Clinical Chemistry Test 2B Total Marks Time allocated Examiner: Moderator:

REFERENCE RANGES/NORMAL RANGES Blood Na K Cl HCO3 Urea Creatinine Glucose Osmolality Anion Gap H+ pH pCO2: 136 145 mmol/L 3.5 5.0 mmol/L 95 106 mmol/L 22 -30 mmol/L 2.5 6.4 mmol/L 53 106 mol/L 3.5 5.5 mmol/L 280 300 mosmol/kg 8 16 mmol/L 36 - 44 nmol/ 7.35 7.45 35 45 mmHg Na K Creatinine Osmolality Urine

17 May 2012 80 1.5 hours Prof T Matsha Mr T Mouton

50 - 200 mmol/24 hour 20 - 60 mmol/24 hour 9 16 mmol/24 hour 300 - 1200 mosmol/kg

Question 1
1.1 A 54 year old man on the psychiatry ward for treatment of manic-depressive disorder. He states that he is always thirsty, and he has a daily urine output of approximately 8L/day. The following laboratory results were obtained. Serum Na K Cl HCO3 Urea Creatinine Glucose Osmolality 126 mmol/L 3.0 mmol/L 92 mmol/L 25 mmol/L 5.0 mmol/L 102.1 mol/L 5.6 mmol/L 269 mosmol/kg Urine Na K Cl Osmolality Creatinine < 10 mmol/L 3.5 mmol/L < 15 mmol/L 53 mosmol/kg 31.7 mmol/L

1.1.1 What would be the most likely reasons for the high urine output by the patient. Give reasons for your answer. 1.1.2 Of the reasons stated in 1.1.1, state which of them contributed to low urine osmolality as observed in this patient. EXPLAIN. 1.1.3 Briefly explain the abnormal sodium results observed in this patient and recommend treatment. 1.1.4 Calculate the osmolol gap for this patient. 1.2 The following laboratory results were obtained from a 40 year old woman: Venous blood Na Cl HCO3 Urea Glucose 140 mmol/L 96 mmol/L 14 mmol/L 6.7 mmol/L 5.9 mmol/L Urine ketones negative (5) (4) [30]
2

(6)

(6)

(4) (5)

Aterial blood pH pCO2 HCO3 7.12 34 mmHg 16 mmol/L

1.2.1 Calculate the anion gap for this patient and comment on your results. 1.2.2 Discuss the calculated anion gap in 1.2.1 in relation to urea and glucose results.

Question 2
2.1 For the following cases; state the acid-base disturbance the patient is suffering from and substantiate your answer with the appropriate clinical and laboratory findings. 2.1.1 JT, a 5-year-old, previously healthy boy, was admitted to the pediatric intensive care unit after 2 weeks of polydipsia, polyuria, weight loss, fatigue, and irritability. His eyes were sunken, his mucous membranes were dry and cracked, and he had tenting of his skin. He was lethargic and irritable in response to stimulation. Heart rate was 155/min, and respirations were 62/min. Urine ketones were positive. Results of electrolyte and arterial blood gas analyses are listed below: Venous blood Na Cl HCO3 Glucose 131 mmol/L 96 mmol/L 10 mmol/L 36.4 mmol/L (6) 2.1.2 A 57 year-old woman presents with 2 days of fevers, dyspnea and a cough productive of rustcolored sputum. The patient has a history suggestive of pneumonia. The intern decides to obtain an arterial blood gas analysis while they are waiting for the chest x-ray to be done. The blood gas reveals: Aterial blood pH pCO2 HCO3 Base excess 7.54 25 mmHg 22 mmol/L -1 (6) 2.1.3 A 65 year-old man is brought into the hospital with complaints of severe nausea and weakness. He has had problems with peptic ulcer disease in the past and has been having similar pain for the past two weeks. Rather than see a physician about this, he opted to deal with the problem on his own and, over the past week, has been drinking significant quantities of milk and consuming large quantities of TUMS Aterial blood pH pCO2 HCO3 7.19 32 mmHg 9 mmol/L

(calcium carbonate). The intern working in the emergency services decides to draw arterial blood for blood gas analysis, which reveals: Venous blood Na Cl HCO3 139 mmol/L 95 mmol/L 34 mmol/L Aterial blood pH pCO2 HCO3 7.47 49 mmHg 34 mmol/L (4) 2.1.4 A 24 year-old woman is found down in Tygervalley by some bystanders. The medics are called and, upon arrival, find her with dilated pupils on examination. Shewas brought into the Tygerberg Hospital where an arterial blood gas was performed and revealed: Aterial blood pH pCO2 HCO3 Base Excess 7.25 60 mmHg 26 mmol/L 1 (5) 2.2 Caluculte the anion gap for cases 2.1.1 and 2.1.3. 2.3 What is the possible reason for the different HCO3 results obtained from arterial and venous bloods in case 2.1.1. 2.4 Describe how H is excreted by the kidneys.
+

(6)

(3) (10) [40]

Question 3
3.1 State the advantages of automating methods in a clinical chemistry laboratory. (4)

3.2 Name the three basic approaches that are applied with automated analysers and state either the advantages or disadvantages of these approaches. (6) [10]