- Comprehensive Metabolic Panel: Full look at metabolic functions in body
- Electrolytes: Sodium, Chloride, Potassium, Magnesium, Phosphorus, Calcium
- Sodium: Main extracellular cation; Regulates fluid volume status
- Elevated: Dehydration (Both hypertonic and isotonic forms), Diabetes Insipidus, excessive intake, diuretic use
- Decreased: Dilution (Excessive free water intake, retention of fluid), decreased PO intake, diarrhea, vomiting, sweating
- Clinical Considerations: Patient history very important: Do they seem dehydrated? Do they have a history of excessive alcohol consumption? How does their nutrition seem? Any neurologic symptoms? What was their last known sodium (if known)?
- Chloride: Main extracellular anion; Tends to follow sodium
- Elevated: See sodium; Normal Saline induced hyperchloremic metabolic acidosis (Chloride goes up -> Anion Gap goes up -> extra HCO3 excreted)
- Decreased: See sodium
- Potassium: Main intracellular cation; Important for cardiac conduction and muscle contraction
- Elevated: Renal insufficiency, dehydration, crush injuries, tumor lysis, excessive ingestion, certain medications, diabetes (Reduces Na-K+ ATPase activity)
- Decreased: Decreased intake, diuretics (Loop), excessive sweating, vomiting, diarrhea
- Clinical considerations: Understand when to treat
- Any hyperkalemia that has cardiac symptoms -> Treat
- Severely elevated (>6) potassium regardless of pH -> Treat
- Remember most “treatments” are temporary, only Lokelma and dialysis are permanent fixes in acute setting
- Magnesium: Important for cardiac conduction; Helps regulate K+ and Ca++
- Elevated: Renal dysfunction, excessive administration (Most common with Pre-eclampsia/Eclampsia treatment)
- Decreased: Poor PO intake, diarrhea, excessive urinary loss
- Phosphorus: Important for production of ATP; Regulated with Calcium
- Elevated: Renal dysfunction, hypoparathyroidism, acidosis
- Decreased: Diabetes, starvation, alcoholism, severe burns, hyperparathyroidism, Refeeding syndrome
- Calcium: Primarily in bones; Active form aids in clotting, muscle contraction, and drug binding
- Elevated: High parathyroid levels, Paraneoplastic syndrome, thiazide diuretics, adrenal insufficiency, excessive intake (TUMs/Antacids)
- Decreased: CKD, decreased intake, low vitamin D, low parathyroid hormone levels, pancreatitis, massive transfusion, magnesium deficiency
- Sodium: Main extracellular cation; Regulates fluid volume status
- BUN: Waste product of protein
- Elevated: Dehydration, renal insufficiency, ATN, hepatorenal syndrome, GI bleeding, too much protein in diet
- Decreased: Low-protein diet, small body type, liver disease (Urea produced by liver)
- Creatinine: Market for renal function
- Elevated: Renal dysfunction, increased muscle mass, increased muscle breakdown, autoimmune conditions, excessive blood loss
- Decreased: Low muscle mass, female gender, significant fluid overload, poor nutrition, pregnancy
- Total CO2/HCO3: Different from PCO2; Is the pressure from CO2 that is free in the blood (5%)
- Technically different from HCO3 which is the total amount of bicarb floating in the blood
- Same reasons for elevation and decreased despite being different measurements
- Elevated: Vomiting, ingestion of bleach, contraction alkalosis, excessive antacid use
- Decreased: Lactic acidosis, diarrhea, renal tubular acidosis (Autoimmune, genetic), hyperchloremic metabolic acidosis
- ALT: Alanine transaminase; Most specific for liver; Converts alanine to pyruvate for energy
- Elevated with liver dysfunction
- AST: Aspartate aminotransferase; Also present in cardiac and skeletal muscle
- Elevated with liver dysfunction
- Glucose: Amount of glucose present in the blood
- Elevated: Diabetes, corticosteroid use, lack of physical activity, stress, physiologic stress, sepsis (more common)
- Decreased: Insulin overdose, not eating enough, liver dysfunction, alcohol intoxication (Liver doesnt create sugar when metabolizing alcohol), pancreatic cancers, hypothyroidism, sepsis (Bad sign)
- Anion Gap: General acid-base balance in your patient; (Na + K) – (HCO3 + Cl)
- < 12 normal
- Elevated: DKA, methanol, uremia, hemochromatosis, salicylate overdose, lactic acidosis, renal failure
- Decreased: Not clinically relevant
- Bilirubin: Byproduct of RBC breakdown
- Elevated: Liver dysfunction (Acute or chronic, structural or infectious), hemolytic anemia, bile/gallbladder obstruction, transfusion reaction
- Decreased: Certain medications, not generally a concern
- Albumin: Main oncotic protein force in blood
- Elevated: Dehydration, severe diarrhea
- Decreased: Malnutrition, liver disease, kidney disease, infection, thyroid disease
- Albumin < 3.5 can result in movement of fluid from intravascular space to extravascular (Peripheral edema, organ congestion, pleural effusion_
- < 2.7 can result in anasarca, or severe generalized edema
