Specimen Name Result Units Range
Plasma Sodium 133 mmol/L (135-145)
Potassium 2.4 mmol/L (3.5-5.5)
Chloride 53 mmol/L (100-109)
Bicarbonate 48 mmol/L (22-32)
Glucose 4.5 mmol/L (3.8-5.5)
Urea 20.0 mmol/L (2.7-7.2)
Creatinine 280 μmol/L (60-110)
Albumin 32 g/L (34-48)
ABG pH 7.66 (7.36-7.44)
PaO2 69 mmHg (70-100)
PaCO2 52 mmHg (35-45)
HCO3- 58 mmol/L (21-26)
Urine Sodium 45 mmol/L (> 20)
Chloride 113 mmol/L
Osmolality 376 mmol/kg

48yo male laborer admitted with 3 weeks of abdominal pain.
Chronic DU - 'Milk-Alkali' Syndrome
  • Mixed hypokalaemic metabolic alkalosis & respiratory acidosis
    → ? better term : partial respiratory compensation
    → ? vomiting & loss of gastric content
  • Dehydration & pre-renal AKI:
    • urinary [Na+] high likely due to NaHCO3 load & renal HCO3- excretion
    • alternatively may be superimposed ATN

 

Hypokalaemic Metabolic Alkalosis
Diuretics (esp. loop agents) - low Na+, Cl- / high urea
Mineralocorticoid excess - normal-high Na+, Cl- / normal urea
Vomiting / Gastric outlet obs. - very low Cl- / low-normal Na+ / high urea
Diarrhoea / laxatives - low Cl- / normal Na+ / high urea
Post massive blood Tx - citrate metabolism & acidosis correction