Specimen Name Result Units Range
Plasma Sodium 127 mmol/L (135-145)
Potassium 2.9 mmol/L (3.5-5.5)
Chloride 36 mmol/L (100-109)
Bicarbonate 41 mmol/L (22-32)
Anion Gap 53 mmol/L (7-17)
Glucose 11.0 mmol/L (3.8-5.5)
Urea 56 mmol/L (2.7-7.2)
Creatinine 705 μmol/L (60-110)
Urate 2.07 mmol/L (0.20-0.40)
Phosphate 7.78 mmol/L (0.80-1.45)
Total Calcium 2.32 mmol/L (2.10-2.55)
Albumin 41 g/L (34-48)
Globulins 50 g/L (22-35)
Total Bilirubin 15 μmol/L (6-24)
GGT 141 U/L (< 60)
ALP 151 U/L (30-110)
ALT 44 U/L (< 55)
AST 63 U/L (< 45)
LDH 311 U/L (110-230)
Lipase 83 U/L (< 60)
Blood Hb 196 g/L (130-180)
Platelets 346 x109/L (150-450)
WCC 19.7 x109/L (4.0-11.0)
INR 1.0 (0.8-1.2)
APTT 31 Sec. (25-35)

Homeless 47yo male admitted with depressed LOC / obtundation.

Known history of ETOH abuse.

Vomiting++ for 1 week prior.
Complex Mixed Picture

Upper GI H+-K+-volume Losses / Hypovolaemia / Hemoconcentration
ARF / Mixed Acid-base Disorder

 

Likely sequence:

  • Pre-existing (mild) hypokalaemia alkalosis given ETOH history & LFTs
  • Recent upper GI losses of H+/K+/volume exacerbating alkalosis
  • Inadequate H2O replacement with hyponatraemia & haemoconcentration:
    • Pre-renal AKI - urea would usually be low
    • ↑↑Hb/protein - would usually be hypoalbuminaemic
  • Acute added raised AG metabolic acidosis (likely lactate) with progression of AKI
    • ± mild rhabdomyolysis (CK ≈ 853 U/L later same day)
    • ± sepsis - clinical diagnosis of CAP on CXR + ↑WCC
  • ↑↑PO4 suggests major cell damage, however, LD/CK not consistent

 

Serial Biochem (on CVVHD)