Basic Metabolic Panel

Test
Sodium
Adult Normals:
135-145 mEq/L
Critical Values:
<120 or >160

Potassium
Adult Normals:
3.6-5.1 mEq/L
Critical Values:
<2.5 or >6.5

Chloride
Adult Normals:
101-111 mEq/L
Critical Values:
<80 or >115

General Information
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.

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-base
balance and other factors.
Measured in serum. Chloride is
the major extracellular anion.
Primary purpose is to maintain
electrical neutrality and serves
as a buffer to assist in acidbase balance.

Causes of Imbalances
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).
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.

Symptoms of Imbalances
Hypernatremia: dry mucous
membranes, thirst, agitation,
restlessness, hyperreflexia, mania
and convulsions.

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

Hyperchloremia: lethargy,
weakness, deep breathing.

Hyponatremia: weakness,
confusion, lethargy, stupor, and
coma.

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.

Hypochloremia: hyperexcitability
of nervous system and muscles,
shallow breathing, hypotension,
tetany.

Basic Metabolic Panel

Test

General Information

Causes of Imbalances
alkalosis, Addisons disease, diuretic
therapy, hypokalemia, burns.

Symptoms of Imbalances

Basic Metabolic Panel

Basic Metabolic Panel

Test
Carbon
Dioxide
Adult Normals:
21-31 mEq/L
Critical Values:
<6
Anion Gap
Adult Normals:
9-18 mEq/L

Glucose
Adult Normals:
65-100 mg/dl

General Information
Measure of H2CO3, dissolved
CO2 and the bicarbonate ion
(HCO3) that exists in serum.
Important in electrical
neutrality and plays a major
role in acid base balance.
Regulated by kidneys.
Calculated based on cations
and anions (see next table)

Measured in serum. Levels

controlled by glucagons
(stimulates glucose production)
and insulin (transports glucose
into target cells).

Critical Values:
<40 or >400

Causes of Imbalances
Alkalosis (increased levels): severe
vomiting, high volume gastric
suctioning, Aldosteronism, use of
mecurial diuretics, COPD, metabolic
alkalosis.
Acidosis (decreased levels):
chronic diarrhea, chronic use of loop
diuretics, renal failure, DKA,
starvation, metabolic acidosis, shock.
Increased levels: Lactic, Diabetic
and alcoholic acidosis, starvation,
renal failure, increased GI losses,
hyperaldosteronism.
Decreased levels: excessive alkali
ingestion (antacids) multiple
myeloma, chronic vomiting or gastric
suction, hyperaldosteronism.
Hyperglycemia: Diabetes mellitus,
acute stress response, Cushings
syndrome, pheochromocytoma,
chronic renal failure, glucagonoma,
acute pancreatitis, diuretic therapy,
corticosteroid therapy, acromegaly.
Hypoglycemia: insulinomia,
hypothyroidism, hypopituitarism,
Addisons disease, extensive liver
disease, insulin overdose, starvation.

BUN
Adult Normals:
6-22 mg/dl
Critical Values:
>100

Indirect 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

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.

Symptoms of Imbalances
Alkalosis: Confusion, Muscle
twitching, Hand tremor, tetany,
Nausea, vomiting, Numbness or
tingling in the face or extremities,
Light-headedness Acidosis: Rapid
breathing, confuion, lethargy.

Hyperglycemia: polydypsia,
polyphagia, polyuria, dry mouth,
poor skin turgor, nausea, vomiting,
abdominal pain, weakness,
confusion, blurred vision,
headache, Kussmauls respirations,
acetone breath, coma.
Hypoglycemia: diaphoresis,
tachycardia, anxiety, shakiness,
weakness, hunger, nausea,
headache, irritability, confusion,
behavioral changes, tremors,
seizures, coma.

Basic Metabolic Panel

Test

General Information
for excretion).

Causes of Imbalances

Symptoms of Imbalances

Basic Metabolic Panel

Test
Creatinine
Adult Normals:
0.7-1.4 mg/dl
Critical Values:
>4

General Information
Measured in serum. Creatinine
is a catabolic product of
creatinine phosphate used in
skeletal muscle contraction and
is excreted entirely by the
kidneys.

Calculating the Anion Gap:

Positive Ions (Cations)
Negative Ions (Anions)
Sodium
140 mEq
Chloride
103 mEq
Potassium
4 mEq
Bicarbonate 27 mEq
Total

144 mEq

Total

130 mEq

144 130 = gap of 14

mEq

Causes of Imbalances
Increased levels:
glomerulonephritis, pyelonephritis,
urinary tract obstruction, reduced
renal blood flow, diabetic
nephropathy, nephritis,
rhabdomyolysis, acromegaly,
gigantism.
Decreased levels: debilitation,
decreased muscle mass.

Unmeasured Anions
Phosphates
Sulfates
Organic acids
(gap of 14 mEq)

Symptoms of Imbalances

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.