Lab case 78 – Interpretation

A 64 year old critically unwell female requiring immediate resuscitation

  1. Mixed HAGMA, respiratory acidosis and possible NAGMA – triple acid base disorder

Anion Gap = 22

Delta ratio = 0.625

Mild hyponatraemia

Severe hyperkalaemia

Severe lactate acidosis

Acute renal failure

Obstructive jaundice – ??Ascending Cholangitis

elevated Troponin – ??AMI



Shock – septic, hypovolaemic, cardiogenic, ??obstructive

consider causes of HAGMA, Resp acidosis and NAGMA

??haemolysed sample – check ECG and repeat/ treat as high

Delta ratio suggests additional NAGMA but is often <1 in renal failure


Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke (MELAS) syndrome is a progressive neurodegenerative disorder.

Sporadic or maternal transmission

Other features, such as seizures, diabetes mellitus, hearing loss, cardiac disease, short stature, endocrinopathies, exercise intolerance, and neuropsychiatric dysfunction are also part of the disorder.

80% of patients have a mutation in tRNA at base pair 3243 A-G mutation

3. Resuscitate

Treat K



End of life care issues