Summary of electrolyte imbalance(also normal FeX and GI secretion concentration)
註:
- Normal FeNa: no normal range, depends on effective arterial volume(RAAS system) and intake and GFR; and affected by 是否伴隨其他anions排出(如若有很多anions如HCO3-, penicillin use...即使dehydration也會high FeNa, 所以UpH>7時(bicarbonaturia), 即使dehydration, UNa and FeNa仍會高)
- Normal FeK: 4-16%(in hypokalemia: 1.5-6.5%, in hyperkalemia: 9.5-24%), daily Urine K loss <15-20 mEq/d if hypokalemia(>20-30 mEq/d 提示腎性流失); TTKG 已被證實假說不成立(原作者 Halperin 2011、Brenner、UpToDate 一致宣告棄用)，因髓質集尿管有尿素再吸收與顯著水/溶質轉運，導致計算失真，現行全面改用 spot UK/UCr 比值(切點 13-15 mEq/g 或 1.5 mEq/mmol)或 24 小時尿鉀取代
- Normal FeCa: ~0.5-2%(至多4%, 隨飲食與鈉排泄變動; FHH<1%, primary hyperparathyroidism>2%), normal UCa 100-250mg/d(若吃low calcium diet可50-150mg/d, 若吃calcium free diet可5-40mg/d)
- 註:PTH↑↑ or PTH↓↓, 皆會造成FeCa↑; 1,25 OH Vitamin D↓者UCa會↓
- PTH和1, 25 OH vitamin D都會促進distal tubules吸收Ca, 但是從骨頭釋放出來的更多的樣子, 所以UCa才會↑
- 註:PTH↑↑ or PTH↓↓, 皆會造成FeCa↑; 1,25 OH Vitamin D↓者UCa會↓
- Normal FeP: 5-20%, 所以TRP normal:0.80-0.95, normal urine P:400-1000mg/d; TmP/GFR(mg/dL) normal:2.5-4.5
- Brenner(p812)的公式是: TmP/GFR (mg/dL)=Serum Pi(mg/dL)-[Urine Pi(mg/dL)*(Scre/Ucre)] 註: 此式等同 Serum Pi × TRP，僅適用 TRP ≤ 0.86；TRP > 0.86 改用 TmP/GFR = [0.3 × TRP / (1 − 0.8 × TRP)] × Serum Pi 或 Walton–Bijvoet nomogram
- 若hypophosphatemia, FeP應<5% and daily urine P loss應<100mg
- Normal FeMg: 3-5%
- 若UMg>10-30mg/d(Brenner(p805):>24) or FeMg>2%-->renal loss of Mg
- Normal FeUA: 6(4)-12%
- Normal values in healthy adults are 8±3% in males and 13±3% in females; The normal FEUA in healthy children is even higher (18±5%)
- Normal urine protein <150mg/d, normal urine albumin<30mg/d
- 注意這些normal value based on normal renal function!(GFR>70), 若GFR<70本來FeX就會↑
1. Summary Table (Electrolyte Imbalance)#
欄位說明：
- Renal related 思考順序：1.GFR, osmotic diuresis(損失K, P, Mg)；2.Fanconi, TIN, vitamin D, PTH, FGF 23；3.Loop, Bartter, CaSR；4.Thiazide, Gitelman, RTA(I)；5.RAAS, Cortisol, ADH
- 即使證實是renal excretion↓, 但serum electrolyte level↑(尤其快速↑)也要找input來源
- Non-renal loss/consumption：chelation, bone(可影響Ca, P, Mg), cells... or intake/absorption↓
- Acute loading：GI, vitamin D, IVF, from cells, from bone...
