CMP Flashcards
What is an electrolyte?
A substance that becomes inos in solution and acquire the capacity to conduct electricity.
What is a Cation?
positively charged ion
What is an Anion?
negatively charged ion
What does CMP stand for?
Comprehensive Metabolic Panel (or Profile)
What tests are included in the CMP?
(14) potassium, chloride, sodium, glucose, creatinine, blood urea nitrogen, ALT, AST, total bilirubin, ALP, Calcium, bicarbonate, total protein, albumin
What is another name for the CMP?
Chem 14
What components make up blood?
Plasma - 55%
Cells - 45%
What makes up blood plasma?
water - 91%
blood proteins - 7%
nutrients, hormones, electrolytes - 2%
What makes up the blood cells?
Buffy Coat - WBCs, Platelets
RBCs
What are the functions of electrolytes?
water maintenance
pH balance
Neuromuscular control
How much of men and women’s body weight is made up by water?
Men - 60%
Women - 50%
Describe the distribution of water throughout the body.
2/3 in the intracellular compartment (ICFV)
1/3 in the extracellular compartment (ECFV)
3/4 of ECFV in the interstitial fluid
1/4 of ECFV in the plasma
What water compartment is being tested in the CMP?
the blood plasma
-plasma reflects the other compartments due to compensation
What is the first compartment to lose water through sweating, fever, and dehydration?
the blood plasma
-the interstitial fluid then compensates
What are the names of the conditions outlying the normal range of sodium?
hyponatremia
hypernatremia
What are the names of the conditions outlying the normal range of potassium?
hypokalemia
hyperkalemia
What are the names of the conditions outlying the normal range of chloride?
hypochloremia
hyperchloremia
What are the names of the conditions outlying the normal range of bicarbonate?
metabolic acidosis - decreased levels
metabolic alkalosis - increased levels
What are the names of the conditions outlying the normal range of magnesium?
hypomagnesemia
hypermagnesemia
What are the names of the conditions outlying the normal range of phosphate?
hypophosphatemia
hyperphosphatemia
What are the names of the conditions outlying the normal range of calcium?
hypocalcemia
hypercalcemia
What is the normal arterial pH range?
7.35 - 7.45
Where is sodium primarily located?
extracellular compartment
What are sodiums main roles in the body?
serum osmolality - size of extracellular fluid volume
maintain acid-base balance
transmit nerve pulses - imbalances can cause cell malfunction and even death
In what conditions would you see hypernatremia?
Events where water loss is not replaced - severe vomiting, diarrhea.
Excessive sweating, extreme fever, exercise and seizures
hyperaldosteronism
Describe hyperaldosteronism.
Aldosterone is a hormone that aids in reabsorption of sodium into the blood stream. Excess aldosterone would lead to higher than normal retention of sodium.
At what serum level can sodium lead to heart failure?
> 160
In what conditions might you see hyponatremia?
hypervolemia - liver and kidney disease
burn victims
hypoaldosteronism
patients on diuretics - monitor regularly
fluid replacement following diarrhea, vomiting, and burns
At what serum level can sodium lead to seizures and coma?
<110
What are some signs and symptoms of hypernatremia?
lethargy, weakness, confusion, muscle twitching, tremors, seizures and irritability
What are signs and symptoms of hyponatremia?
CONFUSION, WEAKNESS, nausea, malaise, headache, lethargy, muscle twitching
Where is potassium primarily located?
intracellular compartment - 90%
What functions are potassium important for?
muscle activity - especially heart rate and contraction
nerve conduction, acid-base balance, osmotic pressure
What conditions may cause hyperkalemia?
Renal insufficiency - most common
Medications (potassium sparing diuretics) - monitor regularly
Aldosterone deficiency
Trauma
Acidosis, low insulin levels, beta blockers
excessive potassium intake
Why are potassium levels often drawn twice if the first draw is a high level?
Trauma to the cells of the puncture site may have released excess potassium, leading to an inaccurately high reading. - Pseudohyperkalemia
What EKG findings might you find with hyperkalemia?
peaked T-waves
What EKG findings might you find with hypokalemia?
