Comprehensive Metabolic Panel with Reflexive Ionized Ca

General Information

Lab Name

Comprehensive Metabolic Panel with Reflexive Ionized Ca

Lab Code

COMPIC

Epic Name

Comprehensive Metabolic Panel with Reflexive Ionized Ca

Description

Note: 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 parathyroid-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).

To detect clinically significant hypo- and hypercalcemia in hospitalized patients, please use Calcium (Reflexive Ionized) [ICAR] or Comprehensive Metabolic Panel with Reflexive Ionized Ca [COMPIC]. In this test panel, a patient receives a total calcium test first, and if the result is <8 mg/dL or >10.2 mg/dL, an ionized calcium test is performed on the same plasma sample. This 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 hyperproteinemia or albuminemia, altered pH, and high concentrations of calcium binding substances like citrate anticoagulants.

Synonyms

Comprehensive Metabolic Panel, Ionized CA

Components

Code	Name
NA	Sodium
K	Potassium
CL	Chloride
CO2	Carbon Dioxide, Total
IGAP	Anion Gap
GLU	Glucose
BUN	Urea Nitrogen
CRE	Creatinine
TP	Total Protein (Beckman)
TPRD	Total Protein (Roche)
ALB	Albumin
BIL	Total Bilirubin (Beckman)
BILRD	Total Bilirubin (Roche)
CA	Calcium
ICARS	Calcium(Ionized Reflex Status)
AST	AST (Beckman)
ASTRD	AST (Roche)
ALK	Alkaline Phosphatase (Total)
ALT	ALT (Beckman)
ALTRD	ALT (Roche)
EGFRR	eGFR by CKD EPI 2021