Lipase?

 

 

Thanks Ali,

 

A good start, these are the initial arterial blood gases results:

 

pH         + 7.492       

Std Bicarb   26.5

pCO2       - 4.74        

Chloride     68

pO2        - 3.3         

Ion Cal    - 0.94

Base XS    + 4.1         

O2 SAT       46.7        

Sodium       103         

Potassium    4.1         

Glucose      5.2         

Lactate      2.50        

ctHb         169         

fO2Hb        45.5        

fCOHb        2.1        

fMetHb       0.4         

 

 

The initial working diagnosis by the medics was pneumonia with para-pneumonic effusions and 4 litres of serosanguinous fluid have been drained via bilateral chest drains.

 

I would argue that the urinary sodium & osmolality are consistent with acute water intoxication with inappropriate anti-diuresis given the very low urinary sodium and inappropriately high urine osmolality.

 

The volume status of the patient was euvolaemic with normal BP but tachycardic.

 

Hint: you can’t really suggest a final diagnosis without performing an extra biochemical test.

 

Mohammad

 

 

 

Supportive of dilutional/appropriate  hyponatraemia and U&E – very likely CA lung –  probably the low urine Na is due to long term salt wastage driven by excess ethanol intake. What is the HCO3/Anion gap/ADH/Aldo!

 

 

Dear mailbase members,

 

You may find this case interesting.

 

 

A 40 year old man presented with severe dyspnea of 5 days duration. CXR showed massive bilateral pleural effusions and biochemistry showed:

 

Sodium     - 108 mmol/L     

Potassium    4.8         

GGT        + 69

Urea         3.1         

ALT          35

Creatinine - 30          

ALP        + 173

Bilirubin    14

CRP        + 266         

Albumin    - 23

Cortisol   + 1000 nmol/L        

S.Osmolal  - 223

EGFR        >90         

TSH          1.87

TnI     <10 ng/L

 

FBC: WC 31.5 mainly neutrophils, HB162 g/L, platelets 345

INR: 1.2

D-dimer: >5000

 

Urine biochemistry:

Ur.Osmolal   673

Ur.Sodium    <5

Ur.Potas     61

Ur.Creat     9.85 mmol/L

 

Pleural fluid biochemistry:

Visual appearance: serosanguinous

Glucose      2.7

Fluid LDH    919

Protein      22

Albumin      12

Sodium       107

Potassium    3.6

Urea         3.7

 

The patient was a heavy drinker.

 

Could you suggest further biochemical tests in order to arrive at the final diagnosis?

 

Reply directly to the mailbase please for a better collective interaction and reasoning.

 

Regards,

 

Mohammad

       

Dr. M. A. Al-Jubouri

MBChB, FRCP Edin, FRCPath

Consultant Chemical Pathologist

Clinical Director of Pathology

St. Helens & Knowsley Teaching Hospitals

 

 

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