Metabolic Panel Explained: Basic (BMP) & Comprehensive Metabolic Panel (CMP) Lab Values for Nurses

Summary

In this educational video, Sarah Threats Turner discusses the importance of understanding the metabolic lab panel, which includes the BMP and CMP, for nurses. She explains that these tests assess electrolytes, renal, and liver functions, and highlights the significance of recognizing normal ranges and abnormal values. Turner also covers the causes of these variations and provides insights into conditions like hypoglycemia, hypercalcemia, and liver diseases, emphasizing the role of the parathyroid gland and the impact of medications on electrolyte levels.

Takeaways

• 🧬 The metabolic panel is a common blood test that assesses electrolytes, renal function, and liver function.
• 🔍 There are two types of metabolic panels: the Basic Metabolic Panel (BMP) and the Comprehensive Metabolic Panel (CMP), with the latter including liver function tests.
• 🩸 Blood samples for metabolic panels are collected through a vein in the arm and sent to a lab for analysis.
• 📊 A BMP includes tests for glucose, calcium, sodium, chloride, potassium, carbon dioxide, BUN, and creatinine.
• 📈 The CMP, in addition to BMP tests, assesses liver function through ALP, AST, ALT, bilirubin, total protein, albumin, and globulin.
• 🚨 Abnormal values in the metabolic panel can indicate conditions such as diabetes, kidney disease, liver disease, and electrolyte imbalances.
• 🍬 Glucose levels are key indicators of blood sugar; hypoglycemia is less than 70 mg/dL, and hyperglycemia is higher than the normal range.
• 🦴 Calcium levels are regulated by the parathyroid gland and vitamin D intake, with abnormalities potentially leading to hypocalcemia or hypercalcemia.
• 💧 Sodium levels are crucial for electrolyte balance, with hyponatremia occurring below 135-140 mEq/L and hypernatremia being excessively high.
• 🌀 Potassium is a critical electrolyte with levels between 3.5 to 5 mEq/L, and abnormalities can be caused by diuretics, corticosteroids, and renal failure.
• 🌪 Carbon dioxide levels affect the body's acid-base balance, with low levels indicating acidosis and high levels potentially due to respiratory issues.
• 📉 Liver function tests in the CMP, such as ALP, AST, and ALT, can indicate liver or bone diseases if results are abnormally high.

Q & A

What is the main topic of Sarah Threats Turner's video?

The main topic of the video is the metabolic lab panel, which includes the BMP and the CMP, and how it is used in assessing a patient's health, particularly focusing on electrolytes, renal function, and liver function.

What does a metabolic panel test for?

A metabolic panel tests for electrolytes, renal function, and liver function. It can be ordered as a Basic Metabolic Panel (BMP) or a Comprehensive Metabolic Panel (CMP), with the latter including additional liver function tests.

What is the difference between a BMP and a CMP?

A BMP focuses on electrolytes and renal function, while a CMP includes all the tests of a BMP plus additional liver function tests such as ALP, AST, ALT, bilirubin, total protein, albumin, and globulin.

What are the normal reference ranges for glucose in the blood?

The normal reference range for glucose is about 70 to 100 milligrams per deciliter for a fasting patient, and up to 125 milligrams per deciliter if the patient has not been fasting.

What conditions can cause abnormal glucose levels in the blood?

Hypoglycemia (low glucose) can be caused by too much insulin or oral diabetic medication, while hyperglycemia (high glucose) can be due to poorly managed diabetes, certain medications like corticosteroids, or other factors that increase blood glucose.

What is the normal blood level range for calcium?

The normal blood level range for calcium is about 8.5 to 10.5 milligrams per deciliter.

Why is potassium a critical electrolyte to monitor?

Potassium is critical to monitor because it has a narrow normal range and can be affected by many factors, including medications, disease processes, and diet. Abnormal potassium levels can affect the toxicity of certain drugs and impact the heart and other muscles.

What does the term 'anion gap' refer to in the context of a metabolic panel?

