Basic Metabolic Panel - Introduction and Electrolytes

1. Sodium

2. Potassium

3. Chloride

4. Carbon dioxide

5. Blood urea nitrogen

6. Creatinine

7. Glucose

8. Calcium

What is measured on a basic metabolic panel?

Sodium, potassium, chloride, and carbon dioxide

What are the electrolytes measured on a BMP?

1. Sodium

2. Potassium

3. Chloride

4. Carbon dioxide

5. Blood urea nitrogen

6. Creatinine

7. Glucose

What was measured on a Chem 7, sequential multiple analyzer (SMA) 7, or Astra 7 (different names for machine used)?

calcium

It was called a BMP once __________ was added to the list

Albumin and liver function tests (LFT's) are added

How is a comprehensive metabolic panel (CMP) different than a BMP?

Full tube

How much blood is required for a BMP specimen?

Tiger, red, or gold top

What is a BMP tube typically indicated by?

Dehydration, a patient of diuretics, potassium, checking glucose, evaluating kidney function, etc

When is BMP done?

Electrolytes

Minerals in your blood and other body fluids that either carry a positive charge (cation) or negative charge (anion)

True

T/F? Electrolytes are typically ingested as chemical components and later dissociate into ions in the body

1. Balance pH and acid/base levels

2. Aid in endocrine system regulation

3. Nerve impulse transmission and muscle contraction

What do electrolytes do?

Sodium

Main extracellular cation

water

Physiologically, sodium is closely related to ____________

Maintain water balance between blood and body tissue cells, transmitting nerve impulses (excitability), and acid-base equilibrium

What are the major roles of sodium?

False; sodium

T/F? Potassium is the most common electrolyte abnormality in hospitalized patients

kidneys; blood

Sodium is excreted by the ______________, which serves to regulate its content in the _____________ after ingesting it

Aldosterone, antidiuretic hormone, and renin angiotensin system

What chemicals alter sodium in the blood?

Hypernatremia

Term for state in which there is too much sodium

"water problem"; sodium homeostasis

Hypernatremia is indicative of a ________________ not a problem with ___________________

Dehydration

What is the most common cause of hypernatremia?

Iatrogenic (excessive Na in IV)

What is a common cause of hypernatremia (besides dehydration)?

Neurologic and dehydration symptoms

What are two broad categories for signs and symptoms of hypernatremia?

Hyperreflexia, ataxia, tremor, delirium, mania, convulsions, and coma

What are some neurologic signs and symptoms of hypernatremia?

Increased thirst, orthostatic hypotension, and oliguria

What are some dehydration symptoms of hypernatremia?

Fluid resuscitation (but not too quickly)

What is the most common treatment for hypernatremia?

Central pontine myelinosis (degradation of myelin sheaths)

What can occur if fluid resuscitation for hypernatremia occurs too rapidly?

Hyponatremia

Too little sodium

Fluid overload (dilutes electrolyte)

Main cause of hyponatremia

True

T/F? Hyponatremia is the most common electrolyte disorder seen in the general hospital population

Decreased sodium intake, increased sodium loss, and increased free body water

What can cause hyponatremia?

Deficient sodium in IVF

What is a common cause for decreased sodium uptake leading to hyponatremia?

Neurologic symptom of weakness

Most common symptom of hyponatremia

volume status; water imbalance

It is important to assess ______________ in the treatment of hyponatremia because most cases are due to _______________

IV saline (different amount/concentration for different patients)

Common treatment for hyponatremia

central pontine myelinolysis

It is important to not administer IV saline too quickly for hyponatremia because it could cause...

Potassium

Main intracellular cation

Potassium

What is the most closely watched electrolyte?

1. Regulating muscle/nerve excitability

2. Control rate and force of heart contraction (cardiac output)

3. Acid-base balance and osmotic pressure

What are the major roles of potassium?

Adverse affects on electrical activity of heart

What is the most serious morbidity associated with potassium?

Kidneys do not conserve it, so deficiencies can occur

Why is it important to replenish potassium daily?

Hyperkalemia

Too much potassium

Renal failure due to kidney disease, hemolysis, medications, and diet

What are some etiologies of hyperkalemia?

True

T/F? Sometimes, hemolyzed lab samples can indicate hyperkalemia because K+ is released as blood is broken down

Weakness or paralysis and cardiac arrhythmias

What are sign and symptoms of hyperkalemia?

Changes in EKG

What is a common symptom of hyperkalemia associated with cardiac arrythmias?

Peaked T-waves and flattened P-waves

How does an EKG change in an individual with hyperkalemia?

Withhold potassium and treat with calcium chloride or gluconate via IV to restore a normal K+ gradient (no direct effect on K+)

What is the first step in treatment of hyperkalemia?

Insulin and dextrose, sodium bicarbonate, sodium polystyrene sulfonate (SPS) (Kayexalate), and dialysis

What are other treatments for hyperkalemia following calcium chloride or gluconate treatment?

IV

Insulin and dextrose is administered via...

IV

Sodium bicarbonate is administered via...

PO (by mouth)

Sodium polystyrene sulfonate (SPS) (Kayexalate) is administered via...

Hypokalemia

Too little potassium

Medications, gastrointestinal (GI), endocrine, and renal

What are some etiologies of hypokalemia?

Diuretics

What medication commonly serves as an etiology for hypokalemia?

Weakness and paralysis, hyporeflexia, and cardiac arrythmias

What are signs and symptoms of hypokalemia?

Depressed T waves

How does an EKG change for a person with hypokalemia?

Oral (mild) or IV (severe) potassium replacement

What is the most common treatment for hypokalemia?

Chloride

Major extracellular anion and least important electrolyte

Acid-bae balance and water balance

Primary functions of chloride

sodium

Chloride changes parallel to...

cations (sodium)

Chloride is excreted with...

sodium

The signs, symptoms, and treatment for hypochloremia and hyperchloremia follow those of...

sodium

Basically to treat chloride, treat...

Carbon dioxide

Electrolyte that serve as a reflection of the acid-base balance in the body

bicarbonate in the blood

Carbon dioxide is an indirect measure of...

bicarbonate

Carbon dioxide is sometimes referred to as _____________ on tests

Dehydration and COPD

What are some etiologies for an increase in carbon dioxide?

alkalosis

An increase in carbon dioxide is referred to as...

Severe diarrhea and renal disease

What are some etiologies for a decrease in carbon dioxide?

acidosis

A decrease in carbon dioxide is referred to as...

Arterial blood gas (ABG)

To diagnose a cause for a change in carbon dioxide, what is performed?

Treat underlying condition

How do you treat changes in carbon dioxide?