BMP/CMP Flashcards
provides information about the body’s chemical balance and metabolism
Measures 8 different lab values within the blood
BMP
3 substances and 5 electrolytes in BMP
3 Substances
Glucose
BUN
Creatinine
5 Electrolytes
Sodium
Potassium
Bicarbonate
Chloride
Calcium
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
glucose
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
BUN
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)
increased BUN
overhydration, liver failure, pregnancy, nephrotic syndrome (kidney disorder
that is leaking too much protein into urine)
decreased BUN
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)
creatinine
Between 10:1 and 20:1
A good measurement for kidney and liver function
BUN to Creatinine Ratio
Doubling of creatinine = 50% reduction in GFR
Inaccurate GFR in setting of higher muscle mass and protein intake
Creatinine and GFR: Creatinine used to predict GFR
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
sodium
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
potassium
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
P O TA S S I U M : H Y P E R K A L E M I A
Normal Range: 22-29 mEq/L
Decreased = metabolic acidosis, respiratory
alkalosis
Increased = metabolic alkalosis, respiratory acidosis
bicarbonate
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
chloride
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
total calcium
Normal = 90-120 mL/min per 1.73m2
<60 suggests renal impairment
GFR = glomerular filtration rate
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
Magnesium (Mg):
normal 2.3-4.7 mg/dL
Elevated = hypoparathyroidism and renal failure
Decreased = nutritional disorders and hyperparathyroidis
phosphate
Includes BMP plus additional lab values
Proteins
* Total Protein
* Bilirubin
* Albumin
Liver Enzymes
* Alkaline Phosphatase (ALP)
* Alanine Transaminase (ALT)
* Aspartate Aminotransferase (AST)
CMP
Normal 6.0-8.0 g/dL
Composed of albumin and immunoglobulins
Fluctuates with albumin, thus usually use albumin clinically
total protein
Normal 3.5-5 g/dL
Decreased = increased protein catabolism, decreased production, edema in spaces
between cells and tissues, hypoalbuminemia
Increased = dehydration, not pathologic
albumin
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
bilirubin
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)
jaundice
Gallstones
Extrahepatic duct obstruction
Extensive liver mets, cholestasis from drugs
Dubin-johnson syndrome
Rotor syndrome
increased conjugated (direct) bilirubin
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
Increased unconjugated (indirect) bilirubin
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
A S PA R TAT E A M I N O T R A N S F E R A S E (AST)
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
A L K A L I N E P H O S P H ATA S E
(ALP)
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
AST
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
A L A N I N E T R A N S A M I N A S E
(ALT)
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
lactate
Normal 100-200 U/L
Previously used to diagnose AMI, now we use troponin
Now used for assessing tissue damage and cancer severity
Lactate dehydrogenase (LDH)
Normal 2%, higher in smokers
CO binds to Hg irreversibly
Always apply oxygen as patient will show normal pulse ox
Carboxyhemoglobin (COHb)
C-Reactive protein (CRP)
Erythrocyte sedimentation rate (ESR)
Inflammatory markers
normal 27-131 U/L
Decreased = seen in cystic fibrosis
amylase
normal 31-186 U/L
Elevated = bile duct obstruction, biliary disease
lipase
normal <500 ng/mL
Elevated = inflammation, PE, injury, infection, cance
D dimer
normal 8-16 mEq/L
Increased = presence of unmeasured anions (lactic acid)
anion gap
