Understanding the Basic Metabolic Panel

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Understanding the Basic Metabolic Panel

• Paul Cousineau NP
• Youville Hospital and Rehab Center

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The Basic Metabolic Pattern

• Blood Urea Nitrogen
• Creatinine
• Sodium
• Potassium
• Chloride
• CO2
• Glucose
• Calcium

• The Basic Metabolic Panel (BMP) is a group of 8
  specific tests that have been approved, named,
  and assigned a CPT code (a Current Procedural
  Terminology number) as a panel by Medicare.

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Collecting the Basic Metabolic Panel

• Wrap a tourniquet around the upper arm to stop
  the flow of blood.
• Clean the needle site with alcohol.
• Put the needle into the vein.
• Attach a gold top tube with serum separator to
  the needle to fill it with blood.
• Remove the band from the arm when enough blood is
  collected.
• Place a gauze pad or cotton ball over the needle
  site as the needle is removed.
• Apply pressure on the site and then apply a small
  bandage.
• OR call the LAB and theyll gladly assist.

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Blood Urea Nitrogen

• The blood urea nitrogen (BUN) a measure of the
  amount of nitrogen in the blood in the form of
  urea, and a measurement of renal function.
• Urea is secreted by the liver, and removed from
  the blood by the kidneys.
• A greatly elevated BUN (gt60 mg/dL) generally
  indicates a moderate-to-severe degree of renal
  failure.
• An elevated BUN in the setting of a relatively
  normal creatinine may reflect a physiological
  response to a relative decrease of blood flow to
  the kidney, as in heart failure or dehydration,
  without indicating any true injury to the kidney.
• Increased production of urea is seen in cases of
  moderate or heavy bleeding in the upper
  gastrointestinal tract (e.g. from ulcers).
• Anuria
• Obstruction (vast majority of patients with
  anuria).
• Bilateral renal cortical necrosis.
• Fulminant glomerulonephritis (usually some type
  of rapidly progressive glomerulonephritis).
• Acute bilateral renal artery or vein occlusion
  (rare).

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Creatinine

• Creatine is a measure of kidney function.
• Creatinine is produced naturally by the body
  (creatinine is a metabolite of creatine, which is
  found in muscle). It is freely filtered by the
  renal glomerulus and excreted in the urine.
• A rise in blood creatinine levels is observed
  only with marked damage to functioning nephrons,
  and is considered a rather poor indication of
  actual renal function.
• Creatinine clearance, a calculated value based on
  age, creatinine, and weight, is more indicative
  of actual renal function.

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Sodium

• Normal Sodium 135 -146
• Extra cellular electrolyte, functions in tandem
  with Potassium.
• Maintains fluid and electrolyte balance of the
  body.
• Sodium is important in how nerves and muscles
  work.
• Hyponatremia - decreased sodium or high fluid
• GI anorexia, diarrhea, or abdominal cramps.
• Neuromuscular headache, confusion depression,
  stupor, coma, and convulsions
• Hypernatremia - increased sodium or low fluids
• GI thirst.
• Neuromuscular agitation or convulsions.
• Cor tachycardia or increased BP.
• Skin dry flushed skin, or dry, sticky mucous
  membranes.
• Renal oliguria or anuria.

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Potassium

• Normal Potassium 3.5 - 5.0
• Intracellular electrolyte, functions in tandem
  with Sodium.
• Maintains fluid and electrolyte balance.
• Potassium is important in how nerves and muscles
  work.
• Hypokalemia - low Potassium
• Gastrointestinal N/V, anorexia, and paralytic
  ileus.
• Neuromuscular flacidity and weakness,
  respiratory arrest, CNS depression, diminished
  deep tendon reflex.
• Cor dysrhythmias, hypotension, ventricular
  tachycardia, cardiac arrest and/or ECG changes.
• Hyperkalemia - high Potassium
• Gastrointestinal N/V/D
• Neuromuscular muscle twitching leading to
  weakness and paralysis.
• Cor conduction defects, bradycardia, ECG changes.

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Chloride

• Chloride is a chemical the human body needs for
  metabolism.
• Chloride helps maintain the body's acid-base
  balance. The amount of chloride in the blood is
  carefully controlled by the kidneys.
• Chloride ions have important physiological roles.
  
• In the central nervous system, the inhibitory
  action of glycine and some of the action of GABA
  relies on the entry of Cl - into specific
  neurons.
• Chloride-bicarbonate exchanger biological
  transport protein relies on the chloride ion to
  increase the blood's capacity of carbon dioxide,
  in the form of the bicarbonate ion.
• The normal blood reference range of chloride for
  adults in most labs is 95 to 105 mEq per liter.

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CO2 / Bicarbonate

• Indicator of Acid / Base balance.
• Bicarbonate is an alkaline, and a vital component
  of the pH buffering system.
• With carbonic acid as the central intermediate
  species, bicarbonate, in conjunction with water,
  hydrogen ions, and carbon dioxide forms this
  buffering system which is maintained at the
  equilibrium required to provide prompt resistance
  to drastic pH changes in both the acidic and
  alkalotic directions
• Indicator of respiratory / metabolic
  abnormalities.

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Anion Gap

• The serum anion gap, calculated from the
  electrolytes measured in the chemical laboratory.
• Used in the detection and analysis of acid-base
  disorders, assessment of quality control in the
  chemical laboratory, and detection of such
  disorders as multiple myeloma, and lithium
  intoxication.
• Can be helpful in determining keto- and lactic
  acidosis ( high anion gap).
• Low anion gap is rare, often seen with low
  albumin.

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Glucose

• Glucose is a direct measurement of the blood
  glucose level. It is frequently used in the
  evaluation of diabetic patients.
• Hyperglycemia (High blood glucose)
• Diabetes mellitus
• Cushing's disease
• Acute stress response, including severe stress,
  infection, burns, and surgery.
• Pancreatitis.
• Corticosteroid therapy.
• Hypoglycemia (Low blood glucose)
• Insulin overdose (most common cause)
• Insulinoma (pancreatic islet cell carcinoma-too
  much insulin production)
• Addison's disease (Cortisol deficiency, thus
  hypoglycemia)
• Starvation (decreased carbohydrate ingestion
  causes hypoglycemia)
• Hypothyroidism and hypopituitarism (with
  decreased levels of these hormones, glucose
  levels fall)

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Calcium

• Calcium is the most common mineral in the body
  and one of the most important. Must be corrected
  with low Albumin.
• Needed to build and repair bones and teeth, helps
  nerves work, enables skeletal and cardiac muscles
  to contract, functions in blood clotting.
• Almost all of the calcium in the body is stored
  in bone. The rest is found in the blood.
• Hypocalcemia - low calcium
• GI increased motility.
• Neuromuscular muscle spasms, or tetany.
• Cardiac dysrhythmias, delayed cardiac
  contractility, heart failure, ECG changes.
• Hypercalcemia - high calcium
• GI diarrhea, anorexia, constipation or nausea.
• Neuromuscular hypo-tonicity, lethargy,
  confusion, coma, bone pain, and or pathologic
  fractures (bone loss).

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Questions ?
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Thank you for your attention, participation and
hard work.