Labs Handout
6
Basic Metabolic Panel Test General Information Causes of Imbalances Symptoms of Imbalances Sodium Adult Normals: 135-145 mEq/L Critical Values: <120 or >160 Measured in serum. Sodium is major cation in extracellular space and is the major determinant of extracellular osmolality. Sodium content is the result of a balance between dietary sodium intake and renal excretion. Hypernatremia: increased sodium intake, decreased sodium loss (Cushing’s syndrome, Hyperaldosteronism), excessive free body water loss (GI loss, excessive sweating, extensive thermal burns, diabetes insipidus, osmotic diuresis) Hyponatremia: decreased sodium intake, increased sodium loss (Addison’s disease, diarrhea, vomiting, NG aspiration, ileus, bowel obstruction, diuretics, chronic renal insufficiency, large volume para- or thoracentesis), increased free body water (excessive po intake, hyperglycemia, IV fluid overload, CHF, ascites, edema). Hypernatremia: dry mucous membranes, thirst, agitation, restlessness, hyperreflexia, mania and convulsions. Hyponatremia: weakness, confusion, lethargy, stupor, and coma. Potassium Adult Normals: 3.6-5.1 mEq/L Critical Values: <2.5 or >6.5 Measured in serum. Potassium is the major cation within the cell with a low serum level. The ratio of intracellular and intravascular potassium is the major determinant in maintaining membrane electrical potential, especially in neuromuscular tissue. Potassium is excreted by the kidneys. Potassium is also an important part of protein synthesis. Potassium concentrations depends on aldosterone, sodium reabsorption, acid- Hyperkalemia: excessive dietary intake, excessive IV intake, acute or chronic renal failure, Addison’s disease, hypoaldosteronism, Aldosterone inhibiting diuretics, crush injuries to tissue, hemolysis, infection, acidosis, dehydration. Hypokalemia: deficient dietary intake, deficient IV intake, burns, GI disorders, diuretics, hyperaldosteronism, Cushing’s syndrome, alkalosis, insulin administration, ascites, renal artery stenosis, trauma. Hyperkalemia: irritability, nausea, vomiting, intestinal colic, diarrhea. Hypokalemia: weakness, paralysis, hyporeflexia, ileus, increased cardiac sensitivity to digoxin, cardiac arrhythmias, and EKG changes as a result of decreased contractility of smooth, skeletal and cardiac muscles.
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Transcript of Labs Handout
Test
Basic Metabolic Panel
TestGeneral InformationCauses of ImbalancesSymptoms of Imbalances
Sodium
Adult Normals:
135-145 mEq/L
Critical Values:
160Measured in serum. Sodium is major cation in extracellular space and is the major determinant of extracellular osmolality. Sodium content is the result of a balance between dietary sodium intake and renal excretion. Hypernatremia: increased sodium intake, decreased sodium loss (Cushings syndrome, Hyperaldosteronism), excessive free body water loss (GI loss, excessive sweating, extensive thermal burns, diabetes insipidus, osmotic diuresis)
Hyponatremia: decreased sodium intake, increased sodium loss (Addisons disease, diarrhea, vomiting, NG aspiration, ileus, bowel obstruction, diuretics, chronic renal insufficiency, large volume para- or thoracentesis), increased free body water (excessive po intake, hyperglycemia, IV fluid overload, CHF, ascites, edema).Hypernatremia: dry mucous membranes, thirst, agitation, restlessness, hyperreflexia, mania and convulsions.
Hyponatremia: weakness, confusion, lethargy, stupor, and coma.
Potassium
Adult Normals:
3.6-5.1 mEq/L
Critical Values:
6.5Measured in serum. Potassium is the major cation within the cell with a low serum level. The ratio of intracellular and intravascular potassium is the major determinant in maintaining membrane electrical potential, especially in neuromuscular tissue. Potassium is excreted by the kidneys. Potassium is also an important part of protein synthesis. Potassium concentrations depends on aldosterone, sodium reabsorption, acid-base balance and other factors.Hyperkalemia: excessive dietary intake, excessive IV intake, acute or chronic renal failure, Addisons disease, hypoaldosteronism, Aldosterone inhibiting diuretics, crush injuries to tissue, hemolysis, infection, acidosis, dehydration.
