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The basic metabolic panel Flashcards

1
Q

What information does the basic metabolic panel(BMP) provide?

A
  • concentration of electrolytes
  • volume status
  • acid- base status
  • Baseline renal function
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2
Q

What does the BMP consist of?

A
  • sodium
  • potassiun
  • chloride
  • bicarbonate
  • blood urea nitrogen(BUN)
  • creatinine
  • glucose
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3
Q

What do electrolytes have effect on?

A
  • hydration
  • acid-base balance
  • osmotic pressure
  • pH
  • heart and muscle contraction
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4
Q

What affects sodium levels?

A
  • hydration status (total free water in serum) Na very sensitive to water in body
  • glucose concentration
  • Hypothalamus regulates water (any disruption can result in dysnatremias)
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5
Q

What affects potassium levels?

A
  • hydration status
  • glucose concentration
  • beta-agonists
  • insulin
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6
Q

What is osmolarity and what is the normal range?

A
  • the concentration of all solutes per liter of solution

- normal range: 280-300mosm/l

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7
Q

What does decreased vs increased osmolarity tell about fluid status?

A
  • Decreased: increase in total body fluids (more dilute)

- Increases: decrease in total body fluid (concentrated)

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8
Q

What electrolytes account most for osmolarity?

A
  • Na (primary determinant)
  • glucose
  • BUN
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9
Q

What is normal range of Na?

A
  • 135-145 mEq/L
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10
Q

What are signs and symptoms of hyponatremia?

A
  • serum concentration below 135 (s&s occur below 125)
  • headache
  • n/v
  • weakness
  • seizure
  • coma
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11
Q

What is euvolemic hyponatremia?

A
  • too little sodium in extracellular space

- normal amount of fluid in the cell

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12
Q

What is hypervolemic hyponatremia?

A
  • enough sodium in ecs (body) but too much fluid in the body (over diluted)
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13
Q

What is hyperosmolar hyponatremia?

A
  • enough sodium in ecs (body) but fluid from ics dilutes the ecs, ( the cell shrink)
  • High osmolarity due to increase in glucose
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14
Q

How to correct for sodium in hyperosmotic hyponatremia if someone’s glucose is high?

A
  • to get an accurate estimate of sodium, increase the sodium by 1.6 for every 100 mg/dL of glucose over 100 mg/dL.
  • example: glucose = 600, thats 500 over normal 100 so 5x1.6 = 8, Na = 128, actual Na = 128+8 = 136
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15
Q

What causes euvolemic hyponatremia?

A
  • low sodium intake
  • high sodium excretion
  • hypothalamus regulation of water issues
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16
Q

What causes hypervolemic hyponatremia?

A
  • heart failure
  • liver failure/cirrhosis
  • renal failure
  • extra IV fluid administration
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17
Q

What causes hyperosmolar hyponatremia?

A
  • hyperglycemia/diabetic ketoacidosis
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18
Q

What are the treatment for hyponatremia?

A
  • depends on the type
  • correct the underlying disorder
  • fluid restriction
  • replace sodium through hypertonic saline
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19
Q

What are the signs/symptoms of hypernatremia?

A
  • concentration above 145 mEq/L
  • altered mental status
  • seizures
  • hyperreflexia
  • spasticity (tight muscles)
  • lethargy
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20
Q

What are the causes of hypernatremia?

A
  • volume loss
  • hyperaldosteronism
  • exogenous administration of Na (hypertonic IV fluid)
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21
Q

What are the treatment for hypernatremia?

A
  • restore fluids with intravenous and/or oral rehydration (regular saline)
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22
Q

what is the normal range of potassium and what can affect it?

A
  • normal range (3.5-5.0mEq/l)
  • renal dysfunction (kidney is the main regulator of potassium homeostasis)
  • dietary intake
  • Meds side effects
23
Q

What are the signs and symptoms of hypokalemia?

A
  • concentration below 3.5
  • muscle weakness
  • constipation
  • palpitation
  • fatigue
  • ECG changes (flattened T wave, ST segment depressions, u-waves)
24
Q

What are the treatment of hypokalemia?

A
  • oral/IV replacement

- replace low magnesium first if hypomagnesemia is present (mg regulates NaKATPase pump)

