Complete Metabolic Panel (CMP) Flashcards
CMP is ___ in frequency of utilization after the CBC
2nd
CMP is most common way to diagnose
diabetes
–when you see high glucose reading, you should evaluate this patient because they may be a diabetic
CMP is also useful to monitor for side effects or ______ from meds or the effect of chronic medical conditions on the ____ +_____
toxicities
kidney +liver
most providers think of labs in a certain order. which are the 2 first?
CBC, CMP
When you think of CMP you primarily think of ____ disease and ____ abnormalities
GI disease
electrolyte abnormalities
if pt is feeling weak/run down, etc. order a
get a CBC and CMP.
If someone is on a med that has a side effect of liver toxicity
Ex: give pt lamocil for toe fungus but it can have harsh side effect on liver/liver toxicity, you should monitor their liver through a
CMP
Components of the Complete/Comprehensive Metabolic Panel
15 things
The baby bunny always crawls around and continues along a perfect calm green sunny cottage
Total Protein BUN Bilirubin ALT Creatinine AST albumin CO2 alkaline phosphatase anion gap potassium Calcium glucose sodium chloride
When looking at electrolyte fan and abnormalities we look at
Sodium, Potassium, Chloride, CO2, Anion Gap, Calcium
When looking at renal fxn we look at
BUN, creatinine
When looking at liver fxn we look at
bilirubin, alkaline phosphatase, AST, ALT, (commonly referred to as LFTs)
When looking at proteins we look at
albumin, total protein
When we monitor diabetes we look at
glucose level
tells you 1 important thing: is pt diabetic or not?
When would we want to know someones electrolyte status?
heart condition, High BP pts, dehydration from intense sports maybe
How do We measure bilirubin in babies
we can see babies with jaundice –> put under heat lamp to decrease jaundice
frequent reasons that Geng orders CMPs
–> In evaluation of abdominal pain to check for elevated liver enzymes, renal dysfunction
For GI tract problems/kidney disease
–> To evaluate for abnormalities of glucose levels in diabetes
–>To evaluate potassium and renal function in the treatment of hypertension
Or just when treating HTN in general
–> To evaluate for liver dysfunction or liver toxicities with medication
Normal Sodium
136-142mEg/L
Normal Potassium
3.5-5 mEg/L
normal glucose
70-110mg/dL
normal BUN
8-23md/dL
normal creatinine
men 0.7-1.3
women 0.6-1.1
mg/dL
bilirubin
0.3-1.2mg/dL
Looking at fluids:
1) Intravascular/Plasma
2) Intracellular
3) Interstitial
what is predominantly in each ?
1) intravascular/plasma =what’s floating in vessels= predominantly Na+ (and also Cl- to balance it out )
2) Intracellular= mostly K+–big player here
3) interstitial fluid= similar to plasma Na+ and Cl- to balance it
Sodium is a predominant cation in the _____ fluid
therefore it is a major determinant of
plasma and interstitial which together= extracellular
osmolality=tonicity which drives sodium reguation
the body maintains sodium homeostasis by
regulating water intake or excretion in the kidneys
So inside cell predominantly _____ and outside cell predominantly _____
K+
Na+
Regulation of Na+ can occur through multiple hormones, including _____ and _____ but Na+ is primarily regulated by _______
aldosterone, naturietic
primary= ADH= ANTI-DIURETIC HORMONE
ADH is produced in the ____ and released by the
hypothalamus
pituitary
ADH is also known as
vasopression
ADH fxns
increases renal free water reabsorption–> so more water reabsorbed, less peeing/diuresis
How to reduce osmolality?
Increase renal free water reabsorption in kidneys
what ADH does
What detects increased osmotic pressure? and what does it mean if it is increased?
osmoreceptors in pituitary
it means too much sodium
this means that BP will go up to increase blood volume/pressure
as plasma water decreases (dehydration), what happens?
you want to CONSERVE WATER
1) so sodium osmolality increases,
2) ADH is secreted to stop you from peeing, and
3) collecting renal tubule reabsorbs more water
increasing ADH _____ diuresis
decreases
as plasma water INCREASES, (hydrated) what happens?
you can get rid of water
1) so sodium and osmolality decrease (dilution)
2) body compensates by decreasing ADH secretion (can pee normally)
3) collecting renal tubule becomes impermeable so water is NOT reabsorbed
Decreasing ADH
pee more
body is very good at homeostasis between sodium intake and ADH so hypernatremia doesn’t occur very often but when it does, it occurs in
unreplaced water loss: specific situations
1) elderly pos who have impaired mental faculties and have diminished thirst stimulation
2) patients not given free access to water or given saline solns (too much of it)
Hyponatremia
can be caused by
1) dietary/nutritional intake (kind of rare to not get enough Na+–but could be from GI issues/diarrhea)
2) thiazide diuretics–make you pee a lot and sodium goes out with the water(chlorthalidone/hydrochlorthalidone)
3) renal insufficiency- not kidney failure, but not working and too much water/Na+ is leaving
Which is more common, hyponatremia or hypernatremia?
