BMP/CMP

Question 1

provides information about the body’s chemical balance and metabolism
Measures 8 different lab values within the blood

Answer 1

BMP

Question 2

3 substances and 5 electrolytes in BMP

Answer 2

3 Substances
 Glucose
 BUN
 Creatinine

5 Electrolytes
 Sodium
 Potassium
 Bicarbonate
 Chloride
 Calcium

Question 3

 75 -105 mg/dL
 Fingerstick glucometers must be calibrated
properly (per shift/box)
 DM = 126+ x2 occasions or random >200
with symptoms
 Elevated = blurred vision, headaches,
polyuria/polydipsia/polyphagia, coma, death
 Decreased = AMS, dizzy, seizures
 Draw labs below site where IV Dextrose
running

Answer 3

glucose

Question 4

 Indirect and rough measurement of renal function
and a measurement of liver function
 BUN measures amount of urea nitrogen in the
blood
 Protein → amino acids during digestion
 Amino acids → ammonia and then to urea in the
liver
 Urea is excreted by the kidneys
 Critical Value: Greater than 80 mg/dL = severe
renal impairment

Answer 4

BUN

Question 5

dehydration, GI bleed, crush injuries, renal failure, ureteral and
urethral obstruction (post-renal azotemia), starvation, burns, shock, high protein diet,
meds (allopurinol, aminoglycosides, cephalosporins, propranolol, lasix, aspirin)

Answer 5

increased BUN

Question 6

overhydration, liver failure, pregnancy, nephrotic syndrome (kidney disorder
that is leaking too much protein into urine)

Answer 6

decreased BUN

Question 7

Marker for impaired renal function
 Creatinine is a by-product of creatine phosphate (CR) → excreted by kidneys
 Directly proportional to renal function

Elevated = glomerulonephritis, pyelonephritis,
rhabdomyolysis, urinary obstruction, dehydration
 Can lead to permanent damage

Decreased = decreased muscle mass (muscular
dystrophy, myasthenia gravis)

Answer 7

creatinine

Question 8

 Between 10:1 and 20:1
 A good measurement for kidney and liver function

Answer 8

BUN to Creatinine Ratio

Question 9

 Doubling of creatinine = 50% reduction in GFR
 Inaccurate GFR in setting of higher muscle mass and protein intake

Answer 9

Creatinine and GFR: Creatinine used to predict GFR

Question 10

 Normal Range: 132 - 146 mEq/L
 Hypernatremia = TBI
 Hyponatremia = CHF (increased free water retention and
Na+ diluted), meds (thiazides (inhibit Na+ reabsorption)),
psychogenic polydipsia (compulsive water consumption),
SIADH (syndrome of inappropriate ADH secretion)
 Pseudohyponatremia = poorly controlled DM draws water
from muscles, every 100 rise in glucose = 1.4mEq/L drop
in sodium
 Critical Range: Below 120 mEq/L

Answer 10

sodium

Question 11

 Normal Range: 3.5 - 5.5 mEq/L
 Starts as peaked T waves on EKG and progresses to
widened QRS complex as K+ level rises
 Hypokalemia symptoms = arrhythmias, muscle pain,
hyporeflexia, N/V, orthostatic hypotension
 Critical: <2.5 or >6.5 mEq/L

Answer 11

potassium

Question 12

 Renal failure most common cause of
hyperkalemia
 Acidosis = to maintain pH H+ ions are driven
into cell and K+ ions are expelled from the cell
causing rise in K+ level
 Meds = ACEI, ARBs
 Opening/closing hand after tourniquet,
hemolysis of lab sample

Answer 12

P O TA S S I U M : H Y P E R K A L E M I A

Question 13

 Normal Range: 22-29 mEq/L
 Decreased = metabolic acidosis, respiratory
alkalosis
 Increased = metabolic alkalosis, respiratory acidosis

Answer 13

bicarbonate

Question 14

 Normal Range: 99 -109 mEq/dL
 Major extracellular anion
 Used by kidneys to concentrate urine
 Decreased = impending renal dysfunction, diuretics
 Elevated = excess diuresis
 Follows sodium (if high, Cl high)
 Critical: < 75 mEq/L and > 126 mEq/L

Answer 14

chloride

Question 15

 Normal Range 8.6 - 10 mg/dL
 Critical Range 12.0 and greater.
 *Most abundant mineral in the body
 Decreased = renal insufficiency, hypomagnesemia, decreased parathyroid
hormone, massive blood transfusion
 Elevated = hyperparathyroidism, parathyroid-secreting tumor, high intake
supplements
 Ionized calcium = decreased in low CO, HOTN, arrhythmias

Answer 15

total calcium

Question 16

 Normal = 90-120 mL/min per 1.73m2
 <60 suggests renal impairment

Answer 16

GFR = glomerular filtration rate

Question 17

normal 1.3-2.1 mEq/L
 Elevated = renal defect, severe dehydration, Mg supplement, aspiration of sea water
 Decreased = GI distress, V/D, cirrhosis, pancreatitis

Answer 17

Magnesium (Mg):

Question 18

normal 2.3-4.7 mg/dL
 Elevated = hypoparathyroidism and renal failure
 Decreased = nutritional disorders and hyperparathyroidis

