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Hi Cheryl,
 
This patient has bulimia nervosa with self induced vomiting, the clue is the hypochloraemic hypokalaemic metabolic alkalosis with intravascular volume contraction and the absent urinary chloride.
 
Best wishes
 
Mohammad
 
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
From: cheryl rigg <[log in to unmask]>
To: [log in to unmask]
Sent: Friday, April 20, 2012 12:15 PM
Subject: Unusual case of hypokalaemic alkalosis

Attached is an interesting case of a 21 year old man presenting to his GP on 23rd Dec 2011 with a skin rash, otherwise fit and healthy. His biochemistry revealed an apparent hypokalaemic alkalosis with hyponatraemia. He was admitted to hospital where he improved rapidly with IV saline and potassium. He was discharged on Christmas Day with Sando K supplements.
 
There is little to note from previous history and biochemistry from 2009 appeared normal. Despite a number of investigations, the reason for the derangement in electrolytes remains a mystery.
 
A summary of his results is attached, including his urine electrolytes which are also unusual. Any opinions on the cause would be appreciated.
 
Many thanks,
 
Cheryl Rigg
Trainee Biochemist, Hull Royal Infirmary
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------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/