Specimen Name Result Units Range
Plasma Sodium 132 mmol/L (135-145)
Potassium 2.5 mmol/L (3.5-5.5)
Chloride 111 mmol/L (100-109)
Bicarbonate 5 mmol/L (22-32)
Anion Gap 18 mmol/L (7-17)
Glucose 5.7 mmol/L (3.8-5.5)
Urea 20.4 mmol/L (2.7-7.2)
Creatinine 542 μmol/L (60-110)
Urea/Creat Ratio 38 (35-80)
Urate 0.54 mmol/L (0.20-0.40)
Phosphate 2.35 mmol/L (0.80-1.45)
Magnesium 0.71 mmol/L (0.70-0.95)
Total Calcium 1.93 mmol/L (2.10-2.55)
Ionized Calcium 1.12 mmol/L (1.07-1.27)
Albumin 32 g/L (34-48)
Globulins 29 g/L (22-35)
Total Protein 61 g/L (60-80)
Total Bilirubin 10 μmol/L (6-24)
GGT 24 U/L (< 60)
ALP 142 U/L (30-110)
ALT 8 U/L (< 55)
AST 15 U/L (< 45)
LDH 161 U/L (110-230)
ABG pH 6.87 (7.36-7.44)
PaO2 204 mmHg (70-100)
PaCO2 10 mmHg (35-45)
HCO3- 2 mmol/L (21-26)
BE -32 mmol/L (±3)

57yo female admitted via ED with severe diarrhoea for 1 week prior.

On arrival from ED, her prescribed IVT included:

  • CSL/Hartmann's + KCL 30mmol/L @ 125mL/hr
  • 8.4% NaHCO3 @ 100mL/2hrs
NAG Metabolic Acidosis / Marked Hypokalaemia
  • severe NAG acidosis 2° GI losses of HCO3- / K+ / volume
  • inadequate respiratory compensation, however :
    • ≈ maximal respiratory effort / hyperventilation for age
    • calling this is 'mixed disorder' is not incorrect, but misleading
  • pre-renal AKI

 

NB:

  • correction of acidosis without prior/adequate K+-replacement
        would be life-threatening
  • adjusted K+ for pH:   [K+]Adj ≈ [K+]Pl - (7.4 - pH)*5 ≈ zero !!
    • obviously, the 'adjustment rule' breaks-down in extreme scenarios
      → for each ↓pH by 0.1 → ↑[K+] ≈ 0.5 mmol/L
  • whole-body K-deficit likely >300 mmol