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Clinical Lab > The basic metabolic panel > Flashcards

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
Q

What causes hyperkalemia?

A
  • concentration above 5
  • renal insufficiency/failure
  • acidosis
  • meds (ACE inhibitor, Angiotensin II receptor blocker, aldosterone antagonist)
26
Q

In what condition would you get a falsely elevated potassium reading?

A
  • 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
Q

What are the signs and symptoms of hyperkalemia?

A
  • muscle weakness
  • muscle cramping
  • paresthesias
  • ECG changes (peaked T waves, prolonged PR interval, as it progresses it will result in Wide QRS complex)
28
Q

What are the treatments for hyperkalemia?

A
  • 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
Q

How is chloride levels adjusted?

A
  • absorption through small intestine and stomach
  • secretion/reabsorption in the renal tubules
  • Normal range 96-106
30
Q

What can cause hypochloremia?

A
  • 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
Q

What can cause hyperchloremia?

A
  • 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
Q

Where is bicarbonate produced and what is the normal range?

A
  • produced and excreted through kidneys

- normal range 22-28

33
Q

What does high vs low bicarbonate lead to?

A
  • high bicarbonate = alkalosis (buffers acid in the blood, bring pH back to normal)
  • low bicarbonate = acidosis
34
Q

What is the normal range for calcium and what are some of it’s functions?

A
  • 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
Q

What are some causes of calcium alterations?

A
  • thyroid disease
  • parathyroid disease
  • renal failure
  • vitamin D deficiency
  • cancer if metastasize to bone
36
Q

What are signs and symptoms of hypocalcemia?

A
  • 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
Q

What is the treatment for hypocalcemia?

A
  • oral/IV replacement

- replace mg if needed (mg has an effect on Ca absorption and balance)

38
Q

What causes hypercalcemia?

A
  • concentration above 10
  • hyperparathyroidism
  • bone malignancy
  • prolonged immobilization
39
Q

What are the signs and symptoms of hypercalcemia?

A
  • abdominal pain
  • bone pain
  • muscle weakness
  • nephro/ureterolithiasis (kidney stones)
  • confusion/lethargy/fatigue
    BONES, MOANS, PSYCHIC GROANS, FATIGUE OVERTONES, STONES
40
Q

What is the treatment for hypercalcemia?

A
  • IV fluid administration (dilute and promotes excretion)
  • loop diuretics
  • restriction of calcium containing foods
  • dialysis
41
Q

What is function of Mg in cells and what is its normal range?

A
  • Normal range: 1.5 - 2.5
  • required for ATP processing, metabolism, neuromuscular transmission
  • regulated similar to Ca
42
Q

What are the causes for hypomagnesemia and what is the treatment?

A
  • poor dietary intake
  • decreased intestinal absorption
  • increased renal excretion
  • GI losses (V/D)
    Treatment: Oral/IV replacement
43
Q

What are the signs and symptoms of hypomagnesemia?

A
  • concentration below 1.5
  • lethargy
  • confusion
  • tremor
  • paresthesias
  • hyperreflexia
  • seizures
44
Q

What causes hypermagnesemia?

A
  • concentration above 2.5
  • renal failure
  • antacid overuse
  • over-zealous replacement
45
Q

What are the signs and symptoms of hypermagnesemia?

A
  • decreased DTRs (reflexes)
  • bradycardia
  • hypotension
  • flaccid paralysis
  • cardiac arrest
46
Q

What is the treatment of hypermagnesemia?

A
  • loop diuretics
  • restriction of magnesium containing foods or meds
  • dialysis
47
Q

What are the 2 types of nitrogens?

A
  • protein nitrogen

- non-protein nitrogen (urea, creatinine)

48
Q

What can cause increased concentration of nitrogen compounds?

A
  • decreased renal function (most nitrogen is excreted through kidneys)
49
Q

What is BUN?

A
  • blood urea nitrogen
  • waste product of protein metabolism
  • dependent on dietary protein
  • excreted by kidneys
  • bad kidneys = more urea
50
Q

What is the normal range of BUN and what does it estimate?

A
  • 7 - 20 (rough estimate of renal function)
  • high levels = uremia
  • decreased levels not clinically significant
51
Q

What is creatinine?

A
  • 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
Q

What is the elevation in both BUN and Cr called?

A
  • Azotemia (due to renal insufficiency)
53
Q

What are the 3 renal azotemia?

A
  • 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
Q

What is the relationship between BUN and Cr?

A

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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