Guest guest Posted October 25, 2003 Report Share Posted October 25, 2003 ,,>> low ammonia can occur when kids are acidotic..... When you say Acidotic?? What kind of acid?? Lactic? He did not have a lacate for some reason.Tell me more about the acidotic/low ammonia level. His creatine was .2 normal and the ref. range is .20 - .40 WBC were 14.5 normal and ref. range is 6 - 17.50 Thank you VERY much for helping out! Krystena Re: lab test Krystena,The high platelets are usually from infection or inflammation, the high BUN/creatinine ratio can occur in dehydration, low ammonia can occur when kids are acidotic. Evan also had low sodium when his ammonia was low and he was sick and acidoitc. High lymphs usually mean it is a viral infection. The reference range for anion gap, RDW, and albumin seem different than the ones that I have seen on pediatric labs. What was his white blood cell count? What was his creatinine?Krystena s wrote: I took Carsen to the dr today since I was worried due to him only urinating 1 time in 16 hrs. He did finally pee but he threw up twice while there. Not done it since ???? Should I be concerned about the following labs? High Platelets 568 (150-400) High ALK phos 298 (40-230) High Lymp 69 (15-40) Low Sodium 133 (139-146) High BUN/CREAT 40 (6-25) LOW ANION GAP 5 (10-18) LOW ALBUMIN 3.6 (3.8-5.40) LOW RDW 11.3 (11.5-14.5) LOW Band 1 (2-21) Get this.....his ammonia was LOW @ 6 (19-60) How is his BUN/CREAT high and not his BUN OR CREATININE????Please contact mito-owner with any problems or questions. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted October 26, 2003 Report Share Posted October 26, 2003 Krystena, Did they check urine for ketones? My son showed really high ketones during that episode and ketones are acidic. It is very common for kids with mito to go into ketosis when they are sick. Do you have any WBC testing on Carsen when he was not sick? Carsen is very young and WBC levels are higher in infants, but we always know with Evan that anytime his WBC count is too far from his norm to watch for illness and ketosis. Evan's labs from that day showed sodium 136 and ammonia 9. In urine his ketones were 100 times the top of the reference range. He wasn't even that sick at the time. Here is some good info-- 13.28.02 Differential Diagnosis of an Infant or Child Presenting with Acidosis and/or Ketosis Overview: An infant or child presenting with acidosis and/or ketosis may have an inborn error of metabolism or simply a physiologic response to fasting, vomiting or diet. By looking at the pattern of laboratory test findings some possible explanations for the patient's condition can be identified. Presenting groups: (1) metabolic acidosis with ketosis (2) metabolic acidosis without ketosis (3) ketosis without metabolic acidosis Metabolic acidosis: (1) pH < 7.30 (2) PCO2 < 30 mm Hg (3) serum bicarbonate < 15 mmol/L (mEq/L) Ketosis: ketonuria increase in ketone bodies Metabolic Acidosis with Ketosis Glucose Levels Additional Testing Diagnostic Considerations increased high ammonia ketolytic defects increased normal or low ammonia branched chain organic acidurias normal high lactate congenital lactic acidosis respiratory chain disorders organic acidurias normal normal lactate maple syrup urine disease late onset form ketolytic defects organic acidurias short chain acylCoA dehydrogenase decreased high lactate often with hepatomegaly gluconeogenesis defects respiratory chain defects decreased normal lactate maple syrup urine disease late onset form branched chain organic acidurias acetoacetyl CoA thiolase adrenal insufficiency Metabolic Acidosis without Ketosis Lactate Glucose Diagnostic Considerations increased normal pyruvate dehydrogenase deficiency increased decreased fatty acid oxidation disorders hydroxymethylglutaryl-CoA lyase glucose 6 phosphatase deficiency fructose biphosphatase deficiency normal normal renal tubular acidosis I and II pyroglutamic aciduria Ketosis without Metabolic Acidosis Glucose Levels Additional Testing Diagnostic Considerations normal glucose intermittent ketosis fasting catabolism recurrent vomiting (physiologic ketonuria) short chain acyl CoA dehydrogenase hydroxy short chain acyl dehydrogenase normal glucose permanent ketosis medium chain triglyceride enriched diet and ketotic diet ketolytic defects fasting hypoglycemia with hepatomegaly and post-prandial hyperlactacidemia glycogenosis type III glycogen synthetase deficiency fasting hypoglycemia without hepatomegaly recurrrent ketotic hypoglycemia hypoglycemia due to adrenal disorders hydroxy short chain acyl dehydrogenase medium chain acyl CoA dehydrogenase glycogen synthetase deficiency ketolytic defects ketolytic defects: oxoacyltransferase deficiency thiolase deficiency branched chain organic acidurias: methylmalonic acid (MMA) propionic acid (PA) isovaleric acid (IVA) congenital lactic acidosis: pyruvate carboxylase (PC) deficiency multiple carboxylase deficiencies ketoglutarate dehydrogenase (KGDH) deficiency lipoamide oxidoreductase (E3) deficiency gluconeogenesis defects: fructose diphosphatase (FDP) deficiency glucose 6 phosphatase (G6P) deficiency glycogen synthase deficiency organic acidurias: 3-hydroxyisobutyric aciduria others References: Saudubray J-M Charpentier C. Chapter 66: Clinical phenotypes: Diagnosis/algorithms. pages 1327-1403 (Table 66-7 page 1342 Table 66-9 page 1344). IN: Scriver CR Beaudet AL et al (editors). The Metabolic & Molecular Bases of Inherited Disease Eighth Edition. McGraw-Hill. 2001 Quote Link to comment Share on other sites More sharing options...
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