BMP - Revision history

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Ostermayer at 15:26, 12 March 2026

2026-03-12T15:26:17Z

← Older revision		Revision as of 15:26, 12 March 2026
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	[[Category:FEN]]		[[Category:FEN]]
			[[Category:Labs]]

Ostermayer: Created page with "The basic metabolic panel (BMP) is the workhorse lab test in emergency medicine — a panel of 8 blood chemistries that assesses electrolyte balance, renal function, acid-base status, and blood glucose. It is one of the most frequently ordered tests in the ED and provides rapid, actionable data across virtually every acute presentation.Basic Metabolic Panel (BMP). MedlinePlus Lab Tests. Accessed 2025. ==Background== ===Components and Normal..."

2026-03-10T23:40:26Z

Created page with "The basic metabolic panel (BMP) is the workhorse lab test in emergency medicine — a panel of 8 blood chemistries that assesses electrolyte balance, renal function, acid-base status, and blood glucose. It is one of the most frequently ordered tests in the ED and provides rapid, actionable data across virtually every acute presentation.<ref name="MedlinePlus">Basic Metabolic Panel (BMP). MedlinePlus Lab Tests. Accessed 2025.</ref> ==Background== ===Components and Normal..."

New page

The basic metabolic panel (BMP) is the workhorse lab test in emergency medicine — a panel of 8 blood chemistries that assesses electrolyte balance, renal function, acid-base status, and blood glucose. It is one of the most frequently ordered tests in the ED and provides rapid, actionable data across virtually every acute presentation.<ref name="MedlinePlus">Basic Metabolic Panel (BMP). MedlinePlus Lab Tests. Accessed 2025.</ref>

==Background==
===Components and Normal Ranges===
{| class="wikitable"
|-
! Component !! Normal Range !! What It Assesses
|-
| '''Sodium (Na)''' || 136–145 mEq/L || Fluid balance, osmolality
|-
| '''Potassium (K)''' || 3.5–5.0 mEq/L || Cardiac conduction, neuromuscular function
|-
| '''Chloride (Cl)''' || 98–106 mEq/L || Acid-base balance (with bicarb)
|-
| '''Bicarbonate (CO2)''' || 22–30 mEq/L || Acid-base status
|-
| '''BUN''' || 7–20 mg/dL || Renal function, hydration status
|-
| '''Creatinine (Cr)''' || 0.7–1.3 mg/dL || Renal function (GFR estimation)
|-
| '''Glucose''' || 70–100 mg/dL (fasting) || Metabolic/endocrine status
|-
| '''Calcium (Ca)''' || 8.5–10.5 mg/dL || Neuromuscular, cardiac, bone
|}
*Reference ranges vary by lab — always use your institution's values
*Most labs also report a '''calculated anion gap''' and '''eGFR''' with the BMP
*'''BMP vs. CMP:''' A comprehensive metabolic panel (CMP) includes all 8 BMP components plus albumin, total protein, total bilirubin, ALP, ALT, and AST. Order a CMP when liver assessment is also needed

===Anion Gap===
*'''Anion gap = Na − (Cl + HCO3)'''
*Normal: 8–12 mEq/L (varies by lab; some use 3–11)
*'''Always calculate the anion gap''' when reviewing a BMP — it is the single most important derived value in the ED
*Elevated anion gap with metabolic acidosis → differential includes: '''MUDPILES''' (Methanol, Uremia, [[Diabetic ketoacidosis|DKA]], Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, [[Salicylate toxicity|Salicylates]])
*'''Correct the anion gap for albumin''' if the patient is hypoalbuminemic: Corrected AG = Calculated AG + 2.5 × (4.0 − measured albumin). A "normal" anion gap in a hypoalbuminemic patient may actually be elevated

==Clinical Features==
The BMP is not ordered based on specific clinical features of the panel itself — it is ordered as a '''foundational assessment''' in most acute presentations. The BMP is appropriate in virtually any ED patient being evaluated for:

