No, bilirubin and alkaline phosphatase are part of a CMP, but lipase and GGT are not.
A comprehensive metabolic panel (CMP) includes bilirubin and alkaline phosphatase (ALP), but does NOT include lipase or gamma-glutamyl transferase (GGT).
What's Actually in a CMP
The standard CMP consists of:
- Electrolytes: Sodium, potassium, chloride, bicarbonate
- Kidney function: BUN, creatinine
- Glucose
- Liver-related tests: Total bilirubin, ALP, ALT, AST
- Protein metabolism: Total protein, albumin
Why This Matters Clinically
According to current guidelines, routine liver chemistries include ALT, AST, alkaline phosphatase, and bilirubin 1. These are the standard tests obtained as part of metabolic panels in both asymptomatic and symptomatic patients 1.
Tests That Require Separate Orders
GGT: This is NOT part of routine metabolic panels. It must be ordered separately when you need to:
- Confirm hepatic origin of an isolated ALP elevation 1
- Evaluate cholestatic liver disease more specifically
- Assess for alcohol-related liver injury
Lipase: This is a pancreatic enzyme test, completely separate from liver function testing and metabolic panels. Order it specifically when evaluating for pancreatitis.
Clinical Algorithm for Ordering
When to order just a CMP:
- Routine metabolic screening
- Initial evaluation of suspected liver disease
- Monitoring electrolytes, kidney function, and basic liver tests together
When to add GGT (separate order):
- ALP is elevated in isolation on CMP and you need to determine if it's hepatic or bone origin 2
- Suspected cholestatic disease requiring more specific evaluation 1
- Note: GGT has limited utility overall—it's only 46.6% sensitive for hepatic ALP elevation 2
When to order lipase (separate order):
- Suspected acute pancreatitis
- Abdominal pain with concern for pancreatic pathology
Common Pitfall
Don't assume all "liver tests" come together. Research shows that in pediatric emergency settings, ordering a CMP instead of targeted testing when specific clinical variables are absent could save significant costs 3. Order GGT and lipase only when clinically indicated—they are not screening tests and are not included in standard metabolic panels.