Answer 18

phosphate

Question 19

Includes BMP plus additional lab values
 Proteins
* Total Protein
* Bilirubin
* Albumin
 Liver Enzymes
* Alkaline Phosphatase (ALP)
* Alanine Transaminase (ALT)
* Aspartate Aminotransferase (AST)

Answer 19

CMP

Question 19

 Normal 6.0-8.0 g/dL
 Composed of albumin and immunoglobulins
 Fluctuates with albumin, thus usually use albumin clinically

Answer 19

total protein

Question 19

 Normal 3.5-5 g/dL
 Decreased = increased protein catabolism, decreased production, edema in spaces
between cells and tissues, hypoalbuminemia
 Increased = dehydration, not pathologic

Answer 19

albumin

Question 20

 Total = normal 0.2-1.0 mg/dL
 Newborn normal = 1-12.0
 Elevated = liver disease, biliary tract
obstruction, RBC hemolysis
 Critical adults >12, newborn >15
 Direct = normal 0.1-0.3 mg/dL
 Indirect = normal 0.2-0.8 mg/dL
 Makes up 70-85% of total bilirubin
 Indications = liver function, hemolytic anemia,
newborn jaundice

Answer 20

bilirubin

Question 20

when bilirubin > 2.5 mg/dL
 Physiologic jaundice of newborn
 Normal physiology due to inadequacy of conjugating
enzymes
 If bilirubin > 15 mg/dL; immediate treatment to prevent
mental retardation (kernicterus)

Answer 20

jaundice

Question 21

 Gallstones
 Extrahepatic duct obstruction
 Extensive liver mets, cholestasis from drugs
 Dubin-johnson syndrome
 Rotor syndrome

Answer 21

increased conjugated (direct) bilirubin

Question 22

 Erythroblastosis fetalis, transfusion reaction, sickle cell anemia  Hemolytic anemia, hemolytic jaundice, pernicious anemia, large-volume blood transfusion  Hepatitis, cirrhosis, sepsis, crigler-najjar syndrome, gilbert syndrome

Answer 22

Increased unconjugated (indirect) bilirubin

Question 22

 Normal 10-30 U/L  0 – 5 days: 35 – 140  < 3 yrs: 15 – 60  6 – 12 yrs: 10 – 50  12 – 18 yrs: 10 – 40  Adults: 7 - 40  Evaluates hepatocellular disease  AST found in the heart muscle, liver cells, skeletal muscle cells, kidney cells

Answer 22

A S PA R TAT E A M I N O T R A N S F E R A S E (AST)

Question 22

 Normal = 30-120 U/L  Indications = liver diseases or bone diseases  ALP found in liver, biliary tract, bone, and placenta  ALP 1 in liver, ALP 2 in bone  Most sensitive test to detect mets to liver  Elevated = cirrhosis, biliary obstruction, mets to bone, healing fracture, osteomalacia, paget disease (bones enlarge/deform/weaken), RA, sarcoidosis  Decreased = malnutrition, pernicious anemia, scurvy, hypophosphatemia

Answer 22

A L K A L I N E P H O S P H ATA S E (ALP)

Question 22

 Injury causes lysis and release of the enzyme  AST is elevated 8 hours after an injury  Peak time: 24 to 36 hours  Return to baseline: 3 to 7 days  Elevated = liver damage, alcoholic cirrhosis, hepatitis, cancer, mono, seizures, heat stroke, severe burns  Acute hepatitis is 20x  Acute extrahepatic obstruction is 10x  Decreased = acute renal disease, beriberi (B1 deficiency), DKA, chronic renal dialysis, pregnancy  Conflicting = pregnancy, exercise, DKA, meds

Answer 22

AST

Question 23

 Normal 10-40 U/L  Indications = hepatobiliary disease  ALT predominantly in liver  Elevated = hemolytic anemia (definitive lab for liver as cause of hemolysis), liver damage, alcoholic cirrhosis, hepatitis, cancer, pancreatitis, mono, shock AST:ALT ratio > 1 = alcoholic cirrhosis (>3:1 highly suggestive), liver congestion, metastatic tumor < 1 = acute hepatitis, viral hepatitis, mono

Answer 23

A L A N I N E T R A N S A M I N A S E (ALT)

Question 24

 Normal 0.5-1.5 mmol/L  Elevated = if level greater than 2mmol/L, perfusion and oxygenation of cells, tissues, and end organs inadequate  Decreased = Levels are slow to respond to adequate resuscitation with fluid

Answer 24

lactate

Question 25

 Normal 100-200 U/L  Previously used to diagnose AMI, now we use troponin  Now used for assessing tissue damage and cancer severity

Answer 25

Lactate dehydrogenase (LDH)

Question 26

 Normal 2%, higher in smokers  CO binds to Hg irreversibly  Always apply oxygen as patient will show normal pulse ox

Answer 26

Carboxyhemoglobin (COHb)

Question 27

 C-Reactive protein (CRP)  Erythrocyte sedimentation rate (ESR)

Answer 27

Inflammatory markers

Question 28

normal 27-131 U/L  Decreased = seen in cystic fibrosis

Answer 28

amylase

Question 29

normal 31-186 U/L  Elevated = bile duct obstruction, biliary disease

Answer 29

lipase

Question 30

normal <500 ng/mL  Elevated = inflammation, PE, injury, infection, cance

Answer 30

D dimer

Question 31

normal 8-16 mEq/L  Increased = presence of unmeasured anions (lactic acid)

Answer 31

anion gap