*Altered mental status, [[syncope]], weakness, [[seizure]]
*Nausea, vomiting, diarrhea, dehydration
*Chest pain, [[dyspnea]], [[cardiac arrest]]
*[[Diabetic ketoacidosis|DKA]], [[hyperosmolar hyperglycemic state|HHS]], hypoglycemia
*[[Acute kidney injury]], [[chronic kidney disease]]
*Drug overdose/toxicologic emergency
*[[Sepsis]], [[shock]]
*Medication monitoring (diuretics, ACEi/ARBs, digoxin, lithium, metformin)
*Trauma (as part of initial laboratory panel)

==Differential Diagnosis==
The BMP does not generate a single differential — each abnormal component points to its own set of diagnoses. The following are the most ED-relevant abnormalities:

===Sodium===
*'''[[Hyponatremia]]''' (<136): Volume depletion, SIADH, heart failure, cirrhosis, psychogenic polydipsia, medications (thiazides, SSRIs), adrenal insufficiency, hypothyroidism, beer potomania
*'''[[Hypernatremia]]''' (>145): Dehydration, diabetes insipidus, osmotic diuresis, insensible losses, inadequate free water intake (elderly, altered patients)

===Potassium===
*'''[[Hyperkalemia]]''' (>5.0): Renal failure, rhabdomyolysis, acidosis, medications (ACEi/ARBs, K-sparing diuretics, TMP-SMX), hemolysis (spurious), adrenal insufficiency, tumor lysis syndrome
*'''[[Hypokalemia]]''' (<3.5): GI losses (vomiting, diarrhea), diuretics, renal tubular acidosis, hypomagnesemia, DKA treatment, alkalosis

===Bicarbonate===
*'''Low HCO3''' (<22): Metabolic acidosis — calculate anion gap to differentiate AGMA from non-anion-gap metabolic acidosis (NAGMA)
*'''High HCO3''' (>30): Metabolic alkalosis (vomiting, diuretics, volume contraction), chronic respiratory acidosis compensation

===BUN/Creatinine===
*'''Elevated BUN and Cr:''' [[Acute kidney injury]] (prerenal, intrinsic, postrenal), [[chronic kidney disease]], dehydration
*'''Elevated BUN with normal Cr (high BUN:Cr ratio >20:1):''' Prerenal azotemia (dehydration, CHF, GI bleed), high-protein diet, catabolic state, upper GI hemorrhage, corticosteroids
*'''Low BUN:''' Malnutrition, liver disease, overhydration

===Glucose===
*'''[[Hyperglycemia]]''' (>200): DKA, HHS, stress response, steroid use, new-onset diabetes, sepsis
*'''[[Hypoglycemia]]''' (<70): Insulin/sulfonylurea use, sepsis, liver failure, adrenal insufficiency, alcohol, malnutrition

===Calcium===
*'''[[Hypercalcemia]]''' (>10.5): Malignancy, hyperparathyroidism, granulomatous disease, immobilization, thiazides, vitamin D toxicity, milk-alkali syndrome
*'''[[Hypocalcemia]]''' (<8.5): Hypoparathyroidism, vitamin D deficiency, pancreatitis, [[rhabdomyolysis]], massive transfusion (citrate), chronic kidney disease, hypomagnesemia, sepsis
*'''Always correct calcium for albumin:''' Corrected Ca = Measured Ca + 0.8 × (4.0 − albumin)

==Evaluation==
===Workup===
*BMP is drawn as a '''venous blood sample''' (green-top lithium heparin tube or red/gold-top serum tube depending on institution)
*Results typically available within '''30–60 minutes''' in most ED laboratories
*'''Point-of-care (POC)''' devices (e.g., i-STAT) can provide electrolytes, glucose, BUN, and creatinine in minutes from a single drop of blood — particularly useful in resuscitation, cardiac arrest, and critical care settings
*'''Hemolyzed specimens''' falsely elevate potassium (K leaks from lysed RBCs) — if potassium is unexpectedly high in a stable patient, '''repeat with a non-hemolyzed specimen''' before treating

===Diagnosis===
*The BMP is a '''screening and monitoring tool''', not a definitive diagnostic test
*Abnormalities should be interpreted in clinical context and often require additional testing (e.g., VBG/ABG for acid-base workup, osmolality for hyponatremia, PTH for calcium disorders, urinalysis for AKI evaluation)
*'''Serial BMPs''' are essential for monitoring electrolyte replacement, DKA management, AKI trends, and response to diuretic therapy

==Management==
Management is directed at the specific abnormality identified. The most time-critical BMP findings in the ED include:

*'''[[Hyperkalemia]] >6.0 mEq/L:''' ECG immediately → calcium gluconate for membrane stabilization → insulin + glucose, albuterol for intracellular shift → kayexalate/patiromer for elimination → consider emergent dialysis
*'''[[Hypoglycemia]] <70 mg/dL:''' D50W IV (or oral glucose if alert); identify and treat cause
*'''Severe [[hyponatremia]] <120 mEq/L:''' Risk of cerebral edema and seizure; hypertonic saline (3% NaCl) if symptomatic; correct slowly (≤8–10 mEq/L in 24 hours) to avoid osmotic demyelination
*'''[[Diabetic ketoacidosis]]:''' Insulin drip, aggressive IV fluids, potassium replacement, close monitoring with serial BMPs every 1–2 hours
*'''Anion gap metabolic acidosis:''' Identify and treat underlying cause (see MUDPILES); consider toxic alcohol workup (osmolar gap, specific levels) if unexplained elevated AG
*'''[[Acute kidney injury]]:''' Volume resuscitation (if prerenal), identify and treat cause, avoid nephrotoxins, consider emergent dialysis for refractory hyperkalemia, acidosis, or volume overload

==Disposition==
*Disposition depends on the specific abnormality and clinical context, not the BMP result in isolation
*'''Admit''' for: Severe electrolyte derangements requiring IV correction or continuous monitoring, DKA/HHS, AKI with rising creatinine or need for dialysis, symptomatic hyponatremia, hyperkalemia unresponsive to ED treatment
*'''Discharge with close follow-up''' for: Mild electrolyte abnormalities that are corrected in the ED, stable chronic kidney disease with known baseline, incidental mild hypo/hyperglycemia with outpatient management plan
*'''Repeat BMP before discharge''' when electrolytes have been repleted in the ED (e.g., after potassium or magnesium replacement) to confirm adequate correction

==See Also==
*[[Hyperkalemia]]
*[[Hyponatremia]]
*[[Hypoglycemia]]
*[[Diabetic ketoacidosis]]
*[[Acute kidney injury]]
*[[Metabolic acidosis]]
*[[Hypercalcemia]]
*[[Rhabdomyolysis]]

==External Links==
*[https://medlineplus.gov/lab-tests/basic-metabolic-panel-bmp/ MedlinePlus: Basic Metabolic Panel]

==References==
{{reflist|2}}

[[Category:FEN]]

← Older revision		Revision as of 09:36, 22 March 2026
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	\|}		\|}
	*Reference ranges vary by lab — always use your institution's values		*Reference ranges vary by lab — always use your institution's values
	*Most labs also report a ~~'''~~calculated anion gap~~'''~~ and ~~'''~~eGFR~~'''~~ with the BMP		*Most labs also report a calculated anion gap and eGFR with the BMP
	*BMP vs. CMP: A comprehensive metabolic panel (CMP) includes all 8 BMP components plus albumin, total protein, total bilirubin, ALP, ALT, and AST. Order a CMP when liver assessment is also needed		*BMP vs. CMP: A comprehensive metabolic panel (CMP) includes all 8 BMP components plus albumin, total protein, total bilirubin, ALP, ALT, and AST. Order a CMP when liver assessment is also needed

Line 34:		Line 34:
	*Anion gap = Na − (Cl + HCO<sub>3</sub>)		*Anion gap = Na − (Cl + HCO<sub>3</sub>)
	*Normal: 8–12 mEq/L (varies by lab; some use 3–11)		*Normal: 8–12 mEq/L (varies by lab; some use 3–11)
	*~~'''~~Always calculate the anion gap~~'''~~ when reviewing a BMP — it is the single most important derived value in the ED		*Always calculate the anion gap when reviewing a BMP — it is the single most important derived value in the ED
	*Elevated anion gap with metabolic acidosis → differential includes: ~~'''~~MUDPILES~~'''~~ (Methanol, Uremia, [[Diabetic ketoacidosis\|DKA]], Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, [[Salicylate toxicity\|Salicylates]])		*Elevated anion gap with metabolic acidosis → differential includes: MUDPILES (Methanol, Uremia, [[Diabetic ketoacidosis\|DKA]], Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, [[Salicylate toxicity\|Salicylates]])
	*Correct the anion gap for albumin if the patient is hypoalbuminemic: Corrected AG = Calculated AG + 2.5 × (4.0 − measured albumin). A "normal" anion gap in a hypoalbuminemic patient may actually be elevated		*Correct the anion gap for albumin if the patient is hypoalbuminemic: Corrected AG = Calculated AG + 2.5 × (4.0 − measured albumin). A "normal" anion gap in a hypoalbuminemic patient may actually be elevated

	==Clinical Features==		==Clinical Features==
	The BMP is not ordered based on specific clinical features of the panel itself — it is ordered as a ~~'''~~foundational assessment~~'''~~ in most acute presentations. The BMP is appropriate in virtually any ED patient being evaluated for:		The BMP is not ordered based on specific clinical features of the panel itself — it is ordered as a foundational assessment in most acute presentations. The BMP is appropriate in virtually any ED patient being evaluated for:

	*Altered mental status, [[syncope]], weakness, [[seizure]]		*Altered mental status, [[syncope]], weakness, [[seizure]]
Line 78:		Line 78:
	*[[Hypercalcemia]] (>10.5): Malignancy, hyperparathyroidism, granulomatous disease, immobilization, thiazides, vitamin D toxicity, milk-alkali syndrome		*[[Hypercalcemia]] (>10.5): Malignancy, hyperparathyroidism, granulomatous disease, immobilization, thiazides, vitamin D toxicity, milk-alkali syndrome
	*[[Hypocalcemia]] (<8.5): Hypoparathyroidism, vitamin D deficiency, pancreatitis, [[rhabdomyolysis]], massive transfusion (citrate), chronic kidney disease, hypomagnesemia, sepsis		*[[Hypocalcemia]] (<8.5): Hypoparathyroidism, vitamin D deficiency, pancreatitis, [[rhabdomyolysis]], massive transfusion (citrate), chronic kidney disease, hypomagnesemia, sepsis
	*~~'''~~Always correct calcium for albumin:~~'''~~ Corrected Ca = Measured Ca + 0.8 × (4.0 − albumin)		*Always correct calcium for albumin: Corrected Ca = Measured Ca + 0.8 × (4.0 − albumin)

	==Evaluation==		==Evaluation==
	===Workup===		===Workup===
	*BMP is drawn as a ~~'''~~venous blood sample~~'''~~ (green-top lithium heparin tube or red/gold-top serum tube depending on institution)		*BMP is drawn as a venous blood sample (green-top lithium heparin tube or red/gold-top serum tube depending on institution)
	*Results typically available within ~~'''~~30–60 minutes~~'''~~ in most ED laboratories		*Results typically available within 30–60 minutes in most ED laboratories
	*Point-of-care (POC) devices (e.g., i-STAT) can provide electrolytes, glucose, BUN, and creatinine in minutes from a single drop of blood — particularly useful in resuscitation, cardiac arrest, and critical care settings		*Point-of-care (POC) devices (e.g., i-STAT) can provide electrolytes, glucose, BUN, and creatinine in minutes from a single drop of blood — particularly useful in resuscitation, cardiac arrest, and critical care settings
	*Hemolyzed specimens falsely elevate potassium (K leaks from lysed RBCs) — if potassium is unexpectedly high in a stable patient, ~~'''~~repeat with a non-hemolyzed specimen~~'''~~ before treating		*Hemolyzed specimens falsely elevate potassium (K leaks from lysed RBCs) — if potassium is unexpectedly high in a stable patient, repeat with a non-hemolyzed specimen before treating

	===Diagnosis===		===Diagnosis===
	*The BMP is a ~~'''~~screening and monitoring tool~~'''~~, not a definitive diagnostic test		*The BMP is a screening and monitoring tool, not a definitive diagnostic test
	*Abnormalities should be interpreted in clinical context and often require additional testing (e.g., VBG/ABG for acid-base workup, osmolality for hyponatremia, PTH for calcium disorders, urinalysis for AKI evaluation)		*Abnormalities should be interpreted in clinical context and often require additional testing (e.g., VBG/ABG for acid-base workup, osmolality for hyponatremia, PTH for calcium disorders, urinalysis for AKI evaluation)
	*Serial BMPs are essential for monitoring electrolyte replacement, DKA management, AKI trends, and response to diuretic therapy		*Serial BMPs are essential for monitoring electrolyte replacement, DKA management, AKI trends, and response to diuretic therapy

← Older revision		Revision as of 15:49, 19 March 2026
Line 1:		Line 1:
	The basic metabolic panel (BMP) is the workhorse lab test in emergency medicine — a panel of 8 blood chemistries that assesses electrolyte balance, renal function, acid-base status, and blood glucose. It is one of the most frequently ordered tests in the ED and provides rapid, actionable data across virtually every acute presentation.<ref name="MedlinePlus">Basic Metabolic Panel (BMP). MedlinePlus Lab Tests. Accessed 2025.</ref>		==Background==
			*The basic metabolic panel (BMP) is the workhorse lab test in emergency medicine — a panel of 8 blood chemistries that assesses electrolyte balance, renal function, acid-base status, and blood glucose.
			*It is one of the most frequently ordered tests in the ED and provides rapid, actionable data across virtually every acute presentation.<ref name="MedlinePlus">Basic Metabolic Panel (BMP).
			*MedlinePlus Lab Tests.
			*Accessed 2025.</ref>


	~~==Background==~~
	===Components and Normal Ranges===		===Components and Normal Ranges===
	{\| class="wikitable"		{\| class="wikitable"
Line 25:		Line 29:
	*Reference ranges vary by lab — always use your institution's values		*Reference ranges vary by lab — always use your institution's values
	*Most labs also report a '''calculated anion gap''' and '''eGFR''' with the BMP		*Most labs also report a '''calculated anion gap''' and '''eGFR''' with the BMP
	*~~'''~~BMP vs. CMP:~~'''~~ A comprehensive metabolic panel (CMP) includes all 8 BMP components plus albumin, total protein, total bilirubin, ALP, ALT, and AST. Order a CMP when liver assessment is also needed		*BMP vs. CMP: A comprehensive metabolic panel (CMP) includes all 8 BMP components plus albumin, total protein, total bilirubin, ALP, ALT, and AST. Order a CMP when liver assessment is also needed

	===Anion Gap===		===Anion Gap===
	*~~'''~~Anion gap = Na − (Cl + HCO<sub>3</sub>)~~'''~~		*Anion gap = Na − (Cl + HCO<sub>3</sub>)
	*Normal: 8–12 mEq/L (varies by lab; some use 3–11)		*Normal: 8–12 mEq/L (varies by lab; some use 3–11)
	*'''Always calculate the anion gap''' when reviewing a BMP — it is the single most important derived value in the ED		*'''Always calculate the anion gap''' when reviewing a BMP — it is the single most important derived value in the ED
	*Elevated anion gap with metabolic acidosis → differential includes: '''MUDPILES''' (Methanol, Uremia, [[Diabetic ketoacidosis\|DKA]], Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, [[Salicylate toxicity\|Salicylates]])		*Elevated anion gap with metabolic acidosis → differential includes: '''MUDPILES''' (Methanol, Uremia, [[Diabetic ketoacidosis\|DKA]], Propylene glycol, Isoniazid/Iron, Lactic acidosis, Ethylene glycol, [[Salicylate toxicity\|Salicylates]])
	*~~'''~~Correct the anion gap for albumin~~'''~~ if the patient is hypoalbuminemic: Corrected AG = Calculated AG + 2.5 × (4.0 − measured albumin). A "normal" anion gap in a hypoalbuminemic patient may actually be elevated		*Correct the anion gap for albumin if the patient is hypoalbuminemic: Corrected AG = Calculated AG + 2.5 × (4.0 − measured albumin). A "normal" anion gap in a hypoalbuminemic patient may actually be elevated

	==Clinical Features==		==Clinical Features==
Line 51:		Line 55:

	===Sodium===		===Sodium===
	*~~'''~~[[Hyponatremia]]~~'''~~ (<136): Volume depletion, SIADH, heart failure, cirrhosis, psychogenic polydipsia, medications (thiazides, SSRIs), adrenal insufficiency, hypothyroidism, beer potomania		*[[Hyponatremia]] (<136): Volume depletion, SIADH, heart failure, cirrhosis, psychogenic polydipsia, medications (thiazides, SSRIs), adrenal insufficiency, hypothyroidism, beer potomania
	*~~'''~~[[Hypernatremia]]~~'''~~ (>145): Dehydration, diabetes insipidus, osmotic diuresis, insensible losses, inadequate free water intake (elderly, altered patients)		*[[Hypernatremia]] (>145): Dehydration, diabetes insipidus, osmotic diuresis, insensible losses, inadequate free water intake (elderly, altered patients)

	===Potassium===		===Potassium===
	*~~'''~~[[Hyperkalemia]]~~'''~~ (>5.0): Renal failure, rhabdomyolysis, acidosis, medications (ACEi/ARBs, K-sparing diuretics, TMP-SMX), hemolysis (spurious), adrenal insufficiency, tumor lysis syndrome		*[[Hyperkalemia]] (>5.0): Renal failure, rhabdomyolysis, acidosis, medications (ACEi/ARBs, K-sparing diuretics, TMP-SMX), hemolysis (spurious), adrenal insufficiency, tumor lysis syndrome
	*~~'''~~[[Hypokalemia]]~~'''~~ (<3.5): GI losses (vomiting, diarrhea), diuretics, renal tubular acidosis, hypomagnesemia, DKA treatment, alkalosis		*[[Hypokalemia]] (<3.5): GI losses (vomiting, diarrhea), diuretics, renal tubular acidosis, hypomagnesemia, DKA treatment, alkalosis

	===Bicarbonate===		===Bicarbonate===
	*~~'''~~Low HCO<sub>3</sub>~~'''~~ (<22): Metabolic acidosis — calculate anion gap to differentiate AGMA from non-anion-gap metabolic acidosis (NAGMA)		*Low HCO<sub>3</sub> (<22): Metabolic acidosis — calculate anion gap to differentiate AGMA from non-anion-gap metabolic acidosis (NAGMA)
	*~~'''~~High HCO<sub>3</sub>~~'''~~ (>30): Metabolic alkalosis (vomiting, diuretics, volume contraction), chronic respiratory acidosis compensation		*High HCO<sub>3</sub> (>30): Metabolic alkalosis (vomiting, diuretics, volume contraction), chronic respiratory acidosis compensation

	===BUN/Creatinine===		===BUN/Creatinine===
	*~~'''~~Elevated BUN and Cr:~~'''~~ [[Acute kidney injury]] (prerenal, intrinsic, postrenal), [[chronic kidney disease]], dehydration		*Elevated BUN and Cr: [[Acute kidney injury]] (prerenal, intrinsic, postrenal), [[chronic kidney disease]], dehydration
	*~~'''~~Elevated BUN with normal Cr (high BUN:Cr ratio >20:1):~~'''~~ Prerenal azotemia (dehydration, CHF, GI bleed), high-protein diet, catabolic state, upper GI hemorrhage, corticosteroids		*Elevated BUN with normal Cr (high BUN:Cr ratio >20:1): Prerenal azotemia (dehydration, CHF, GI bleed), high-protein diet, catabolic state, upper GI hemorrhage, corticosteroids
	*~~'''~~Low BUN:~~'''~~ Malnutrition, liver disease, overhydration		*Low BUN: Malnutrition, liver disease, overhydration

	===Glucose===		===Glucose===
	*~~'''~~[[Hyperglycemia]]~~'''~~ (>200): DKA, HHS, stress response, steroid use, new-onset diabetes, sepsis		*[[Hyperglycemia]] (>200): DKA, HHS, stress response, steroid use, new-onset diabetes, sepsis
	*~~'''~~[[Hypoglycemia]]~~'''~~ (<70): Insulin/sulfonylurea use, sepsis, liver failure, adrenal insufficiency, alcohol, malnutrition		*[[Hypoglycemia]] (<70): Insulin/sulfonylurea use, sepsis, liver failure, adrenal insufficiency, alcohol, malnutrition

	===Calcium===		===Calcium===
	*~~'''~~[[Hypercalcemia]]~~'''~~ (>10.5): Malignancy, hyperparathyroidism, granulomatous disease, immobilization, thiazides, vitamin D toxicity, milk-alkali syndrome		*[[Hypercalcemia]] (>10.5): Malignancy, hyperparathyroidism, granulomatous disease, immobilization, thiazides, vitamin D toxicity, milk-alkali syndrome
	*~~'''~~[[Hypocalcemia]]~~'''~~ (<8.5): Hypoparathyroidism, vitamin D deficiency, pancreatitis, [[rhabdomyolysis]], massive transfusion (citrate), chronic kidney disease, hypomagnesemia, sepsis		*[[Hypocalcemia]] (<8.5): Hypoparathyroidism, vitamin D deficiency, pancreatitis, [[rhabdomyolysis]], massive transfusion (citrate), chronic kidney disease, hypomagnesemia, sepsis
	*'''Always correct calcium for albumin:''' Corrected Ca = Measured Ca + 0.8 × (4.0 − albumin)		*'''Always correct calcium for albumin:''' Corrected Ca = Measured Ca + 0.8 × (4.0 − albumin)

Line 80:		Line 84:
	*BMP is drawn as a '''venous blood sample''' (green-top lithium heparin tube or red/gold-top serum tube depending on institution)		*BMP is drawn as a '''venous blood sample''' (green-top lithium heparin tube or red/gold-top serum tube depending on institution)
	*Results typically available within '''30–60 minutes''' in most ED laboratories		*Results typically available within '''30–60 minutes''' in most ED laboratories
	*~~'''~~Point-of-care (POC)~~'''~~ devices (e.g., i-STAT) can provide electrolytes, glucose, BUN, and creatinine in minutes from a single drop of blood — particularly useful in resuscitation, cardiac arrest, and critical care settings		*Point-of-care (POC) devices (e.g., i-STAT) can provide electrolytes, glucose, BUN, and creatinine in minutes from a single drop of blood — particularly useful in resuscitation, cardiac arrest, and critical care settings
	*~~'''~~Hemolyzed specimens~~'''~~ falsely elevate potassium (K leaks from lysed RBCs) — if potassium is unexpectedly high in a stable patient, '''repeat with a non-hemolyzed specimen''' before treating		*Hemolyzed specimens falsely elevate potassium (K leaks from lysed RBCs) — if potassium is unexpectedly high in a stable patient, '''repeat with a non-hemolyzed specimen''' before treating

	===Diagnosis===		===Diagnosis===
	*The BMP is a '''screening and monitoring tool''', not a definitive diagnostic test		*The BMP is a '''screening and monitoring tool''', not a definitive diagnostic test
	*Abnormalities should be interpreted in clinical context and often require additional testing (e.g., VBG/ABG for acid-base workup, osmolality for hyponatremia, PTH for calcium disorders, urinalysis for AKI evaluation)		*Abnormalities should be interpreted in clinical context and often require additional testing (e.g., VBG/ABG for acid-base workup, osmolality for hyponatremia, PTH for calcium disorders, urinalysis for AKI evaluation)
	*~~'''~~Serial BMPs~~'''~~ are essential for monitoring electrolyte replacement, DKA management, AKI trends, and response to diuretic therapy		*Serial BMPs are essential for monitoring electrolyte replacement, DKA management, AKI trends, and response to diuretic therapy