- 高血鉀新藥(2020s, 慢性期用): patiromer(Veltassa)與sodium zirconium cyclosilicate(SZC/Lokelma)為口服K binder, 可讓RAASi/MRA得以續用(DIAMOND 試驗, Eur Heart J 2022; PMID 35900838：HFrEF 中降低高血鉀復發與 MRA 劑量下修); 非急性高血鉀第一線(急性仍以Ca, insulin/glucose, HCO3-, β2-agonist, diuretics, 透析為主)
| Pseudo | Transcellular shifting | Non-renal loss/consumption or intake/absorption↓ | Renal related | Acute loading | Volume status change | Others/special | |
|---|---|---|---|---|---|---|---|
| Hyponatremia | 1.Hypertriglyceridemia 2.Hyperproteinemia 3.Obstructive jaundice (因為lipoprotein-X↑) (可用Gas看Na) |
1.Hyperosmotic hyponatremia(hyperglycemia, much osmos(mannitol, glycerol, sorbitol(TURP, hysteroscopy...)) | 1.GI loss...(理論上是不太會, 除非intake也↓ or vomiting induced SIADH) 2.Intake↓(beer/toast diet) |
1.CKD, GFR↓ 2.Salt wasting nephropathy(TIN...), cerebral salt wasting 3.Thiazide 4.SIADH, adrenal insufficiency and hypothyroidism |
Nil | 1.Edematous status(肝, 心, 腎, Alb) 2.Primary polydipsia/ any reasons causing much water intake |
1.Osmotic reset 2.Hyperlipidemia可以pseudohyponatremia, pseudohyperphosphatemia, pseudohyperchloremia... |
| Hypernatremia | Nil | Nil | 1.Loss water[Loss的fluid (Na+K)concentration < plasma (Na+K) concentration] - Seizure, severe exercise - Sweat loss/insensible loss(up to 20ml/kg/d) - Respiratory loss(loss水氣only)(一般身體代謝carbohydrate產生的water and CO2為1:1, 而呼吸吐出的water和CO2分壓(47:40/0.8)也約為1:1所以不影響serum Na; 不過若acute respiratory alkalosis呼出的水氣會比代謝產生的多吧?) - GI loss: Vomiting, Diarrhea(不含secretory diarrhea) |
Urine loss: Osmotic diuresis(GLU, 醇類, urea...), loop diuretics(loss concentration gradients), DI | 2.Salt loading: Intake↑, many drugs, IVF containing salt... | Nil | 3.Special: Hypothalamic lesions(Impaired thirst sensation +/- CDI) |
| Hypokalemia | 1.AML(spurious hypokalemia)(速記:降鉀套餐*3 and HAS); AML血鉀可真高(tumor lysis)真低(AML(M4, M5)lysozymes injure tubules)假高(from clots)假低(spurious hypokalemia) | 1.Insulin(including refeeding syndrome) 2.Alkalosis 3.Beta2 agonist and any high sympathetic tone conditions(ACS(也會hypomagnesium), head trauma, SAH, alcohol withdraw, TPP(and hypokalemic periodic paralysis, Andersen-Tawil syndrome(可hyperkalemia, 不過多hypokalemia)) and theophylline(也會高血鈣), Acute chloroquine intoxication, caffeine, alpha 1 antagonists 4.HAS(hypothermia, anabolic status(also P↓), Seroquel/Haldol/Risperidone(case reports)) 5.Barium/Cesium(K+出不去細胞) |
1.Diarrhea, K binders, sweating(cystic fibrosis Pts, sweat會loss NaCl and K) 2.TPE with alb as replacement fluid 3.PD, CVVH(未含鉀者) 4.Intake↓(理論上只有intake↓不會hypokalemia) |
1.Metabolic alkalosis: Diuretics; Bartter(also hypercalcemia, cisplatin(renal所以segments都會受傷), aminoglycoside, MM related)/Gitelman; Much Soda use(salt diuresis and bicarbonaturia?); RAAS↑(RAS, renin secreting tumors, malignant HTN, vomiting, dehydration(理論上因為distal Na delivery↓所以不會hypokalemia), Cushing, Fludrocortisone use, Licorice use/SAME(11-beta-hydroxysteroid dehydrogenase type II↓), Liddle's syndrome(ENaC↑), Geller syndrome, many congenital diseases) 2.Metabolic acidosis: RTA I, RTA II, DKA/non-reabsorbable anions 3.No acid-base imbalance: Hypomagnesemia, Osmotic/salt diuresis, TIN(salt wasting) |