The anion gap refers to the difference between the positively and negatively charged electrolytes in the blood, calculated from sodium, chloride, and bicarbonate (from CO2). A high anion gap may indicate metabolic acidosis.

What does an elevated BUN (Blood Urea Nitrogen) level suggest about a patient's kidney function?

An elevated BUN level suggests that the kidneys are under stress or not functioning well, as it indicates a higher amount of urea nitrogen in the blood, which should normally be filtered out by healthy kidneys.

Why is creatinine an important indicator of kidney function?

Creatinine is an important indicator of kidney function because it is a waste product from muscle that should be filtered out by the kidneys and excreted in urine. High levels of creatinine in the blood can indicate kidney stress or failure.

How does the metabolic panel assess liver function?

The metabolic panel assesses liver function through the CMP, which includes tests for ALP, AST, ALT, bilirubin, total protein, albumin, and globulin. Abnormal levels of these components can indicate liver disease or dysfunction.

What is the significance of albumin levels in the blood?

Albumin levels are significant because they play a crucial role in regulating oncotic pressure within blood vessels. Low albumin levels can lead to fluid leakage from the vessels, causing swelling, while high levels may indicate liver problems or immune disorders.

Outlines

00:00

🧪 Introduction to Metabolic Panel Testing

Sarah Threats Turner introduces the topic of the metabolic lab panel, which includes both the Basic Metabolic Panel (BMP) and the Comprehensive Metabolic Panel (CMP). She emphasizes the importance for nurses to understand these tests for patient assessment, including recognizing normal ranges and potential abnormalities. The video is part of a series on lab values for nurses, covering various tests such as CBC, PT/INR, and D-Dimer. The metabolic panel is a common blood test that evaluates electrolytes, renal function, and liver function, depending on whether a BMP or CMP is ordered. The video promises to cover what the panels assess, their normal ranges, and reasons for abnormal values.

05:02

📊 Understanding Electrolytes and Renal Function

The second paragraph delves into the specifics of electrolytes and renal function testing within the metabolic panel. It explains the normal reference ranges for glucose, calcium, sodium, chloride, potassium, and carbon dioxide, and discusses the causes of abnormal results such as hypoglycemia, hyperglycemia, hypocalcemia, hypercalcemia, hyponatremia, and others. Conditions like diabetes, parathyroid issues, vitamin D deficiency, Cushing's syndrome, dehydration, and certain medications are mentioned as factors affecting these levels. The paragraph also touches on the impact of renal insufficiency and the use of diuretics on electrolyte balance.

10:04

🌡️ Assessing Liver Function with Metabolic Panels

This paragraph focuses on the liver function tests included in the CMP, detailing the role of enzymes such as ALP, AST, and ALT in evaluating liver health. It provides normal reference ranges for these enzymes and explains that elevated levels may indicate liver or bone disease. The paragraph also discusses bilirubin, a waste product from red blood cell breakdown, and its significance in liver function assessment. High bilirubin levels can suggest liver disease or bile duct obstruction, leading to jaundice. The importance of albumin and globulin in the metabolic panel is highlighted, with their normal ranges and potential implications for immune function and oncotic pressure in the blood.

15:06

🚑 Clinical Implications of Abnormal Liver Function Tests

The fourth paragraph continues the discussion on liver function, emphasizing the clinical implications of abnormal liver function tests. It explains how high levels of liver enzymes can indicate liver issues requiring further investigation. The paragraph also describes the process of bilirubin production and excretion, and how disruptions in this process can lead to jaundice, characterized by yellowing of the skin and eyes, and changes in urine color. The importance of albumin levels in maintaining blood vessel integrity and preventing edema is also discussed, with low albumin levels signaling potential liver or kidney issues.

20:07

📝 Concluding the Metabolic Panel Review

In the concluding paragraph, the video script summarizes the key points covered in the metabolic panel review, including the assessment of electrolytes, renal function, and liver function. It reiterates the importance of understanding these tests for patient care and encourages viewers to take a free quiz to reinforce their knowledge. The paragraph serves as a reminder of the significance of the metabolic panel in evaluating a patient's overall health and identifying potential abnormalities.