Hypokalemia: deficient dietary intake, deficient IV intake, burns, GI disorders, diuretics, hyperaldosteronism, Cushings syndrome, alkalosis, insulin administration, ascites, renal artery stenosis, trauma.Hyperkalemia: irritability, nausea, vomiting, intestinal colic, diarrhea.
Hypokalemia: weakness, paralysis, hyporeflexia, ileus, increased cardiac sensitivity to digoxin, cardiac arrhythmias, and EKG changes as a result of decreased contractility of smooth, skeletal and cardiac muscles.
Chloride
Adult Normals:
101-111 mEq/L
Critical Values:
115Measured in serum. Chloride is the major extracellular anion. Primary purpose is to maintain electrical neutrality and serves as a buffer to assist in acid-base balance. Hyperchloremia: dehydration, excessive infusion of NS, metabolic acidosis, Cushings syndrome, kidney dysfunction, hyperparathyroidism, eclampsia, respiratory alkalosis.
Hypochloremia: over hydration, SIADH, CHF, vomiting, prolonged gastric suction, chronic diarrhea, chronic respiratory acidosis, metabolic alkalosis, Addisons disease, diuretic therapy, hypokalemia, burns.Hyperchloremia: lethargy, weakness, deep breathing.
Hypochloremia: hyperexcitability of nervous system and muscles, shallow breathing, hypotension, tetany.
TestGeneral InformationCauses of ImbalancesSymptoms of Imbalances
Carbon Dioxide
Adult Normals:
21-31 mEq/L
Critical Values:
100Indirect and rough measurement of renal function. Measures the amount of Urea Nitrogen in the blood which is the end product of protein metabolism and digestion (protein is broken down into amino acids which are catabolized and free ammonia is formed, ammonia molecules are combined to form urea which is deposited in the blood and transported to the kidneys for excretion).Increased levels: Prerenal causes (hypovolemia, shock, burns, dehydration, CHF, MI, GI bleeding, excessive protein ingestion, starvation, sepsis); Renal causes (renal disease, renal failure, nephrotoxic drugs); postrenal azotemia (ureteral obstruction, bladder outlet obstruction)
Decreased levels: liver failure, over hydration, negative nitrogen balance, pregnancy, nephritic syndrome.
TestGeneral InformationCauses of ImbalancesSymptoms of Imbalances
Creatinine
Adult Normals:
0.7-1.4 mg/dl
Critical Values:
>4Measured in serum. Creatinine is a catabolic product of creatinine phosphate used in skeletal muscle contraction and is excreted entirely by the kidneys.Increased levels: glomerulonephritis, pyelonephritis, urinary tract obstruction, reduced renal blood flow, diabetic nephropathy, nephritis, rhabdomyolysis, acromegaly, gigantism.
Decreased levels: debilitation, decreased muscle mass.
Calculating the Anion Gap:
Positive Ions (Cations)Negative Ions (Anions)Unmeasured Anions
Sodium140 mEq
Potassium4 mEq
Total
144 mEqChloride103 mEq
Bicarbonate 27 mEq
Total
130 mEq
144 130 = gap of 14 mEqPhosphates
Sulfates
Organic acids
(gap of 14 mEq)
References:
Corbett, J.V. (2004) Laboratory Tests and Diagnostic Procedures with Nursing Diagnoses, 6th ed., Upper Saddle River, New Jersey: Prentice Hall.
Pagana, K.D. and Pagana, T.J. (2002) Mosbys Manual of Diagnostic and Laboratory Tests, 2nd ed., St. Louis: Mosby.
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