Hepatitis C; Understanding the Basic Metabolic Profile (BMP)

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Hepatitis C; Understanding the Basic Metabolic Profile (BMP)

The Basic Metabolic Profile (BMP) is a group of tests that examine blood chemistry, that is, the components of blood excluding red and white blood cells and platelets. The tests which make up a BMP may vary slightly between labs or institutions, but generally they will provide the physician with information about serum electrolytes, blood sugar and kidney function.The tests described in this article include:SodiumPotassiumChlorideCarbon DioxideCalciumGlucoseBlood Urea Nitrogen (BUN)CreatinineAnion Gap.SodiumThe normal range for serum sodium in the adult is 135 to 148 mEq/L.Sodium (Na) aids in the regulation of the body's fluid balance, and along with potassium, maintains the electrical potential in the body that allows nerves to operate properly. The fluids containing sodium are

found almost entirely in extracellular (outside the cell) spaces, such as blood vessels. Sodium levels are maintained by the ingestion of sodium in food, and it is excreted through sweat, urine and feces. .Common causes of decreased serum sodium (hyponatremia) include:Decreased sodium intake / increased sodium lossExcess water ingestionDiarrheaVomitingAdministration of diureticsKidney disease’s diseaseEdema and/or ascites..Common causes of increased sodium (hypernatremia) include:Increased sodium intake / decreased sodium lossExcessive free water loss, such as sweating, burnsDiabetes insipidusOsmotic diuresis..PotassiumThe normal range for serum potassium in the adult is 3.5 to 5.5

mEq/L.Potassium (K), as opposed to sodium, is found almost entirely inside the cells of the body. Proper levels of potassium are critical to the normal function of muscles, including the heart.Abnormal levels of potassium can cause severe irregularities in the heart's rhythm and ability to contract. Potassium is ingested in the diet and is excreted in urine. Common causes of decreased potassium (hypokalemia) include:Diuretic use without potassium replacementAdministration of IV fluids without potassiumAlcoholic cirrhosisDiarrheaCrohn's diseaseCushing's syndrome..Common causes of increased potassium (hyperkalemia) include:Kidney disease or failureRapid administration of IV fluids containing potassiumBurns and crushing injuries, traumaMyocardial infarction (heart attack)'s disease..ChlorideThe normal range for serum chloride in the adult is 95 to 105 mEq/L. Chloride (Cl) works with sodium to maintain the balance of fluids in the body, and aids in the regulation of the acid / base balance. It is an anion (negatively charged particle) found mainly in extracellular spaces. Chloride abnormalities can cause increased nervous system irritability, exaggerated reflex responses, decreased respiration, weakness, stupor and coma. Alterations in chloride levels are unusual, but are found in association with other electrolyte imbalances. Common causes of deceased chloride (hypochloremia) include:Vomiting, diarrhea, or gastrointestinal suctioningAdministration of diureticsAdministration of IV fluids without electrolyte replacement..Common causes in increased chloride (hyperchloriemia)

include:DehydrationAcid/base imbalancesAdministration of medications containing chloride..Carbon DioxideThe normal range for serum carbon dioxide in the adult is 23 to 30 mEq/L or 23 to 30 mmol/L. Carbon dioxide (CO2) is an anion (negatively charged ion) that assists in acid / base balance and helps maintain the electrical neutrality of fluids both inside and outside cells. In solution, carbon dioxide (CO2) combines with water (H2O) to form carbonic acid (H 2CO3). Higher levels of CO2 in the blood create an acidic condition (acidosis), and low levels create an alkaline condition (alkalosis).Levels of CO2 are regulated by the kidneys and CO2 is expelled by the lungs during respiration. Alterations in the concentration of this electrolyte do not occur in isolation; that is, abnormalities in CO2 are always related to a co-existing

disease or condition. Common causes of increased serum carbon dioxide (acidosis) include:Diseases / conditions that decrease respirationBurnsCongestive heart failureUncontrolled diabetesStarvationKidney disease / failureDiarrheaCertain medications and poisons..Common causes of decreased serum carbon dioxide (alkalosis) include:Diseases / conditions that increase respiration (hyperventilation)Fluid losses from the GI tract (vomiting, suctioning)Administration of diureticsAdministration of steroidsCushing's diseaseSalicylate intoxicationExcessive administration of medications containing bicarbonate..CalciumThe normal range for serum calcium in the adult is 9 to 10.5 mg/dL, or 2.25 to 2.75 mmol/L. Calcium (Ca) is

found primarily in the body in the form of bones and teeth; however, about 10% is found in the blood, in the form of a cation (positively charged ion) that plays an important role in the function of nerves and coagulation of blood. When levels of serum calcium are low, the body produces hormones that remove calcium from bone to supplement serum calcium. Because serum calcium plays an important role in nerve function, alterations in calcium levels can cause serious symptoms. These include decreased or exaggerated muscle tone, abnormal reflexes, severe gastrointestinal problems, such as nausea, vomiting, cramping and constipation, and disorders of the central nervous system, like lethargy, depression, convulsions and coma. In extreme cases, pathological bone fractures can occur as a result of prolonged calcium loss. Common causes of decreased serum calcium (hypocalcemia) include:Diseases of the small intestine,

