Basic Metabolic Panel
Pangkalahatang-ideya
Ang basic metabolic panel (BMP), na tinatawag ding Chem-7, ay isang madalas i-order na blood test na nagbibigay ng snapshot ng mahahalagang metabolic function: electrolyte balance, kidney function, at blood glucose. Ang comprehensive metabolic panel (CMP) ay nagdadagdag ng hepatic function tests (LFTs, albumin, bilirubin).
Maaaring bahagyang mag-iba ang reference intervals depende sa institusyon at laboratory method, kaya dapat laging i-interpret ang values laban sa range ng reporting lab. Ang ilang pasilidad ay gumagamit ng alternatibong adult electrolyte intervals (halimbawa sodium 135 hanggang 145 mEq/L, chloride 95 hanggang 105 mEq/L, bicarbonate 23 hanggang 30 mEq/L, at phosphorus 3.4 hanggang 4.5 mg/dL).
Mga Normal na Halaga
| Component | Normal Range | Clinical Significance |
|---|---|---|
| Sodium (Na⁺) | 136–145 mEq/L | Regulasyon ng volume at osmolality |
| Potassium (K⁺) | 3.5–5.1 mEq/L | Cardiac at neuromuscular function |
| Chloride (Cl⁻) | 97–107 mEq/L | Acid-base balance; inverse ang relasyon sa HCO₃⁻ |
| CO₂ / Bicarbonate (HCO₃⁻) | 22–29 mEq/L | Acid-base buffer; regulasyon ng kidneys |
| BUN (Blood Urea Nitrogen) | 7–20 mg/dL | Protein metabolism; renal clearance |
| Creatinine | 0.6–1.2 mg/dL | Muscle metabolism; glomerular filtration marker |
| Glucose (fasting) | 70–100 mg/dL | Carbohydrate metabolism; insulin function |
| Calcium (CMP only) | 8.6–10.2 mg/dL | Bone/muscle/nerve function; PTH regulated |
Karaniwang CMP Add-On Values
| Component | Typical Adult Range | Clinical Significance |
|---|---|---|
| Phosphorus | 3.0–4.5 mg/dL | Bone/mineral metabolism; ATP-related cellular function |
| Magnesium | 1.3–2.1 mEq/L | Neuromuscular stability at modulation ng dysrhythmia risk |
| Serum osmolality | 285–295 mOsm/kg H2O | Interpretasyon ng tonicity at free-water balance |
| Albumin | 3.5–5.5 g/dL | Marker ng oncotic pressure at protein status |
| Total protein | 5.5–8.3 g/dL | Context ng pinagsamang albumin/globulin trend |
| Total bilirubin | 0.1–1.2 mg/dL | Cue ng hepatic processing at hemolysis-related changes |
| AST | 9–25 U/L (female), 10–40 U/L (male) | Hepatocellular injury signal kasama ng ALT trend |
| ALT | 7–20 U/L (female), 10–55 U/L (male) | Hepatocellular injury signal kasama ng AST trend |
Interpretasyon ng Mga Component
Sodium (Na⁺) 136–145 mEq/L
- Hyponatremia (<136): Pagkalito, lethargy, seizures (malubha) — mga sanhi: SIADH, overhydration, heart failure
- Hypernatremia (>145): Uhaw, agitation, seizures — mga sanhi: dehydration, diabetes insipidus, sobrang sodium intake
- Sumasalamin ang sodium sa fluid status — ang hyponatremia ay kadalasang sobrang tubig kumpara sa sodium, hindi palaging mababang kabuuang sodium
Potassium (K⁺) 3.5–5.1 mEq/L
- Hypokalemia (<3.5): Panghihina ng kalamnan, cramps, constipation, U-waves sa ECG, mapanganib na dysrhythmias
- Hyperkalemia (>5.1): Peaked T-waves sa ECG, bradycardia, cardiac arrest — critical emergency kapag K⁺ >6.5 mEq/L
