Sudden deterioration means perforated viscus, sepsis or both.
It will help to give the full biochemistry profile including trends of UEs, CRP, Calcium, Phosphate and albumin.
The discrepant serum sodium and chloride results suggests contamination of sample by a sodium phosphate containing compound/drug (? antibiotic salt). The lactate is worryingly high (if true) and could reflect a state of irreversible shock with high mortality.
Best regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin, FRCPath
Consultant Chemical Pathologist
--------------------------------------------
On Wed, 6/8/14, Dr. Sutirtha Chakraborty <[log in to unmask]> wrote:
Subject: Suggestions please
To: [log in to unmask]
Date: Wednesday, 6 August, 2014, 7:56
David - What is the cause
of GOO? Malignancy?A sudden rise in Na can be due to a
CNS dysfunction like raised intracranial pressure. Any
changes in CNS function.Best
Regards,Sutirtha
On Monday,
August 4, 2014, David James <[log in to unmask]> wrote:
This one has us scratching our
heads – suggestions please
Patient with gastric outlet
obstruction, has been on IVN for a few weeks, biochemically
stable (mild hyponatraemia +/- 130mM).
Over weekend, suddenly
deteriorates, pH on 2 separate gas analysers 7.34
Lactate (BGA + lab) around 32mM,
PO4 5.7mM
Na increased rapidly to 160mM, Cl
67mM
Some vomiting, but not to extent
that clinician believes would cause increase in Na due to
fluid loss
DJ
This message contains
confidential information and is intended only for the
individual named. If you are not the named addressee you
should not disseminate, distribute or copy this e-mail.
Please notify
the sender immediately by e-mail if you have received this
e-mail in error and delete this e-mail from your system. If
you are not the intended recipient you are notified that
disclosing, copying, distributing or taking any action in
reliance on the contents
of this information is strictly prohibited.
------ACB discussion List Information--------
This is an open discussion list for the academic and
clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the
individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
--
Thanks and Regards,
Dr Sutirtha Chakraborty, MD
Consultant,Dept of Biochemistry
Peerless Hospital&B.K Roy Research
Center
Kolkata 700094,India
Mobile: +91 9874787638
------ACB discussion List Information--------
This is an open discussion list for the academic and
clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed
via the internet. Views expressed are those of the
individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/
|