Specimen Name Result Units Range
Plasma Sodium 131 mmol/L (135-145)
Potassium 6.5 mmol/L (3.5-5.5)
Chloride 97 mmol/L (100-109)
Bicarbonate 10 mmol/L (22-32)
Anion Gap 31 mmol/L (7-17)
Glucose 44 mmol/L (3.8-5.5)
Urea 14.4 mmol/L (2.7-7.2)
Creatinine 310 μmol/L (60-110)
Osmolality 313 mmol/kg (275-295)
Urate 0.50 mmol/L (0.20-0.40)
Phosphate 3.43 mmol/L (0.80-1.45)
Total Calcium 2.10 mmol/L (2.10-2.55)
Ionized Calcium 1.08 mmol/L (1.07-1.27)
Albumin 39 g/L (34-48)
Globulins 26 g/L (22-35)
Total Bilirubin 22 μmol/L (6-24)
GGT 119 U/L (< 60)
ALP 116 U/L (30-110)
ALT 792 U/L (< 55)
AST 790 U/L (< 45)
LDH 1,323 U/L (110-230)
CK 1,985 U/L (< 200)

Middle-aged female patient, comatose.
Diabetic Ketoacidosis
  • Metabolic acidosis : hyperkalaemic & raised AG
  • Hyperglycaemia : therefore diabetic disorder, likely DKA
  • Corrected [Na+] ≈ 142 mmol/L
  • Anion gap : ↑AG ≈ fall in HCO3- → minimal renal HCO3- loss

However:

  • why is the PO4 so high → ? cell death/leakage (+↑LDH)
  • is [creatinine] artefactually caused by [acetoacetate]?
  • marked elevation of LFTs → mainly hepatocellular?
  • combination AST/LDH/CK → ?AMI

NB: there is clearly some additional disease process, with a marked hepatic component → DDx for hepatic picture

 

Hepatitis

  1. infective
    • Hepatitis A, B, C, Delta, E, NANBNC
    • EBV, CMV, HSV, Coxsackie, Yellow fever
  2. drugs
    • cholestasis
      • alcohol
      • chlorpromazine, chloramphenicol, chlorpropamide
      • tetracyclines, erythromycin, rifampicin
      • oestrogens, OCP, androgens
    • hepatitis
      • α-methyl-dopa
      • paracetamol, phenytoin, isoniazid, rifampicin
      • halothane, enflurane, & ? isoflurane
  3. toxins
    • CCl4, vinyl chloride, chloroform
    • Amanita phalloides (mushroom)
  4. cardiovascular
    • ischaemic - hypovolaemic shock, ischaemia
    • congestive - cor pulmonale, RV failure, CCF, Budd-Chiari
  5. metabolic
    • alcohol
    • Wilson's disease (hepatolenticular degeneration)
    • Haemochromatosis
    • α1-antitrypsin deficiency
  6. autoimmune
    • chronic active hepatitis
    • drug induced
    • vasculitis, SLE, UC, PN
    • 1° biliary cirrhosis
  7. pregnancy - acute fatty liver of pregnancy
  8. hyperthermia