The comprehensive metabolic panel or cmp panel consists of 14 blood tests which serve as an initial medical screening tool to review overall health. The CMP blood test panel functions as a check for kidney function, liver function, and electrolyte and fluid balance. FASTING IS REQUIRED. These are the tests included:
1. Sodium (Na)
Sodium is one of the body's principal minerals, regulated by the kidneys. It plays an important role in water balance in your body. A high level can be caused by dehydration, excessive salt intake in your diet or certain diseases. A low level of sodium may be caused by diarrhea, vomiting, or excessive sweating. Numerous drugs, including diuretics, certain blood pressure medications and steroids, may alter the sodium level.
2. Potassium (K)
Potassium is one of the body's principal minerals, found primarily inside cells. It helps maintain water balance as well as proper function of nerves and muscles. Low or high levels in the blood are of critical significance and should be evaluated by your healthcare provider. This is especially important if you are taking a diuretic or heart medication. A high level may indicate kidney or liver disease, too much medication or bodily injury, such as a burn. A low level of potassium can develop rapidly, most frequently produced as a side effect of drugs that cause increased urination.
3. Chloride (C)
Chloride is one of the body's minerals involved with water balance. Most body chloride comes from salt in the diet. A high chloride level may mean severe dehydration, certain kidney disorders or hyperventilation. A low chloride level may result from excessive vomiting, diarrhea, severe burns, excessive sweating or kidney failure. Borderline low or high levels of chloride have very little significance.
4. Carbon Dioxide (CO2)
n the body, most of the carbon dioxide (CO2) is in the form of a substance called bicarbonate (HCO3). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level. Changes in your CO2 level may suggest that you are losing or retaining fluid, which causes an imbalance in your body's electrolytes. CO2 levels in the blood are influenced by kidney and lung function. The kidneys are mainly responsible for maintaining the normal bicarbonate levels. The CO2 level is interpreted with other results to aid in medical diagnoses.
5. Albumin (Alb)
Albumin is the largest portion of total blood protein. Decreased blood albumin may indicate many disorders including poor nutrition and advanced liver disease. Modest decreases in albumin may be seen in people with low thyroid gland function and protein-losing conditions.
6. Alkaline Phosphatase (ALP)
Alkaline phosphatase is an enzyme found primarily in bone and the liver. Elevated levels may indicate the presence of bone or liver disorders. It is commonly increased when the bile duct is blocked which may be caused by gallstones.
7. Bilirubin (Bil) Total
Bilirubin is the main pigment in bile and a major product of normal red cell breakdown. It is helpful in evaluating liver function, various anemias and in evaluating jaundice, yellowing of the skin.
8. Aspartate Transaminase (AST)
Aspartate aminotransferase (AST) is an enzyme found in the liver and in cardiac and skeletal muscle. AST may rise in liver, heart, and muscle disorders. It can also rise following strenuous, prolonged exercise.
9. Transaminase (ALT)
Alanine aminotransferase (ALT) is an enzyme produced primarily in the liver, skeletal and heart muscle. ALT is present in the liver in a higher concentration than AST and is more specific for differentiating liver injury from muscle damage. ALT rises in the instance of liver disease.
10. Blood Urea Nitrogen (BUN)
Urea, measured as blood urea nitrogen (BUN) is a waste product derived from the natural breakdown of protein in the liver. Urea is excreted in the urine after blood is filtered through the kidneys. The urea nitrogen level reflects both the metabolism of protein and the effectiveness of the kidneys in filtering blood.
The BUN/creatinine ratio is a calculated value derived by dividing the urea nitrogen result by the creatinine result. This ratio can be helpful in determining whether elevated urea nitrogen is due to impaired kidney function or to other factors such as dehydration, urinary blockage or excessive blood loss.
Please Note: If results for BUN and Creatinine are both within the normal reference range, the BUN/Creatinine ratio will not be reported (not applicable). Clinical Significance: The BUN/Creatinine ratio is useful in the differential diagnosis of acute or chronic renal disease.
