These are the biochemical results taken from a 48-year-old male, missing from an alcohol rehabilitation program and found in his home, comatose, by police, three days from the time he was last seen.
| Parameter | Patient Value | Normal Adult Range |
| Sodium | 126 mmol/L* | 138 – 145 |
| Potassium | 3.5 mmol/L | 3.5 – 5.0 |
| Creatinine | 250 μmol/L* | 40 – 100 |
| Urea | 7.0 mmol/L | 3.1 – 7.5 |
| Bilirubin (total) | 509 μmol/L * | 2.0 – 22.0 |
| Protein (total) | 40 g/L* | 65 – 85 |
| Albumin | 20 g/L* | 38 – 48 |
| Alkaline phosphatase (ALP) | 153 IU/L* | 40 – 100 |
| Gamma glutamyl transferase (GGT) | 459 IU/L* | 0 – 50 |
| Alanine aminotransferase (ALT) | 336 IU/L* | 0 – 45 |
| Creatine kinase (CK) | 400 IU/L* | 30 – 180 |
| Glucose | 3.2 mmol/L* | 3.5 – 4.6 |
| Ammonia | 342 μmol/L | 0 – 50 |
| Lactate | 3.7 mmol/L* | 0.6 – 2.4 |
a) Comment, with explanation, on each of the biochemical abnormalities.
b) List three possible causes of his altered conscious state.
a) Comment, with explanation, on each of the biochemical abnormalities.
Liver dysfunction as demonstrated by elevated enzymes, reduced albumin. Hypoglycaemia with decompensation indicated by marked elevation of ammonia. Hyponatraemia in keeping with cirrhosis.
Raised lactate as a result of liver dysfunction / alcoholic ketoacidosis / sepsis / thiamine deficiency
Raised creatinine indicates renal dysfunction and urea may be apparently “normal” because of
decreased hepatic dysfunction and possible nutritional deficiencies. Urea:creatinine ratio suggests
that GI bleed and/or dehydration are unlikely
b) List three possible causes of his altered conscious state.
This question is nearly identical to Question 29.2 from the second paper of 2011. The answer to that question is also duplicated here, to simplify revision
The following is a list of biochemical abnormalities and plausible explanations for them:
The college asks for three possible causes of unconsciousness in this comatose drunk. Three only. The most relevant ones would have to be
A possible list of differentials would have to also include the following:
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