Understanding the Basic Metabolic Panel Understanding the BMP Thursday, April 20, 2017 Understanding the Basic Metabolic Panel Paul Cousineau NP Youville Hospital and Rehab Center Paul Cousineau NP

The Basic Metabolic Pattern Understanding the BMP Thursday, April 20, 2017 The Basic Metabolic Pattern 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. Blood Urea Nitrogen Creatinine Sodium Potassium Chloride CO2 Glucose Calcium Paul Cousineau NP

Collecting the Basic Metabolic Panel Understanding the BMP Thursday, April 20, 2017 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 they’ll gladly assist. Paul Cousineau NP

Understanding the BMP Thursday, April 20, 2017 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 (>60 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). Paul Cousineau NP

Creatinine Creatine is a measure of kidney function. Understanding the BMP Thursday, April 20, 2017 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. Paul Cousineau NP

Sodium Normal Sodium: 135 -146 Understanding the BMP Thursday, April 20, 2017 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. Paul Cousineau NP

Potassium Normal Potassium: 3.5 - 5.0 Understanding the BMP Thursday, April 20, 2017 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. Paul Cousineau NP

Chloride Chloride is a chemical the human body needs for metabolism. Understanding the BMP Thursday, April 20, 2017 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. Paul Cousineau NP

CO2 / Bicarbonate Indicator of Acid / Base balance. Understanding the BMP Thursday, April 20, 2017 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. Paul Cousineau NP

Understanding the BMP Thursday, April 20, 2017 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. Paul Cousineau NP

Understanding the BMP Thursday, April 20, 2017 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) Paul Cousineau NP

Understanding the BMP Thursday, April 20, 2017 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). Calcium and phospholipid (a platelet membrane constituent) are required for the tenase and prothrombinase complexes to function. Calcium mediates the binding of the complexes via the terminal gamma-carboxy residues on FXa and FIXa to the phospholipid surfaces expressed by platelets as well as procoagulant microparticles or microvesicles shedded from them. Calcium is also required at other points in the coagulation cascade. Paul Cousineau NP

Questions ? Understanding the BMP Thursday, April 20, 2017 Paul Cousineau NP

Thank you for your attention, participation and hard work. Understanding the BMP Thursday, April 20, 2017 Thank you for your attention, participation and hard work. Paul Cousineau NP