From the Guidelines
The patient's laboratory results indicate metabolic alkalosis, and I recommend further evaluation of her hydration status, dietary intake, and medication history to address the underlying cause of this condition, as suggested by the most recent study 1. The patient has a low creatinine level (0.48 mg/dL), elevated CO2 (31 mEq/L), high BUN/creatinine ratio (33), low alkaline phosphatase (23 IU/L), low anion gap (12), and low albumin/globulin ratio (1.00). These findings suggest metabolic alkalosis, as evidenced by the elevated CO2 level. The low creatinine could indicate decreased muscle mass, malnutrition, or overhydration, as noted in the study 1. The high BUN/creatinine ratio may suggest pre-renal issues such as dehydration or early kidney dysfunction, though the GFR remains normal (>60 mL/min), which is consistent with the guidelines for chronic kidney disease evaluation, classification, and stratification 2, 3, 4. The low alkaline phosphatase could be related to malnutrition, vitamin D deficiency, or certain medications. Some key points to consider in the evaluation of this patient's kidney function include:
- The serum creatinine concentration is affected by factors other than GFR, such as creatinine secretion and generation and extrarenal excretion, as noted in the study 2.
- Clinical laboratories should report an estimate of GFR using a prediction equation in addition to reporting the serum creatinine measurement, as recommended in the study 3.
- The MDRD study equation has many advantages, including being more accurate and precise than the Cockcroft–Gault equation for persons with a GFR less than approximately 90 mL/min per 1.73 m2, as noted in the study 4.
- Factors having a chronic effect on creatinine, such as increased creatinine generation, muscular body habitus, Afro-Caribbean ethnicity, decreased glomerular filtration, chronic kidney disease, and false reduction of creatinine, should be considered when interpreting serum creatinine results, as discussed in the study 1. I strongly recommend addressing the underlying cause of the metabolic alkalosis, which could include discontinuation of certain medications, adjustment of diuretic therapy if applicable, or correction of electrolyte imbalances, as suggested by the most recent study 1. Follow-up testing in 2-4 weeks would be advisable to monitor these abnormalities.
From the Research
Laboratory Results
- Glucose: 88 mg/dL (within normal range of 65-99 mg/dL)
- BUN: 16 mg/dL (within normal range of 7-30 mg/dL)
- Creatinine: 0.48 mg/dL (low, normal range 0.70-1.20 mg/dL)
- Sodium: 143 mmol/L (within normal range of 135-145 mmol/L)
- Potassium: 4.0 mEq/L (within normal range of 3.5-5.2 mEq/L)
- Chloride: 104 mEq/L (within normal range of 97-109 mEq/L)
- CO2: 31 mEq/L (high, normal range 20-29 mEq/L)
- BUN/creat: 33 (high, normal range 7-25)
- Calcium: 9.3 mg/dL (within normal range of 8.5-10.1 mg/dL)
- Total protein: 7.7 g/dL (within normal range of 6.2-8.0 g/dL)
- Albumin: 3.9 g/dL (within normal range of 3.6-5.0 g/dL)
- AST/SGOT: 15 U/L (within normal range of 4-35 U/L)
- ALT/SGPT: 28 U/L (within normal range of 2-40 U/L)
- Alkaline phos: 23 IU/L (low, normal range 46-116 IU/L)
- Total bili: 0.4 mg/dL (within normal range of 0.2-1.5 mg/dL)
- Anion gap: 12 (low, normal range 12-21)
- A/G ratio: 1.00 (low, normal range 1.10-2.20)
- Non-aa GFR: >60 mL/min
- Afr amer GFR: >60 mL/min
Relevance of Studies
There are no research papers to assist in answering this question, as the provided study 5 discusses the effects of chlordiazepoxide on self-rated depression, anxiety, and well-being, which is not directly relevant to the laboratory results provided.