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As an example how extreme things can get: We had a 81 year old patient with a carcinoma in the head of the pancreas. The drain in his galbladder got sludged and had to be reopened. Hereupon 3 liters (!) of fluid were drained from his biliary system. This increased his creatinine from 221 to 425 micromoles/L in one day. The precise mechanism remains unclear. Volume contraction by redistribution is a factor, but in itself unsufficiently to explain the doubling of creatinine values. Best regards, Raymond Wulkan Rotterdam NL ------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 List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/