BMP Flashcards
Anion Gap
- used to determine the cause of Metabolic Acidosis
- normal range 8-16
- equation:
- ANION GAP = ([Na+] + [K+]) - ([HCO3-] + [Cl-])
- if anion gap is HIGH, suggests that an acid is “soaking” up HCO3-
Causes of an anion gap metabolic Acidosis
CAT MUDPILES
- Carbon Monoxide
- Aminoglycosides
- Theophylline
- Methanol
- Uremia
- DKA
- Paraldehyde
- Iron, Isoniazid
- Lactic Acidosis
- Ethanol, Ethylene Glycol
- Salicylate/ASA/Aspirin
What is in a BMP?
- calcium
- Carbon dioxide
- chloride
- creatinine
- glucose
- potassium
- urea nitrogen (BUN)
- sodium
When do you order a BMP?
- screening for diabetes and renal disease
- monitoring of kidney function in pts on meds
- to explore cause of sxs the pt is c/o
- in acute illness or trauma to help evaluate the state of the patient
*
Fish Bone
- Na+
- K+
- Cl-
- CO2-
- BUN
- Cr
- Glucose
Sodium
Main Cation of the extracellular space
normal range 135-145 mEq/L
**Critical Values : <120 or >160
sodium in the blood = balance of dietary sodium and renal excretion
hyperglycemia can lead to low sodium → for every 60mg/100ml > normal - sodium decreased by 1mEq
→ glucose pulls water into ECF and dilutes the sodium
Potassium
Normal Range: 3.3-5 mmol/L
Critical Value <3 or >6.1
Major intracellular cation
- intracellular concentration of K+ = 150 mEq/L
- potassium is excreted in the kidneys
- small variations = effect HR and cardiac contractility
- normally supplied by the diet
- important role in protein synthesis, acid base balance, sodium reabsorption
- Collection Errors:
- opening and closing fist with tourniquet will increase K
- hemolysis of blood in collection or processing can increase K
Chloride
Major Extracellular Anion
normal 95-110mmol?L
Critical values <80 or >115
- maintain electrical neutrality mostly as a salt NaCl
- effects water balance
- acts as buffer to assist in acid base balance
- shifts in chloride are usually related to sodium or bicarb
Carbon Dioxide
aka Bicarbonate HCO3-
measure of CO2 in the blood
normal: 24-32mmol/L
critical <10 or >40
- assists in evaluating pH status of pt
- major role in acid base balance
- negative charge: important for electrical neutrality
- venous blood sample NOT as accurate arterial blood gas in finding the CO2 levels
Arterial Blood Gas
collected from arteries NOT veins
special processing → immediately placed on ice and brought to lab
- Normal Values:
- pH = 7.35-7.45
- PaO2: >90mmHg
- PaCO2: 35-45mmHg
- HCO3-: 18
Arterial Blood Gas
collected from arteries NOT veins
special processing → immediately placed on ice and brought to lab
- Normal Values:
- pH = 7.35-7.45
- PaO2: >90mmHg
- PaCO2: 35-45mmHg
- HCO3-: 24-32 mEq/L
BUN
Blood urea nitrogen
indirect rough measurement of renal function and GFR
must have normal liver fx to be a valid test
-
Normal Range: 8-22mg/dL
- critical >100 (no critical low)
- BUN = formed in the liver at the end of protein metabolism then excreted through the kidneys
- increased BUN = azotemia
- BUN may be low in severe liver disease (decreased synthesis of BUN)
- non-renal causes:
- pre-renal azotemia: result of pathological condition that causes BUN to rise before kidneys
- post-renal azotemia: BUN accumulates in kidneys due to ureteral or urethral obstruction
Creatinine
-
Average Adult Range = 0.44-1.27mg/dL
- critical value >4
- Measurement of renal function
- lean body mass effects level of creatinine
- * in general, doubling of creatinine = >50% reduction of GFR ***
- used as estimate of GFR (eGFR)
normal is variable and is dependent on age, gender, and muscle mass → should trend these!
Creatinine Clearance Test
requires urine collection for 24 hours and a serum creatinine level for 24 hours
expensive and takes a lot of time → more efficient and reasonable for everyday practice to use eGFR
Glucose
-
Normal Range for Fasting Adult: 70-99
- critical values:
- male: <50 or >450
- female: <40 or >450
- infant: <40
- newborn: <30 or >300
- critical values:
