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I think the previous comment re OG is valid. L and P contribute to AG but not OG. Ahmed Waise York Hospital Wigginton Road YORK YO31 8HE Tel 01904 725855/ 725670 [log in to unmask] -----Original Message----- From: Mohammad Al-Jubouri [mailto:[log in to unmask]] Sent: 15 June 2004 16:07 To: [log in to unmask] Subject: Re: A metabolic pickle/little addition Sorry, just forget to say that thiamine deficiency in alcoholic patients is the cause of raised pyruvate and lactate, as suggested Tim Reynolds. thanks Mohammad Mohammad Al-Jubouri <[log in to unmask]> wrote: 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 Mohammad Al-Jubouri <[log in to unmask]> wrote: Dear All A 62-year-old lady presented with short history of vomiting and breathlessness. Physical examination was unremarkable!!, CXR normal. A biochemical profile showed: U/E: Na 143 mmol/L, K 4.6 mmol/L, urea 8.3 mmol/L, creatinine 150 umol/L, chloride 87 mmol/L, bicarbonate 8.0 mmol/L. LFTs: Bilirubin 12 umol/L, ALP 102 IU/L, ALT 39 IU/L, AST 67 IU/L, GGT 42 IU/L, albumin 46 g/L. Others: glucose 11.2 mmol/L, CK 67 IU/L, adjusted calcium 2.24 mmol/L, phosphate 3.44 mmol/L, osmolality 361 mOsm/kg, CRP < 5 mg/L, INR 1.0 Acid base status: pH 7.13 kPa, PCO2 2.7 kPa, PO2 11.2 kPa Anion gap 54 mmol/L Osmolal gap > 50 mmol/L Lactate 15 mmol/L Beta-hydroxybutyrate 15 mmol/L Serum alcohol 136 mg/dL Toxic alcohols screen: to follow. Drug history: None. Alcohol drinking: ++++ Impression: Profound combined lactic/ ketoacdosis. Question: can all this be due to alcohol only? have you had any experience with a similar case, would be grateful for your comments. regards Mohammad Dr. M A Al-Jubouri Consultant Chemical Pathologist _____ <http://uk.rd.yahoo.com/evt=21626/*http://uk.messenger.yahoo.com> ALL-NEW Yahoo! Messenger - sooooo many all-new ways to express yourself ------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/ Dr. M A Al-Jubouri Consultant Chemical Pathologist _____ <http://uk.rd.yahoo.com/evt=21626/*http://uk.messenger.yahoo.com> ALL-NEW Yahoo! Messenger - sooooo many all-new ways to express yourself Dr. M A Al-Jubouri Consultant Chemical Pathologist _____ <http://uk.rd.yahoo.com/evt=21626/*http://uk.messenger.yahoo.com> ALL-NEW Yahoo! Messenger - sooooo many all-new ways to express yourself ------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/ ------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/