Medical Necessity Documentation:
Client Notes:
Patient Preparation:
Specimen Requirements:
1.0 mL Plasma in a PST Mint Green Top Tube - Li Heparin (preferred)
or
1.0 mL Serum in a SST Gold Top Tube
Collection Instructions:
Centrifuge and Separate from Cells within 4 hours of collection
Avoid Hemolysis
Minimum Volume:
0.2 mL Plasma or Serum
Neonatal Volume:
0.5 mL Whole Blood Green Microtainer
Transport & Storage: Temperature/Stability:
2 days Refrigerated
Rejection Criteria:
ETDA Specimens
Reference Range:
Blood Urea Nitrogen (BUN)
Pediatric
1 day to 5 days: 5 - 17 mg/dL
5 days to 14 years: 7 - 17 mg/dL
14 years to 20 years: 7 - 21 mg/dL
Male > 20 years: 9 -21 mg/dL
Female > 20 years: 7 - 18 mg/dl
Calcium:
Pediatric
<1 year: 8.7 - 10.5 mg/dL
1 year to 4 years: 8.5 - 10.6 mg/dL
4 years to 20 years: 8.9 - 10.4 mg/dL
Adult
>20 yrs: 8.5-10.3 mg/dl
Creatinine:
Male:
< 1 year: 0.3 - 1.0 mg/dl
1 year to 4 years: 0.1 - 0.4 mg/dl
5 years to 11 years: 0.2 - 0.7 mg/dl
12 years to 15 years: 0.4 - 0.9 mg/dl
> = 16 years: 0.8 - 1.4 mg/dl
Females
< 1 year: 0.3 - 1.0 mg/dl
1 year to 5 years: 0.1 - 0.5 mg/dl
6 years to 15 years: 0.3 - 0.7 mg/dl
> = 16 years: 0.6 - 1.1 mg/dl
Electrolytes:
Carbon Dioxide
< 1 year: 14 - 23 mmol/L
> 1 year: 21 - 29 mmol/L
Chloride
98 - 107 mmol/L
Potassium
1 day to 1 month: 4.0 - 6.0 mmol/L
1 month to 2 years: 3.8 - 5.6 mmol/L
> 2 years: 3.6 - 5.1 mmol/L
Sodium
1 day to 1 month: 133 - 150 mmol/L
1 month to Adult: 134 - 146 mmol/L
Glucose:
70 - 99 mg/dL
Critical Ranges:
Blood Urea Nitrogen (BUN)
Pediatric to Adult
>100 mg/dL
Calcium:
Low: < 6.0 mg/dL
High: > 11.5 mg/dL
Low: < 7.0 mg/dL
High: > 13.0 mg/dL
Creatinine:
> 10.0 mg/dL
Electrolytes:
Carbon Dioxide
Low: < 10 mmol/L
High: > 45 mmol/L
Potassium
Low: <3.5 mmol/L
High: >6.9 mmol/L
Low: < 2.5 mmol/L
High: > 6.0 mmol/L
Sodium
1 day to Adult:
Low: < 120 mmol/L
High: > 160 mmol/L
Glucose:
Pediatric Low: < 30 mg/dL
Pediatric High: > 300 mg/dL2
Outpatient Low: < 40 mg/dL
Outpatient High: > 400 mg/dL
Test Comments:
Test can be reported with disclaimer if on cells for 4-6 hours
Methodology:
Colorimetric / Ion Selective Electrode
Clinical Significance:
Documentation:
Custom Panel:
No
PRODUCTION SCHEDULE
Days Performed:
Sunday, Monday, Tuesday, Wednesday, Thursday, Friday, Saturday
Sites Performed:
Parkview Dekalb Hospital, Parkview Huntington Hospital, Parkview LaGrange Hospital, Parkview Noble Hospital, Parkview Randallia Hospital, Parkview Regional Medical Center, Parkview Southwest , Parkview Wabash Hospital, Parkview Warsaw , Parkview Whitley Hospital
PHL Test Code:
DABMP
EPIC Test Code:
LAB3256
Alternate Test Names:
Basic Metabolic Panel (Chem 8); BMP; BMP Direct Access; Chem 8; Chemistry Panel 8
Included Tests:
Blood Urea Nitrogen (BUN); Calcium (Ca); Creatinine; Electrolytes [Carbon Dioxide (CO2); Chloride (CL); Potassium (K); Sodium (Na)]; Glucose
CPT Coding:
80048