Hi Ali
Nice to hear from you as well. This is her ABG from the last admission, she felt feverish with loin pain ?UTI and she was started on antibiotics. Mg was 0.58 mmol/L, sinus tachycardia, breathlessness and chest pain. Forgot to mention that these episodes usually associated with syncope.
pH [POCT] 7.37
pCO2 [POCT] 3.93 kPa
pO2 [POCT] 17.20 kPa
Base excess [POCT] -7.8 mmol/L
Base excess ecf [POCT] -7.8 mmol/L
Total Hb (calculated) [POCT] 133.0 g/L
Carboxyhaemoglobin [POCT] 0.8 % <2.0
Methaemoglobin [POCT] 1.2 % <1.5
Sodium [POCT] 140 mmol/L 133-146
Potassium [POCT] 2.5 mmol/L * 3.5-5.0
Chloride [POCT] 109 mmol/L * 95-108
Calcium (ionised) [POCT] 1.20 mmol/L 1.15-1.30
Glucose [POCT] 17.8 mmol/L * 2.8-12.0
Lactate [POCT] 6.0 mmol/L * 0.5-1.6
-----Original Message-----
From: Al-Bahrani Ali [mailto:[log in to unmask]]
Sent: 13 September 2016 11:31
To: Soha Zouwail (Cardiff and Vale UHB - Medical Biochemistry); [log in to unmask]
Subject: RE: Hypokalaemia
Dear Soha
Great to hear from, I hope you are doing well!
What was the pattern of Electrolyte while hypokalaemic was it Hypokalaemia alkalosis or hypercholaermic normal anion gap metabolic acidosis with hypokalaemia.
Kind Regards
ALi
Dr Ali Al-bahrani MBCh.B MSc.Chem Path. EuClin.chem. CSci. FRCPath.
Lead Pathologist for Blood Sciences
RCPath Wessex Professionalism Lead
Consultant Chemical Pathologist and metabolic medicine and HOD of Blood Sciences St Mary's Hospital Newport Isle of Wight
PO30 5TG
United Kingdom
Te: 01983 534859/534917
Kind Regards
ALi
Dr Ali Al-bahrani MBCh.B MSc.Chem Path. EuClin.chem. CSci. FRCPath.
Lead Pathologist for Blood Sciences
RCPath Wessex Professionalism Lead
Consultant Chemical Pathologist and metabolic medicine and HOD of Blood
Sciences
St Mary's Hospital
Newport
Isle of Wight
PO30 5TG
United Kingdom
Te: 01983 534859/534917
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]] On Behalf Of
[log in to unmask]
Sent: 13 September 2016 11:02
To: [log in to unmask]
Subject: Hypokalaemia
Dear all
I wonder if I can pick your brain regarding this patient A 26 year old
lady who experienced recurrent episodes of "weakness and excessive
tiredness" while she was in High School that resulted in many days of
abscences and family attributed that to depression but she had never
sought any medical medical help. These episodes meant that she could
not maintain a job as she was constantly feeling tired. She is fostered
with no information about family history other than a brother who
suffers from epilepsy.
She has moved area and was later diagnosed with fibromyalgia. She
experiences a constant feeling of palpitations and had several A&E
attendances with these symptoms heart rate 140 bpm, hypokalaemia
2.5mmol/L, lactic acidosis, sometimes hypoMg, breathlessness and
sweating .
She was diagnosed with inappropraite sinus tachycardia. 24hr heart rate
was 115 bpm with a range of 90-160. Beta blockers and ablation had no
effect on her heart rate. Thyroid function is normal and in between
these episodes her bloods including K are all normal. No renal K wasting
was found. These episodes can happen at any time and there is no
definite precipitating factor. She said that she started to experience
constant weakness in her left arm with weak grip and is waiting for an
EMG. Genetics (CACNA1S and SCN4A) have excluded Hypokalaemic periodic
paralysis, Conn's have been excluded as well. She has a right kidney
stone.
Do you think that the HypoK is secondary to the sustained tachycardia?
If that is the case why would her potassium be normal in between the
episodes if she experiences constant tachycardia ?
Any other investigations that should be done in this case?
Many thanks for your help in revealing the mystery of this case.
BW
Soha
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