Comprehensive Metabolic Profile

On April 27, 2010, in Tests, by Andrea

The CMP, or comprehensive metabolic panel, is a series of 14 blood tests which is a pretty routine draw for annual physicals or check-ups.  Over time, it can show some important baselines for basic physiology and can show how WLS changes our physiology in the long-term.  Any changes or abnormal results can direct a physician to order more specific tests.  The CMP provides basic information on kidney function, liver function, and electrolyte and fluid balance.  It is also used to monitor patients of chronic disease such as diabetes or hypertension.

Ranges given are simply given as a point of reference from MY laboratory.  Your lab may use slightly different lab values.  Adapt as necessary.

This is a fasting test.

The following tests are performed as part of the CMP:

  • General Tests
    • Serum glucose – the amount of glucose, or sugar present in the blood; this is a tightly regulated number and when it falls outside the normal range, it may be an indicator of a medical condition such as hyperglycemia (diabetes) or hypoglycemia; temporary elevated levels could have several causes, such as stress, trauma, stroke, heart attack, surgery, illness, alcohol, etc.; certain drugs can also increase or decrease glucose levels; in US, measurement is in mg/dL (milligrams per deciliter); Range: 70-110 mg/dL
    • Calcium - levels in mammals are tightly regulated with bone acting as major mineral storage site; ions are released from bone into the bloodstream under controlled conditions and is transported through the bloodstream as dissolved ions or bound to proteins such as serum albumin; parathyroid hormone (PTH) regulates the resorption of calcium from the bone, reabsorption in the kidney back into circulation, and increases the activation of vitamin D3 to Calcitrol (the active form of D3); calcium is vital to muscle contraction and thus the body uses this system of regulation to keep a fairly specific amount of calcium in the blood at any point of time; Range: 8.4-10.2 mg/dL
  • Protein Tests
    • Human serum albumin – the most abundant protein in human blood plasma, comprising about half of the blood serum protein; synthesized in the liver as preproalbumin; reference range is 30-50 g/L; serum half-life of 20 days; transports thyroid hormones as well as other hormones (particularly the fat-solubles); transports “free” fatty acids to liver; transports unconjugated bilirubin; transports many drugs (serum albumin levels can affect half-life of drugs); competitively binds calcium ions; not a valid marker of nutritional status as much as it is a marker in inflammatory states; prevents photodegradation of folic acid; Hypoalbuminemia (low) can be caused by liver disease, excess excretion by the kidneys, excess loss in bowel, burns, redistribution (as in pregnancy), acute disease states, or mutation (very rare); Hyperalbuminemia (high) is a sign of severe or chronic dehydration (should be treated with zinc and water), and is associated with high protein diets; Range: 3.2-5.5 g/dL (Andrea’s ideal 4.0+)
    • Serum total protein (TP) – test for measuring total amount of protein in blood plasma or serum; protein in the plasma is made up of albumin and globulin; levels below the reference range usually reflect low albumin concentration while above the range are found in paraproteinaemia, Hodgkin’s lymphoma, or leukaemia; Range: 6.0-8.0 g/dL (Andrea’s ideal 7.0+)
  • Electrolytes
    • Sodium - important in neuron (brain and nerve) function and in influencing osmotic balance between cells and the interstitial fluid; additionally, serum sodium and urine sodium play important roles in the maintenance of sodium and total body fluid homeostasis and in the diagnosis of disorders causing homeostatic disruption of salt/sodium and water balance; Range: 135-145 mmol/L
    • Potassium - important in neuron (brain and nerve) function and in influencing osmotic balance between cells and the interstitial fluid; important in preventing muscle contraction and the sending of all nerve impulses in animals; shortage of potassium in body fluids may cause a potentially fatal condition called hypokalemia, typically resulting from vomiting, diarrhea, and/or increased diuresis; deficiency symptoms include muscle weakness, paralytic ileus, ECG abnormalities, decreased reflex response, and in severe cases respiratory paralysis, alkalosis and cardiac arrhythmia; very high concentrations of potassium ion can kill tissue and cause injury to the gastric or intestinal mucosa so non-prescription supplements are limited by law in US to only 99mg of potassium; Range: 3.6-5.0 mmol/L
