Specimen Name Result Units Range
Plasma Sodium 144 mmol/L (135-145)
Potassium 4.8 mmol/L (3.5-5.5)
Chloride 102 mmol/L (100-109)
Bicarbonate 27 mmol/L (22-32)
Anion Gap 20 mmol/L (7-17)
Glucose 4.8 mmol/L (3.8-5.5)
Urea 33 mmol/L (2.7-7.2)
Creatinine 820 μmol/L (60-110)
Osmolality 313 mmol/kg (275-295)
Urate 0.58 mmol/L (0.20-0.40)
Phosphate 1.89 mmol/L (0.80-1.45)
Total Calcium 1.87 mmol/L (2.10-2.55)
Albumin 28 g/L (34-48)
Globulins 44 g/L (22-35)
Total Bilirubin 41 μmol/L (6-24)
Conj. Bilirubin 35 μmol/L (1-4)
GGT 470 U/L (< 60)
ALP 285 U/L (30-110)
AST 92 U/L (< 45)
LDH 686 U/L (110-230)
Cholesterol 3.2 mmol/L (3.5-5.5)

68yo female known to Renal Unit.
CRF
  • raised urea/creatinine
  • low Ca++ / high PO4
  • hypoalbuminaemia

However, why is this patient jaundiced ?

  • mixed obstructive/hepatocellular picture
  • cause unknown
    • ? auto-immune (high globulins & CRF)
    • ? infective

 

Hepatitis

  1. infective
    • Hepatitis - A, B, C, D, E
      • {A,E} → faecal-oral
      • {B,C,D} → blood/body-fluid
    • EBV, CMV, HSV, Coxsackie, Yellow fever
  2. metabolic
    • alcohol
    • Wilson's disease (hepatolenticular degeneration)
    • haemochromatosis
    • α1-antitrypsin deficiency
  3. autoimmune
    • chronic active hepatitis
    • drug induced
    • vasculitis, SLE, UC, PN
    • 1° biliary cirrhosis
  4. drugs
    • cholestasis
      • alcohol
      • chlorpromazine, chloramphenicol, chlorpropamide
      • tetracyclines, erythromycin, rifampicin
      • oestrogens, OCP, androgens
    • hepatitis
      • α-methyl-dopa
      • paracetamol, phenytoin, isoniazid, rifampicin
      • halothane, enflurane, & ? isoflurane
  5. toxins
    • methanol
    • vinyl chloride (H2C=CHCl), chloroform (CHCl3), CCl4
    • Amanita phalloides (mushroom)
  6. cardiovascular
    • ischaemic - hypovolaemic shock, ischaemia
    • congestive - cor pulmonale, RV failure, CCF, Budd-Chiari
  7. pregnancy - acute fatty liver of pregnancy
  8. hyperthermia