Michael,
You don't say how these analytes were measured: presumably indirect ISE
for sodium.
Direct ISE result for sodium would be useful ( e.g. blood gas
analyser, neighbours Vitros analyser etc).
LipoClear tubes are excellent for clearing lipids in samples like
these.
Try
www.phitec.co.uk
or
http://www.phitec.co.uk/products/productdetail.asp?SubProductId=75&ProductId=41&ManuId=37
Regards, Wayne Bradbury
Mr. W.H. Bradbury
Consultant Biochemist
Cumberland Infirmary
CARLISLE
CA2 7HY
Telephone: 01228 814521
Facsimilie: 01228 814831
E-mail: [log in to unmask]
>>> "Colley, Michael" <[log in to unmask]> 20/12/04
16:03:56 >>>
Your help is requested.
Female 34 years of age. Admitted on 18/12/04 at 39/40 pregnancy with
upper
abdo. pain.
Comment Sample is extremely lipaemic ?validity of
results.
Sodium ! 114 mmol/L 135 - 145
! LOW
Potassium 3.92 mmol/L 3.5 - 5.0
Urea * 10.9 mmol/L 2.5 - 6.6 *
high
Serum amylase 97 U/L 30 - 122
Total Protein * 90 g/L 60 - 80 *
high
Serum Albumin 37 g/L 35 - 50
Aspartate transaminase 24 U/L
Gamma Glutamyl Transferas 7 U/L 5 - 50
Serum bilirubin Lipaemic sample - ?validity of result
*/L
Alkaline Phosphatase 141 U/L 30 - 170
C-reactive protein Lipaemic sample - ?validity of result
*/L
Trigs 86 mmol/L
Chol 26 mmol/L
No apparent settling after two days - presumably no chylomicrons.
Hb 11.4 g/dl 11.5 - 16.5
RBC 3.80 x10^12/l 3.8 - 5.8
PCV * 0.334 0.370 - 0.470 *
low
MCV 88.0 fl 76 - 96
MCH 29.9 pg 27 - 32
MCHC 34.0 g/dl 31.5 - 36.0
RDW 13.8
TOTAL WBC * 13.0 x10^9/l 4.0 - 11.0 *
high
Glucose 9 mmol/L (?stress induced)
OK. So triglyceride induced pancreatitis as possibility, with
apparently
(lipid interfered with?) normal amylase, but whence the elevated
trigs/chol?
No history of alcohol. Possible Non-alcoholic steatohepatosis??
No
recorded FH of elevated lipids, though father died in 20s after having
Rheumatic fever as a child.
PMH - kidney stone in previous pregnancy No comment re. lipaemia in
previous pregnancy (2002) or in Downs screening sample July 2004.
LFTs pretty unremarkable (or ?should be higher if it weren't for
lipid).
Presumably many of the results are depressed as a result of the lipid
content of the serum.
Laparotomy performed at Caesarian section. Nil found except milky
fluid in
abdominal cavity, and continuing to drain via abdominal drain. ?chyle
leak
?exudate
Today's sample, still markedly lipaemic, with haemolysis ( ? Zieve's
without
alcohol )
The thoughts of my esteemed colleagues would be much appreciated.
Michael
[Colley, Michael]
-----Original Message-----
From: Les Culank [mailto:[log in to unmask]]
Sent: 20 December 2004 14:58
To: [log in to unmask]
Subject: Re: fat embolus
Our Histopath / Morbid Anat / Forensic Path colleagues might also be
of
help,
but not usually ante-mortem I'm afraid.
Best wishes
Les
From: Mohammad Al-Jubouri <[log in to unmask]>
Reply-To: Mohammad Al-Jubouri <[log in to unmask]>
Date: Mon, 20 Dec 2004 14:20:33 +0000
To: [log in to unmask]
Subject: Re: fat embolus
No there isn't. Lipuria doesn't occur in all cases and if it occurs it
is a
late sign. Retinal examination to detect fat globules in retinal
vessles may
be more helpful, in a patient with characteristic petechiae, pulmonary
and
cerebral dysfunction following long bone fractures.
Mohammad
"Taylor, Andrew" <[log in to unmask]> wrote:
Is there a useful biochemical investigation for suspected fat embolism
in
orthopaedic patients. I vaguely remember chyluria - anyone have any
ideas
please?
Thanks
Dr. M A Al-Jubouri
Consultant Chemical Pathologist
_____
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