Keywords

💡Metabolic Panel

A metabolic panel is a set of blood tests that provides an overview of a person's metabolic state, including the function of the liver, kidneys, and electrolytes. In the video, it is the main focus, as it is used to assess various aspects of a patient's health, such as electrolyte balance and organ function. The script discusses both the Basic Metabolic Panel (BMP) and the Comprehensive Metabolic Panel (CMP), highlighting the tests included in each.

💡Basic Metabolic Panel (BMP)

The BMP is a subset of the metabolic panel that focuses on electrolytes and renal function. It is mentioned in the script as a common blood test ordered by physicians, which includes tests for glucose, calcium, sodium, chloride, potassium, and carbon dioxide, as well as blood urea nitrogen (BUN) and creatinine for assessing kidney function.

💡Comprehensive Metabolic Panel (CMP)

The CMP is an expanded version of the BMP, which includes all the tests of the BMP plus additional liver function tests. The script explains that the CMP is called 'comprehensive' because it provides a more detailed analysis of the blood, including liver enzymes such as ALP, AST, and ALT, as well as bilirubin, total protein, albumin, and globulin.

💡Electrolytes

Electrolytes are minerals that carry an electric charge and are essential for various bodily functions, including nerve and muscle function. The script discusses several electrolytes, such as sodium, potassium, and chloride, which are part of the metabolic panel, and their normal reference ranges, as well as the causes of abnormal levels.

💡Renal Function

Renal function refers to how well the kidneys are working. The script explains that the metabolic panel assesses renal function through the measurement of blood urea nitrogen (BUN) and creatinine, which are waste products that should be filtered by the kidneys and excreted in urine. Abnormal levels of these substances can indicate kidney problems.

💡Liver Function

Liver function tests are part of the CMP and are used to evaluate the health and activity of the liver. The script describes how the CMP includes tests for liver enzymes such as ALP, AST, and ALT, which can be elevated in cases of liver disease or damage. It also mentions bilirubin, a waste product processed by the liver, and its relevance to liver health.

💡Hyponatremia

Hyponatremia is a condition characterized by low levels of sodium in the blood. The script discusses this condition in the context of electrolyte imbalances, mentioning that it can be caused by kidney problems, diuretic use, or conditions like Cushing's syndrome, which can affect sodium levels.

💡Hyperglycemia

Hyperglycemia refers to high blood sugar levels, often associated with diabetes. The script explains that in the context of the metabolic panel, high glucose levels can indicate poorly managed diabetes or the use of certain medications like corticosteroids that can raise blood sugar.

💡Hypocalcemia

Hypocalcemia is a condition where there is a low level of calcium in the blood. The script discusses the role of the parathyroid gland in regulating calcium levels and how its removal, as in a parathyroidectomy, can lead to hypocalcemia. It also mentions the importance of vitamin D in calcium absorption.

💡Carbon Dioxide

Carbon dioxide is a waste product of metabolism and plays a crucial role in maintaining the acid-base balance in the body. The script explains that the metabolic panel measures carbon dioxide levels in the blood, which can be affected by respiratory issues or metabolic disorders, and is important for understanding the body's overall metabolic state.

💡Anion Gap

The anion gap is a calculated value derived from the difference between the concentrations of positively and negatively charged ions in the blood. The script mentions that a high anion gap can indicate metabolic acidosis, which can be caused by conditions such as diabetic ketoacidosis or renal failure, and is an important aspect of the metabolic panel.

Highlights

Sarah Threats Turner discusses the importance of understanding the metabolic lab panel for nurses.

The video covers the BMP and CMP as part of the metabolic panel.

Metabolic panels are as common as CBC and assess electrolytes, renal, and liver function.

BMP focuses on electrolytes and renal function, whereas CMP includes liver function assessment.

Reference ranges for lab results vary and are used to identify abnormal values.

Glucose levels are key in identifying hypoglycemia and hyperglycemia.

Calcium levels can indicate parathyroid issues or vitamin D deficiencies.

Sodium levels are crucial for detecting hyponatremia and hypernatremia.

Potassium levels are closely monitored for hypokalemia and hyperkalemia.

Carbon dioxide levels are essential for assessing acid-base balance.

Anion gap calculation helps identify metabolic acidosis.

BUN and creatinine levels are critical for evaluating kidney function.

GFR estimation is used to determine renal insufficiency.

Liver function tests include ALP, AST, ALT, and bilirubin levels.

Bilirubin levels can indicate liver disease or bile duct obstruction.

Total protein, globulin, and albumin levels are assessed for liver and kidney health.

Albumin's role in oncotic pressure is vital for preventing fluid leakage.

A free quiz is available to test knowledge on the metabolic panel content.

Transcripts

hey everyone it's Sarah threats Turner

sorry n comm and in this video we're

going to talk about the metabolic lab

panel which includes the BMP and the cmp

and as always whenever you get done

watching this YouTube video you can

access the free quiz that will test you

on this content so let's get started for

exams and whenever you're working on the

job as a nurse what you want to know

about the metabolic panel is what it

assesses what those normal reference

ranges are and why your patient may be

having abnormal values in specific areas

which we're going to cover all three

things in this video now this video is

actually part of a review series called

lab values for nurses so if you're

studying labs in school or you're a new

nurse need to know what these tests look

at like the CBC the pt/inr d-dimer etc

you definitely want to check out those

videos in this series so a metabolic

panel is a very common blood test

ordered on a patient it is just as

common as the complete blood count which

is a CBC that is also ordered on a

patient many times now the CBC looked at

specific cells that hang out in the

blood like white blood cells red blood

cells platelets etc now a metabolic

panel is going to look at electrolytes

the renal function of the person and

liver function now a metabolic panel can

be ordered in two ways by the physician

the physician can order a basic

metabolic panel which is a BMP or they

can order a comprehensive metabolic

panel known as a CMP now a CMP hint is

called comprehensive so it's going to

look a little bit more into some things

in the blood so it's going to look at

the electrolytes the renal function

however it's going to take it a step

further and look at liver function so

regardless of if they order a BMP or CMP

this sample is collected through a vein

in the arm usually and you take a needle

withdrawal that blood put it in a tube

send it to the lab and the lab will run

that blood and you will get the results

back so let's look at the difference

between what a

BMP covers and a CMP a BMP which again

stands for basic metabolic panel is

going to just look at electrolytes and

the person's renal function so the

electrolytes is going to look at our

glucose calcium sodium chloride

potassium and carbon dioxide and for

renal function is going to look at the B

UN and creatinine

however the cmp which again stands for

comprehensive metabolic panel is going

to look at those electrolytes and renal

function plus it's going to look at the

liver function which includes ALP which

is alkaline phosphatase ast which is a

sport a transaminase la T which is

alanine transaminase and then it's going

to look at the bilirubin total protein

albumin and globulin so first let's talk

about the normal reference ranges and

the causes for why we have abnormal lab

results in the electrolyte part of the

metabolic panel now these reference

ranges are going to vary depending on

the source you're looking at and the lab

that you are using so for exams just

know that they are going to give you

something that is noticeably abnormal

for a lab result for instance like with

sodium they're not gonna give you a lab

result that is like right on the edge of

that normal reference range they're like

if they're gonna test you on

hyponatremia they're gonna give you

something that is like 110 115 that

you're gonna know that that's abnormal

or hypernatremia something that's like

180 200 so whenever you look at that lab

result you're gonna know oh this is not

normal so keep that in mind okay the

first electrolyte we're going to talk

about is glucose glucose is like sugar

so we're looking at the amount of sugar

in a patient's blood a normal reference

range is about seventy to a hundred

milligrams per deciliter and this is a

reference range we use if the patient

was fasting whenever we drew their blood

now if the patient hasn't been fasting

they've had food up to that point this

can be extended up to about 125 M

per decilitre so let's talk about

abnormal results low versus high so

