Specimen Name Result Units Range
Plasma Sodium 144 mmol/L (135-145)
Potassium 3.0 mmol/L (3.5-5.5)
Chloride 100 mmol/L (100-109)
Bicarbonate 14 mmol/L (22-32)
Anion Gap 33 mmol/L (7-17)
Glucose 1.9 mmol/L (3.8-5.5)
Urea 3.3 mmol/L (2.7-7.2)
Creatinine 210 μmol/L (60-110)
Osmolality 277 mmol/kg (275-295)
Urate 0.47 mmol/L (0.20-0.40)
Phosphate 1.96 mmol/L (0.80-1.45)
Total Calcium 2.45 mmol/L (2.10-2.55)
Albumin 46 g/L (34-48)
Globulins 28 g/L (22-35)
Total Bilirubin 122 μmol/L (6-24)
Conj. Bilirubin 49 μmol/L (1-4)
GGT 29 U/L (< 60)
ALP 131 U/L (30-110)
AST 9,025 U/L (< 45)
LDH 6,380 U/L (110-230)
Cholesterol 4.8 mmol/L (3.5-5.5)

Unconscious 18yo female brought to ED.
Paracetamol-induced Hepatic Necrosis
  • Metabolic acidosis (high AG)
  • Hypoglycaemia
  • High ASL, ALT, LDH
  • Low Ca++
  • Other Ix : ABG, INR, BAL, [paracetamol]
  • Hepatic metabolic pathways

Clinical Features:

  • nausea & vomiting
  • abdominal pain & tenderness
  • pallor
  • coma - unusual, unless other drugs or late presentation
  • liver dysfunction → *late*, usually ≥ 24 hours
  • of those above "treatment line" and not treated:
    • ≈ 60% → severe liver damage at 3-5 days
    • ≈ 5% → hepatic failure, encepalopathy, coma & death
  • uncommon complications
    • renal failure - ATN ± papillary necrosis
    • cardiac failure
    • pancreatitis