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 µmol/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 1 1 A 54 year old man on the psychiatry ward for treatment of manic-depressive disorder. Give reasons for your answer.0 mmol/L 92 mmol/L 25 mmol/L 5.7 mmol/L 5. 1.2.0 mmol/L 102.2. and he has a daily urine output of approximately 8L/day.12 34 mmHg 16 mmol/L 1.2 Of the reasons stated in 1.1 in relation to urea and glucose results. 1.6 mmol/L 269 mosmol/kg Urine Na K Cl Osmolality Creatinine < 10 mmol/L 3.1 Calculate the anion gap for this patient and comment on your results.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. 1.4 Calculate the osmolol gap for this patient.1 µmol/L 5.7 mmol/L 1. 1.3 Briefly explain the abnormal sodium results observed in this patient and recommend treatment.1.9 mmol/L Urine ketones negative (5) (4) [30] 2 (6) (6) (4) (5) Aterial blood pH pCO2 HCO3 7.1.1. EXPLAIN.2 Discuss the calculated anion gap in 1.1. He states that he is always thirsty. .5 mmol/L < 15 mmol/L 53 mosmol/kg 31.1 What would be the most likely reasons for the high urine output by the patient.Question 1 1. state which of them contributed to low urine osmolality as observed in this patient. Serum Na K Cl HCO3 Urea Creatinine Glucose Osmolality 126 mmol/L 3.2. The following laboratory results were obtained.1.1. 1. Heart rate was 155/min. and respirations were 62/min.2 A 57 year-old woman presents with 2 days of fevers. a 5-year-old. 2. fatigue. his mucous membranes were dry and cracked. was admitted to the pediatric intensive care unit after 2 weeks of polydipsia. His eyes were sunken. The intern decides to obtain an arterial blood gas analysis while they are waiting for the chest x-ray to be done. and irritability. The blood gas reveals: Aterial blood pH pCO2 HCO3 Base excess 7.1. he opted to deal with the problem on his own and. state the acid-base disturbance the patient is suffering from and substantiate your answer with the appropriate clinical and laboratory findings. 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 36.19 32 mmHg 9 mmol/L 3 .1 For the following cases. polyuria. has been drinking significant quantities of milk and consuming large quantities of TUMS Aterial blood pH pCO2 HCO3 7.54 25 mmHg 22 mmol/L -1 (6) 2. He has had problems with peptic ulcer disease in the past and has been having similar pain for the past two weeks. over the past week. The patient has a history suggestive of pneumonia.1. and he had tenting of his skin. weight loss. dyspnea and a cough productive of rustcolored sputum.3 A 65 year-old man is brought into the hospital with complaints of severe nausea and weakness. He was lethargic and irritable in response to stimulation. previously healthy boy.4 mmol/L (6) 2. Urine ketones were positive. Rather than see a physician about this.Question 2 2.1.1 JT. 1.1 State the advantages of automating methods in a clinical chemistry laboratory. (4) 3.1 and 2.3.1.3 What is the possible reason for the different HCO3 results obtained from arterial and venous bloods in case 2.1. + (6) (3) (10) [40] Question 3 3. which reveals: Venous blood Na Cl HCO3 139 mmol/L 95 mmol/L 34 mmol/L Aterial blood pH pCO2 HCO3 7. The medics are called and.1. 2. (6) [10] 4 .25 60 mmHg 26 mmol/L 1 (5) 2.4 A 24 year-old woman is found down in Tygervalley by some bystanders.2 Caluculte the anion gap for cases 2.1.47 49 mmHg 34 mmol/L (4) 2. Shewas brought into the Tygerberg Hospital where an arterial blood gas was performed and revealed: Aterial blood pH pCO2 HCO3 Base Excess 7.(calcium carbonate). 2.4 Describe how H is excreted by the kidneys. upon arrival.2 Name the three basic approaches that are applied with automated analysers and state either the advantages or disadvantages of these approaches. The intern working in the emergency services decides to draw arterial blood for blood gas analysis. find her with dilated pupils on examination.