Specimen Name Result Units Range
Plasma Sodium 135 mmol/L (135-145)
Potassium 3.3 mmol/L (3.5-5.5)
Chloride 77 mmol/L (100-109)
Bicarbonate 42 mmol/L (22-32)
Anion Gap 19 mmol/L (7-17)
Glucose 5.7 mmol/L (3.8-5.5)
Urea 5.5 mmol/L (2.7-7.2)
Creatinine 60 μmol/L (60-110)
Osmolality 267 mmol/kg (275-295)
Urate 0.36 mmol/L (0.20-0.40)
Phosphate 1.02 mmol/L (0.80-1.45)
Total Calcium 2.12 mmol/L (2.10-2.55)
Albumin 38 g/L (34-48)
Globulins 35 g/L (22-35)
Total Bilirubin 11 μmol/L (6-24)
Conj. Bilirubin 2 μmol/L (1-4)
Cholesterol 5.6 mmol/L (3.5-5.5)

69yo female inpatient.
Hypochloraemic Metabolic Alkalosis
  • any fluid loss replaced with insufficient Na+ → H+ excretion
  • acid loss is either renal or GIT
  • common causes:
    • diuretics
    • vomiting / GI losses
    • following correction of hypercarbia

Aetiology:

  1. increased H+ losses
    • renal
    • GIT
  2. increased base / HCO3-
    • administration of NaHCO3
    • metabolic conversion of exogenous acid-anions - citrate, lactate, acetate
    • 'milk-alkali' syndrome
    • renal conservation of HCO3- - acidosis/hypercarbia

Factors tending to maintain an alkalosis:

  • hypovolaemia
  • hypokalaemia
  • hypochloraemia
  • hypomagnesaemia
  • chronic hypercapnia
  • mild CRF

 

Hypokalaemic Metabolic Alkalosis
Diuretics (esp. loop agents) - low Na+, Cl- / high urea
Mineralocorticoid excess - normal-high Na+, Cl- / normal urea
Vomiting / Gastric outlet obs. - very low Cl- / low-normal Na+ / high urea
Diarrhoea / laxatives - low Cl- / normal Na+ / high urea
Post massive blood Tx - citrate metabolism & acidosis correction