Specimen Name Result Units Range
Plasma Sodium 143 mmol/L (135-145)
Potassium 4.8 mmol/L (3.5-5.5)
Chloride 99 mmol/L (100-109)
Bicarbonate 3 mmol/L (22-32)
Anion Gap 46 mmol/L (7-17)
Glucose 14.8 mmol/L (3.8-5.5)
Urea 31 mmol/L (2.7-7.2)
Creatinine 747 μmol/L (60-110)
Urate 0.70 mmol/L (0.20-0.40)
Phosphate 4.64 mmol/L (0.80-1.45)
Magnesium 1.13 mmol/L (0.70-0.95)
Total Calcium 2.29 mmol/L (2.10-2.55)
Ionized Calcium 1.21 mmol/L (1.07-1.27)
Albumin 27 g/L (34-48)
Globulins 32 g/L (22-35)
Total Bilirubin 10 μmol/L (6-24)
GGT 60 U/L (< 60)
ALP 100 U/L (30-110)
ALT 113 U/L (< 55)
AST 142 U/L (< 45)
LDH 617 U/L (110-230)
Amylase 1,011 U/L (20-100)
TnT 0.5 ng/L (< 15)
CK 195 U/L (< 200)
CK-MB 9 U/L (< 15)
Blood Hb 110 g/L (130-180)
Platelets 354 x109/L (150-450)
WCC 37 x109/L (4.0-11.0)
INR 1.7 (0.8-1.2)
APTT 70 Sec. (25-35)
Fibrinogen 3.00 g/L (1.5-4.0)
D-Dimer 37 mg/L (< 0.5)
ABG pH 6.68 (7.36-7.44)
PaO2 271 mmHg (70-100)
PaCO2 38 mmHg (35-45)
HCO3- 4 mmol/L (21-26)

58yo female with T2DM on oral Rx

Presenting with acute abdomen+++.
Metformin-Associated Lactic Acidosis
  • Metabolic acidosis : ↑↑ AG but modest ↑BGL
  • Hyperglycaemia : mild but ∴ likely diabetic disorder
  • Lactate ≈ 16.9 mmol/L
  • On oral Rx with metformin
  • Severe AKI ∝ process present for days

 

MALA:

  1. Aetiology → uncertain
  2. Metformin effects:
    • ↑ peripheral glucose uptake
    • ↓ gluconeogenesis
    • ↓ fatty acid oxidation
  3. Clinical features:
    • abdominal pain, nausea and vomiting
    • fatigue & myalgias
    • altered mental status
    • myocardial insufficiency
    • multi-organ failure
  4. Risk factors:
    • ↑age
    • ↑ETOH intake
    • high dose, renal impairment (elimination → renal excretion)
    • hypoxia, sepsis, dehydration, shock, acidosis