Specimen Name Result Units Range
Plasma Sodium 139 mmol/L (135-145)
Potassium 3.2 mmol/L (3.5-5.5)
Chloride 123 mmol/L (100-109)
Bicarbonate 4 mmol/L (22-32)
Anion Gap 15 mmol/L (7-17)
Glucose 9.5 mmol/L (3.8-5.5)
Urea 7.0 mmol/L (2.7-7.2)
Creatinine 170 μmol/L (60-110)

23yo female admitted earlier same day with DKA.
DKA & Hyperchloraemic Acidosis
  • Ketoacidosis adequately treated:
    • Glucose & [Na+] ≈ normal
    • AG ≈ normal
  • Persistent hyperchloraemic acidosis ∝
    • renal H2O loss & N-saline IVT: [Na+] ≈ 154 mmol/L / pH ≈ 5-7
    • severe renal HCO3- loss during diuresis
  • Hypokalaemia 2°
    • diuresis & renal losses
    • correction of acidaemia
    • ICF shift with insulin & glucose
  • NB : continued IVT
    • consider ½N-saline + adequate K+
    • HCO3- replacement reasonable, but would ↓K+ further