Basic Metabolic Panel Flashcards
What is substances are examined in a Basic Metabolic Panel?
Sodium (Na), Potassium (K), Chloride (Cl), Bicarbonate(HCO3), Bile Urea Nitrogen (BUN), Creatinine (CR), Glucose and Calcium (Ca)
What is the term for low serum sodium
Hyponatremia
How is Hyponatremia clinically defined
Serum sodium
What are the 2 major causes of persistent hyponatremia?
SIADH and Reduced effective arterial blood volume due to diuretics, vomiting/diarrhea and decreased tissue perfusion in heart failure or cirrhosis
What are the 3 classifications of hyponatremia
Hypovolemic - A decrease in total body water with a great decrease in total body sodium
Euvolemic - Normal body sodium with increase in total body water
Hypervolemic - An increase in total body sodium with even a greater increase in total body water
What are the symptoms of hyponatremia
Nausea, dizziness, fatigue, gait disturbances, forgetfulness, confusion, lethargy, and muscle cramps (extra severe
What are three ways hyponatremia is diagnosed
Urine Osmolality - Differentiates btwn conditions associated with impaired free water excretion and primary polydipsia
Serum Osmolality - Differentiates btwn true hyponatremia and pseudohyponatremia
Urine sodium concentration - Differentiates btwn hyponatremia secondary to hypovolemia
What is the most common form of hyponatremia
Hypotonic hyponatremia
Which can be safely treated more quickly acute or chronic hyponatremia
Acute
What is the condition of elevated serum sodium
Hypernatremia
What is the most common causes of hypernatremia?
1) Failure to replace water losses due to impaired thirst or lack of access to H2O.
2) Intake of salt in excess of H2O
3) Administration of a hypertonic salt solution
What kind of condition is hypernatremia
A hyperosmolar condition
How is hypernatremia clinically defined
Serum sodium concentration > 145 mEq/L
Severe > 158 mEq/L
> 180 mEq/L associated with a high mortality rate
What population is hypernatremia most found in
Elderly who are physically and mentally impaired
What are the clinical manifestations of hypernatremia
Lethargy, weakness, irritability, twitching, seizure and coma.
Rapid decrease in brain volume can cause rupture of cerebral veins leaching to hemorrhages in brain and Acute manifestations of the condition can result in demyelinating brain leisions
What condition is due to elevated potassium
Hyperkalemia
Why can Hyperkalemia be difficult to diagnose
Due to a lack of distinctive signs and symptoms
How is Hyperkalemia clinically diagnosed
Mild - 5.5-6.0 mEq/L
Moderate - 6.1-7.0 mEq/L
Severe -
What are the major causes of Hyperkalemia
Acute or chronic kidney disease or disorders (Urinary obstruction, Sickle disease, Addisons) or drugs that inhibit the renin-angiotensin-aldersterone axis (diuretics)
How is Hyperkalemia clinically diagnosed
Mild - 5.5-6.0 mEq/L
Moderate - 6.1-7.0 mEq/L
Severe -
Signs and symptoms of Hyperkalemia
Fatigue and weakness, n/v, palpitations, paresthesia, bradycardia, extrasystoles, decreased motor strength, renal failure (edema and skin changes), paralysis (rare)
What is essential to diagnose hyperkalemia
an EKG
How is Hypokalemia clinically defined
Defined - serum K+
What are some EKG changes associated with Hyperkalemia
Widened QRS
Peaked T waves
What is the condition of low potassium
Hypokalemia
How is Hypokalemia clinically defined
Defined -
What are the signs and symptoms of Hypokalemia
Often asymptomatic.
Weakness and fatigue most common
More severe - Muscle cramps and pain, worsening diabetes, hallucinations, delirium, and depression, bradicardia and CV collapse
What are EKG changes that can occur with Hypokalemia
Change in QT interval
Look for U wave after T wave.
Chloride’s role in the body
Plays an important role in acid/base balance and with sodium maintains H2O balance and serum osmolality
What are the normal and critical values of chloride
Normal - 98-106 mmol/L
Critical - 120 mmol/L
What is the condition of high/low chloride levels
Hyperchloremia/Hypochloremia
What can cause Hyperchloremia
Renal failure, nephrotic syndrome, dehydration, hyperparathyroidism, diabetes insipidus, respiratory alkalosis, hyperadrenocorticism and certain drugs
What can cause Hypochloremia
V/d, renal failure with salt deprivation, overtreatment of diuretics, diabetic ketoacidosis, SIADH, water intoxication , adrenal insufficiency, hyperaldeosteroidism, metabolic alkalosis and certain drugs (laxative, diuretics, and corticosteroids
What does the level of Bicrobonate (HCO3-) indicate
The concentration of H+ ions (or the bicarbonate level)
What does Bicarbonate usually counterbalanced by
a change of chloride
What conditions can indicate an elevated or decreased bicarbonate level
Elevated - Metabolic alkalosis and respiratory alkalosis
Decreased - Respiratory acidosis and metabolic acidosis
What is the Anion Gap a measurement of?
It represents the difference btwn unmeasured cation and anions… AG = (Na+)-{(HCO3 + Cl-)}
What conditions can show a rise in the Anion gap
Acidosis, renal failure and ingestion of certain toxins
What does the BUN level reflect?
The function of the liver and/or the kidneys
What is the normal BUN reference range?
3-20 mg?dL
What do BUN levels vary inversely with…
Glomerular filtration levels (GFR)
What are the normal glucose reference ranges
Fasting plasma glucose - 70/99 mg/dL
Postparandial plasma glucose at 2hrs. -
What is the reason to monitor levels of creatinine?
It’s important in assessing renal function. in blood it is a marker of glomerular filtration rate
What are the normal reference ranges for creatinine?
Adult males: 0.5-1.2 mg/dL
Adult females - 0.4 - 1.1 mg/dL
Children (up to 12 y.o) - 0.0 - 0.7 mg/dL
What are reasons for low/high serum creatinine levels
Low 1) Low muscle mass 2) Increased glomerular rates (GFRs) High 1) Decreased GFR (due to acute kidney injury or chronic kidney disease)
What are the normal glucose reference ranges
Fasting plasma glucose - 70/99 mg/dL
Postparandial plasma glucose at 2hrs. -
What are the reference ranges for diabetes mellitus
- Fasting plasma glucose -> 125 mg/dL
- Postparandial plasma glucose at 2hrs. - > 200mg/dL
- Random plasma glucose - > 200 mg/dL
- Impaired fasting glucose : Fasting glucose of 100-125 mg/dL
- Impaired glucose tolerance testing: Postprandial glucose at 2 hours of 140-200 mg/dL
What are the reference ranges for hypoglycemia
Value less than 60 mg/dL
