The following venous blood results are from a 56-year-old patient presenting with abdominal pain.
Parameter |
Patient Value |
Adult Normal Range |
|
Sodium |
130 mmol/L' |
135 - 145 |
|
Potassium |
5.1mmol/L |
3.5 - 5.0 |
|
Chloride |
101 mmol/L |
95 - 105 |
|
Bicarbonate |
10 mmol/L |
22 - 28 |
|
Creatinine |
305 umol/L |
50 - 100 |
|
Urea |
75.6 mmol/L* |
3.5 - 7.2 |
|
Glucose |
5.2 mmol/L |
3.5 - 6.0 |
|
Calcium corrected |
2.05 mmol/L* |
2.12 -2.62 |
|
Ionized Calcium |
0.97 mmol/L* |
1.14 -1.30 |
|
Phosphate |
3.97 mmol/L* |
0.73 - 1.37 |
|
Protein |
66 g/L - |
61 - 83 |
|
Albumin |
29 g/L* |
35 - 50 |
|
Alkaline phosphatase |
220 U/L• |
30 - 110 |
|
y-Glutamyl transferase |
30 U/L |
< 40 |
|
Alanine transferase |
27 U/L |
< 35 |
|
Magnesium |
0.83 mmol/L |
0.75 -0.95 |
Interpret the biochemical results, giving underlying reasons to explain the abnormalities.
(40% marks)
• Chronic renal failure with secondary hyperparathyroidism
• Elevated urea and creatinine
• Decreased calcium, raised ALP and phosphate
• Dehydration or GI bleed
• Raised U:Cr
• Mixed HAGMA and NAGMA
• Low HCO3 and delta ratio >1
• Chronic renal failure (uraemia and RTA)
• Acute on chronic renal failure (sepsis, dehydration, GI bleed etc.)
(Other reasonable explanations were accepted.)
Let us dissect these results systematically:
The college do not ask for a diagnosis.