25
What causes hyperkalemia?
- concentration above 5 - renal insufficiency/failure - acidosis - meds (ACE inhibitor, Angiotensin II receptor blocker, aldosterone antagonist)
26
In what condition would you get a falsely elevated potassium reading?
- hemolysis of rbc when drawing the blood or shaking the tube, resulting in K to leak out of cell - always get another lab test done if pt coming from outside clinic
27
What are the signs and symptoms of hyperkalemia?
- muscle weakness - muscle cramping - paresthesias - ECG changes (peaked T waves, prolonged PR interval, as it progresses it will result in Wide QRS complex)
28
What are the treatments for hyperkalemia?
- IV calcium (stabilizes cardiac membranes, prevent QRS from widening more) - insulin (and glucose), promotes shunting of potassium into the intracellular compartment - beta agonists (causes K to shift inside) - potassium excretion (oral or rectal), kayexalate - dialysis
29
How is chloride levels adjusted?
- absorption through small intestine and stomach - secretion/reabsorption in the renal tubules - Normal range 96-106
30
What can cause hypochloremia?
- concentration <96 - prolonged vomiting (high level of cl in gastric fluid) - NGT suctioning - GI acid supression - results in primary metabolic alkalosis - could be due to compensation for a respiratory or metabolic acidosis
31
What can cause hyperchloremia?
- concentration >106 - could be due to aggressive administration of IV fluids - results in primary metabolic acidosis - could be due to compensation for an alkalosis
32
Where is bicarbonate produced and what is the normal range?
- produced and excreted through kidneys | - normal range 22-28
33
What does high vs low bicarbonate lead to?
- high bicarbonate = alkalosis (buffers acid in the blood, bring pH back to normal) - low bicarbonate = acidosis
34
What is the normal range for calcium and what are some of it's functions?
- 8.5 - 10 - required for blood coagulation, muscle contractions, nerve conduction, osteoclastic activity - stored in bones and teeth - regulated by parathyroid, thyroid and kidneys
35
What are some causes of calcium alterations?
- thyroid disease - parathyroid disease - renal failure - vitamin D deficiency - cancer if metastasize to bone
36
What are signs and symptoms of hypocalcemia?
- chvostek sign (facial spasms with percussion of facial nerve) - trousseau sign (hand contracts inward with inflation of a BP cuff) - paresthesias (pins and needles) - muscle cramps/spasms - hyperreflexia - tetany - seizures - ECG changes (prolonged QT interval, torsades de pointes)
37
What is the treatment for hypocalcemia?
- oral/IV replacement | - replace mg if needed (mg has an effect on Ca absorption and balance)
38
What causes hypercalcemia?
- concentration above 10 - hyperparathyroidism - bone malignancy - prolonged immobilization
39
What are the signs and symptoms of hypercalcemia?
- abdominal pain - bone pain - muscle weakness - nephro/ureterolithiasis (kidney stones) - confusion/lethargy/fatigue BONES, MOANS, PSYCHIC GROANS, FATIGUE OVERTONES, STONES
40
What is the treatment for hypercalcemia?
- IV fluid administration (dilute and promotes excretion) - loop diuretics - restriction of calcium containing foods - dialysis
41
What is function of Mg in cells and what is its normal range?
- Normal range: 1.5 - 2.5 - required for ATP processing, metabolism, neuromuscular transmission - regulated similar to Ca
42
What are the causes for hypomagnesemia and what is the treatment?
- poor dietary intake - decreased intestinal absorption - increased renal excretion - GI losses (V/D) Treatment: Oral/IV replacement
43
What are the signs and symptoms of hypomagnesemia?
- concentration below 1.5 - lethargy - confusion - tremor - paresthesias - hyperreflexia - seizures
44
What causes hypermagnesemia?
- concentration above 2.5 - renal failure - antacid overuse - over-zealous replacement
45
What are the signs and symptoms of hypermagnesemia?
- decreased DTRs (reflexes) - bradycardia - hypotension - flaccid paralysis - cardiac arrest
46
What is the treatment of hypermagnesemia?
- loop diuretics - restriction of magnesium containing foods or meds - dialysis
47
What are the 2 types of nitrogens?
- protein nitrogen | - non-protein nitrogen (urea, creatinine)
48
What can cause increased concentration of nitrogen compounds?
- decreased renal function (most nitrogen is excreted through kidneys)
49
What is BUN?
- blood urea nitrogen - waste product of protein metabolism - dependent on dietary protein - excreted by kidneys - bad kidneys = more urea
50
What is the normal range of BUN and what does it estimate?
- 7 - 20 (rough estimate of renal function) - high levels = uremia - decreased levels not clinically significant
51
What is creatinine?
- non-protein form of nitrogen that test kidney function - more muscle, higher creatinine - excreted only by kidneys - increase Cr = bad kidney function - not dependent on dietary protein - decreased levels not considered clinically significant - Normal range 0.6 - 1.2
52
What is the elevation in both BUN and Cr called?
- Azotemia (due to renal insufficiency)
53
What are the 3 renal azotemia?
- prerenal azotemia: results from poor perfusion of the kidney, dehydration, shock, diminished blood volume - renal azotemia: results from disease of kidney itself (glomerulonephritis, pyelonephritis(infection of kidney), polycystic kidney disease, nephrosclerosis - post renal azotemia: results from obstruction of excretion (kidney stones, enlarged prostate, prostate tumors, bladder tumor)
54
What is the relationship between BUN and Cr?
Normal ratio = 10:1 - 20:1 - >20:1 suggests prerenal causes (dehydration) - <10:1 suggests renal causes (ATN, glomerulonephritis, CKD)

Clinical Lab (4 decks)

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