Specimen Name Result Units Range
Plasma Sodium 173 mmol/L (135-145)
Potassium 11.1 mmol/L (3.5-5.5)
Chloride 133 mmol/L (100-109)
Bicarbonate 8 mmol/L (22-32)
Anion Gap 43 mmol/L (7-17)
Glucose 5.3 mmol/L (3.8-5.5)
Urea 118 mmol/L (2.7-7.2)
Creatinine 3,039 μmol/L (60-110)
Osmolality 464 mmol/kg (275-295)
Urate 1.16 mmol/L (0.20-0.40)
Phosphate 6.06 mmol/L (0.80-1.45)
Total Calcium 2.59 mmol/L (2.10-2.55)
Ionized Calcium 1.25 mmol/L (1.07-1.27)
Albumin 41 g/L (34-48)
Globulins 31 g/L (22-35)
Total Protein 72 g/L (60-80)
Total Bilirubin 10 μmol/L (6-24)
GGT 20 U/L (< 60)
ALP 122 U/L (30-110)
ALT 16 U/L (< 55)
AST 15 U/L (< 45)
LDH 463 U/L (110-230)
Lipase 4,210 U/L (< 60)
CK 278 U/L (< 200)
Blood Hb 39 g/L (130-180)
Platelets 112 x109/L (150-450)
WCC 14.9 x109/L (4.0-11.0)

35yo male with longstanding CRF.

Weeks of moderate abdominal pain with acute exacerbation.

Now depressed LOC/obtundation with acute abdomen & hypotension.

 

NB: you might reasonably think these aren't real (we did):
CRF + GI Bleed/Perforation + Pancreatitis
  • longstanding CRF and DU → self-medication with alkali
  • acute perforation → peritonitis + GI Bleed + pancreatits
  • hypovolaemia / anaemia / hypotension
    → added AKI & severe metabolic acidosis (acute on chronic)
  • life-threatening hyperkalaemia

Urea/Creatinine:

NB: hyperkalaemia:

  • to survive [K+] > 10, his baseline must be high → smaller proportional rise
    e.g. baseline ≈ 6 → 11 represents a < 2x increase
  • you could argue the rate of correction (see serial image) was way too fast
    → correction to [K+] ≈ 3.5 mmol/L within 36 hours carried a high risk of arrhythmia
  • CRRT should have been aiming for 'high-normal ', e.g. dialysis [K+] ≈ 5-6 mmol/L