Specimen Name Result Units Range
Plasma Sodium 133 mmol/L (135-145)
Potassium 4.6 mmol/L (3.5-5.5)
Chloride 95 mmol/L (100-109)
Bicarbonate 20 mmol/L (22-32)
Urea 9.9 mmol/L (2.7-7.2)
Creatinine 164 μmol/L (60-110)
eGFR 38 mL/min/1.73m2 (>60)
Phosphate 2.49 mmol/L (0.80-1.45)
Magnesium 1.04 mmol/L (0.70-0.95)
Total Calcium 2.89 mmol/L (2.10-2.55)
Albumin 61 g/L (34-48)
Globulins 51 g/L (22-35)
Total Protein 112 g/L (60-80)
Total Bilirubin 21 μmol/L (6-24)
GGT 105 U/L (< 60)
ALP 77 U/L (30-110)
ALT 29 U/L (< 55)
AST 45 U/L (< 45)
ABG pH 7.29 (7.36-7.44)
PaO2 74 mmHg (70-100)
PaCO2 39 mmHg (35-45)
HCO3- 18 mmol/L (21-26)
BE -8 mmol/L (±3)
Hb 178 g/L (120-180)
     FO2Hb 91.3 % (96-100)
     FCOHb 1.7 % (< 2.0)
     FMetHb 0.7 % (< 1.5)
     FHHb 6.3 % (< 5.1)
Lactate 1.6 mmol/L (< 1.3)
Glucose 10.6 mmol/L (4.0-7.8)

Critically unwell female with decompensated CCF:

  • 2° probable pneumonia
  • intubated / IPPV / inotropes
  • 'aggressive' CVVHDF ∝ fluid overload / AKI
  • liberal Albumin replacement.
 
courtesy: D.Compton
Submitted as HAGMA secondary (in part) to Albumin

However,

  • rise in AG is moderate ≈ 23 and consistent with:
    • level of renal impairment
    • modest fall in HCO3-
    • this alone doesn't suggest presence of another major acid anion
    • supported by modest ↑[lactate] on ABG
  • grossly elevated globulins also present ... ?!!
    • albumin products in AU are >96% albumin
    • albumin replacement per se would not be expected to cause this rise
    • ↑GG (+'ve) may artificially lower the observed AG
      *this may explain
      • severity of clinical picture, c.f. observed AG
      • origin of clinical picture, e.g. underlying MM, auto-immune or hepatic disease
    • haemoconcentration may play a part, noting [Hb]=178 in the setting of 'aggressive' filtration