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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/