Specimen Name Result Units Range
Plasma Sodium 126 mmol/L (135-145)
Potassium 6.2 mmol/L (3.5-5.5)
Chloride 85 mmol/L (100-109)
Bicarbonate 23 mmol/L (22-32)
Anion Gap 24 mmol/L (7-17)
Glucose 104 mmol/L (3.8-5.5)
Urea 21.1 mmol/L (2.7-7.2)
Creatinine 171 μmol/L (60-110)
Urate 0.55 mmol/L (0.20-0.40)
Phosphate 2.02 mmol/L (0.80-1.45)
Total Calcium 2.63 mmol/L (2.10-2.55)
Ionized Calcium 1.27 mmol/L (1.07-1.27)
Albumin 37 g/L (34-48)
Globulins 50 g/L (22-35)
Total Protein 87 g/L (60-80)
Total Bilirubin 9 μmol/L (6-24)
GGT 29 U/L (< 60)
ALP 230 U/L (30-110)
ALT 29 U/L (< 55)
AST 16 U/L (< 45)
LDH 198 U/L (110-230)
Amylase 247 U/L (20-100)
Lipase 994 U/L (< 60)
Cholesterol 7.4 mmol/L (3.5-5.5)

60yo female with obtundation, abdominal pain and hypotension.
Hyperglycaemic Non-ketotic Coma
  • Hyperglycaemia : ∴ diabetic disorder but BGL >> DKA range (≈ 25-45 mmol/L)
  • Hyperosmolar hyponatraemia : corrected [Na+] ≈ 157 mmol/L
  • HCO3- : normal range but ↑AG ∝ AKI ± other
  • Aceto-acetate : not detected by dipstick, however:
    • in mixed metabolic acidosis (keto + lactic) Ac-Ac ≈ 0
    • [Ac-Ac]↔[β-OH-B] are a redox pair and ↓↓pH → R-shift
  • Pre-renal failure : likely hypovolaemia ± SIRS
  • Likely precipitant → pancreatitis ∝ [lipase]

 

Hyperosmolar Hyponatraemia:

  1. Glucose
    • DKA, HONC
    • 'Corrected' [Na+] ≈ [Na+]Pl + [BGL-10]/3
  2. Urea:
    • esp. salt-losing nephritis
    • high [K+], creatinine, urea
  3. Others:
    • mannitol
    • glycine port-TURP
    • glycerol, sorbitol, ethanol, methanol

Differential:

  • IVT arm sample - normal osmolality
  • salt-losing nephritis - normal BGL, no ketones