whenever a patient has a low glucose

level like less than 70

we call that hypoglycemia what are some

causes of hypoglycemia well you see this

a lot in patients who are diabetic who

are receiving insulin or oral diabetic

medications so let's say they've had too

much insulin or they have had too much

oral diabetic medication this can draw

up their blood sugar so we'd look at

that on the flip side if it's higher

than this reference range we call that

hyperglycemia so what can cause a

patient's glucose to rise in their blood

well several things a lot of times it's

with patients who have diabetes it's not

being managed very well they need more

insulin or more medication or they're on

certain medications that actually

increase the glucose in the blood like

corticosteroids next is calcium a normal

calcium blood level is about eight point

five to ten point five milligrams per

deciliter so anything less than eight

point five is termed hypocalcemia so

what if you cause a low blood level of

calcium well there's a certain gland in

your body that helps regulate calcium

and it's known as the parathyroid gland

so sometimes a patient will have to have

surgery to remove that gland it's

overactive which is termed a

parathyroidectomy however whenever

that's removed the nurse post-op really

wants to monitor those calcium levels

because they can draw the patient can

experience hypocalcemia another thing

that can draw up the calcium levels is

if a patient doesn't have a really good

intake of vitamin D because vitamin D

helps us really absorb calcium then on

the flip side we have a really high

level it's termed hypercalcemia this is

where a patient has a really high

calcium level in their blood what if you

call it this well if a patient's

parathyroid gland is really overactive

so we're just keeping more calcium in

our blood too much or if a patient has a

really high intake of vitamin D we're

gonna increase how much calcium we're

taking in now whenever a patient has a

high calcium level you definitely want

to monitor them and their renal status

because they're at risk for kidney

stones then we have sodium and a normal

sodium level is about 135 to 140 5 milli

equivalents per liter anything less than

this would be termed hyponatremia

so what if it cause a low sodium level

in the blood well let's think about this

your sodium is really regulated within

your kidneys so if a person has kidney

problems they're at risk for

hyponatremia

because certain areas of the tubules

they will either cause the body to keep

which reabsorb that sodium put it back

in the blood or excrete it which means

that they're gonna put it back into the

urine so as you're gonna see

a lot of these electrolytes are going to

be thrown off if a patient has renal

failure

so renal insufficiency also diuretics we

know from our reviews over diuretics

that they act on certain areas of the

tubules in the kidneys so one diuretic

family that can cause a low sodium level

or thiazide so they will actually cause

the kidneys to waste that sodium so you

will lose it more in the urine and that

will drop it in the blood in addition

diarrhea can cause a low sodium level

however on the flip side what can

increase this level really high well

Cushing's syndrome can cause the body to

specifically those kidneys to keep more

sodium whenever that happens you're

gonna lose potassium so whenever we jump

over here to potassium you'll see that

in Cushing's syndrome

potassium levels can drop in addition

dehydration can increase the sodium

levels in the blood along with renal

insufficiency the next we have chloride

a normal chloride level is about 95 to

105 million quids per liter so whenever

the chloride level in the blood drops we

turn that hypokalemia but what can make

the chloride level drop well severe lung

disease like patients who have emphasis

I can experience this also patients who

are using loop diuretics because from

our video where we talked about loop

diuretics we learn that they affect that

loop of Henle and it can alter how

chloride is reabsorbed so if we're not

really reabsorbing that and that part of

the nephron we're gonna lower those

blood levels of chloride also if the

patient is losing a lot of chloride

through either throwing it up or having

diarrhea that can happen then on the

flip side we can increase our chloride

levels in our blood this can happen

again through probably how you've

already guessed it renal problems so if

within that to be it's really having

problems reabsorb or reabsorbing too

much chloride we can increase our

chloride levels in our blood

next is potassium a normal potassium

level is about 3.5 to 5 milli

equivalents per liter

now all these electrolytes are important

and we want to monitor them but

potassium is one of those ones that you

want to really keep a close eye on

because from experience I have seen

patients levels being really low or

really high and you have this narrow

