Basic metabolic panel

a. BUN and creatinine. High values are signs of acute or chronic renal failure.

b. Potassium. If high, consider tumor lysis, rhabdomyolysis, and hemolysis.

c. Glucose. Look for diabetic ketoacidosis. Low calcium level may occur secondary to hyperphosphatemia, hypoparathy-roidism, or pseudohypoparathyroidism. High serum calcium level may point to vitamin D intoxication.

2. Phosphorus. Hyperphosphatemia may be missed because serum phosphorus level is not included in most chemistry panels. Serum phosphorus level is physiologically elevated in young children or infants and does not have to be treated. Normal levels are age dependent (see Section II, Phosphorus, p. 472).

3. ABGs. Evaluate acid-base status; look for respiratory or metabolic acidosis.

4. CBC with differential. Look for blasts in leukemia, signs of hemolysis.

5. Creatinine phosphokinase. Check for rhabdomyolysis.

6. Vitamin D. 25-Hydroxyvitamin D level is diagnostic of vitamin D toxicity. No need to routinely check 1,25-dihydroxyvitamin D levels.

7. Parathyroid hormone. Intact PTH may be low in hypoparathyroidism, high in pseudohypoparathyroidism and renal failure.

C. Radiographic and Other Studies. X-ray film of hands can confirm diagnosis of Albright hereditary osteodystrophy.

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