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June 1989

Low Serum Creatinine Levels in Severe Hepatic Disease

Arch Intern Med. 1989;149(6):1471. doi:10.1001/archinte.1989.00390060173051

To the Editor.—The article by Takabatake et al1 in the June 1988 issue of the Archives warrants a brief comment.

In 1969 Matz et al2 described two patients who had alcoholic hepatitis associated with severe hypophosphatemia, hypouricemia, low serum creatinine levels, and low serum urea nitrogen levels. We described elevated phosphate (19 and 2 mL/min) and uric acid (34 and 32 mL/min) clearances. The New York State Journal of Medicine would not accept our report of creatinine clearances in excess of 250 mL/min because these results were obtained in a routine clinical laboratory. The lowest serum creatinine level was 44.2 μmol/L in one of our patients; the serum urea nitrogen level was as low as 14.3 mmol/L; and the serum urate level was 24 μmol/L.

These abnormalities persisted over a 3- to 4-week period, and then the levels slowly returned to normal as the patient's hepatic dysfunction

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