Possibly re-feeding syndrome, both phosphate and K fallen
dramatically, with the use of dextrose and I assume the resultant
endogenous insulin secretion, leading to re-distribution of phosphate and K
into the cells.
Simon Fleming
Royal Cornwall Hospital
Truro.
> -----Original Message-----
> From: Taylor, Andrew [SMTP:[log in to unmask]]
> Sent: Friday, September 08, 2000 17:17
> To: [log in to unmask]
> Subject: something for the weekend?
>
> I wonder if anyone can offer an explanation of these results:
> patient with chronic alcohol problem, repeated previous admissions with
> vomiting accompanied by hypokalaemia, arrives in casualty:
> Sod 146
> Pot 4.0 |Bil + 42 |GGT + 48
> Urea + 9.6 |ALP 74 |
> Crea + 261 |Prot + 91 |TSH 2.79
> Gluc + 7.2 |Alb 52 |
> Calc 2.69 |ALT 30 |
> PO4 + 2.50 |Glob + 39 |
>
> looks dry, IV dextrose started.
> 4 hours later, patient collapses, cardiopulmonary resus, including further
> 2
> litres IV (gelofusine and Hartmann's)
>
> Sod 137 |Alb - 27
> Pot - 1.8 |Calc - 1.77 |ALT + 66
> Bic 35 |PO4 0.81 |Glob 29
> Urea + 8.8 |CPK + 22080
> Crea + 271 |Bil + 26
> Gluc 4.7 |ALP 39 |
> |Prot - 56 |
>
> Could the potassium fall be explained by rehydration? (the second
> potassium
> result is of course what one might expect in a patient with prolonged
> vomiting (K loss in gastric fluid, metabolic alkalosis due to H loss in
> gastric fluid causing potassium shift into cells, loss in urine)). Note
> the
> fall in albumin is suggestive of significant expansion of plasma volume
> having occurred, but the urea isn't.
> incidentally the CK is attributed to neuroleptic drug
>
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