- Nagbabago ang potassium levels ayon sa pH: acidosis → hyperkalemia (lumalabas ang K⁺ mula sa cells); alkalosis → hypokalemia
Chloride (Cl⁻) 97–107 mEq/L
- Hypochloremia (<97): Madalas kasabay ng hyponatremia o metabolic alkalosis (pagsusuka)
- Hyperchloremia (>107): Madalas kasabay ng hypernatremia o metabolic acidosis (normal anion gap)
- Magkasabay ang trend ng chloride at sodium
CO₂ / Bicarbonate (HCO₃⁻) 22–29 mEq/L
- Ito ang total CO₂ o bicarbonate sa BMP — hindi ito kapareho ng PaCO₂ sa ABG
- Low HCO₃⁻ (<22): Metabolic acidosis — mga sanhi: DKA, lactic acidosis, renal failure, diarrhea
- High HCO₃⁻ (>29): Metabolic alkalosis — mga sanhi: pagsusuka, paggamit ng diuretic, corticosteroids
BUN 7–20 mg/dL
- Sumasalamin ang BUN sa protein metabolism at renal clearance
- Elevated BUN: Dehydration (prerenal), renal failure, high protein diet, GI bleed (natutunaw na blood protein), muscle breakdown
- BUN:creatinine ratio >20:1 = prerenal cause (dehydration); 10–20:1 = intrinsic renal disease
Creatinine 0.6–1.2 mg/dL
- Ang creatinine ay nailalabas mula sa muscle metabolism sa halos constant na rate at nililinis sa glomerular filtration — ito ang pinakamainam na routine marker ng GFR (kidney function)
- Elevated creatinine: Renal insufficiency, rhabdomyolysis (muscle breakdown)
- Ang eGFR (estimated glomerular filtration rate) ay kinakalkula mula sa creatinine, edad, kasarian, lahi — normal >60 mL/min/1.73m²
- Nahuhuli ang pagtaas ng creatinine — nakakabawi pa ang kidneys hanggang humigit-kumulang 50% nephron loss
Glucose 70–100 mg/dL (fasting)
- Hypoglycemia (<70): Diaphoresis, tremors, confusion, pagkawala ng malay — agad gamutin ng oral glucose o IV dextrose
- Hyperglycemia (>100): DM, stress hyperglycemia, paggamit ng corticosteroid, TPN
- Diabetes criteria: Fasting glucose ≥126 mg/dL (sa 2 pagkakataon); random glucose ≥200 na may sintomas
Karaniwang Clinical Patterns
| Pattern | Likely Cause |
|---|---|
| ↑BUN + ↑Creatinine (both) | Renal failure (acute or chronic) |
| ↑BUN alone, normal creatinine | Dehydration, GI bleed, high protein diet |
| ↓Na⁺ + ↓HCO₃⁻ | Pagsusuka na may dehydration |
| ↓HCO₃⁻ + ↓K⁺ + ↑Glucose | Diabetic ketoacidosis (DKA) |
| ↑K⁺ + ↑Creatinine + ↓HCO₃⁻ | Renal failure |
Mga Kaugnay na Konsepto
- anion-gap — Kinakalkula mula sa BMP components (Na⁺, Cl⁻, HCO₃⁻); tumutulong mag-classify ng metabolic acidosis.
- serum-calcium — Kasama sa comprehensive metabolic panel (CMP).
- sodium-balance-disorders — Kumpletong assessment at management ng hyponatremia at hypernatremia.
- potassium-balance-disorders — Kumpletong assessment at management ng hypokalemia at hyperkalemia.
- kidney-disease — BUN at creatinine bilang markers ng CKD progression.
- diabetes-mellitus — Interpretasyon ng BMP glucose at HCO₃⁻ sa DKA.
Self-Check
- Ang BMP ng pasyente ay may BUN 48 mg/dL at creatinine 0.9 mg/dL. Ano ang malamang na sanhi, at ano ang ipinapahiwatig ng ratio na ito?
- Anong ECG changes ang kaugnay ng hyperkalemia, at bakit ito itinuturing na life-threatening emergency?
- Sa pasyenteng may DKA, aling mga BMP values ang aasahang abnormal at sa anong direksyon?