Comprehensive Metabolic Panel without ALT

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The following is a list of what is included in the item above. Click the test(s) below to view what biomarkers are measured along with an explanation of what the biomarker is measuring.

Also known as: Comprehensive Metabolic Panel WO Alt


Albumin is a protein made by the liver. A serum albumin test measures the amount of this protein in the clear liquid portion of the blood.

Albumin/Globulin Ratio

The ratio of albumin to globulin (A/G ratio) is calculated from measured albumin and calculated globulin (total protein - albumin). Normally, there is a little more albumin than globulins, giving a normal A/G ratio of slightly over 1. Because disease states affect the relative amounts of albumin and globulin, the A/G ratio may provide a clue as to the cause of the change in protein levels. A low A/G ratio may reflect overproduction of globulins, such as seen in multiple myeloma or autoimmune diseases, or underproduction of albumin, such as may occur with cirrhosis, or selective loss of albumin from the circulation, as may occur with kidney disease (nephrotic syndrome). A high A/G ratio suggests underproduction of immunoglobulins as may be seen in some genetic deficiencies and in some leukemias. More specific tests, such as liver enzyme tests and serum protein electrophoresis, must be performed to make an accurate diagnosis. With a low total protein that is due to plasma expansion (dilution of the blood), the A/G ratio will typically be normal because both albumin and globulin will be diluted to the same extent.

Alkaline Phosphatase

Alkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone.


AST (aspartate aminotransferase) is an enzyme found in high amounts in liver, heart, and muscle cells. It is also found in lesser amounts in other tissues.

Bilirubin, Total

Bilirubin is a yellowish pigment found in bile, a fluid made by the liver. A small amount of older red blood cells are replaced by new blood cells every day. Bilirubin is left after these older blood cells are removed. The liver helps break down bilirubin so that it can be removed from the body in the stool.

Bun/Creatinine Ratio

A ratio between a person’s BUN and blood creatinine to help determine what is causing these concentrations to be higher than normal. The ratio of BUN to creatinine is usually between 10:1 and 20:1. An increased ratio may be due to a condition that causes a decrease in the flow of blood to the kidneys, such as congestive heart failure or dehydration. It may also be seen with increased protein, from gastrointestinal bleeding, or increased protein in the diet. The ratio may be decreased with liver disease (due to decrease in the formation of urea) and malnutrition.


You have more calcium in your body than any other mineral. Calcium has many important jobs. The body stores more than 99 percent of its calcium in the bones and teeth to help make and keep them strong. The rest is throughout the body in blood, muscle and the fluid between cells. Your body needs calcium to help muscles and blood vessels contract and expand, to secrete hormones and enzymes and to send messages through the nervous system.

Carbon Dioxide

CO2 is carbon dioxide. Measures the amount of carbon dioxide in the liquid part of your blood, called the serum. In the body, most of the CO2 is in the form of a substance called bicarbonate (HCO3-). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level.


Chloride is a type of electrolyte. It works with other electrolytes such as potassium, sodium, and carbon dioxide (CO2). These substances help keep the proper balance of body fluids and maintain the body's acid-base balance. This is a measure of the amount of chloride in the fluid portion (serum) of the blood.


The creatinine blood test measures the level of creatinine in the blood. This test is done to see how well your kidneys work.

Egfr African American

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.

Egfr Non-Afr. American

Glomerular filtration rate (GFR) is a test used to check how well the kidneys are working. Specifically, it estimates how much blood passes through the glomeruli each minute. Glomeruli are the tiny filters in the kidneys that filter waste from the blood.


Globulins is the collective term for most blood proteins other than albumin. Identifying the types of globulins can help diagnose certain disorders. Globulins are roughly divided into three groups: alpha, beta, and gamma globulins. Gamma globulines include various types of antibodies such as immunoglobulins (Ig) M, G, and A.


A blood glucose test measures the amount of a sugar called glucose in a sample of your blood. Glucose is a major source of energy for most cells of the body, including those in the brain. The hormones insulin and glucagon help control blood glucose levels.


Potassium is a mineral that the body needs to work normally. It helps nerves and muscles communicate. It also helps move nutrients into cells and waste products out of cells. A diet rich in potassium helps to offset some of sodium's harmful effects on blood pressure.

Protein, Total

The total protein is the total amount of two classes of proteins, albumin and globulin that are found in the fluid portion of your blood. Proteins are important parts of all cells and tissues. Your albumin helps prevent fluid from leaking out of blood vessels and your globulins are an important part of your immune system.


