Basic Metabolic Panel

Traditional metabolic units

mEq/L, mg/dL, mcg/dL, mcg/L

International System (SI) units

mmol/L, μmol/L, nmol/L

What is a Basic Metabolic Panel (BMP)? What does it provide information on?

Provides information on the chemical balance and body metabolism (transformation of food into energy)

Electrolytes (minerals with an electric charge)

• control function of _____________ and ________________

• maintain the _____ balance of ___________

• maintain balance of __________

• control function of muscle and nerve

• maintain the pH balance (acid-base balance) of blood

• maintain balance of water

How is a BMP measured?

by a venous blood draw by a phlebotomist

The FISHBONE for BMP

• Na+-Sodium

• K+-Potassium

• Cl- Chloride

• HCO3- Bicarbonate

• BUN-Blood Urea Nitrogen

• Cr-Creatinine

• Glucose-Glucose

FISHBONE for BMP diagram

Normal Sodium (Na+) Range

135-145 mEq/L (135-145 mmol/L or mM)

Sodium (Na+) is crucial to......

maintain/regulate water balance and osmolality

Kidneys are the primary organ for what?

retaining and excreting sodium and water

Sodium (Na+) is the most abundant.....

- EXTRAcellular cation

- Major regulating factor for bodily fluid & water balance (HOMEOSTASIS)

Sodium (Na+) depends on a person's _________________

volume status- hypovolemia, euvolemia, hypervolemia

Hyponatremia value

- <120-125 mEq/L

- sodium depletion is more than total body water (depleted extracellular fluid)

What can cause hyponatremia?

- vomiting, diarrhea

- salt-losing nephropathy

-exercise (marathon runners-without salt replacement)

- water intoxication or excess sweating

Diluted causes of hyponatremia (5)

- SIDH-Syndrome of Inappropriate Antidiuretic Hormone

- Compromised kidney

- CHF

- cirrhosis

- neuroendocrine

What medications cause hyponatremia?

• Thiazides & Diuretics

• ACE Inhibitors, Aldosterone Antagonists, ARB

Hypernatremia value

>145-155 mEq/L

Hypernatremia causes

- dehydration

- polyuria

- hyperaldosteronism

- inadequate water intake

- excessive salt

What medications cause hypernatremia?

- steroids

- licorice

- oral contraceptives

Normal Potassium (K+) range

3.5-5.0 mEq/L (3.5-5 mmol/L)

What is the physiology of potassium (K+)?

What is it regulated by?

- excites muscle and nervous tissue (action potential)

- regulated by excretion from kidney

Potassium (K+) is the primary....

INTRAcellular cation-most abundant intracellular cation

K+ is involved with....

neuromuscular irritability

K+ also affects....

HEART rhythm-arrhythmias, affects contractions of muscle

Hypokalemia value

<3 mEq/L

Causes of hypokalemia

• Vomiting (Bulimia/Anorexia-Nervosa)

• Diarrhea chronic

• Renal Tubular acidosis Types I and II

• Hyperaldosteronism

• Cushing Syndrome

What medications cause hypokalemia?

loop diuretics

Hyperkalemia value

>6 mEq/L

Causes of hyperkalemia

• Dehydration

• Acute/Chronic Renal Failure

• Addison's Disease

• Renal tubular acidosis type IV

• Hypoaldosteronism

What medications cause hyperkalemia?

• Potassium Salt

• Potassium-Sparing diuretics (spironolactone)

• ACE Inhibitors & ARB

• NSAIDs

• Beta-Blockers

• High-dose TMP-SMX

• Verapamil

T/F: K+ and Vitamin K are the same thing

FALSE

K+ is NOT vitamin K

Normal Chloride (Cl-) range

95-105 mEq/L (95-105 mmol/L)

Chloride is partially regulated by _____________, also absorbed from ________________ and in _____________

- kidney

- small intestine (PASSIVE)

- large intestine

Chloride (Cl-) is the most abundant....

EXTRAcellular ANion

Chloride (Cl-) maintain correct ____________ of body _____, ___________ pressure, _____-______ balance

- distribution

- body water

- osmotic pressure

- acid-base balance

When chloride is lost...

alkalosis

When chloride is ingested/retained...

acidosis

Causes of hypochloremia

• Vomiting/Diarrhea

• Metabolic alkalosis

What medications cause hypochloremia?

• Laxative (Chronic)

• Diuretics

Causes of hyperchloremia

• DEHYDRATION

• Metabolic acidosis from diarrhea (loseHCO3-)

What medications cause hyperchloremia?

• Acetazolamide (Hyperchloremic acidosis)

• Androgens

• HCTZ

• Salicylate intoxication

Carbon Dioxide (CO2) or Bicarbonate (HCO3-) normal range

22-28 mEq/L

What is the purpose of CO2/HCO3-?

- ACID-BASE balance

- bicarbonate-carbonic acid buffer very important to keeping body fluid pH normal!

