Thanks Wolfgang
I wasn't aware of this information. As I said, am
still waiting for toxic alcohols screen by HPLC and
hope that acetone can be detected.
Mohammad
--- Wolfgang Schneider
<[log in to unmask]> wrote: > Hi,
>
> The lactate and B-OH butyrate should be mostly
> ionized at pH 7.1 and
> therefore need a counterion, ie sodium , which is
> accounted for in the
> osmolal gap. Therefore, they can't contribute to the
> osmolal gap; there has
> to be another neutral molecule - acetone ? Is that
> being measured as part
> of the alcohols ?
>
> Wolfgang
>
>
***********************************************************
> Wolfgang Schneider
> Division of Medical Biochemistry, Montreal General
> Hospital
> 1650 Cedar Avenue, Montreal, Quebec H3G 1A4, Canada
> Phone (514)-934-1934 x 42782 Fax (514)
> 934-8086
> Email at work: [log in to unmask]
> Email at home: [log in to unmask]
> Manufactured only with 100% recyclable electrons
>
***********************************************************
>
>
>
>
>
> Mohammad Al-Jubouri
> <[log in to unmask]>@JISCMAIL.AC.UK> on
> 2004-06-15
> 10:46:47 AM
>
> Please respond to Mohammad Al-Jubouri
> <[log in to unmask]>
>
> Sent by: Clinical biochemistry discussion list
> <[log in to unmask]>
>
>
> To: [log in to unmask]
> cc:
> Subject: Re: A metabolic pickle
>
>
>
> Thanks to all replies
>
> Most of you agree that this represents a case of
> alcoholic ketoacidosis but
> find the accompanying lactic acidosis atypical.
> There are at least 3
> further samples showing less severe metabolic
> derangement during her
> therapy with saline infusion, 10% dextrose/insulin
> infusion and pabrinex.
> This is therefore a genuine metabolic derangement
> and citrate contamination
> is not to blame. She needed potassium, magnesium and
> phosphate supplements
> as you might expect with treated metabolic acidosis.
> Her biochemical
> parameters quickly recovered back to normal within
> 24 hours. The
> hypochloraemia due to vomiting has exaggerated the
> calculated anion gap.
> The osmolal gap can probably be expalined by ethanol
> (30 mmol) + lactate
> (15 mmol) and B-OH-Butyrate (15 mmol), but I am
> still waiting for toxic
> alcohols screen.
>
> Learning point: Profound hyperlactataemia can
> accompany alcoholic
> ketoacidosis.
>
> Regards
>
> Mohammad
>
>
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=====
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
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------ACB discussion List Information--------
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