Nil | Nil | Nil |
| Hyperkalemia | 1.Hemolysis 2.Familial forms of pseudohyperkalemia(↑passive K permeability of RBC): AE1 mutation(也會type I RTA, spherocytosis, SAO), Rh-associated glycoprotein (RhAG) mutation, PIEZO1 mutation(類似RhAG mutation) 3.CLL with WBC>12W(cell lysis), AML(from clots; AML血鉀可真高(tumor lysis)真低(lysozymes injure tubules)假高(from clots)假低(spurious hypokalemia)) 4.Thrombocytosis(from clots) 5.Repeated fist clenching/Forearm contraction |
1.Insulin deficiency, fasting, DKA, HHS 2.Hyperosmolarity 3.Acidosis; 註:tissue hypoxia本身可因為↓Na-K pump activity而hyperkalemia 4.Beta-blocker, alpha-agonist(可↓insulin release) and drugs(ABCDEFAIDSMT): Arginine, Beta-blocker, CNI, Digoxin, Exercise, Fluoride(註:也會hypocalcemia), Aminocaproic acid, Isoflurane, Diazoxide, Succinylcholine, sigmart, Minoxidil, Thalidomide 5.Hyperkalemic periodic paralysis |
Nil | 1.GFR<20ml/min 2.Aldosterone resistance: CNI(also ↓renin(secondary due to hypervolemia)), MRA, Amiloride/triamterene/Baktar/Pentamidine/Nafamostat, CTIN, DM(also ↓renin), Pseudohypoaldosteronism type 1((AD)mineralocorticoid receptor loss of function mutation, (AR)ENaC loss of function mutation) 3.Aldosterone deficiency: CNI(also ↑aldosterone resistance), NSAID, Beta-blockers, Direct renin inhibitors, ACEI/ARB, Heparin/LMWH, Above CTIN久了, AGN/severe illness/volume overload..., DM(also↑aldosterone resistance), Adrenal insufficiency, ketoconazole, fluconazole, phenytoin, rifampin, barbiturates, Congenital diseases, Pseudohypoaldosteronism type 2(Gordon's syndrome)(WNK4↓(AD) or WNK1(inhibit WNK4)↑ or [cullin 3 (CUL3; AD) or Kelch-like 3 (KLHL3; AD or AR)]↓) |
1.Any IVF with K, blood transfusion, high K diet, GIB 2.Cell lysis(hemolysis, tumor lysis, rhabdomyolysis) |
Nil | Nil |
| Hypocalcemia | 1.MRI contrast(gadodiamide or gadoversetamide) 且用比色法(colorimetric)檢驗 just after contrast use | Nil | 1.Vitamin D deficiency(also renal effect)(見Vitamin DVitamin D) 2.Citrate intoxication(含massive blood transfusion, TPE)(應該只↓iCa, total Ca不影響) 3.Pancreatitis 4.Hyperphosphatemia 5.Fluoride poisoning(formation of fluorapatite)(註:也會hyperkalemia) 6.Osteoblastic metastasis(Breast, prostate CA) 7.Hungry bone syndrome(also P, Mg↓) 8.Bisphosphonate, Denosumab, Calcitonin (口訣:CHOP FB) |
1.GFR<15(due to Vitamin D↓ and P↑) 2.Fanconi syndrome(Foscarnet, Cisplatin(也↓TRPM6(不過TRPM6主要是吸收Mg2+))...) 3.Hypoparathyroidism: Sepsis, HIV, AIR(isolated activating Ab to CaSR), Autoimmune polyglandular syndrome, Infiltrative disease(tumor, sarcoidosis(一般是因為1,25 OH vitamin D↑而hypercalcemia), iron overload, Wilson's disease), Mg<0.5 or >2.5mM(因為當成Ca在作用?), Cinacalcet, Post-PTX, neck R/T, ADH(Bartter's syndrome type V(CaSR↑)), DiGeorge syndrome, other congenital diseases 4.Pseudohypoparathyroidism(renal unresponsiveness to PTH) 5.Lasix, Bartter's syndrome, ADH, FHHNC(mutation of Claudin-16 or mutation of Claudin-19), hypermagnesemia >2.5mM 6.Idiopathic hypercalciuria(其中的renal leak type) |