Critical low CO2/HCO3- value

<15 mEq/L

Critical high CO2/HCO3- value

>40 mEq/L

Normal range of Blood Urea Nitrogen (BUN (not RBC))

8-23 mg/dL (2.9-8.2 mmol/L)

BUN physiology

- end product of protein metabolism excreted by the kidney

- Liver breaks down proteins your body uses to make ammonia (has N)

- Combines with carbon, hydrogen, oxygen to make UREA (waste product)

UREA goes from _______ to _______ and is filtered by __________ as a waste product in urine

- liver to kidneys

- kidney

Urea is the body's way to get rid of....

extra nitrogen

BUN is related to...

serum creatinine

Causes of decreased BUN

• Hepatic failure

• Nephrotic syndrome

• Starving & Malnourished (low protein and high carbohydrate diets)

Causes of increased BUN

• Renal failure (acute or chronic)

• Urinary tract obstruction

• Dehydration

• Increased Protein Breakdown: Shock, Fever,Burns

Medications that increase BUN

• drugs that affect kidneys

• Corticosteroids, tetracyclines

• ACEI/ARB

• NSAIDS

• Radio Contrast Dye

BUN/Cr ratio normal

normal 10:1-20:1

BUN/Cr ratio in <10:1

- What is seen? (3)

• advanced liver disease

• low protein diet/intake

• malnutrition

BUN/Cr ratio in > 20:1

- What is seen? (3)

• Dehydration

• GI bleeding

• Heart Failure

BUN/Cr ratio example

BUN: 30 mg/dL

Cr: 0.8 mg/dL

BUN/Cr= 30/0.8 = 37.5:1 <-- Increase in ratio, > 20:1

BUN/Cr ratio example

BUN: 8 mg/dL

Cr: 1.2 mg/dL

BUN/Cr= 8/1.2 = 6.7:1 <-- Decrease in ratio < 10:1

Creatinine (Cr) normal range

0.6-1.2 mg/dL (53-106 μmol/L)

Where is creatinine produced?

What is it a by-product of?

- Produced in muscle

- by-product of muscle activity

- waste product filtered and removed by kidneys

What is creatinine affected by? (4)

- age

- muscle mass

- low-protein diets

- medications

What does creatinine correlate to?

- correlates to glomerular filtration rate (GFR)

- INVERSE relationship between GFR and Cr

A 50% reduction in GFR leads to...

almost a double in Cr

Creatinine clearance is often a measure of _________, but not always

GFR

Causes of decreased Creatinine (Cr)

- reduced muscle mass

- malnourished

- aging

Causes of increased Creatinine

- Dehydration

- HF

- renal failure

- urinary tract obstruction

- nephrotoxic drugs

- hypothyroidism

Difference between creatine and creatinine

creatine is converted into creatinine

Normal range of glucose

70-100 mg/dL (3.3-5.6 mmol/L)

Glucose intake leads to what?

pancreatic production of insulin

Glucose is found in the _______________, it serves as a ___________________ for tissues. It is not excreted in the __________

- extracellular fluid

- balance of energy source

- urine

Glucose is the REASON we check...

BMP-fasting (8 hours)

Medications that can cause low glucose

insulin and medications for diabetes

Causes of severe hyperglycemia >500 mg/dL

• Diabetes mellitus

• Cushing syndrome

• Chronic pancreatitis

Medications that can increase glucose

• Corticosteroids (PREDNISONE)

• Phenytoin

• Estrogen

• Diuretics: Loop & thiazides

NON-DIABETES

FBG:

Non-FBG (Random):

A1c:

FBG: <100 mg/dl

Non-FBG (Random): <140 mg/dL

A1c: <5.7%

PREDIABETES

FBG:

Non-FBG (Random):

A1c:

FBG: 100-125 mg/dl

Non-FBG (Random): 140-199 mg/dl

A1c: 5.7-6.4%

DIABETES

FBG:

Non-FBG (Random):

A1c:

FBG: ≥ 126 mg/dl

Non-FBG (Random): ≥ 200 mg/dl*with classic symptoms of hyperglycemia (increased thirst, urination, hunger, etc.)

A1c: ≥ 6.4%

GOALS FOR PTS WITH DIABETES

FBG:

Non-FBG (1-2 hr post meal):

A1c:

FBG: 80-130 mg/dl

Non-FBG (1-2 hr post meal): <180 mg/dl

A1c: <7% or ~154 mg/dl

Level 1 hypoglycemia

<70 mg/dl and ≥ 54 mg/dl

Level 2 hypoglycemia

<54 mg/dl

Level 3 hypoglycemia

severe event characterized by altered mental and/or physical status requiring assistance for treatment, irrespective of glucose level

Symptoms of hypoglycemia

- shaky

- fast heartbeat

- sweating

- dizzy

- anxious

- hungry

- blurry vision

- weakness/fatigue

- headache

- irritable

Conversions between mEq/L to mmol/L