Specimen Name Result Units Range
Plasma Sodium 125 mmol/L (135-145)
Potassium 8.1 mmol/L (3.5-5.5)
Chloride 83 mmol/L (100-109)
Bicarbonate 7 mmol/L (22-32)
Urea 22 mmol/L (2.7-7.2)
Creatinine 490 μmol/L (60-110)
Osmolality 365 mmol/kg (275-295)

Comatose 24yo male.

Serum random cortisol 1,660 nmol/L.
Diabetic Ketoacidosis

Calculated osmolality ≈ 279 + glucose → large osmolar gap even if hyperglycaemic

Glucose was markedly elevated (mid 50's) → osmolar gap ≈ 30's

High Osmolar Gap:

  • alcohols - ethanol, methanol, propylene glycol, mannitol, sorbitol
  • hyperlipidaemia
  • hyperproteinaemia - multiple myeloma
  • glycine

Anion gap ≈ 43 : ↑AG metabolic acidosis ∝ AKI (AG ≤ 25) + other cause

Creatinine rise >> urea : possibly artefactual ∝ ketones (Ac-Ac)

Aetiology of coma → multiple:

  • ketoacidosis
  • severe dehydration
  • drug intoxication (e.g. ethanol)