Specimen Name Result Units Range
Plasma Sodium 141 mmol/L (135-145)
Potassium 5.1 mmol/L (3.5-5.5)
Chloride 106 mmol/L (100-109)
Bicarbonate 13 mmol/L (22-32)
Anion Gap 27 mmol/L (7-17)
Glucose 4.2 mmol/L (3.8-5.5)
Urea 11.2 mmol/L (2.7-7.2)
Creatinine 130 μmol/L (60-110)
Urea/Creat Ratio 85 (35-80)
Urate 0.65 mmol/L (0.20-0.40)
Phosphate 1.75 mmol/L (0.80-1.45)
Magnesium 1.02 mmol/L (0.70-0.95)
Total Calcium 2.45 mmol/L (2.10-2.55)
Ionized Calcium 1.27 mmol/L (1.07-1.27)
Albumin 37 g/L (34-48)
Globulins 30 g/L (22-35)
Total Bilirubin 153 μmol/L (6-24)
Conj. Bilirubin 97 μmol/L (1-4)
GGT 18 U/L (< 60)
ALP 146 U/L (30-110)
ALT 4,938 U/L (< 55)
AST 7,333 U/L (< 45)
LDH 6,725 U/L (110-230)
CK 65 U/L (< 200)

74yo male admitted unconscious via ED.

Pharmacist. Recent diagnosis malignancy left axilla.
Fulminant Hepatic Necrosis (Chloroform ingestion)
  • Acute severe hepatocellular death
  • Massive rise in AST, ALT & LDH
  • Metabolic acidosis (↑AG)
  • Mild hypoglycaemia
  • Mixed hyperbilirubinaemia
  • Early renal failure / AKI
  • NB: Ingested chloroform (CHCl3 - trichloromethane) would have resulted in a high osmolar-gap (if measured) hinting at presence of a toxin in plasma.

 

Analysis at 2 days:

  • ↓ AST, ALT, LDH ≈ 1000-2000
  • ↑ bilirubin > 200 μmol/L
  • ↑↑ INR
  • persisting hypoglycaemia
  • persisting metabolic acidosis despite CRRT
  • terminal hepatic failure