    • Carbon dioxide (CO2) – carried in blood in 3 ways (70-80% converted to bicarbonate ions in the red blood cells, 5-10% dissolved in plasma, 5-10% bound to hemoglobin); CO2 bound to hemoglobin does not bind to the same site as O2, but does decrease the amount of O2 that can be bound; bicarbonate is crucial for regulating blood pH; breathing rate influences level of CO2 in the blood — too slow or shallow causes respiratory acidosis while too rapid leads to hyperventilation which can lead to respiratory alkalosis; breathing is stimulated by higher CO2 levels; Range: 22.0-34.0 mmol/L
    • Chloride - chemical needed for metabolism, and for keeping the body’s acid-base balance; levels in blood carefully controlled by the kidneys; important for CNS function and in increasing the blood’s capacity of CO2 in the form of bicarbonate; Range: 97-113 mmol/L
  • Kidney function
    • Blood urea nitrogen (BUN) – a measure of the amount of nitrogen in the blood in the form of urea (a waste substance secreted by the liver and removed from the blood by the kidneys) and a measurement of renal function; pronounced B-U-N; low BUN can indicate liver problems, malnutrition (including insufficient protein), excessive alcohol, or normal pregnancy changes; Range: 5-25 mg/dL
    • Creatinine - break-down product of creatine phosphate in muscle and usually produced at a fairly constant rate by the body; chiefly filtered out of the body by the kidneys; if filtering of kidneys is deficient, blood levels rise and thus usually a renal diagnostic tool; a BUN level and creatinine level together can point out other problems besides kidney issues –> a urea level raised out of proportion to the creatinine may indicate a pre-renal problem such as volume depletion; men tend to have higher levels, vegetarians tend to have lower; urine creatinine testing can be done to verify drug testing; Range: 0.5-1.5 mg/dL
  • Liver function
    • Alkaline phosphatase (ALP) – present in all tissues, but particularly concentrated in liver, bile duct, kidney, bone, and placenta; high ALP levels can show that bile ducts are blocked; levels significantly higher in children and pregnant women; elevated ALP indicates that there could be active bone deposition occurring as ALP is a by-product of osteoblast activity; lowered levels less common than elevated levels but could be due to postmenopausal HRT because of osteoporosis, malnutrition, magnesium deficiency, hypothyroidism, or severe anemia, pernicious or aplastic anemias; oral contraceptives can lower ALP levels; Range: 42-128 U/L
    • Alanine amino transferase (ALT or SGPT) – found in serum and in various bodily tissues, but most commonly associated with the liver; part of a diagnostic liver function test; slightly elevated levels often, but not always, suggest existence of other medical problems and for this reason ALT is commonly used as a way of screening for liver problems; levels will fluctuate through the course of the day; Range: 10-60 IU/L
    • Aspartate amino transferase (AST or SGOT) – associated with the liver; raised in acute liver damage; also present in red blood cells, cardiac muscle, skeletal muscle, kidney and brain tissue, and may be elevated due to damage to one of these areas as well; commonly measured as part of a diagnostic liver function test; Range: 10-42 IU/L
    • Bilirubin - yellow breakdown product of normal heme catabolism; excreted in bile and urine and is responsible for the yellow color of bruises, urine, and yellow discoloration in jaundice; bilirubin is broken down by light - blood collection tubes (especially serum tubes) should be protected from light exposure; two types of bilirubin – “BC” or “Conjugated” and “BU” or “Unconjugated”;  BC is is water soluble while BU is fat soluble; there are no normal levels of bilirubin as it is an excretion product – different sources provide references ranges which are similar but not identical; different ranges are used for newborns; Adult Range, Total Bilirubin: 0.1-1.2 mg/dL
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