Specimen Name Result Units Range
Plasma Sodium 142 mmol/L (135-145)
Potassium 4.3 mmol/L (3.5-5.5)
Chloride 104 mmol/L (100-109)
Bicarbonate 31 mmol/L (22-32)
Anion Gap 11 mmol/L (7-17)
Glucose 0.6 mmol/L (3.8-5.5)
Urea 8.3 mmol/L (2.7-7.2)
Creatinine 90 μmol/L (60-110)
Osmolality 280 mmol/kg (275-295)
Urate 0.26 mmol/L (0.20-0.40)
Phosphate 0.99 mmol/L (0.80-1.45)
Total Calcium 2.34 mmol/L (2.10-2.55)
Albumin 44 g/L (34-48)
Globulins 22 g/L (22-35)
Total Bilirubin 9 μmol/L (6-24)
Conj. Bilirubin 3 μmol/L (1-4)
GGT 99 U/L (< 60)
ALP 296 U/L (30-110)
AST 50 U/L (< 45)
LDH 464 U/L (110-230)
Cholesterol 4.5 mmol/L (3.5-5.5)

75yo female - comatose.
Profound Hypoglycaemia

 

Causes for Severe Hypoglycaemia:

A. Glucose underproduction

  1. Endocrine
    • hypopituitarism, hypothyroidism
    • Addison's
    • glucagon deficiency
    • autonomic nervous dysfunction
  2. Enzyme deficiency
    • G-6-phosphatase, F-1,6-diphosphatase
    • liver phosphorylase, glycogen synthase
    • pyruvate decarboxylase
    • idiopathic leucine sensitivity
  3. Substrate Deficiency
    • severe malnutrition, wasting
    • post-gastrectomy, gastro-enterostomy
    • late pregnancy
    • ketotoic hypoglycaemia of infancy
    • prematurity
  4. Hepatic dysfunction
    • congestion
    • severe hepatitis, cirrhosis
    • uraemia
    • hypothermia
  5. Drugs
    • alcohol, propranolol, salicylates

B. Glucose overutilization

  1. Hyperinsulinism
    • tumours - islet cell
    • exogenous insulin / sulphonylureas
    • infant of diabetic mother
    • autoimmune - insulin or receptor Ab's
    • drugs - quinine, disopyramide, pentamidine
    • endotoxic shock
  2. Normal insulin
    • tumours - adrenal cell, stomach, hepatic, fibrosarcoma
    • carnitine deficiency
    • enzyme deficiencies - β-fatty-oxidation, 3-OH-3-methylglutaryl-CoA lyase
    • drugs - empagliflozin