gen chem

BMP

chem 7/chem 8 (ca2+), routinely ordered, establish/confirm dx

Na, K, Cl, CO2/bicarb, BUN, creatinine, glu, Ca measured in what panel?

BMP

basic metabolic panel PLUS liver fxn test is what panel? aka chem 12/chem 14

CMP

CMP

monitors HTN, liver disorders, diabetes, etc

sodium

indicates fluid, electrolyte balance, solutes in extracellular space

hypernatremia

>145 mEq/dL

due to water loss, sodium overload

dry mucous membranes, thirst, agitation, convulsions

hyponatremia

< 125 mEq/dL => weakness

< 115 mEq/dL => lethargy, confusion, coma

due to water excess

potassium

indicates cardiac fxn, intracellular ion

hyperkalemia

>5 mEq/dL

due to excess ingestion, chronic renal failure

irritability, nausea, vomiting

PEAKED T waves on ECG (arrhythmia)

hypokalemia

<3.5 mEq/dL

due to diarrhea, poor intake

decr mm contractility

FLAT T waves on ECG

chloride

acid base status + hydration, act as buffer, extracellular, partnered w/ Na in H2O movement

hyperchloremia

due to dehydration

lethargy, weakness, deep breathing

hypochloremia

due to vomiting, gastric suctioning, burns

nervous system + mm excitability (tetany, hypotension), shallow breathing

carbon dioxide/bicarbonate

buffer maintains pH values

excreted from kidneys

best indicator = arterial blood value

anion gap

calc difference btwn serum cations and anions

evaluates acid-base disorders

norm = 8-16 mEq/L

BUN

product of protein metabolism excreted in urine (blood urea nitrogen), estimate of renal fxn + GFR (if liver normal)

Low BUN indicates?

liver disease

high BUN indicates?

kidney disease

creatinine

nitrogenous waste excreted in the urine, indicator of renal fxn

urea

nitrogen containing waste product produced by liver + excreted by kidneys

increased creatinine

kidney disease, rhabdomyolysis (damages glomeruli), shock, dehydration

decreased creatinine

diseases that decrease mm mass, muscular dystrophy, myasthenia gravis

glucose

pancreatic endocrine fxn + general metabolic rate

controlled by insulin + glucagon prod in pancreatic islets of Langerhans

hyperglycemia

diabetes mellitus, steroids, sepsis, obesity

hypoglycemia

inadvertent insulin dosing, insulinoma, severe liver disease, hypothyroidism, malnutrition

alkaline phosphatase (ALP)

liver injury/obstruction

80% iso-enzymes from liver (ALP 1) or bone (ALP 2)

increased ALP

intrahepatic: hepatitis, cirrhosis

extrahepatic: choledocholithiasis, bile duct strictures, tumors

alanine aminotransferase (ALT)

liver injury/obstruction, specific to liver disease (transaminase abundant in liver)

increased ALT

alcoholic liver disease, Hep B/C, hemochromatosis, hepatocellular carcinoma

aspartate aminotransferase (AST)

liver injury/obstruction, present in tissues w/ high metabolic rates (liver, heart, skeletal mm)

increased ALT

cirrhosis, gallstones, hepatitis, pancreatitis, diabetic ketoacidosis, rx

AST/ALT <1

acute hepatitis

AST/ALT = 1-2

non-alcoholic fatty liver disease, alcoholic liver disease, cirrhosis, chronic hep B/C

AST/ALT >2

alcoholic hepatitis, cirrhosis, metastatic liver disease

albumin

maintains osmotic pressure in blood, formed in liver with half life of 21 days

pre-albumin (transthyretin)

half life 2 days, rapid fluctuation in response to nutritional status, better indicator of liver fxn than albumin

decreased transthyretin

malnutrition, liver damage, inflammation, severe burns

increased transthyretin

pregnancy, nephrotic syndrome

bilirubin

pigment released by the liver in bile, indicator of hepatocellular fxn

calcium

indicator of parathyroid fxn + metabolism

used to monitor renal failure/transplant, hyperparathyroidism, malignancies, blood transfusions

free calcium

ionized, half total calcium, not bound to serum albumin

protein-bound calcium

1/2 total calcium, bound to serum albumin > if serum albumin low > calcium ALSO low

hypercalcemia

hyperparathyroidism (MC), malignancy

s/s: anorexia, nausea/vomiting, constipation, cog dysfxyn, psychosis, lethargy

hypocalcemia

malnutrition in alcoholics (MC), hypoparathyroidism

generally asymptomatic

severe cases: mm spasms, cramps, numbness in hands + feet

magnesium

regulation of nerve + mm fxn, blood sugar, BP, bone/DNA/protein metabolism

2/3 in bone, 1/3 in cells

closely linked to K and Ca

hypermagnesemia

due to ingestion of antacids (MC) or renal insufficiency

s/s: nausea, vomiting, headache, neurological changes, skin flushing

hypomagnesemia

due to malnutrition, malabsorption, alcoholism w/ incr urinary excretion

s/s: nausea, vomiting, weakness, mm spasm, seizures, cardiovascular disease

phosphate/phosphorous

parathyroid + calcium abnormalities

levels det by Ca metabolism, PTH, small bowel absorption, renal excretion

hyperphosphatemia

due to renal insufficiency (Ca and PO4 INVERSE relationship)

s/s: mm cramp/spasms, bone/joint pain, pruritis

hypophosphatemia

due to long term malnutrition, anorexia, starvation

s/s: mm weakness, loss mm mass, numbness, seizures