What is included in a metabolic panel?

Components of a Metabolic Panel

A comprehensive metabolic panel (CMP) includes blood urea nitrogen (BUN), serum creatinine, calcium, glucose, sodium, potassium, chloride, carbon dioxide, and liver function tests (alanine aminotransferase, aspartate aminotransferase, alkaline phosphatase, total bilirubin, total protein, and albumin).

Basic Metabolic Panel (BMP) Components

The basic metabolic panel is a subset of the comprehensive metabolic panel and typically includes:

• Glucose - measures blood sugar levels 1
• Electrolytes:
  • Sodium 1
  • Potassium 1
  • Chloride 1
  • Carbon dioxide (bicarbonate) 1
• Kidney function tests:
  • Blood Urea Nitrogen (BUN) 1
  • Creatinine 1
• Calcium 1

Comprehensive Metabolic Panel (CMP) Components

The comprehensive metabolic panel includes all BMP components plus liver function tests:

• All components of the basic metabolic panel 1
• Liver function tests:
  • Alanine aminotransferase (ALT) 2
  • Aspartate aminotransferase (AST) 2
  • Alkaline phosphatase 2
  • Total bilirubin 2
  • Total protein 2
  • Albumin 2

Clinical Applications

Metabolic panels are commonly ordered for:

• Initial evaluation of patients with suspected medical conditions 1
• Screening for electrolyte imbalances 1
• Assessment of kidney function 1
• Evaluation of liver function 1
• Monitoring patients with chronic conditions such as hypertension 1
• Part of emergency department workup for acute conditions 1, 3
• Pre-operative assessment 1
• Medication monitoring 1

Specific Uses in Different Clinical Contexts

• In stroke patients, metabolic panels help rule out metabolic causes of stroke-like symptoms and assess eligibility for thrombolytic therapy 1
• In kidney cancer evaluation, metabolic panels provide information about renal function and detect paraneoplastic syndromes 1
• In hypertension management, metabolic panels help detect secondary causes and assess target organ damage 1
• In acute leukemia workup, metabolic panels help assess for tumor lysis syndrome 1
• In neuroblastoma evaluation, metabolic panels monitor for tumor lysis syndrome during treatment 1

Clinical Significance

• Abnormal electrolyte values may indicate dehydration, kidney dysfunction, or endocrine disorders 1, 4
• Elevated BUN and creatinine suggest impaired kidney function 1
• Liver function test abnormalities may indicate hepatic disease, biliary obstruction, or medication effects 1, 2
• Glucose abnormalities may suggest diabetes or other metabolic disorders 1
• Calcium abnormalities can indicate parathyroid disorders, malignancy, or vitamin D deficiencies 1

Point-of-Care Testing

• Point-of-care comprehensive metabolic panel testing can reduce emergency department length of stay by approximately 22 minutes compared to central laboratory testing 3
• This approach may be particularly beneficial in busy emergency departments to improve patient flow 3

Cost Considerations

• Using a basic metabolic panel instead of a comprehensive metabolic panel when liver function tests are not clinically indicated can result in significant cost savings 2
• In pediatric emergency departments, limiting testing to a BMP for patients without specific clinical indications for liver function tests has demonstrated potential annual cost savings 2