Specimen Name Result Units Range
Plasma Sodium 131 mmol/L (135-145)
Potassium 2.9 mmol/L (3.5-5.5)
Chloride 95 mmol/L (100-109)
Bicarbonate 14 mmol/L (22-32)
Anion Gap 25 mmol/L (7-17)
Glucose 5.1 mmol/L (3.8-5.5)
Urea 38 mmol/L (2.7-7.2)
Creatinine 647 μmol/L (60-110)
Urate 0.19 mmol/L (0.20-0.40)
Phosphate 2.98 mmol/L (0.80-1.45)
Total Calcium 2.13 mmol/L (2.10-2.55)
Albumin 16 g/L (34-48)
Globulins 34 g/L (22-35)
Total Bilirubin 894 μmol/L (6-24)
GGT 46 U/L (< 60)
ALP 129 U/L (30-110)
ALT 65 U/L (< 55)
AST 86 U/L (< 45)
Blood Hb 82 g/L (130-180)
Platelets 27 x109/L (150-450)
WCC 8.2 x109/L (4.0-11.0)

52yo male with longstanding cirrhosis.

Acute deterioration with confusion, obtundation.
Hepato-Renal Syndrome
  • marked jaundice but minimal LFT rise ∝ hepatocellular loss
  • acute renal failure / AKI
  • metabolic acidosis ∝ AKI
    *cirrhosis usually alkalotic → [serial biochemistry profile]
  • chronic anaemia / thrombocytopenia ∝ cirrhosis + hypersplenism

 

Predominantly Unconjugated

  1. Overproduction
    • haemolysis
    • reabsorption of haematoma
    • ineffective erythropoeisis
  2. Decreased hepatic uptake
    • sepsis
    • prolonged fasting
    • RV failure
    • drugs - rifampicin, probenecid
  3. Decreased conjugation
    • hepatocellular disease - hepatitis, cirrhosis
    • sepsis
    • drugs - chloramphenicol
    • inherited glucuronyl transferase deficiency
      • Gilbert's syndrome - actually ligandin deficiency
      • Crigler-Najjar - types II & I

Predominantly Unconjugated

  1. Biliary obstruction
    • biliary cirrhosis - primary | secondary
    • sclerosing cholangitis
    • extrahepatic obstruction - stone, tumour, stricture
  2. Impaired hepatic excretion
    • sepsis
    • post-operative state
    • hepatocellular disease
      • hepatitis - viral, ischaemic, drug-induced
      • cirrhosis
    • drug-induced cholestasis - OCP, methyltestosterone
    • inherited disorders - Dubin-Johnson, Rotor syndrome, benign familial cholestasis
    • cholestasis of pregnancy