hyponatremia
When a patient has hyponatremia, think of
medications, such as diuretics
Thiazides increase water permeability and water reabsorption with an effect that is independent of ADH
Bob is a 35 year old man with a history of hypertension. Four years ago, he was placed on a thiazide-type diuretic, Chlorthalidone 25 mg at dose of 1 daily. Recently, his physician advised him that his BP was still not adequately controlled and he was thinking of placing Bob on a second hypertension medication. Bob was not happy to hear this, so he promised his physician that he would begin an exercise regimen and change his diet. Bob went on a crash diet of chicken, white rice and water. He avoided all fruits and vegetables to He has been exercising in the summer heat without drinking water. Bob is brought into the ER with sudden cardiac arrest
What electrolyte abnormality may have contributed to his event?
Chlorthalidone and Hydrochlorothiazide are two very common thiazide type diuretics that are used 1st line to treat HTN. The most common side effect that you might see is hypokalemia.
Bob also failed to eat any potassium when he changed his diet.
What happened here? he decreased his K+ in what he eats and he’s on chlorthalidone which drops K+ anyways
When K+ went dangerously low (heart muscle contractility) caused heart to stop contracting
As part of the CMP, the glucose level is one of the more ______ values that you will commonly use
It is a direct measurement of the quantity of _______
Glucose levels are a direct result of feedback mechanisms and are controlled by
important
glucose in serum
glucagon and insulin
insulin and is secreted when glucose levels go up (it decreases blood glucose)
glucagon is secreted when glucose levels are low (it increases blood glucose)
what secretes insulin?
cells in the Islet of Langerhans in the pancreas
does Serum glucose need to be measured when patient has been fasting?
Many factors can increase glucose levels
such as
no it can be measured fasting or non-fasting
Stress, pregnancy, glucose-containing IV fluids
Medications (↑ or ↓)
reasons for increased glucose
1) diabetes
2) acute stress response (-body needs energy (fight or flight) so it needs glucose
Running from a tiger– need glucose )
3) pancreatitis (because pancreas gets inflamed and releases more glucose)
4) corticosteroid therapy –so for diabetics this can be hard to take
normal fasting glucose
70-110
Patients who have hypothyroidism have impaired hormonal responses to_____ They also have impaired ability to produce adequate _________
low glucose levels and inadequately respond when glucose levels are low. (low growth hormone and cortisol response).
glucose/gluconeogenesis
Karen is a 15 year old girl who presents to your family practice office with her mother, Linda. Linda states that Karen has been experiencing frequent bouts of dizziness over the last 3 weeks which are worse in the morning, but can happen at any time during the day. Karen feels tired, clammy and sometimes close to passing out frequently with the dizzy spells. She has no other neurologic symptoms, takes no medications, has no significant family history of cardiac disease, and her physical exam is unremarkable except you notice that she is wearing baggy clothes and refused to be weighed in at your office. After you coax her to the scale, you record her height at 5’6” and weight as 90 lbs.
1) What electrolyte abnormality could be causing her symptoms?
2) What other test(s) might you order?
3) What might you recommend?
1) -K+, glucose
- could also be an eating disorder
- one of the things you see a lot: young women in teens that are not eating as well as they should and they come in and feel tired/dizzy/syncopy. Ask them if they ate anything before feeling this? If they didn’t eat breakfast sugar could be low
2) - nutritional marker= prealbumin serum protein test
- -quick measure of nutritional status
3) tracking what she eats, eating at least 3x a day—eat every few hours
BUN
The ______ is the main filtering structure of the kidney
Glomerular filtration rate=
glomerulus
number of milliliters of body fluid cleared by the kidneys per unit of time = mL/minute
BUN
Urea formation occurs primarily in the _______ as a result of :
liver
the catabolism of protein into amino acids → free ammonia is formed in process
Ammonia molecules then combine to form urea, which is filtered by the glomerulus
so when you think urea, think protein
BUN
Approximately 50% of urea is reabsorbed in renal tubule and rest is excreted in urine
BUN therefore reflects the metabolic functioning of the
liver and excretory function of the kidneys
tells us about both liver and fxn of kidneys
Is BUN is the best reflector of kidney fxn alone?
no –it also tells you about liver fxn.–it is not specific to just kidneys. it is affected by fxn of kidney
Increased BUN can be due to
1) High protein diets
2) GI bleed (Digested blood is a source of urea and also patient may have decreased perfusion to kidneys due to bleeding)
3)dehydration
(increased protein of some kind)
If pt comes in with suspected GI bleed what tests do you run/what do you look for?
1) CBC (looking at hGB and HCT)
2) CMP (looking at BUN because blood is a source of protein that you are ingesting during a bleed)
Decreased BUN can be due to
1) low protein diets
2) starvation
3) over-hydration
(low protein in some way)