A U-wave
What are symptoms of hyperkalemia?
PALPITATIONS, weakness, malaise
What conditions may cause hypokalemia?
severe vomiting, diarrhea and laxative abuse
excessive sweating
inadequate oral intake - starving
increased cellular uptake - due to insulin and metabolic acidosis
hyperaldosteronism, diuretics
patients who are post dialysis
What are symptoms of hypokalemia?
weakness, muscle cramps, myalgia
paralysis (usually lower extremities first)
Where is chloride primarily located?
extracellular compartment
What are the main functions of chloride in the body?
electrolyte balance, hydration and osmotic pressure
What symptoms do hyper/hypochloremia display?
Generally asymptomatic
What may cause hyperchloremia?
dehydration and metabolic acidosis
What may cause hypochloremia?
gastrointestinal losses from prolonged vomiting or nasogastric suctioning
burns
diuretics, metabolic alkalosis
Where is bicarbonate primarily found?
extracellular compartment (2nd major ion in the ECF)
What are the primary functions of bicarbonate?
Transport system to carry CO2 from tissues to lungs
maintain pH of blood
What two main ions do you have to order in addition to the CMP?
Magnesium and Phosphate
What is the primary function of magnesium?
Regulate neuromuscular activity
Heart function
Where do you primarily find magnesium in the body?
40-60% in bone
30% in cells
20% in muscle
1% in serum
What might cause hypermagnesemia?
Renal Failure
dehydration, hypothyroidism, addison’s disease, magnesium supplementation
What are symptoms of hypermagnesemia?
weakness, nausea/vomiting, impaired breathing, hypotension, and arrhythmias
What might cause hypomagnesemia?
hpercalcemia, diabetic acidosis, hemodialysis, chronic pancreatitis, chronic cirrhosis, chronic glomerulonephritis
What are symptoms of hypomagnesemia?
TETANY
involuntary muscle contractions
What is the primary function of phosphate in the body?
generation of bony tissue
functions in the metabolism of glucose and lipids
acid-base balance
energy transfer in the body
What ion does phosphate have an inverse relationship with?
Calcium - always evaluated in relationship to
What might cause hyperphosphatemia?
Kidney dysfunction
What is the most abundant electrolyte in the human body?
Calcium
Where is calcium primarily found in the body?
bound to the skeleton
What are the primary functions of calcium in the body?
neuromuscular activity
blood coagulation
bone metabolism
functional integrity of cell membranes
What might cause hypercalcemia?
hyperparathyroidism
malignancy (cancer)
vitamin D toxicity
What are symptoms of hypercalcemia?
abdominal pain from constipation, fatigue, lethargy, depression, bone pain
What might cause hypocalcemia?
hypoparathyroidism
vitamin D deficiency
What are symptoms of hypocalcemia?
oral, perioral, and acral parethesias
caropedal and generalized tetany
What are the main functions of the liver?
Protein synthesis
Digestion - bile synthesis
Decomposition of RBCs
metabolize and store carbohydrates (glucose = glycogen)
hormone production
production of blood clotting factors
breakdown of drugs, alcohol, and other toxins
What are symptoms of liver damage?
Pale stools - lack of bilirubin
Dark urine - bilirubin
Jaundice
Swelling - abdomen, ankles, feet (lack of albumin)
Excessive fatigue - loss of nutrients
Bruising, steady bleeding - lack of coagulants
What is bilirubin?
Product of breakdown of hemoglobin
What are the two types of bilirubin?
Conjugated - processed by liver, water soluble
Unconjugated - pre-liver. bound to albumin in serum
How is bilirubin normally excreted?
through the intestines, which eventually break it down to urobilinogen in the large intestine
What are some reasons for increased total bilirubin?
bile duct obstruction
cirrhosis of the liver, hepatitis, infectious mono, chemotherapy, malignancy of the liver/gallbladder
What is total bilirubin?
Measure of both conjugated and unconjugated bilirubin in the blood.
