What specific laboratory tests should be ordered for a routine health‑maintenance visit in a typical adult patient?

Routine Laboratory Tests for Health Maintenance

For a routine health-maintenance visit in a typical adult patient, order a comprehensive metabolic panel (which includes electrolytes, glucose, kidney function tests), complete blood count, lipid profile, hemoglobin A1C, thyroid-stimulating hormone, and urinalysis. 1

Core Laboratory Panel

The American Diabetes Association's 2022 Standards of Care provides the most comprehensive and current guideline for routine laboratory testing in adults 1:

Essential Tests (Annual or Initial Visit)

• Comprehensive Metabolic Panel including:

  • Fasting blood glucose 1
  • Serum creatinine with estimated glomerular filtration rate 1
  • Serum sodium, potassium, and calcium 1
  • Liver function tests 1

• Complete Blood Count 1

• Lipid Profile (total cholesterol, LDL, HDL, and triglycerides) 1

• Thyroid-Stimulating Hormone 1

• Urinalysis 1

• Hemoglobin A1C (if not checked within past 3 months) 1

Additional Considerations Based on Patient Factors

• Spot urinary albumin-to-creatinine ratio for kidney disease screening 1

• Vitamin B12 if patient is on metformin 1

• Serum potassium monitoring in patients on ACE inhibitors, ARBs, or diuretics (may need more frequent testing) 1

Pre-Test Patient Instructions

Fasting Requirements

Patients should fast 8-12 hours before the test, consuming only water and avoiding coffee, tea, juices, and food 2. Regular medications can be taken with small sips of water unless otherwise indicated 2.

Critical Timing Considerations

• If cortisol testing is included, blood must be drawn strictly between 7:00-9:00 AM, ideally at 8:00 AM, due to circadian rhythm 2

• Biotin supplements must be suspended at least 72 hours before testing, as biotin interferes with immunoassays and can generate falsely abnormal thyroid and other results 2

• If patient takes levothyroxine, they should take it after blood draw that day, not before 2

Additional Pre-Test Instructions

• Avoid intense exercise 24 hours before blood draw 2
• Abstain from alcohol 48 hours before testing 2
• Maintain normal hydration the day before 2

Clinical Context for Hypertension Screening

For patients with newly diagnosed or established hypertension, the ACC/AHA 2017 guidelines recommend the same basic panel to facilitate cardiovascular risk profiling and screen for secondary causes 1. An electrocardiogram should also be obtained 1.

Common Pitfalls to Avoid

• Do not schedule cortisol testing after 9:00 AM - reference values are specific to morning collection and lose diagnostic utility 2

• Do not overlook biotin supplementation - it is commonly found in multivitamins and hair/nail supplements and must be discontinued 72 hours prior 2

• Do not order tests more frequently than needed - in stable patients without medication changes, testing every 6-12 months is appropriate 1

• Verify local laboratory normal ranges - normal values vary by laboratory 1