A 30-year-old man was administered in the Accident and Emergency (A&E) department of a metropolitan hospital. He appeared partially conscious and extremely weak. His biochemical blood results are:Analyte (SERUM)ResultReference intervalSodium121135 – 145 mmol/LPotassium5.63.5 – 5.5 mmol/LChloride8695 – 110 mmol/LBicarbonate1922 – 32 mmol/LUrea10.93.0 – 8.0 mmol/LCreatinine9840 – 90 μmol/LSerum osmolality340275 – 295 mOsm/kgWhat could have explained his altered serum electrolytes and osmolality?Group of answer choicesHe has acute kidney injury (AKI)Uncontrolled hyperglycaemiaHe has Conn’s syndromeHe has chronic kidney injury (CKD)
Question
A 30-year-old man was administered in the Accident and Emergency (A&E) department of a metropolitan hospital. He appeared partially conscious and extremely weak. His biochemical blood results are:Analyte (SERUM)ResultReference intervalSodium121135 – 145 mmol/LPotassium5.63.5 – 5.5 mmol/LChloride8695 – 110 mmol/LBicarbonate1922 – 32 mmol/LUrea10.93.0 – 8.0 mmol/LCreatinine9840 – 90 μmol/LSerum osmolality340275 – 295 mOsm/kgWhat could have explained his altered serum electrolytes and osmolality?Group of answer choicesHe has acute kidney injury (AKI)Uncontrolled hyperglycaemiaHe has Conn’s syndromeHe has chronic kidney injury (CKD)
Solution
The patient's lab results show low sodium (hyponatremia), high potassium (hyperkalemia), low chloride (hypochloremia), low bicarbonate (metabolic acidosis), high urea (uremia), high creatinine (indicative of kidney dysfunction), and high serum osmolality.
These results suggest that the patient is suffering from acute kidney injury (AKI). AKI is characterized by a rapid loss of kidney function, as evidenced by the high urea and creatinine levels. This condition can also cause electrolyte imbalances, such as the hyponatremia, hyperkalemia, and hypochloremia seen in this patient.
Uncontrolled hyperglycemia could also cause high serum osmolality, but it would not explain the other electrolyte imbalances or the high urea and creatinine levels.
Conn's syndrome is characterized by hyperaldosteronism, which would typically cause hypernatremia, hypokalemia, and metabolic alkalosis, not the symptoms seen in this patient.
Chronic kidney disease (CKD) could cause these symptoms, but it would typically present with a more gradual onset of symptoms and a history of kidney problems, not the acute presentation seen in this patient.
Therefore, the most likely explanation for this patient's altered serum electrolytes and osmolality is acute kidney injury (AKI).
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