Specimen Name Result Units Range
Plasma Sodium 126 mmol/L (135-145)
Potassium 3.1 mmol/L (3.5-5.5)
Chloride 96 mmol/L (100-109)
Bicarbonate 17 mmol/L (22-32)
Anion Gap 16 mmol/L (7-17)
Glucose 19 mmol/L (3.8-5.5)
Urea 4.2 mmol/L (2.7-7.2)
Creatinine 150 μmol/L (60-110)
Phosphate 0.49 mmol/L (0.80-1.45)
Total Calcium 1.51 mmol/L (2.10-2.55)
Albumin 38 g/L (34-48)
Total Protein 59 g/L (60-80)
Total Bilirubin 29 μmol/L (6-24)
ALP 74 U/L (30-110)
Amylase 100 U/L (20-100)
Blood Hb 180 g/L (130-180)
Platelets 156 x109/L (150-450)
WCC 14.0 x109/L (4.0-11.0)
INR 1.5 (0.8-1.2)
APTT 40 Sec. (25-35)
ABG pH 7.26 (7.36-7.44)
PaO2 87 mmHg (70-100)
PaCO2 38 mmHg (35-45)
HCO3- 17 mmol/L (21-26)

45yo male smoker with history of heavy alcohol intake.

Admitted 3 days ago with severe abdominal pain.
Acute Pancreatitis (Day 3)
  • abdominal pain with ↑lipase
    *amylase was mildly elevated initially
  • ionized Ca++ ≈ 0.97 mmol/L
  • mixed metabolic and respiratory acidosis
  • mild {pre-renal impairment + ↑WCC + ↑bilirubin + ↑BGL}
    → all consistent with acute pancreatitis

 

Aetiology:

  1. Ethanol*
  2. Gallstones* : → {1+2} ≈ 85%
  3. Idiopathic ≈ 7%
  4. Traumatic
  5. Familial / hereditary
  6. Cystic fibrosis
  7. SIRS, ARDS, MODS → ?ischaemic pancreatitis
  8. Metabolic
    • hyperlipidaemia
    • hyperparathyroidism, hypercalcaemia
    • renal failure
    • acute fatty liver of pregnancy
    • haemochromatosis
  9. Infections
    • viral hepatitis, mumps
    • Coxsackie, Echovirus and other viruses
    • Mycoplasma, Ascariasis
  10. Autoimmune → "pancreatic vasculitis"
    • SLE, TTP, necrotising vasculitis
  11. Drugs
    • thiazides, frusemide, valproate
    • vit D, oestrogens
    • sulphonamides, tetracyclines, azathioprine
    • possible associations : steroids, methyl-dopa, procainamide, chlorthalidone, ethacrynic acid, β-blockers, cimetidine, clonidine, rifampicin, phenformin, paracetamol
  12. Toxins
    • methanol
    • scorpion envenomation
    • organophosphate poisoning
  13. Renal transplant
    • surgery
    • hypercalcaemia, steroids (?), diuretics
    • viral infections, immunosuppressives
  14. GIT disease
    • duodenal ulcer, penetration / perforation
    • Crohn's disease
    • obstruction of the Ampulla of Vater
    • pancreas divisum