• Impaired kidney function
• Intrinsic kidney disease
• Glomerulonephritis
• Pyelonephritis
• Nephrotic syndrome
• Acute tubular necrosis
• Amyloidosis
• Nephritis
• Reduced renal blood flow

• State of high CO
• Pregnancy
• Burns
• CO poisoning

• Glomerulonephritis
• Pyelonephritis
• Acute Tubular Necrosis
• Urinary Obsruction

• Acromegaly
• Giantism
• DM
• Hypothyroidism
• Pregnancy

• Hyperthyroidism
• Anemia
• Muscular Dystrophy
• Polymyositis
• Neurogenic Atrophy
• Inflammatory Muscle Disease
• Advanced Renal Disease/Renal Stenosis
• Leukemia

•  Impairment of renal function
• Chronic renal disease (Glomerulonephritis/Pyelonephritis)
• Urinary tract obstruction
• Hemorrhage into GI tract
• Diabetes mellitus with ketoacidosis
• Excessive protein intake
• Excessive protein catabolism (burns or cancer)
• Anabolic steroid use

• Liver Failure
• Acromegaly
• Malnutrition
• Impaired Absorption

• gallstones
• Pancreatic CA
• sarcoidosis
• cholestasis from drugs

• Pulm Infarct
• hemolytic anemia
• Gilbert's syndrome
• Crigler-Najjar Syndrome

• hepatocellular disease
• alcoholic cirrhosis
• metastatic liver tumor
• obstructive jaundice
• pancreatitis
• MI/HF
• Polymyositis
• burns/shock
• muscle trauma

• acute and chronic hepatitis
• active cirrhosis
• mono
• alcoholic hepatitis
• CA
• Reye's
• hypothyroid
• hemolytic anemia
• PE
• shock/heat stroke
• dermatomyositis
• polymyositis
• TSS
• cardiac cath
• brain trauma

• alcoholic cirrhosis
• liver congestion
• metastatic cancer
• MI
• pancreatitis
• ARD
• musculoskeletal dz

• Pancreatitis
• salivary gland obstruction
• small bowel obstruction
• acute cholecystitis
• acute appendicitis

• dehydration

• malnutrition
• pregnancy
• liver disease
• third-space losses
• overhydration
• inflammatory disease
• protein losing enteropaties
• protein losing nephropathies

• Azotemia
• renal disease
• Vit B6 deficiency

jaundice

CA

cirrhosis

cholestasis

hepatitis

mono

DM

alcoholism

Gilbert's

UC

PUD

Bowel Perforation

Patet's

Bone stuff

Hyperthyroid/parathyroid

MI/CHF

Sarcoidosis

Amyloidosis

renal failure

• malnutrition
• hypothyroid
• pernicious anemia
• Mg/Zn deficiency
• celiac sprue

• pancreatic insufficiency
• hepatitis
• CF
• pancreatectomy

MI

Pulm Infarct

•Chronic Active Hepatitis    70-90

• PBC (>90% of pts)  60-70
• Chronic Hepatitis    30-60
• Biliary Obstruction   5-10
• SLE
• RA
• Thyroid d/o
• Addison’s
• Pernicious anemia
• Alcohol Hepatitis  0

Wegner's

Primary Sclerosing Cholangitis

• IBD
• Pancreatitis
• Alcoholic Cirrhosis
• PUD
• Cholecystitis
• Chronic RF
• Fibrocystic disease
• Pulm Infarct