Nil | Nil | 註:1.Sepsis(PTH resistance↑, PTH secretion↓, Mg↓, vitamin D↓, GI intake↓)(Sepsis容易低Ca, P, Mg...) 2.HIV(PTH↓, vitamin D↓(機制未明且複雜)) |
| Vitamin D deficiency | 1.Vitamin D deficiency: Skin(Sun exposure↓, 黑人, burns, elderly(皮膚製造儲存vitamin D↓, intake↓)); GI(malnutrition, poor absorption(胃酸↓, pancreatic insufficiency, hepatobiliary problems, proximal small bowel disease)) 2.25 OH vitamin D deficiency: Severe liver disease(liver cirrhosis)(除了↓25 OH hydroxylation外, 若有biliary problems, 也會↓vitamin D GI absorption); Vitamin D-dependent rickets type 1B (VDDR-1B)(25-hydroxylase loss of function mutation(AR)); Proteinuria(Proteinuria者Megalin被其他proteins(including Alb)佔據, 導致25-OH vitamin D吸收↓, 進而導致1,25 OH vitamin D↓, 再惡性循環導致Megalin↓); CKD(FGF 23↑-->1.↓25-OH vitamin D; 2.↓1,25 OH vitamin D-->↓Megalin); Drugs(INH, Rifampin, phenytoin, carbamazepine, oxcarbazepine, phenobarbital, theophylline(P450 enzymes↑使25-OH vitamin D代謝成inactive forms)) 3.1, 25 vitamin D deficiency: ESRD; Vitamin D-dependent rickets type 1A (VDDR-1A)(=Pseudovitamin D-deficient rickets)(1-α hydroxylase mutation(AR)); PTH↓; DM(本身會↑ 24-OH hydroxylase); 5-FU + Leucovorin(maybe due to decreased GI vitamin D absorption(mucositis) and decreased 1,25 OH vitamin D production) 4.Vitamin D resistance: Hereditary vitamin D-resistant rickets (HVDRR)(AR) |
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| Hypercalcemia | 1.Hyperparaproteinemia(rare)(因為和Ca binding affinity不好, 所以除非level很高or 剛好MM分泌的paraprotein Ca affinity高才會) | Nil | Nil | 1.iPTH↑(含Li, FHH/NSHPT, ectopic, primary(小心MEN I and IIA and other congenital d.)/tertiary), PTHrP↑ 2.Thiazide use, Gitelman's syndrome 3.Metabolic alkalosis(Milk-alkali syndrome) |
1.Ca片, Ketosteril, Kalimate, betel nuts, TPN 2.Vitamin D intoxication(含granulomatous inflammation...) 3.Cancers(不一定要osteolytic metastasis), Estrogen/Tamoxifen use in bony metastatic breast CA 4.Vitamin A intoxications(含ATRA...), Hyperthyroidism/adrenal insufficiency, immobilization 5.ESRD with adynamic bone disease(or aluminum intoxication) |
1.Adrenal insufficiency | 1.Theophylline/aminophylline(↑ PTH function by adrenergic effects) 2.Acromegaly(大多因為coexisting hyperparathyroidism(MEN I?), 但也可以1, 25 OH vitamin D↑)也會hyperphosphatemia(↑p. tubule P resorption and by ↑1,25 OH vitamin D) 3.Advanced liver disease(acute or chronic)(機制未明, 可能是一些發炎物質導致bone resorption↑) 4.Pheochromocytoma(可因為MENIIA or PTHrP分泌(PTHrP could be suppressed by alpha blocker, 機制未明) or tumor本身(因為有OP完好的案例)) |
| Hypophosphatemia | Nil | (和Hypokalemia類似) 1.Insulin use(including refeeding syndrome) 2.Acute respiratory alkalosis 3.High sympathetic tone(due to glycolysis↑); Sepsis, cytokine storm, TPP |
1.Intake↓, malnutrition, alcoholism(malnutrition+vitamin D↓ + GI absorption↓ + Fanconi + refeeding) 2.Phosphate binders, niacin use 3.Malabsorption, Vitamin D deficiency 4.Bisphosphonate(P最終結果可高可低) 5.Osteoblastic meta(prostate CA, breast CA), anabolic status(also K↓), hungry bone syndrome(also Ca, Mg↓) 6.NHD, CVVH (HOB + GI) |