Why may unconjugated bilirubin levels be increased?
RBC destruction from hemolytic anemia
neonatal jaundice
gilbert disease, crigler-najarr syndrom (both rare)
What causes neonatal jaundice?
Increased breakdown of fetal erythrocytes, due to a shortened RBC life span and higher mass than an older infant
Also, low concentration of binding proteins for conjugation
What is the treatment for neonatal jaundice?
Phototherapy
What is the best enzyme to measure to identify liver damage?
Alanine Aminotransferase (ALT) - very specific to the liver
What might elevated ALT levels indicate?
hepatitis, cirrhosis, bile duct obstruction, infectious mono, drugs
What is a less specific enzyme test that is often ran with the ALT test?
Aspartate Aminotransferase (AST)
What does an AST/ALT ratio greater than 2:1 generally indicate?
Alcoholic hepatitis
Possibly cirrhosis in chronic viral hepatits
What other conditions may elevated ALT and AST levels indicate?
acute muscle injury, thyroid dysfunction, celiac disease, adrenal insufficiency, myocardial infarction, acute pancreatitis, acute hemolytic anemia, sever burns, acute renal disease, trauma
What conditions may you see excessively high levels of AST or ALT?
Acute viral hepatitis, ischemic hepatitis, acute drug or toxin liver injury, autoimmune hepatitis, acute bile duct obstruction.
In what situations may you want to perform a liver biopsy, to rule out the liver, when AST and ALT levels are elevated?
Acute muscle injury, thyroid dysfunction, celiac disease, adrenal insufficiency.
What is the Gamma Glutamyltransferease (GGT) used to determine?
Liver cell dysfunction. Most commonly used to detect alcohol induced liver disease, and to monitor cessation or reduction of alcohol consumption in alcoholics.
Is the GGT a part of the normal CMP?
No
What circumstances might it be beneficial to order a GGT?
Alcohol can mask other symptoms - it is good to get a GGT to detect if alcohol plays a role.
You can also use a GGT to help determine what meds to give for the shakes, or to confirm that a patient has been drinking, even when they say they have not.
What is an Alkaline Phosphate (ALP) test used for?
The diagnosis of liver disorders by recognizing CHOLESTATIC DISEASE. Think GALLBLADDER!
What conditions may you find an elevated ALP?
Cholestasis, cholecystitis, cholangitis, cirrhosis, hepatitis, liver tumor, liver metastasis, and drug intoxication.
Why is ALP commonly elevated in children?
Because it is primarily found in the bone. (also found in the liver and intestinal tract)
What is the most abundant plasma protein in the body?
Albumin
What are the main functions of albumin?
Maintaining osmotic pressure in intravascular compartments.
Where is albumin made?
In the Liver
Why may albumin levels be increased?
Dehydration
Why may albumin be decreased?
Cirrhosis, alcoholism, renal disease, chron’s disease, thyroid disease.
What are Prothrombin time and International normalized ration (PT/INR) used to measure?
Extrinsic pathway of coagulation.
Used to determine the clotting tendency of the blood, warfarin dosage, vitamin k status, and LIVER DAMAGE.
Why does warfarin affect your PT/INR levels?
Warfarin is an anticoagulant, so it will reduce the bloods ability to clot.
If a patient is NOT taking warfarin and has elevated PT/INR levels, what should you be concerned about?
Liver disease.
The liver makes clotting factors for the blood. If the liver is impaired, the ability of the blood to clot will be decreased.
What does a Total Protein test measure?
Rough measurement of all the proteins in the serum, SPECIFICALLY total albumin and globulin.
What conditions may you see with an elevated Total Protein?
Hep B, Hep C, HIV, multiple myeloma.
What conditions may you see with a decreased Total Protein?
Nephrotic syndrome, glomerulonephritis, burns, bleeding, malnutrition.
What conditions may show elevated Lactate Dehydrogenase (LDH)?
NOT specific to liver.
Can be elevated in liver disease, but also cancer of many organs in the body.
