Lab case 404 interpretation

PH = 7.395, that is within normal range.

pCO2 = 42 mmHg, Normal for venous blood gases ( Normal pCO2 is 40 mmHg for arterial blood and 48 mmHg for venous).

HCO3 = 25 mmol/L. that is very slightly above the normal (normal level is 24)

Next we will calculate the Anion Gap for this patient. Anion gap is calculated as:

Na- (HCO3+Cl) = 131 – (93+25) = 13, that is slightly elevated.

The presence of mildly elevated AG and slightly elevated HCO3 raise the possibility of combined HAGMA and metabolic alkalosis.

Other abnormal findings:

Na = 131 mmol/L, that is mild hyponatraemia. However, Na level is influenced by Glucose level. The presence of high serum glucose level causes pseudohyponatraemia due to osmotic shift of water from intracellular compartment.

To calculate corrected Na level, we use the following equation:

Corrected Na = Measured Na + (Glucose – 5)/3. According to this, the corrected Na level for this patient is 142 mmol/L.

Glucose of 39 mmol/L, that is severe hyperglycemia.

Lactate = 1.6 mmol/L, that is acceptable for a patient in stressed physiology.

Ketones = 1.6 mmol/L, that is mildly elevated.

This patient has severe hyperglycemia with normal PH, lactate and acceptable ketones level. He doesn’t fit the definition of DKA. This happened because this patient had intact kidneys.

However, this patient should be managed as DKA.