Complete metabolic panel (CMP) - Total protein: Nursing

Notes

TOTAL PROTEIN

KEY POINTS
NOTES
PHYSIOLOGY
  • Two proteins in serum
    • Albumin
    • Globulins
  • Albumin
    • Made in liver
    • Most abundant
    • Helps maintain oncotic pressure
    • Transports lipids,  bilirubin, and others
  • Globulins
    • Alpha, beta, and gamma
    • Carrier protein
    • Enzyme
    • Immuoglobulin
    • Clotting factor
  • Albumin/Globulin ratio (A/G ratio)
  • Normal ranges
    • Total protein
      • 6.4-8.3 g/dL
    • Albumin
      • 3.1-4.3 g/dL
    • Globulins
      • 2.6-4.1 g/dL
    • A/G ratio
      • >1

PATHOLOGY
  • Increased
    • Chronic inflammatory diseases
    • Decreased fluid
  • Decreased
    • Long-term decrease in protein intake
    • Decreased production

INDICATIONS
  • History of conditions that predispose to altered protein
  • Signs or symptoms of protein imbalance

NURSING IMPLICATIONS
  • Goals of care
    • Assist in addressing underlying cause
    • Assist in restoring normal protein level
  • Obtain venous sample
  • Invert gently
  • Deliver promptly to lab
  • Assess for signs of dehydration
  • Administer prescribed IV fluids
  • Encourage oral fluid intake
  • Monitor vital signs, intake and output, and protein levels
  • Check diagnostic results

Transcript

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Content Reviewers

Kelsey LaFayette, DNP, ARNP, FNP-C,Lisa Miklush, PhD, RNC, CNS,Janine Eagon MS, APNP, CNS, RNC-OB

A 78-year-old male is brought to the clinic by his daughter, who says she noticed her father has been losing weight and has recently become lethargic and confused. Based on these findings, the health care provider is concerned about undernutrition and orders a complete metabolic panel, or CMP, to evaluate his nutritional status.

Alright, total serum protein measures two proteins found in the serum: albumin and globulins. Albumin is produced by the liver, and is the body’s most abundant protein. It keeps fluids from leaking out into the tissues by helping to maintain oncotic pressure within the intravascular space. Albumin also functions as a transport for lipids, bilirubin, and many other compounds like medications; and provides a protein reserve for creating and repairing tissue.

Next, globulins include alpha, beta, and gamma globulins. These proteins also serve as carrier proteins, as well as enzymes, immunoglobulins, and clotting factors. The albumin value can be divided by the globulin value, to get the albumin:globulin ratio, also known as the A/G ratio. Now, total serum proteins can be drawn on their own, or as a part of a complete metabolic panel. In healthy adults, total protein ranges from 6.4 to 8.3 g/dL; albumin ranges from 3.1 to 4.3 g/dL; globulin ranges from 2.6 to 4.1 g/dL, the A/G ratio is usually slightly higher than 1.

Alright, there are some conditions that can increase a client’s total serum protein. Chronic inflammatory diseases, such as systemic lupus erythematosus and multiple myeloma can increase the production of some types of protein. Alternatively, if the amount of fluid in the blood decreases, like with dehydration, the blood becomes more concentrated, and the protein value can increase.

On the other hand, decreased total serum protein can be caused by a long-term decrease in protein intake, like in undernutrition; or decreased absorption of nutrients. Low total serum protein can also be caused by decreased production, like in chronic liver disease, or with increased elimination, like in nephrotic syndrome; or the loss of proteins through burn wounds due to increased vascular permeability.