Dear colleagues,
I would appreciate any help in respect of a query I just had from a GP
concerning a 39 year old male patient.
Late yesterday evening I was authorising a last few results before going
home when a sample from a GP patient was flagged as outside the delta limits
for calcium. Corrected (/adjusted) calcium had dropped from 3.18 mmol/L on
23/10 to 2.44 on 1/11. At the same time PO4 dropped from 1.14 mmol/L to
0.62.
Although only bone profile was requested on the second day I added renal and
liver profiles to compare to the first day. There were some interesting
changes, including, 23/10 Cl=96, TCO2=32, urea=4.6, creat=134, versus 1/11
Cl=103, TCO2=28, urea=4.4, creat=90.
The doctor was gone home when I phoned but I left a message and she phoned
back this morning. On the 23rd this man had been very sick with sinus/chest
problems and also had a red face with what the doctor described as a very
flary rosacea. Klacid (clarithromycin) was the main ingredient of treatment.
A week later his chest was a lot better but not clear.
My first thought when I see results changing like this is to strongly
consider a sample mix-up. However, the samples were taken in the hospital
under circumstances that imply a mix-up was unlikely. I checked with
Haematology and the view from there was that the FBC results were consistent
with the samples being from the same patient (though we sometimes see that
even when we know there's been a mix-up).
I would appreciate views from colleagues on this case, particularly if
you've seen anything like this before (which I haven't). I can work out
possible scenarios on theoretical grounds, but to be honest I don't have
much faith in them. For example, could it be sarcoidosis? Any thoughts would
be appreciated.
best wishes.
Peadar
Dr Peadar McGing, MRCPath EurClinChem,
Principal Biochemist,
Biochemistry Dept., Mater Misericordiae University Hospital,
Eccles Street, Dublin 7, Ireland.
Tel: (+353 1)8032080; Fax: (+353 1)8034781.
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