What is the clinical significance of a 39-year-old female's laboratory results showing hyponatremia (Sodium), hypokalemia (Potassium), hyperchloremia (Chloride), metabolic acidosis (CO2), normal anion gap, normoglycemia (Glucose), normal blood urea nitrogen (BUN), normal creatinine, normal estimated glomerular filtration rate (eGFR), hypocalcemia (Calcium), and normal liver function tests?

From the Guidelines

The patient's low calcium level of 8.5 mg/dL requires prompt attention and possible correction, as hypocalcemia can have significant effects on the coagulation cascade and cardiac function, particularly in the context of critical bleeding or massive transfusion, as noted in the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1. The lab results show a few abnormalities that require attention, including elevated chloride (110 mmol/L, normal range 98-107), low CO2 (21 mmol/L, normal range 22-32), and low calcium (8.5 mg/dL, normal range 8.9-10.3).

• The high chloride and low CO2 suggest a mild hyperchloremic metabolic acidosis.
• The low calcium level is mild but should be monitored, as ionised calcium levels below 0.8 mmol/L are associated with cardiac dysrhythmias, and hypocalcemia can predict mortality and the need for multiple transfusions 1.
• The low liver enzymes (AST and alkaline phosphatase) are generally not concerning as they are below the reference range rather than elevated. I recommend addressing the metabolic acidosis by identifying and treating the underlying cause, which could include renal tubular acidosis, diarrhea, or medication effects.
• Oral bicarbonate supplementation may be considered if the acidosis is symptomatic or persistent.
• The preferred agent to correct hypocalcemia is calcium chloride, which may be preferable to calcium gluconate in the setting of abnormal liver function 1.
• Kidney function appears normal with an excellent eGFR of 115 mL/min/1.73m2. Overall hydration status and electrolyte intake should be evaluated to address the chloride and bicarbonate abnormalities.

From the Research

Laboratory Results

• The patient's sodium level is 141 mmol/L, which is within the normal range of 136-145 mmol/L.
• The patient's potassium level is 4.2 mmol/L, which is within the normal range of 3.6-5.1 mmol/L.
• The patient's chloride level is 110 mmol/L, which is higher than the normal range of 98-107 mmol/L.
• The patient's CO2 level is 21 mmol/L, which is lower than the normal range of 22-32 mmol/L.
• The patient's anion gap is 10, which is within the normal range of 6-18.
• The patient's glucose level is 82 mg/dL, which is within the normal range of 70-99 mg/dL.
• The patient's BUN level is 12 mg/dL, which is within the normal range of 8-20 mg/dL.
• The patient's creatinine level is 0.65 mg/dL, which is within the normal range of 0.60-1.30 mg/dL.
• The patient's eGFR is 115 mL/min/1.73m2, which is higher than the normal range of >=60 mL/min/1.73m2.
• The patient's BUN/Creatinine Ratio is 18.5, which is within the normal range of 12.0-20.0.
• The patient's calcium level is 8.5 mg/dL, which is lower than the normal range of 8.9-10.3 mg/dL, indicating hypocalcemia 2, 3.
• The patient's AST (SGOT) level is 11 unit/L, which is lower than the normal range of 15-41 unit/L.
• The patient's ALT (SGPT) level is 8 unit/L, which is within the normal range of 7-52 unit/L.
• The patient's Alkaline Phosphatase level is 28 unit/L, which is lower than the normal range of 32-91 unit/L.
• The patient's Total Protein level is 6.8 g/dL, which is within the normal range of 6.1-7.9 g/dL.
• The patient's Albumin level is 4.1 g/dL, which is within the normal range of 3.5-4.8 g/dL.
• The patient's Total Bilirubin level is 0.3 mg/dL, which is within the normal range of 0.3-1.2 mg/dL.

Hypocalcemia

• Hypocalcemia can be caused by various disorders, including hypoparathyroidism and disorders that disrupt the metabolism of vitamin D 2.
• Symptoms of hypocalcemia can range from asymptomatic to life-threatening conditions, and may involve almost any organ and system 3.
• Treatment and management options for hypocalcemia vary depending on the underlying disorder, and may include calcium and vitamin D supplementation, as well as replacement of parathyroid hormone in hypoparathyroidism 2, 3.

Electrolyte Imbalances

• Maintaining the balance of fluid and electrolytes is crucial to patient care, and requires monitoring and assessment of key parameters 4.
• Electrolyte imbalances can have significant consequences, and require prompt treatment to prevent complications 4.

Patient Outcomes

• Evidence-based practice has been shown to improve patient outcomes and healthcare system return on investment 5.
• Continuous physiological monitoring can improve patient outcomes by allowing for early detection of patient deterioration 6.