11. Total Protein
Urea, measured as blood urea nitrogen (BUN) is a waste product derived from the natural breakdown of protein in the liver. Urea is excreted in the urine after blood is filtered through the kidneys. The urea nitrogen level reflects both the metabolism of protein and the effectiveness of the kidneys in filtering blood.
12. Calcium (Ca)
Calcium is one of the most important elements in the body. It is essential for maintenance and repair of bone and teeth, heart function, muscle function, and blood clotting. Ninety-nine percent of the calcium in your body is contained in your bones and only one percent is in the blood. Although most of the calcium in the body is in the bones, the body regulates blood calcium levels very tightly, since its functions are essential to health and performance.
13. Creatinine (Cr) with calculated eGFR
Creatinine is derived from muscles and released into the blood. It is removed from the body by the kidneys. When the creatinine level is elevated, a decrease in kidney function is suggested. For patients 50 years of age and older, and whom identify as African-American the upper reference range for creatinine is approximately 10-15% higher.
Estimated Glomerular Filtration Rate (eGFR) is a test for kidney damage. eGFR is calculated using your serum creatinine result, age and gender. Creatinine is not sensitive to early renal damage since it varies with age, gender and ethnic background. If you are African American, your eGFR is estimated differently. Since race is not reported in this screening, you will need to use the reported result that is associated with your race. To get a African American specific result, you can multiply this result by 1.21 to get your true eGFR. The same reference ranges will apply.
14. Glucose
Glucose (“blood sugar”) is the chief source of energy for all cells in the body. Glucose levels are regulated by hormones produced by your pancreas, including insulin. A glucose level outside the optimal range could be a sign that the body is not correctly producing or using insulin. These conditions are hypoglycemia (low blood sugar), prediabetes (elevated blood sugar), and diabetes (high blood sugar). For the most accurate result you should fast (not eat or drink anything but water) for at least 8 hours before your screening. If you were not fasting at the time of your screening, you should interpret your result against an optimal range of less than 140 mg/dL.
When the doctor looks at your report of the cmp blood test panel, 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)?
Now let's go over the cmp blood 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).
Comprehensive Metabolic Panel Test FAQ
Now that you know what a CMP panel contains, let’s find out some answers to some of the questions you might have about it.
1. How Can I Do the CMP Panel Test?
The test is done using a single blood sample. You go to a clinic and draw blood which will be analyzed in a medical laboratory. The doctors will perform the tests above to determine the levels of each substance in your bloodstream. You get the results back in a few business days, and you can compare them against standard reference values.
2. Is the Comprehensive Metabolic Panel Test Painful?
In most cases, it's not, but it depends on whether you have a fear of needles or not. Today's doctors are very efficient at drawing blood, so you might not even feel the sting when the needle enters your vein.
3. What If Some Variables or Enzymes Are Out of Normal Ranges?
Once the results are back, and you see that some substances are off the charts, you can go to your healthcare provider for recommendations. If you have high glucose levels, your doctor might recommend starting an exercise regimen as this is known to increase insulin sensitivity and prevent diabetes.
If your calcium levels are low, you might need to eat more dairy products. If your sodium levels are high, you might want to avoid salty foods. These recommendations are based on the specific results of each, so there’s no one-size-fits-all here.
4. Do I Need to Fast Before Doing the Test?
Yes, fasting is mandatory. You should avoid eating and drinking anything else than water for 10-12 hours before doing this test. Fasting is necessary to let the hormonal values return to baseline, so the diagnosis is more accurate.
5. Why Should I Do This Test?
It’s important to do the test to get a broad overview of the hormones and enzymes in your body. If some substances are not in the comprehensive metabolic panel normal ranges, you can take action and prevent more serious health complications. Plus, the test is affordable, quick, and easy to do, so why not taking advantage of it?
6. How Can I Read and Interpret My Results?
The comprehensive metabolic panel normal ranges are published on the internet, and you can find them with a simple Google search. You can also ask your doctor to interpret the results for you as well as checking out this interesting CMP guide on reading your comp metabolic panel.
Ready to Take the Test?
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