BMP/CMP Flashcards
BMP components
3 substances;
glucose
BUN
creatinine
5 electrolytes
sodium
potassium
bicarb
chloride
calcium
What’s a normal glucose level
75-105
What can elevated glucose cause?
blurred vision, headaches, polyuria/polydipsia/polyphagia, coma, death
What can decreased glucose cause?
AMS, dizzy, seizures
draw labs below site where IV dextrose running
BUN measures what
amount of urea nitrogen in the blood
What is a critical BUN measure?
> 80 = severe renal impairment
When is BUN increased?
dehydration, GI bleed, crush, renal failure, ureteral/urethral obstruction, starvation, burns, shock, high protein diet, meds (allopurinol, AGs, cephs, propanolol, lasix, aspirin)
When is BUN decreased?
overhydration, liver failure, pregnancy, nephrotic syndrome
What is a normal BUN range?
9-23
What’s normal BUN for adults
10-20
What’s normal for children and infants BUN?
5-18
What’s a normal newborn BUN?
3-12
Creatinine is a marker for
impaired renal function
What’s a normal range of creatinine for males
.7-1.3
What’s a normal range of creatinine for females
.5-1.1
creatinine: <2y
.1-.4
creatinine: 2-<6y
.2-.5
creatinine: 6-<10y
.3-.6
creatinine: 10y - <18y
.4-1
creatinine: 18y-<41y
female .5-1,, male .6-1.2
creatinine: 41y-<61y
female .5-1.1, male .6-1.3
creatinine: >61
female .5-1.2, male .7-1.3
What can elevated creatinine be caused by
glomerulonephritis, pyelonephritis, rhabdomyolysis, urinary obstruction, dehydration
What can decreased creatinine be caused by
low muscle mass (muscular dystrophy, myasthenia gravis)
ideal BUN:creatinine ratio
10:1 and 20:1
doubling of creatinine =
50% reduction in GFR
Normal sodium range
132-146
Hypernatremia =
TBI
Hyponatremia =
CHF, meds (thiazides), psychogenic polydipsia, SIADH
What’s a critical sodium range?
<120
What’s a normal potassium range?
3.5-5.5
What can hypokalemia cause?
arrhythmias, muscle pain, hyporeflexia, N/V, orthostatic HOTN
What are critical potassium values?
<2.5 or >6.5
Most common cause of hyperkalemia
renal failure
What meds can cause hyperkalemia
ACEI, ARBS
What’s a normal bicarb range?
22-29
Decreased bicarb
metabolic acidosis, respiratory alkalosis
Increased bicarb
metabolic alkalosis, respiratory acidosis
normal chloride
99-109
decreased chloride =
impending renal dysfunction, diuretics
Elevated chloride =
excess diuresis
If sodium is high, ___ is high
chloride
every 100 rise in glucose
1.4 drop in sodium
What are critical chloride values?
<75 and >126
What’s a normal calcium range?
8.6-10
What’s a critical calcium level?
> 12
decreased calcium =
renal insufficiency, hypomagnesemia, decreased parathyroid hormone, massive blood transfusion
increased calcium =
hyperparathyroidism, thyroid tumor, high intake supplements
Normal GFR
90-120
<60 = renal impairment
Normal magnesium
1.3-2.1
elevated - renal defect, severe dehydration, supplement, aspiration of sea water
decreased - GI distress, V/D, cirrhosis, pancreatitis
Normal phosphate
2.3-4.7
elevated - hypoparathyroidism and renal failure
decreased - nutritional disorders + hyperparathyroidism
BMP includes:
total protein, bilirubin, albumin
liver enzymes - alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST)
What’s a normal total protein?
6-8
composed of albumin + immunoglobulins
fluctuates w/ albumin
What’s a normal albumin?
3.5-5
decreased = increased protein catabolism, production, edema, hypoalbuminemia
increased = dehydration
Normal bilirubin
.2-1
elevated = liver disease, biliary tract obstruction, RBC hemolysis
critical bilirubin level
> 12 adults, <15 newborn
normal direct bilirubin
.1-.3
normal indirect bilirubin
.2-.8 (most)
When should you test bilirubin
liver function, hemolytic anemia, newborn jaundice
Jaundice results when bilirubin is
> 2.5
15 needs immediate treatment
Increased direct bilirubin –
gallstones
extrahepatic duct obstruction
extensive liver mets
dubin-johnson syndrome
rotor syndrome
increased indirect bilirubin–
erythroblastosis fetalis
transfusion reaction
sickle cell anemia
hemolytic anemia/jaundice, pernicious anemia
hepatitis, cirrhosis, sepsis
normal alkaline phosphatase
30-120
When do you check alkaline phosphatase?
liver diseases or bone diseases
1 = liver
2= bone
** most sensitive test to detect mets to liver **
ALP is elevated with
cirrhosis
biliary obstruction
mets to bone
healing fracture
osteomalacia
paget disease
RA
sarcoidosis
ALP is decreased with
malnutrition
pernicious anemia
scurvy
hypophosphatemia
Normal aspartate aminotransferase
10-30
0-5d = 35-140
<3y = 15-60
6-12y = 10-50
12-18y=10-40
adults = 7-40
evaluating hepatocellular disease
AST is elevated 8 hours after
injury
peak = 24-36 hours
returning 3-7 days
When is AST elevated?
liver damage, alcoholic cirrhosis, hepatitis, cancer, mono, seizures, heat stroke, severe burns
acute hepatitis 20x
acute extrahepatic obstruction 10x
When is AST decreased?
acute renal disease, beriberi, DKA, chronic renal dialysis, pregnancy
What’s a normal alanine transaminase?
10-40
for hepatobiliary disease, predom. in liver
When is ALT elevated?
hemolytic anemia (definitive lab), liver damage, alcoholic cirrhosis, hepatitis, cancer, pancreatitis, mono, shock
AST: ALT ratio
>1
<1
> 1 - alcoholic cirrhosis (esp >3:1), liver congestion, tumor
<1 = acute hepatitis, viral, mono
normal lactate
.5-1.5
elevated - >2, perfusion + oxygenation is not adequate
decreased - slow to respond
normal lactate dehydrogenase
100-200
used for assessing tissue damage and cancer severity
LDH
carboxyhemoglobin (COHb)
higher in smokers, normal 2%
apply oxygen
normal amylase
27-131
decreased in CF
normal lipase
31-186
elevated in bile duct obstruction, biliary disease
normal d-dimer
<500
elevated in inflammation, PE, injury, infection, cancer
normal anion gap
8-16
increased = presence of unmeasured anions