range that you have to work within and a

lot of times patients are on medications

that can further draw up their potassium

levels or they're on medications that

are really dependent on those potassium

levels because if they're too abnormal

it can increase the toxicity of that

drug so keep an eye on this potassium

level especially during your medication

passes you want to know what that

potassium level is before you throw on a

lot of lasix or frosts amide so a low

potassium level anything less than 3.5

is considered hypokalemia so what can

lower that well one thing is like loop

diuretics they cause the body to waste

potassium also corticosteroids can do

that disease processes like Cushing's

syndrome can do this so with Cushing's

syndrome you have the high production of

aldosterone aldosterone influences the

kidneys and it's going to tell specific

parts of the kidneys to excrete

potassium so you're gonna lose it in

your urine which hence is gonna drop it

in the blood so you can have low levels

with that plus if your patients having a

lot of flu

that's rich in potassium like diarrhea

vomiting things like that then on the

flip side what can increase potassium

well if you're going to be sitting in a

patient for dialysis and be you and

creatinine is crazy

I can guarantee their potassium level is

going to be really high so renal failure

will increase potassium levels also

Addison's disease it's the opposite of

Cushing's syndrome in a sense so with

Addison's disease you have low

production of the aldosterone so it's

going to cause the kidneys to actually

keep more potassium instead of excreta

so you can increase levels with that and

of course medications can increase that

potassium level and two big ones are

like those potassium sparing diuretics

and ACE inhibitors and then the last

electrolyte that this metabolic panel

looks at is carbon dioxide a normal

carbon dioxide level in the blood is

about 21 to 31 million quids per liter

so carbon dioxide plays a huge role with

the acid-base balance in her body and it

is a waste product from metabolism so

much of the carbon dioxide that is in

your blood is really in the form of

bicarbonate so if we have a low carbon

dioxide level our blood is really acidic

so what are some things that can cause

your blood to be a sitting diabetic

ketoacidosis or if a patient ingest like

toxic drugs like if they have aspirin

toxicity this can do it now what can

increase the carbon dioxide levels in

the blood well let's think about this

patients who have respiratory issues

where they like to retain carbon dioxide

so patients who have COPD can have this

and also sometimes assess in this

electrolyte part of this metabolic panel

will be what's called an anion gap now

what is this well this is calculated by

looking at certain electrolytes within

this metabolic panel such as sodium

chloride sometimes potassium and

bicarbonate which comes from the co2 so

what this is going to look at is the gap

or the difference between the positively

and negatively charged

electrolytes in that panel and what

we're concerned about is a really high

gap so a normal gap is about 3 to 10

milli equivalents per liter so we have a

really big difference a hence a big gap

that's telling us that we probably have

metabolic acidosis going on now what

causes that well some conditions are

like DKA diabetic ketoacidosis and renal

failure now let's look at the renal

function part that the metabolic panel

assesses so the metabolic panel is going

to look at two important things the B UN

and the creatinine and these two live

values really go together and helping us

interpret how well those kidneys are

working and we're really concerned about

live values that are really high with

the B UN and creatinine

so first BM this measures the amount of

urea nitrogen in the blood and arrange

for this is anywhere between 5 to 20 so

if this is really high this is telling

us whom our kidneys are stressed out

what's our creatinine a normal

creatinine level should be anywhere

between point 6 to 1 point 2 milligrams

per deciliter so I want you to notice

something about this range it's very

small there should not be a lot of

creatinine in your blood because your

kidneys should filter majority of it out

of the blood and you're gonna excrete it

out in your urine so let's talk a little

bit about creatinine creatinine is a

waste product from muscle so your

kidneys are made up of nephrons and we

talked about this in depth in a review

over the anatomy of the kidneys but your

nephrons can have this glomerulus in it

and it filters your blood so it's going

to remove water ions such electrolytes

and waste and one of those waste

products is creatinine and if the

kidneys are not working well like that

glomerulus structure is not working well

it's not going to be able to remove that

creatinine from your blood so those

levels of creatinine in your blood are

