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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
High Anion Gap and Low Serum Chloride
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<blockquote data-quote="finkelet" data-source="post: 65476" data-attributes="member: 14265"><p>It's amazing what lab errors can be made. Cl closley follows Na. This is because the main source of Cl in the body is from disassociated NaCl molecules. The main cause of low Cl and Na is hemodilution. Some root causes of that are Ingestion of a deadly amount of water, (I had a patient for of that last week. He was an inmate and he did this to kill himself. His Na was 120 and his Cl 85.) Addisions disease, CHF, or severe metabolic alkalosis can also lower Cl. But never to a level in the 20s. </p><p></p><p>Rhabdomyolysis would cause excessive K however it would not effect Cl. </p><p></p><p>On that note a K of 8 is a medical emergency that I see and treat not infrequently in critical care. It doesn't effect Cl marginally. There are 2 reasons for this. 1 Na and K are both cations. They are positively charged so they inversely follow each other. Cl is an anion or negatively charged. The major intracellurar anion is phosphate. Secondly to have such a massive shift of intracellurar and intravascular ions simply isn't possible. Your patient would be dead way befor that happened. </p><p></p><p>Sorry for the long reply but in a nutshel there is nothing that would cause a patient to have a Cl as low as 23 with the exception of a fatal transfusion of sterile water or D5W. Like 30 liters worth. Considering that our average blood volume is around 6L (100kg patient) you see the impossibility of this.</p></blockquote><p></p>
[QUOTE="finkelet, post: 65476, member: 14265"] It's amazing what lab errors can be made. Cl closley follows Na. This is because the main source of Cl in the body is from disassociated NaCl molecules. The main cause of low Cl and Na is hemodilution. Some root causes of that are Ingestion of a deadly amount of water, (I had a patient for of that last week. He was an inmate and he did this to kill himself. His Na was 120 and his Cl 85.) Addisions disease, CHF, or severe metabolic alkalosis can also lower Cl. But never to a level in the 20s. Rhabdomyolysis would cause excessive K however it would not effect Cl. On that note a K of 8 is a medical emergency that I see and treat not infrequently in critical care. It doesn't effect Cl marginally. There are 2 reasons for this. 1 Na and K are both cations. They are positively charged so they inversely follow each other. Cl is an anion or negatively charged. The major intracellurar anion is phosphate. Secondly to have such a massive shift of intracellurar and intravascular ions simply isn't possible. Your patient would be dead way befor that happened. Sorry for the long reply but in a nutshel there is nothing that would cause a patient to have a Cl as low as 23 with the exception of a fatal transfusion of sterile water or D5W. Like 30 liters worth. Considering that our average blood volume is around 6L (100kg patient) you see the impossibility of this. [/QUOTE]
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Testosterone Replacement, Low T, HCG, & Beyond
Blood Test Discussion
High Anion Gap and Low Serum Chloride
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