26-year-old man comes in for flank pain. He has a history of renal stones. It is August in Alabama, he has been working outside. He does state that he has been drinking and urinating.
| Na | 139 | Cl | 92 | BUN | 28 | glu | 128 |
| K | 4.5 | CO2 | 22 | creat | 2.5 | Ca++ | 10.6 |
These lab tests led to his admission. What can you glean from these labs? Postulate on the cause of these numbers.
{ 4 comments… read them below or add one }
1) Anion gap of 25
2) Delta gap of 13
3) Hes' got an anion gap metabolic acidosis
4) Since his bicarb is not 11, but 22, he also has a primary metabolic alkalosi
Two possibilities here:
5) I noticed he's got a high normal calcium, which can be seen with volume depletion. I'm not sure if the renal stones have anything to do with his lab abnormalities without a CT or ultrasound to check for hydro. He may have renal failure from rhabdo. You say he's "drinking". If it's EtOH, then his gap is from alcohol. I assume he's not a drinker of toxic alcohols. If he doesn't drink, it's perhaps lactate or starvation ketosis. I doubt he's a diabetic on metformin. You only read about that in text books.
6) The other possibility is that he's got an obstructive kidney stone from getting dehydrated and now he's got an obstruction. He's still peeing because it's only unilateral. It sure would be nice to see his UA and micro.
agree early myoglobinuric renal failure is a good possibility.
Broken record – need a blood gas.
U/A – check for blood , no cells and myoglobin.
Also CPK, aldolase.
In absence of that w/u for primary hyperparathyroidism
Primary AG metabolic acidosis and primary metabolic alkalosis
Would be helpful to know osmolal gap. Suspicious for ethylene glycol intoxication given history of kidney stones perhaps due to calcium oxalate crystals and renal insufficiency.
Metabolic alkalosis maybe due to contraction alkalosis/volume depletion.
does he take calcium carbonate for GERD ?