comprehensive metabolic panel

what other conditions can elevate blood glucose values

excessive food intake

acute physiologic stress

endocrine disorders

how should we determine follow up testing

pt history

what does a blood glucose level of 70-90 indicate

normal fasting glucose

what does a blood glucose level of 100-125 indicate

prediabetes

what does a blood glucose level of 126+ indicate

diabetes

what is measure in total protein

albumin

globulin

what percent of blood protein is albumin

60

what conditions may total protein levels decrease

conditions that decrease production of albumin or globulin (malnutrition, cancer, liver diseases)

increase in breakdown/loss of protein (kidney disease)

increase/expand volume of plasma (congestive heart failure)

what conditions may increase total protein levels

inflammatory disorders

multiple myeloma

decrease in plasma volume

what does hypercalcemia cause

bone turnover

what happens if there is low albumin levels

bound calcium levels drop

what are some conditions that can cause hypocalcemia

malnutrition

eating disorders

malabsorption

what follow up tests should we order to test calcium levels

total calcium (tCa)

ionized CA (iCa)

what are the electrolyes

sodium

potassium

chloride

bicarbonate

carbon dioxide

what causes hyponatremia

increased sodium loss

decreased sodium intake

increased fluid intake/retention

decreased body water loss

what does hyponatremia reflect

excess of total body water relative to total body sodium content

what can cause an absolute loss of sodium

decreased intake coupled with continual excretion in urine

what is hypernatremia

increase in serum sodium concentration cause by a decrease of total body water relative to solute

what can cause hypernatremia

impairment of thirst mechanism

increased sodium intake

decreased sodium losses

increased body water loss

what is hypokalemia

decreased intake or excessive losses of potassium in the urine from GI tract

what can cause an absolute loss of potassium

decreased intake

vomiting

diarrhea

renal loss secondary to aldosterone

what condition can cause a relative decrease in potassium

insulin dependent diabetes

how does insulin dependent diabetes effect potassium levels

redistribute potassium by drawing it through cell membranes when insulin increases uptake of the cell

when is hypokalemia most commonly seen

in hospitalized pt

result of severe disease or medications to manage those diseases

what can hyperkalemic patients be prescribed

ACE inhibitor

ARBs

both potassium sparing medications

what is the role of chloride

help regulate acid/base balance and fluid levels

what kind of relationship do chloride and sodium have

proportional

what is indicated if chloride is gained or lost in excess of sodium

metabolic acidosis?

not too sure about this one

what is indicated if sodium is gained or lost in excess of chloride

metabolic alkalosis?

not to sure about this one

what does hypochloremia indicate

defective tubular absorption

vomiting, diarrhea, metabolic acidosis

what can lead to hyperchloremia

dehydration

excessive salt intake

congestive heart failure

cystic fibrosis

what kind of relationship do bicarbonate and carbon dioxide have

inverse proportional

co2 high bicarb low

bicarb high co2 low

what is indicated with a high bicarbonate level

cushings

metabolic alkalosis

lung disease (COPD included)

severe prolonged vomiting

what conditions are indicated with low bicarbonate levels

addisons

diabetic ketoacidosis

metabolic acidosis

kidney disease

methanol/ethylene poisoning

compensated respiratory alkalosis

aspirin overdose (salicyte)

what are the s/s of low bicarbonate levels

shock

diarrhea

chronic diarrhea

what happens in metabolic acidosis

HCO3 decreases

pCO2 increases

pH decreases

what happens in repsiratory alkalosis

pCO2 decreases

HCO3 decreases

pH increases

what happens during respiratory acidosis

pCO2 increases

HCO3 increases

pH decreases

what happens in metabolic alkalosis

HCO3 increases

pCO2 increases

pH increases

are BUN and creatinine included on a CMP

no

if there is increases cortisol levels what is indicated

cushings

if there is increases aldosterone levels what is indicated

conns

if the BUN/CR ration is over 20:1 where is the problem

prerenal

what is the mechanism of above 20:1 BUN/Cr ratio

BUN reabsorption increased

hypofusion of kidneys due to heart failure

dehydration

bleeding

increased diet protein

what does a BUN/Cr ration of 12:1-20:1 indicate

normal

where is the problem if the BUN/Cr ratio is less than 12:1

intrarenal

what does a BUN/Cr ration of less than 12:1 indicate

renal damage cause reduced reabsorption of BUN and lowered the BUN/Cr ratio

indicates liver damage or malnutrition

what is the livers job

main metabolizer

what are some enzymes the liver uses to achieve metabolism

alkaline phosphatase (ALP)

alanine amine transferase (ALT, SGPT)

asparte amine transferase (AST, SGOT)

bilirubin