Specimen Name Result Units Range
Plasma Sodium 130 mmol/L (135-145)
Potassium 2.7 mmol/L (3.5-5.5)
Chloride 90 mmol/L (100-109)
Bicarbonate 28 mmol/L (22-32)
Anion Gap 15 mmol/L (7-17)
Glucose 13.0 mmol/L (3.8-5.5)
Urea 6.2 mmol/L (2.7-7.2)
Creatinine 100 μmol/L (60-110)
Phosphate 0.12 mmol/L (0.80-1.45)
Total Calcium 2.32 mmol/L (2.10-2.55)
Albumin 31 g/L (34-48)
Total Protein 56 g/L (60-80)
Total Bilirubin 308 μmol/L (6-24)
ALT 31 U/L (< 55)
Amylase 22 U/L (20-100)

46yo cachectic alcoholic, 24 hours after presenting with SOB/CCF.
Hypophosphataemia Post-LVF Rx
  • unknown if 1° or 2° acute LVF
  • marked hyperbilirubinaemia with raised NH3 ≈ 105 mmol/L
  • ∴ pre-existing hepatic disease with 2° hyperaldosteronism

 

Causes of Hypophosphataemia

  1. acute ∝ entry into cells
    • ↑ insulin - post-prandial, Rx of hyperkalaemia
    • Rx of acidosis - DKA, rhabdomyolysis, hypercapnia
    • TPN in malnourished or anorexic patients
  2. acute ∝ increased loss / utilization
    • phosphaturia from diuresis - osmotic / diuretic
    • severe illness - sepsis, hypercatabolic states
  3. chronic
    • ↓ intake - TPN, alcoholics, aged, anorexia
    • ↓ absorption - VitD3, rickets/osteomalacia, malabsorption
    • ↑ loss - diuresis, 1° hyperparathyoidism, RTA
    • ↑ utilisation - hypercatabolic states, cancer, multitrauma