	==Management==		==Management==
	Management is directed at the specific abnormality identified. The most time-critical BMP findings in the ED include:		Management is directed at the specific abnormality identified. The most time-critical BMP findings in the ED include:

	*~~'''~~[[Hyperkalemia]] >6.0 mEq/L:~~'''~~ ECG immediately → calcium gluconate for membrane stabilization → insulin + glucose, albuterol for intracellular shift → kayexalate/patiromer for elimination → consider emergent dialysis		*[[Hyperkalemia]] >6.0 mEq/L: ECG immediately → calcium gluconate for membrane stabilization → insulin + glucose, albuterol for intracellular shift → kayexalate/patiromer for elimination → consider emergent dialysis
	*~~'''~~[[Hypoglycemia]] <70 mg/dL:~~'''~~ D50W IV (or oral glucose if alert); identify and treat cause		*[[Hypoglycemia]] <70 mg/dL: D50W IV (or oral glucose if alert); identify and treat cause
	*~~'''~~Severe [[hyponatremia]] <120 mEq/L:~~'''~~ Risk of cerebral edema and seizure; hypertonic saline (3% NaCl) if symptomatic; correct slowly (≤8–10 mEq/L in 24 hours) to avoid osmotic demyelination		*Severe [[hyponatremia]] <120 mEq/L: Risk of cerebral edema and seizure; hypertonic saline (3% NaCl) if symptomatic; correct slowly (≤8–10 mEq/L in 24 hours) to avoid osmotic demyelination
	*~~'''~~[[Diabetic ketoacidosis]]:~~'''~~ Insulin drip, aggressive IV fluids, potassium replacement, close monitoring with serial BMPs every 1–2 hours		*[[Diabetic ketoacidosis]]: Insulin drip, aggressive IV fluids, potassium replacement, close monitoring with serial BMPs every 1–2 hours
	*~~'''~~Anion gap metabolic acidosis:~~'''~~ Identify and treat underlying cause (see MUDPILES); consider toxic alcohol workup (osmolar gap, specific levels) if unexplained elevated AG		*Anion gap metabolic acidosis: Identify and treat underlying cause (see MUDPILES); consider toxic alcohol workup (osmolar gap, specific levels) if unexplained elevated AG
	*~~'''~~[[Acute kidney injury]]:~~'''~~ Volume resuscitation (if prerenal), identify and treat cause, avoid nephrotoxins, consider emergent dialysis for refractory hyperkalemia, acidosis, or volume overload		*[[Acute kidney injury]]: Volume resuscitation (if prerenal), identify and treat cause, avoid nephrotoxins, consider emergent dialysis for refractory hyperkalemia, acidosis, or volume overload

	==Disposition==		==Disposition==
	*Disposition depends on the specific abnormality and clinical context, not the BMP result in isolation		*Disposition depends on the specific abnormality and clinical context, not the BMP result in isolation
	*~~'''~~Admit~~'''~~ for: Severe electrolyte derangements requiring IV correction or continuous monitoring, DKA/HHS, AKI with rising creatinine or need for dialysis, symptomatic hyponatremia, hyperkalemia unresponsive to ED treatment		*Admit for: Severe electrolyte derangements requiring IV correction or continuous monitoring, DKA/HHS, AKI with rising creatinine or need for dialysis, symptomatic hyponatremia, hyperkalemia unresponsive to ED treatment
	*~~'''~~Discharge with close follow-up~~'''~~ for: Mild electrolyte abnormalities that are corrected in the ED, stable chronic kidney disease with known baseline, incidental mild hypo/hyperglycemia with outpatient management plan		*Discharge with close follow-up for: Mild electrolyte abnormalities that are corrected in the ED, stable chronic kidney disease with known baseline, incidental mild hypo/hyperglycemia with outpatient management plan
	*~~'''~~Repeat BMP before discharge~~'''~~ when electrolytes have been repleted in the ED (e.g., after potassium or magnesium replacement) to confirm adequate correction		*Repeat BMP before discharge when electrolytes have been repleted in the ED (e.g., after potassium or magnesium replacement) to confirm adequate correction

	==See Also==		==See Also==