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)
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)

Critically unwell male patient.

On 'aggressive' CVVHDF with Albumin replacement.

 
submitted 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
  • grossly elevated globulins also present?
    • albumin products in AU are >96% albumin
    • generous albumin replacement would not be expected to cause this rise
    • if GG (+) then this would artificially lower the observed AG
    • this may explain
      • severity of clinical picture, c.f. observed AG
      • origin of clinical picture, e.g. underlying MM or hepatic disease