Basic Metabolic Panel with Reflexive Ionized Calcium

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General Information

Lab Name
BMP with Reflexive Ionized Ca
Lab Code
BMPICR
Epic Ordering
BMP w/Reflexive Ionized Ca
Description

Note: for anion gap see test component Anion Gap [IGAP] Reflexive Testing Information: If initial Total Calcium is less than 8.0 mg/dL or greater than 10.2 mg/dL, an Ionized Calcium will be performed at an additional charge. [SRICG or PLIC is added if indicated.]

Direct vs. Reflexive Ionized Calcium Testing

Calcium testing is useful for investigating disorders involving the parathryoid-vitamin D-calcium endocrine system. Testing is indicated for patients with documented or suspected derangements in this system, but there is little evidence to suggest that screening unselected patients with calcium testing is useful, even in critically ill patients. Standing orders for monitoring ionized or total calcium and replacing with calcium gluconate in patients WITHOUT documented or suspected calcium disorders is unlikely to be of benefit, and may lead to poorer outcomes (see references below).

In order to detect clinically-significant hypo- and hyper-calcemia in hospitalized patients, please use Calcium (Reflexive Ionized) [ICAR] or Basic Metabolic Panel with Reflexive Ionized Calcium [BMPICR]. In this test panel, a patient receives a total calcium test first, and if the result is <8 mg/dL or >10.2mg/dL, an ionized calcium test is performed on the same plasma sample. The test panel was developed as an alternative to daily ionized calcium testing in patients hospitalized at UW and Harborview Medical Centers, a largely unnecessary practice that was associated with excessive calcium therapy.

Calcium (Ionized), Whole Blood [WIC] is intended for patients in whom a calcium metabolic derangement has ALREADY been detected and in whom the calcium concentration needs to be followed, i.e. in post-surgical hypoparathyroidism. Additionally, nonreflexive ionized calcium testing is useful when the total calcium is not expected to correlate well with ionized calcium concentrations, i.e. hypo- or hyper- proteinemia or albuminemia, altered pH, and high concentrations of calcium binding substances like citrate anticoagulants.

Synonyms
Anion Gap
Components

Interpretation

Reference Range
See individual components

Ordering & Collection

Specimen Type
Blood
Collection

HMC, UW-NW, and UW-MT Onsite Locations:

Preferred: 4 mL blood in LIME GREEN PST tube
Also Acceptable: 4 mL blood in ORANGE RST, GOLD SST, RED TOP or GREEN TOP (Lithium Heparin) tube
Pediatric: 1 Full LIME GREEN MICROTAINER
Unacceptable: GRAY TOP or GREEN TOP (Sodium Heparin)

Offsite Clinic or Other Locations:

Preferred: 4 mL blood in GOLD SST tube
Also Acceptable: 4 mL blood in ORANGE RST or LIME GREEN PST, RED TOP or GREEN TOP (Lithium Heparin) tube
Pediatric: 1 Full LIME GREEN MICROTAINER
Unacceptable: GRAY TOP or GREEN TOP (Sodium Heparin)

Note: Microtainer tubes are acceptable for the BMP only. If an Ionized Calcium is reflexively ordered on a sample from a microtainer, the ionized calcium test will be cancelled and credited. See Microtainer section in Processing section below.

Handling Instructions

Note: For addon of Ionized calcium, see specimen stability listed below.

Note2: This battery cannot be added onto a specimen that was received more than 8 hours ago since it contains a CO2 test.

Quantity
requested: 2 mL serum (see Handling section below)
minimum: 1.5 mL serum (see Handling section below)

Processing

Processing

Affix CID label to ORANGE RST, GOLD SST or LIME GREEN PST.Load on track or manual spin dependent on volume.BMP testing is performed and ionized CA reflex status is evaluated. The remaining processing is dependent on what tubes are received:

ORANGE RST: If SRICG is reflexively added, chemistry tech will pass ORANGE RST to ionized calcium tech to run SRICG. See SRICG for more details.

GOLD SST: If SRICG is reflexively added, chemistry tech will pass GOLD SST to ionized calcium tech to run SRICG. See SRICG for more details

LIME GREEN PST: If PLIC is reflexively added, chemistry tech will pass LIME GREEN PST to ionized calcium tech to run PLIC. See PLIC for more details.

MICROTAINER (GOLD, LIME GREEN or RED): If a Microtainer tube is received, affix CID label, spin and pass tube to bench. Acceptable for BMP only. If ionized calcium (SRICG or PLIC) is reflexively ordered on a sample from a microtainer, then the chemistry tech will CANCEL and CREDIT the ionized calcium as unacceptable sample.

Stability for addons of Ionized Calcium: Centrifuged, unopened SST/PST stable 24 hr @ 4°C. Once tube is uncapped (both SST/PST and Red tops), serum sample is stable for 60 minutes.

Performance

LIS Dept Code
Chemistry, Automated Panels (CHA)
Performing Location(s)
HMC Chemistry, Automated
206-520-4600

325 9th Ave, Rm # GWH-47, Seattle, WA 98104-2420
UW-NW Main Lab
206-668-1344

UW Medical Center – Northwest
1550 N 115th Street, A200
Seattle, WA 98133
UW-MT Chemistry, Automated
206-520-4600

Clinical Lab, Room NW220,
University of Washington Medical Center,
1959 NE Pacific street, Seattle, WA 98195
Frequency
Daily, as received.
Available STAT?
Yes

Billing & Coding

CPT codes
80048
LOINC
18719-5