2: GENERAL CHEMISTRY: BMP/CMP

BMP includes ___ to ___ tests

7 to 8

Eighth test in BMP is

calcium

what is included in a BMP

Sodium

Potassium

BUN

Creatinine

Glucose

Calcium

Chloride

Bicarb

BMP fishbone

CMP includes what

Basic panel PLUS

albumin, alkaline phosphatase, ALT, AST, bilirubin, and total protein

Function of Na

Evaluation and monitoring of fluid and electrolyte balance; indicator of solutes in extracellular space

What causes hypernatremia and what is the clinical presentation?

Cause: due to water loss or sodium overload

Clinical presentation: Dry mucous membranes, thirst, agitation, convulsions

What causes hyponatremia and what is the clinical presentation?

Cause: due to hypo/eu/hypervolemia or water excess

Clinical presentation: lethargy, confusion, coma

What is the function of K

major electrolyte for cardiac function; intracellular

What causes hyperkalemia and what is the clinical presentation?

Causes: excess ingestion, chronic renal failure

Clinical presentation: Irritability, nausea/vomiting, arrhythmias, Peaked T-waves on ECG

What causes hypokalemia and what is the clinical presentation?

Causes: diarrhea, poor intake

Clinical presentation: Decreased muscular contractility, Arrhythmias , Flat T-waves on ECG

what is the function of Cl-

determining acid/base status and hydration

Cl- is partnered with _____ in movement of water

sodium

hyperchloremia is due to

dehydration

hyperchloremia results in

lethargy, weakness, deep breathing

hypochloremia is usually due to

vomiting, gastric suctioning, burns

hypochloremia results in

NS and muscular excitability, tetany, hypotension, shallow breathing

function of CO2/HCO3-

•buffering to maintain appropriate pH values

CO2/HCO3- is excreted from the

kidneys

____ is the best indicator of CO2

arterial blood, but venous blood provides an estimate of pH

Carbonic acid

anion gap

The calculated difference between the cations (positive) and anions (negative)

anion gap is used for

•evaluation of acid-base disorders

•Identify underlying cause

•Monitor therapy

how to calculate anion gap

(Na + K) - (Cl + HCO3)

the more acid you have, the ____ the anion gap

bigger

what causes increased leveled anion gap

•Lactic acidosis

•Diabetic ketoacidosis

•Alcohol intoxication

•Renal failure

•Starvation

what causes decreased levels of anion gap

•Ingestion of alkali (antacids)

•Chronic emesis/GI suctioning (removing acid)

•Multiple myeloma

mneumonic for high anion gap acidosis

Methanol

Uremia

DKA

Prophylene glycol

Isoniazid, iron

Lactic acidosis

Ethylene glycol

Salicylates

What is the function of BUN

estimate of renal function and glomerular filtration rate (GFR) if liver is functioning properly

____ is a nitrogen containing waste product produced in the liver and excreted by kidneys

urea

NH3 is ____ and Urea is ____

toxic

neutral non toxic

BUN is directly related to metabolic function of the ____ and excretory function of the ____

liver

kidneys

if BUN is low, it means

liver dysfunction (not making Urea)

if BUN is high, it means

kidneys are dysfunctioning (urea is building up and the kidneys aren't getting rid of it)

Creatinine is an indicator of

indicator of renal function (measured in serum)

creatinine depends on

muscle mass

creatinine is filtered through ____ and excreted in ____

glomeruli

urine

creatinine is increased in

•Kidney dz - glomerulonephritis, CRF pyelonephritis, acute tubular necrosis

•Dehydration

•Shock

•Rhabdomyolysis (breakdown of skeletal muscle) - damages glomeruli

creatinine is decreased in

•Diseases that decrease muscle mass

•Muscular dystrophy

•Myasthenia gravis

Creatine is a

compound produced by pancreas, kidneys, or by eating meat (ends up turning into creatinine)

Ratio of _____ is indicative of renal function

BUN/Creatinine

function of glucose

Indicative of pancreatic endocrine function and general metabolic state

glucose levels are controlled by

insulin and glucagon produced in pancreatic islets of Langerhans

hyperglycemia is caused by

•Diabetes mellitus

•Medications (steroids)

•Sepsis

•Obesity

hypoglycemia is caused by

•Inadvertent insulin dosing

•Insulinoma

•Severe liver disease

•Hypothyroidism

•Malnutrition

ALP function

Indicates liver injury or obstruction

you can get ____ to distinguish source of ALP

fractionated (ALP 1-liver, ALP-2 bone)

which ALP fractionation is used the most

ALP-1

what causes increased ALP

intrahepatic: hepatitis, cirrhosis

extrahepatic: Choledocholithiasis, Bile duct strictures, tumor metastases to liver

ALT function

Indicates liver injury or obstruction

transaminase is the most abundant in the

liver

increased ALT is due to

•Alcoholic liver disease

•Hepatitis B or C

•Hemochromatosis (excess iron storage)