going to rise and that tells us that the

kidneys are stressed out and they're not

performing very well it could be that

they're failing due to like infection or

I mean profuse well I can shock or

something like that so we can take it a

step further and we can look and see

what the patient's estimated GFR is so

GFR again stands for glomerular

filtration rate a normal rate should be

greater than sixty it's less than sixty

we have renal insufficiency and those

glomerulus are not working very well

so this estimated GFR is calculated by

looking at the patient's creatinine

looking at their age their sex and their

race now let's wrap up this lecture and

let's talk about the liver function that

this metabolic panel assesses

specifically that comprehensive

metabolic panel so it's going to look at

liver function and it's going to look at

the ALP ALP is an enzyme that is found

in your bones and liver so a normal ALP

is about 40 to 120 international units

per liter we're really concerned about

high results this could indicate that we

may have some liver or bone disease

going on then it also looks at the ast

and the alt and these two enzymes really

go together because they're going to

tell us how really well this liver is

working ast this is an enzyme found in

the heart in the liver and a normal

level is about 10 to 40 and alt is an

enzyme that is found in the liver in the

kidneys and a normal level is about 7 to

56 so we have high levels that could

indicate that hey we definitely probably

have some liver issues going on and that

needs to further be investigated then it

also looks at bilirubin and a normal

bilirubin level should be point one to

one milligrams per deciliter and notice

this range that is really low so the

bilirubin level should be like less than

one in your patient should be low just

like the creatinine level now let's talk

a little bit about Billy ribbing because

it's going to help you for your other

exams and just understanding GI so Billy

Ruben is a product that is created from

the breakdown of red blood cells and

this process occurs in the

ever so whatever red blood cells are

broken down it releases like this

oranges yellowish substance and normally

this bilirubin should leave the body

through the bile and be excreted in your

stool and that's what helps give your

stool that nice brown color but if you

have some type of liver disease going on

where this process is occurring very

well or let's say that bile duct has

maybe a stone in or something's wrong

with it that bile can't drain out with

that bilirubin in it it will cause the

blood levels of bilirubin to increase

and whenever that happens you can start

seeing that in your patient with really

looking at without looking at the slab

value your patient will start to have

like an orangish yellowish hue to their

skin their mucus membranes especially

the whites of the eyes could have this

yellowish tint color to it and their

urine will start to look different

because as these levels build up in the

blood the kidneys filter the blood

remember so that Billy or even will

start leaking into the urine and so in

that person urinates their urine will

have an orangish color to it also assess

is the total protein level and this is

the complete amount of proteins in the

blood such as globulin and albumin so

normal level is about six point two to

eight point two grams per deciliter now

if we have a really low level this could

mean that the patient's liver just isn't

producing enough of these proteins or

the kidneys are leaking proteins where

they normally shouldn't leak proteins

proteins should stay in the blood the

kidneys shouldn't really filter them out

unless there's some type of renal

insufficiency so you're losing it from

the urine which can drop the blood

levels if the levels are really high

this can mean that the patient may have

some type of cancer or other type of

liver problem so then this test can take

it a little further and look

specifically at the globulin and albumin

so globulin is a protein produced in the

liver that is influenced by the immune

system so a normal level is about two to

four grams per deciliter and we're

really concerned about high levels

because that could mean that we have an

immune problems like cancer

and then albumin this is a big one that

you definitely want to know

albumin a normal level should be about

three point four to five point four

grams per deciliter and albumin plays a

huge role in regulating the oncotic

pressure within the blood vessels and if

you don't have enough albumin within

your blood vessels your vessels start to

leak and you'll get swelling so we are

really concerned about when those

albumin levels drop because they'll have

to be replenished so we can correct the

oncotic pressure and help relieve those

vessels from leaking okay so that wraps

up this review over the metabolic panel

and don't forget to access the free quiz

that will test you on this content