CMP - Comprehensive Metabolic Panel
Includes liver and kidney function, glucose and electrolytes
The comprehensive metabolic panel, or chemical screening, (CMP) is a panel of 14 blood tests which serves as an initial medical screening tool to review overall health. The CMP functions as a check for kidney function, liver function, and electrolyte and fluid balance. These are the tests included:
1. Sodium (Na)
2. Potassium (K)
3. Chloride (C)
4. Carbon Dioxide (CO2)
5. Albumin (Alb)
6. Alkaline Phosphatase (ALP)
7. Bilirubin (Bil) Total
8. Aspartate Transaminase (AST)
9. Transaminase (ALT)
10. Blood Urea Nitrogen (BUN)
11. Total Protein
12. Calcium (Ca)
13. Creatinine (Cr) with calculated eGFR
When the doctor looks at your report of the complete metabolic profile (CMP), he organizes it in his mind according to body systems or possible diseases. The sodium, potassium, chloride, and total carbon dioxide measure the salt and acid base balance of the body. The glucose level is how we diagnose diabetes. The BUN, Creatinine, and BUN to Creatinine ratio tells us how the kidneys are functioning, and also can give us an idea about water balance and possible heart function. The calcium and phosphorus give us information on a possible endocrine disorder called hyperparathyroidism, and also can give information on possible bone disease and malabsorption. The total protein, albumin, globulin, all can point to a liver problem, a kidney problem, or an immune disease. The total direct bilirubin can be abnormal in liver disease and in some blood diseases. The alkaline phosphatase, AST, and ALT can be abnormal in liver disease.
What Tests Are Included in a Complete Metabolic Profile (CMP) Test?
Now let's go over the tests in somewhat more detail.
The Serum Glucose test is how we diagnose diabetes. If the glucose is 126 on a fasting blood draw, meaning the blood was drawn first thing in the morning after an overnight fast, before you ate any breakfast, then you have diabetes. Now, that's assuming that when we repeat the test, we get the same results. It needs to be abnormal more than once.
The Uric Acid test is how we diagnose gout.
The BUN, Blood Urea Nitrogen, can be abnormal in kidney disease, dehydration, and heart failure, as well as malnutrition and liver disease.
The Serum Creatinine is a measure of kidney function. The BUN to Creatinine ratio can give information on the possible cause of the kidney dysfunction, say heart failure or dehydration or decreased kidney blood flow.
The Serum Sodium can be increased in dehydration. The Serum Sodium can be decreased in diuretic therapy and in the syndrome of inappropriate antidiuretic hormone abbreviated, SIADH. The Serum Potassium can be increased in adrenal insufficiency and acute renal failure, as well as with an inappropriate combination of medicines. Potassium could be decreased in primary aldosteronism, diuretic therapy, and renal tubular acidosis.
The Serum Chloride can be increased in dehydration and renal tubular acidosis, and it can be decreased in congestive heart failure and in primary aldosteronism. The Carbon Dioxide can be increased in primary pulmonary disease, such as severe COPD and in primary aldosteronism. It can be decreased in metabolic acidosis, such as occurs with the diabetic ketoacidosis.
The Serum Calcium can be increased in an endocrine disease called primary hyperthyroidism. It can also be increased in malignancy. However, most of the time, when a person has a high Serum Calcium found unexpectedly, it's simply due to hyperparathyroidism, which can be treated. Now, we can also have a decreased Serum Calcium in hypoparathyroidism and in vitamin D deficiency.
The Serum Phosphorus can be increased in acute or chronic renal failure and decreased in malabsorption and vitamin D deficiency.
The total Serum Protein can be increased in multiple myeloma and sarcoidosis, and it can be decreased in chronic glomerulonephritis, which is a type of chronic renal disease.
The Serum Albumin can be decreased in liver disease, cirrhosis, and in nephrotic syndrome. The total Globulin and the Albumin to Globulin ratio can be increased or decreased due to a number of causes.
The total Bilirubin can be increased in hepatitis, hemolytic anemia, and in blockage of the bile ducts, either the bile ducts within the liver or within the bile duct that drains the gallbladder and the liver. That's what we mean when we say cholestasis or biliary obstruction. The direct Bilirubin is increased in the same things as the total Bilirubin, but the ratio of direct to total gives us clues as to the causes. One of the most common causes of a mildly elevated total Bilirubin found on a routine CMP is a syndrome called Gilbert's disease. Although it's called a disease, it's common, and it doesn't cause any liver damage or any health damage.
The Alkaline Phosphatase can be increased in bone disease and liver disease and decreased in malnutrition and celiac disease.
The AST, and ALT are often called liver enzyme tests. They don't measure liver function, but rather give evidence of liver damage, but they can also be elevated in damage to other parts of the body. They can be increased in liver disease, muscle disease, pancreatitis, and excessive exercise.
More Details on Liver Function Tests
Liver function tests, also known as the hepatic panel, are laboratory tests that help measure how well the liver is working. The liver carries out many vital bodily functions; when it is not working properly, levels of various enzymes, proteins, and other substances in the blood may rise or fall. Elevated liver enzyme levels may be a sign of liver damage caused by factors such as viral hepatitis, heavy alcohol consumption, or drug toxicity.
Alanine transaminase (ALT): formerly called SGPT, ALT is an enzyme normally present in liver cells. When these cells are damaged, ALT is released into the bloodstream. A normal ALT level for adult men is 0-50 International Units per liter (IU/L); levels are somewhat lower in women. While mild elevations are common (especially in people who exercise), an ALT level more than 2.5 times the upper limit of normal (ULN) is cause for concern. In general, upward or downward trends in ALT are more informative than a single measurement.
Aspartate transaminase (AST): formerly called SGOT, AST is another liver enzyme that may spill into the blood when liver cells are damaged. AST levels may also be elevated in people with muscle damage. A normal AST level for adult men is 0-45 IU/L.
Bilirubin: bilirubin is a pigment released when red blood cells are broken down. A normal bilirubin level is 0.1-1.5 mg/dL. An elevated level (hyperbilirubinemia) may indicate liver damage, impaired bile flow, or excessive red blood cell destruction. High bilirubin levels can lead to jaundice (yellowing of the skin and whites of the eyes).
Alkaline phosphatase (AP): elevated AP levels may signal obstructed bile flow or bone destruction. A normal level is 35-115 IU/L.
More Details on Kidney Function Tests
Blood urea nitrogen (BUN): nitrogen is a metabolic waste product that is normally filtered out by the kidneys and excreted in the urine. A normal BUN is 8-20 mg/dL. Elevations may indicate kidney dysfunction, high protein intake or a body fluid imbalance (e.g., dehydration).
Creatinine: this waste product of protein metabolism is also normally excreted by the kidneys. A normal blood creatinine level is 0.6-1.5 mg/dL. Elevated creatinine levels may indicate kidney damage. Creatinine is used in calculating creatinine clearance (creatinine clearance below 60 may indicate impaired kidney function).
To learn more about how to interpret your CMP: Click Here
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