•Hepatocellular carcinoma (HCC)

AST indicates

Indicates liver injury or obstruction

AST is a _____ present in tissues/organs with high ____ rates

transaminase

metabolic (liver, heart, skeletal muscle)

is ALT or AST more specific to liver disease

ALT (L- liver)

there are increased AST in

•Cirrhosis, gallstones, hepatitis

•Pancreatitis, diabetic ketoacidosis

•Numerous medications

albumin function

Indicates hepatocellular function to synthesize proteins

albumin is a protein formed in the

liver

albumin makes up ____ % of total protein in body

60

albumin is important for

Important for maintaining osmotic pressure – keep fluid within vessels

half life of albumin

21 days

decreased albumin in

*** anything that causes depletion of AA to make albumin

•Malnutrition

•Hepatic failure

•Crohn's disease, ulcerative colitis, celiac dz

•Nephrotic syndrome (losing lots of protein)

•Pregnancy

•Severe burns

What causes increased albumin?

dehydration (decreased intravascular volume)

what is the name for pre-albumin

transthyretin

what is the function of pre-albumin

hepatocellular function

what is the half life of pre-albumin

2 days

pre-albumin fluctuates in response to

nutritional status

pre-albumin is a better indicator of liver function and nutrition than ______ due to _____

albumin

rapid turnover

decreased pre-albumin is from

•Malnutrition

•Liver damage

•Inflammation - negative acute phase protein

•Severe burns

increased pre-albumin is from

•Pregnancy

•Nephrotic syndrome

what is the function of bilirubin

•Indicates hepatocellular function

increased unconjugated (indirect) bilirubin is always due to

breakdown of RBCs

•Hemolysis (hemolytic anemia)

•Hepatocellular dysfunction

•Neonatal jaundice (no maturity of enzymes)

increased in conjugated (direct) bilirubin is due to

•Cholelithiasis

•Extrahepatic obstruction

•Tumor/metastasis

•Congenital defects

function of Ca

evaluation of parathyroid function and calcium metabolism

Ca is useful in monitoring pts for what conditions

•Renal failure, renal transplant

•Hyperparathyroidism

•Malignancies

•Massive blood transfusions

PTH increases _____ levels

calcium

what are the components of total serum Ca

1/2 free (ionized) form/nonbound

1/2 protein bound form (albumin and globulin)

if serum albumin is low, calcium will be ____

low

causes of hypercalcemia

•Hyperparathyroidism – most common cause

•Malignancy – paraneoplastic PTHrP (parathyroid hormone-related protein)

signs and symptoms of hypercalcemia

•Anorexia, nausea & vomiting; constipation

•Lethargy; cognitive dysfunction, psychosis

patient with normal calcium may actually be _____ if their serum albumin is _____

hypercalcemia

low

what is the main cause of hypocalcemia

hypoalbuminemia due to malnutrition in alcoholics

***also hypoparathyroidism

what are the signs and symptoms of hypocalcemia

generally asymptomatic

severe cases: muscle spasms, cramps, numbness in hands and feet

function of Mg

Regulation of nerve & muscle function, blood sugar & blood pressure, bone, DNA & protein metabolism

2/3 of Mg is in ___, 1/3 of Mg is in____

bone

cells

Mg is mostly ______ (intracellular/extracellular)

intracellular

Mg is bound to

ATP for phosphorylation

Mg is linked to ___ and ____ levels

K and Ca

hypermagnesemia is caused by

•Ingestion of antacids – common

•Renal insufficiency

signs and symptoms of hypermagnesemia

•Nausea & vomiting

•Headache; neurologic changes

•Flushing of skin

causes of hypomagnesemia

•Malnutrition

•Malabsorption

•Alcoholism with increased urinary excretion secondary to ethanol

signs and symptoms of hypomagnesemia

•Nausea & vomiting

•Weakness; muscle spasms

•Seizures

•Cardiovascular disease

function of phosphate

assist in evaluation of parathyroid and calcium abnormalities

what are the two forms of phosphate

•Organic

•Part of another compound

•Not measured

•Inorganic

•15% of total

•Unbound

•Measured in serum phosphate test

•Electrical and acid-base homeostasis

levels of phosphate are determined by

Ca metabolism

PTH

Small bowel absorption

renal excretion

hyperphosphatemia caused by

Caused by renal insufficiency where

Ca++ and PO4--- exist in an inverse

relationship

signs and symptoms of hyperphosphatemia

•Muscle cramps and spasms

•Bone/joint pain

•Pruritis

hypophosphatemia caused by

Long-term malnutrition, anorexia or starvation due to chronic infection, disease or long hospital admission

signs and symptoms of hypophosphatemia

•Muscle weakness; loss of muscle mass

•Numbness; seizures