Sodium is a substance that the body needs to work properly it is vital to normal body processes, including nerve and muscle function

Urea Nitrogen (Bun)

BUN stands for blood urea nitrogen. Urea nitrogen is what forms when protein breaks down. BUN measures the amount of urea nitrogen in the blood.
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The Comprehensive Metabolic Panel without ALT test contains 1 test with 18 biomarkers.

Brief Description: The Comprehensive Metabolic Panel (CMP) is a set of blood tests that provides information about the body's chemical balance, levels of electrolytes, and how well the kidneys and liver are functioning. When referenced as "without ALT," it indicates that Alanine aminotransferase (ALT), a liver enzyme, is excluded from the panel.

Collection Method: Blood Draw

Specimen Type: Serum

Test Preparation: Fasting preferred but not required.

When and Why a Comprehensive Metabolic Panel without ALT Test May Be Ordered

A CMP without ALT is often ordered as part of:

  1. Routine Health Exams: To assess the overall health of an individual.
  2. Hospital Admissions: To get a comprehensive understanding of a patient's health.
  3. Monitoring: For patients with known conditions, especially if they are on medications that can affect kidneys or electrolyte balance.
  4. Symptoms Evaluation: In cases where symptoms like fatigue, dizziness, nausea, or abdominal pain are present, to identify a potential metabolic cause.

What the Comprehensive Metabolic Panel without ALT Test Checks For

The CMP generally includes the following tests:

  1. Electrolytes

    • Sodium
    • Potassium
    • Chloride
    • Bicarbonate (or total carbon dioxide)
  2. Kidney Tests

    • Blood urea nitrogen (BUN)
    • Creatinine
  3. Blood Sugar

    • Glucose
  4. Proteins

    • Albumin
    • Total protein
  5. Liver Tests

    • Alkaline phosphatase (ALP)
    • Aspartate aminotransferase (AST)
    • Bilirubin

(Keep in mind ALT, which typically is part of a CMP, is excluded in this case.)

Other Lab Tests Ordered Alongside Comprehensive Metabolic Panel without ALT Test

Depending on the results of a CMP or the suspected conditions, other tests may be ordered for further clarification or investigation:

  1. Lipid Panel:

    • Purpose: Measures levels of various types of cholesterol and triglycerides in the blood.
    • Why Is It Ordered: To assess the risk of cardiovascular disease, especially if the CMP suggests diabetes or if the patient has a family history of heart disease.
  2. Thyroid Function Tests (TFTs):

    • Purpose: Include measurements of TSH (Thyroid Stimulating Hormone), Free T3, and Free T4.
    • Why Is It Ordered: To investigate symptoms such as fatigue, weight changes, or when lipid levels from the CMP are abnormal, indicating possible thyroid dysfunction.
  3. Hemoglobin A1c (HbA1c):

    • Purpose: Provides an average of blood glucose levels over the past three months.
    • Why Is It Ordered: To diagnose or monitor diabetes, especially if the CMP shows high glucose levels.
  4. Uric Acid:

    • Purpose: Measures the level of uric acid in the blood.
    • Why Is It Ordered: To help diagnose gout or to further assess kidney function if related abnormalities are found in the CMP.
  5. Magnesium:

    • Purpose: An important electrolyte not included in the standard CMP.
    • Why Is It Ordered: To check for magnesium deficiency or excess when symptoms such as muscle cramps or cardiac arrhythmias are present, or if other electrolytes are out of balance.
  6. Phosphate:

    • Purpose: Important for bone health and is regulated by the kidneys.
    • Why Is It Ordered: To evaluate further when kidney function is abnormal or if there are concerns related to bone metabolism.
  7. Complete Blood Count (CBC):

    • Purpose: Evaluates the levels and health of red blood cells, white blood cells, and platelets.
    • Why Is It Ordered: To provide more information on signs of infection, anemia, or other blood-related issues indicated by the CMP.
  8. Coagulation Panel:

    • Purpose: Measures the clotting ability of the blood.
    • Why Is It Ordered: To assess blood clotting function if liver tests are abnormal, due to the liver’s role in producing clotting factors.
  9. Serum Iron and Total Iron Binding CapacityFerritin, and Transferrin:

    • Purpose: Assess body iron stores and transport.
    • Why Is It Ordered: To identify or rule out disorders of iron metabolism when signs of anemia or liver disease are present on the CMP.
  10. C-Reactive Protein (CRP) or Erythrocyte Sedimentation Rate (ESR):

    • Purpose: Non-specific markers of inflammation.
    • Why Is It Ordered: To detect inflammation or infection that might be suggested by abnormalities in the CMP.
  11. Hepatitis Panel:

    • Purpose: Screening for viral infections that affect the liver and immune system.
    • Why Is It Ordered: If liver dysfunction is indicated on the CMP, or if the patient has risk factors for these infections, testing is essential for appropriate management.

