Specimen Name Result Units Range
Plasma Sodium 140 mmol/L (135-145)
Potassium 4.4 mmol/L (3.5-5.5)
Chloride 101 mmol/L (100-109)
Bicarbonate 29 mmol/L (22-32)
Anion Gap 14 mmol/L (7-17)
Glucose 6.7 mmol/L (3.8-5.5)
Urea 4.7 mmol/L (2.7-7.2)
Creatinine 46 μmol/L (60-110)
Osmolality 413 mmol/kg (275-295)
Urate 0.38 mmol/L (0.20-0.40)
Phosphate 1.28 mmol/L (0.80-1.45)
Total Calcium 2.28 mmol/L (2.10-2.55)
Ionized Calcium 1.18 mmol/L (1.07-1.27)
Albumin 36 g/L (34-48)
Globulins 32 g/L (22-35)
Total Protein 68 g/L (60-80)
Total Bilirubin 3 μmol/L (6-24)
GGT 40 U/L (< 60)
ALP 100 U/L (30-110)
ALT 29 U/L (< 55)
AST 29 U/L (< 45)
LDH 212 U/L (110-230)
Lipase 66 U/L (< 60)

67 male BIBA with GCS=6 & CT → atrophic changes
High Osmolar Gap
  • OG ≅ OsmoMeas - OsmoCalc
    • ≈ 413 - (1.86*(140+4.4) + 4.7 + 6.7 + 10)
    ≈ 123 → ≈ 110 increase
  • OG ≤ 10 usually but can be ≤ 24
  • OG > 25 → >80% specific for toxic alcohol ingestion

MW (ethanol) : C2H5OH = (2*12)+(6*1)+(1*16) = 46, ∴ 1mol = 46g

g/dL ≅ .0046 x mmol/L
∴ 0.0046 x 110 ≈ 0.5 g/dL

Lab BAL = 0.48 g/dL (104.2 mmol/L) → ≈10x legal limit

 

Aetiology:

  • alcohols
    • ethanol, methanol
    • mannitol, sorbitol
    • propylene glycol
  • hyperlipidaemia
  • hyperproteinaemia (multiple myeloma)
  • glycinaemia - post-TURP syndrome
  • NB : 2 groups:
    • impermeate solutes → hypertonic state
    • permeate solutes → isotonic states