A 70 year old female presents generally unwell with malaise and fatigue for the past two days.
Her blood results are as follows:
Hb 95 g/l (110-155)
PCV 0.280
MCV 78
MCH 26
Plt 589 (150 -400) X10^9
WCC 15.1 (4-11) X10^9
Na 138 mmol/l (137-145)
K 6.0 mmol/l (3.5-5)
Cl 102 mmol/l (99-111)
HCO3 18 mmol/l (24 +-2)
Urea 16.7 mmol/l (3-8)
Creat 356 umol/l (30-100)
1. Describe and interpret the abnormalities
2. What ECG changes would you expect?
Mildly hypochromic, mildly microcytic anaemia:
?secondary to chronic renal impairment, iron deficiency, chronic disease
?Acute on chronic renal failure – moderate hyperkalaemia, uraemia, high creatinine
?secondary to sepsis/intercurrent illness although wcc and platelets not hugely deranged
HAGMA based on HCO3 with anion gap of 22
Delta (22-12 =10)/(24-18 =6). = 1.6, pure HAGMA
Would like to see lactate /glucose/pH on formal gas and capillary ketones.
I think the uraemia is too low to account for this on its own, however if this is in conjunction with metformin in an acute renal deterioration?
ECG changes in moderate hyperkalaemia include repolarisation abnormalities (tall peaked t waves) and early flattening of p waves
If there is cardiac hypoperfusion from the same renal insult there may also be some mild widespread ischaemic changes.
Or I could be way off the mark since its 3am!
Very good Rachel. One more thought, could there be some acute blood loss on top of all the chronic changes, Possibly GI. The low HB with low Hct and high platelets may suggest this.
3 am, wow that’s dedication or you could be bored at work