Conditions or Diseases that Require a Comprehensive Metabolic Panel without ALT Test

The CMP without ALT can be ordered for a variety of conditions including, but not limited to:

  • Kidney Disease: Elevated BUN and creatinine can indicate kidney dysfunction.
  • Liver Disease: Elevations in AST or bilirubin can suggest liver damage or disease.
  • Electrolyte Imbalances: Abnormal levels of sodium, potassium, or chloride can indicate conditions like dehydration, heart disease, or metabolic acidosis.
  • Endocrine Disorders: Abnormal glucose levels can suggest diabetes or hypoglycemia.

Usage of Results from Comprehensive Metabolic Panel without ALT Test by Health Care Providers

Healthcare providers interpret the results of the CMP in the context of the patient's medical history, symptoms, physical examination, and other diagnostic tests. Abnormal results can indicate:

  • Issues with kidney or liver function.
  • Imbalances in the body's electrolytes, which can affect muscular and neural function.
  • Blood sugar levels that are too high or too low.

Based on the results, healthcare providers can diagnose conditions, decide on treatment plans, adjust medications, or order further testing to pinpoint a diagnosis.

Most Common Questions About the Comprehensive Metabolic Panel without ALT test:

Purpose and Clinical Indications

Why is the Comprehensive Metabolic Panel without ALT test ordered?

The Comprehensive Metabolic Panel without ALT test is typically ordered to get a broad overview of the body's chemical balance and metabolism. It can help check the function of the kidneys, liver (excluding ALT), and other organs, and can show if certain drug levels are too high or too low.

Which conditions or diseases can the Comprehensive Metabolic Panel without ALT test help diagnose?

The test can help diagnose conditions such as diabetes, kidney disease, breathing problems, and complications related to hypertension. It can also help monitor conditions like kidney disease progression or the side effects of certain medications.

Interpretation of Results

What do abnormal results in the Comprehensive Metabolic Panel without ALT test indicate?

Abnormal results can indicate a variety of conditions depending on the specific component that's abnormal. For instance, high blood sugar levels might suggest diabetes, high creatinine levels can indicate kidney dysfunction, and abnormal calcium levels can point to a parathyroid disease or malignancy.

Why is ALT specifically excluded in this version of the Comprehensive Metabolic Panel?

The ALT (alanine aminotransferase) test is a specific indicator of liver health. While it is often included in standard comprehensive metabolic panels, there are occasions when a physician might not deem it necessary, possibly due to the cost, patient condition, or when other liver function tests provide sufficient information.

Implications and Medical Management

If there are abnormal results in the Comprehensive Metabolic Panel without ALT test, what might be the next steps?

Depending on the specific abnormal results, the physician may recommend further testing to pinpoint the diagnosis. For example, if blood sugar levels are high, an HbA1c test might be ordered to check for diabetes. If kidney-related results are abnormal, further kidney function tests or imaging might be recommended.

Do abnormal results always indicate a serious condition?

Not necessarily. While some abnormal results can indicate serious conditions, others might be due to temporary factors like dehydration, certain medications, or even the time of day the test was taken. It's crucial to consult with a healthcare provider to interpret the results in the context of the individual's overall health and other factors.

Post-Test Management

Is there any need for regular monitoring or follow-up after the Comprehensive Metabolic Panel without ALT test?

If the test results are within the normal range and the patient doesn't have any ongoing health issues that require monitoring, there might not be a need for regular follow-ups. However, if there are abnormal results or if the patient has certain conditions like diabetes or kidney disease, regular monitoring and follow-ups will be essential.

Can lifestyle changes impact the results of the Comprehensive Metabolic Panel without ALT test on a subsequent retest?

Yes, lifestyle changes such as a balanced diet, regular exercise, adequate hydration, and avoiding excessive alcohol or certain medications can positively influence many of the factors tested in the comprehensive metabolic panel.

We advise having your results reviewed by a licensed medical healthcare professional for proper interpretation of your results.

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