached in adulthood after age 20 years, when growth and muscle accretion have stopped.”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [112]
Serum albumin levels in healthy children are inversely associated with growth rate, within the normal range.
“Serum albumin levels in healthy children have been found in population studies to be inversely associated with growth rate, although within a range considered normal.”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [112]
In females, serum albumin levels increase until puberty to levels comparable with men, then decrease below levels in men, possibly related to pubertal growth and the menstrual cycle.
“In females, serum albumin levels increase until puberty to levels comparable with men, after which they decrease, although still within the normal range, to below levels in men, possibly related to pubertal growth and subsequent to their menstrual cycle with cyclic tissue synthesis and breakdown.112”
From Hypoalbuminemia: Pathogenesis and Clinical Significance (2019) · cites this paper as [112]
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Hypoalbuminemia: Pathogenesis and Clinical Significance
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- Authors
- Loh, T. P., & Metz, M. P.
- Affiliations
- South Australia Pathology (AU)
- Corresponding author
- Loh, Tze Ping
- Venue
- Pathology
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 47
- Issue
- 5
- Pages
- 452-461
- ISSN
- 0031-3025 (ISSN-L)
- OpenAlex
- W2302480828
- Cited by
- 61
- References
- 37
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 5 · 2021: 9 · 2020: 7 · 2019: 9 · 2018: 7 · 2017: 4 · 2016: 3
- FWCI
- 3.44
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Pathology (publishedVersion)
- PubMed (publishedVersion)
- Adelaide Research & Scholarship (AR&S) (University of Adelaide) (submittedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Human Health and Disease
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Neonatal Health and Biochemistry
- Keywords
- serum biochemistry, pediatric reference intervals, centile charts, serum sodium, osmolality, urea, creatinine, uric acid, bicarbonate, potassium, calcium, phosphate, albumin, globulin, alkaline phosphatase, gamma-glutamyl transferase, aspartate aminotransferase, lactate dehydrogenase, alanine aminotransferase, bilirubin, total cholesterol, puberty, biological variation
- MeSH terms
- Adolescent, Age Factors, Bilirubin, Blood Chemical Analysis, Child, Child, Preschool, Cholesterol, Female, Humans, Infant, Infant, Newborn, Male, Potassium, Reference Values, Sex Factors, Sodium
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