interfering with calcium absorptionExcessive protein intakeAdministration of blood with citrateHypoparathyroidism..Common causes of increased serum calcium (hypercalcemia) include:Prolonged immobilizationHyperparathyroidismDiseases involving the breakdown of boneExcessive ingestion of vitamin DKidney diseases / failure..GlucoseThe normal range for serum glucose in the adult is 70 to 110 mg/dL. Glucose (Glu) is a form of sugar that circulates in the blood to provide metabolic fuel for all body processes. Carbohydrates and sugars are ingested through food, broken down and absorbed in the small intestine, and are stored in the liver in the form of glucose. The most common cause of abnormal blood sugar levels is Diabetes Mellitus, a disease in which serum glucose is

consistently elevated as a result of decreased or absent insulin production, insulin resistance, or both. The physical consequences of persistently elevated serum glucose / diabetes are many, and affect almost every body system. The symptoms of decreased levels of serum glucose (hypoglycemia) can include sweating, anxiety, rapid pulse, and headache. If serum glucose drops to below 50 mg/dL, the patient may have loss of consciousness, and perhaps convulsions. Common causes of increased serum glucose (hyperglycemia) include:Diabetes MellitusAdministration of certain steroids and hormonesAdministration of total parenteral nutritionAdministration of diureticsDiseases of the pancreas..Decreased serum glucose (hypoglycemia) is not common, but causes may include:Administration of insulin or other hypoglycemic

medicationExerciseExposure to severe coldMalnutritionProlonged feverDiseases of the pancreasDecreases in pituitary or adrenocortical function..Blood Urea NitrogenThe normal range for blood urea nitrogen in the adult is 4 to 22 mg/dL. Blood urea nitrogen (BUN) is a waste product of protein metabolism. It is produced by the liver and excreted in the urine. Abnormal elevations of BUN are most commonly caused by diseases of the kidney, prostate, and urinary tract, and the patient may have symptoms characteristic of fluid overload: decreased urine output, weight gain, edema, and distended neck veins. The skin may be yellowed and easily bruised, and the patient's mental state may be affected. Decreased BUN is uncommon, but common causes may include:Liver failure, inhibiting protein

metabolismNegative nitrogen balance (when protein breakdown exceeds protein intake)AnorexiaMalnutritionProlonged IV therapy in patients receiving inadequate oral nutritionOverhydration..Common causes of increased blood urea nitrogen (azotemia) include:Kidney diseases / failureDiseases decreasing the ability to excrete urineIncreased protein metabolismBreakdown of muscle tissue (starvation, anorexia nervosa)InfectionTraumaSurgeryGastrointestinal bleedingAdministration of corticosteroidsAdministration of tetracyclinesDehydration..CreatinineThe normal range for serum creatinine in the adult is 0.6 to 1.2 mg/dL. The ideal BUN:creatinine ratio is 20:1. Creatinine (Cr) is a nitrogen-based waste product that is produced

as a result of protein metabolism in muscle tissue. Creatinine is produced at a very steady rate and is not subject to rapid fluctuations. It is excreted by the kidneys. Creatinine and BUN both measure kidney function, but in slightly different ways. It is clinically useful to evaluate the ratio of BUN to creatinine when conducting a diagnostic assessment. Dehydration and protein breakdown can cause elevation in BUN, but may affect serum creatinine only slightly or not at all. However, if both BUN and serum creatinine are elevated, this strongly suggests the presence of primary kidney disease. Common causes of increased serum creatinine include:Kidney diseases / failureAdministration of diuretics, sulfonamides, chloramphenicol, ascorbic acidUse of marijuanaDiet high in red meat..Decreased serum creatinine is rare, but has been associated with muscular

dystrophy. Anion GapThe normal range for anion gap is 12 to 18 mmol/L; however, newer, more sensitive test equipment may have a reference range of -4 to 7 mmol/L.The anion gap is a figure calculated by subtracting the number of anions (chloride and bicarbonate, the negatively charged electrolytes) from the cations (sodium and potassium, the positively charged electrolytes). The remainder, the "gap," is composed of unmeasured electrolytes, organic ions, and plasma proteins. An increased anion gap indicates that presence of an excess of the unmeasured anions which can occur when surplus hydrogen ions have been introduced into the body. Surplus hydrogen ions can shift the pH (the measure of acid / base balance) of the body towards an acid state, or acidosis. Common causes of an increased anion gap include condition or diseases that induce acidosis, such as:Diabetic

ketoacidosisLactic acidosisKidney failure associated with increased BUNVarious drug or chemical toxicities..Summary of Normal Ranges (Adult)Sodium: 135 to 148 mEq/LPotassium: 3.5 to 5.5 mEq/LChloride: 95 to 105 mEq/LCarbon Dioxide: 23 to 30 mEq/L or 23 to 30 mmol/L Calcium: 9 to 10.5 mg/dL, or 2.25 to 2.75 mmol/LGlucose: 70 to 110 mg/dL BUN: 4 to 22 mg/dLCreatinine: 0.6 to 1.2 mg/dLBUN / Creatinine ratio: 20:1Anion Gap: 12 to 18 mmol/L (older equipment) Anion Gap: -4 to 7 mmol/L (newer equipment)McFarland M, Grant M. Nursing Implications of Laboratory Tests, 3rd ed. Delmar Publishers Inc

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