1.Osmotic diuresis, acetaminophen(why?因為osmotic diuresis(算一種osmotic diuresis?)) 2.Fanconi syndrome; HHRH(NaPi-IIc↓); Autosomal recessive renal phosphate wasting(NaPi-IIa↓; 也會Fanconi syndrome!), NHERF1 mutation(NaPi↓, 原因?) 3.Primary hyperparathyroidism(could be secondary to hypocalcemia, vitamin D deficiency) 4.FGF 23↑ or 作用↑: Iron supplement(但小心iron也可以堆積在parathyroid造成hypoparathyroidism), XLH, ARHR(inhibitors↓), ADHR(不被分解), TIO(secretion↑)(多為mesenchymal tumors), KLOTHO gene overexpression(HRH)；治療: 抗 FGF23 單株抗體 burosumab 可用於 XLH 與無法切除之 TIO（FDA 2018 核准 XLH、2020 核准 TIO） 5.Drugs/special condition(原因未知): Imatinib/nilotinib(可能是因為↓bone resorption with secondary PTH↑), mTORi/VEGF inhibitors, Steroid(also ↓GI P absorption)(因為1,25 OH vitamin D↓?), Following partial hepatectomy(部分也因為長肝, 但主要因為↑Urine P機轉不明), Hyperthermia/heat stroke(機轉?) |
Nil | 1.Volume expansion with hypophosphatemia | 1.有一些post-OP hypophosphatemia的reports, 可能是因為tissue growth, high sympathetic tones...原因不是很清楚 |
| Hyperphosphatemia | (只有某些檢驗方法會被影響)(有點像hyponatemia and hyperkalemia的集合) 1.Hyperglobulinemia(MM, Waldenström macroglobulinemia...) 2.Hyperlipidemia 3.Hyperbilirubinemia 4.Hemolysis(也會真的hyperphosphatemia) 5.Drugs(high dosage Ambisome, heparin, tPA) |
(類似hyperkalemia但沒有beta-blocker此一D/D) 1.Insulin deficiency 2.Metabolic/respiratory acidosis |
Nil | 1.GFR↓(多要CKD stage IV以上) 2.PTH↓, pseudohypoparathyroidism(congenital; renal PTH resistance) 3.FGF 23↓(Familial tumoral calcinosis) 4.Acromegaly(促p. tubules吸收P(IGF-1會↑Na-Pi IIa), 也因為↑1,25 OH vitamin D而↑GI Ca,P吸收)也會hypercalcemia(見上述) 5.Bisphosphonate(可高or低磷) |
1.Vitamin D intoxication 2.Fleet enema, fosphenytoin(metabolized to phenytoin, phosphate, and formaldehyde) 3.Cell lysis(osteolytic metastasis(also Ca↑)), tumor lysis, hemolysis/transfusion, rhabdomyolysis, fulminant hepatitis) |
Nil | Hyperlipidemia可以pseudohyponatremia, pseudohyperphosphatemia, pseudohyperchloremia... |
| Hypomagnesemia | Nil | 1.ACS(也會hypokalemia) 2.TPP |
1.Malnutrition 2.GI malabsorption(尤其steatorrhea者, 因為free fatty acid會binds Mg2+), alcoholism(malnutrition+GI absorption↓ + diarrhea + pancreatitis + Fanconi + refeeding) 3.PPI(↓GI TRPM6 and TRPM7) 4.Primary intestinal hypomagnesemia(GI and renal TRPM 6 mutation(AR)) 5.Skin loss(excessive sweating(sweat可含有0.2mM的Mg(不是蠻少的...)), burns(40% hypomagnesium)) 6.Diarrhea 7.Pancreatitis 8.Post-OP(circulating FA binding Mg(理論上也會chelate Ca...)) 9.Citrate intoxications 10.Hungry bone syndrome(also Ca, P↓)/post-correction of severe metabolic acidosis(算hungry bone syndrome) (7-10類似hypocalcemia)(CHOP) |
1.Salt diuresis, osmotic diuresis(註:DM還有其他機制↑UMg) 2.Proximal tubules:Fanconi syndrome(含many drugs/diseases causing TN, tubular dysfunction...) 3.Loop:loop diuretics, Bartter's syndrome, FHHNC, hypercalcemia 4.Distal tubules:hypokalemia, thiazide, Gitelman's syndrome, anti-EGFR Ab(↓TRPM6)(EGFR TKI則少見不過也會), Ampho B, primary intestinal hypomagnesemia, Autosomal dominant isolated hypomagnesemia (Na-K-ATPase gamma subunit, Kv1.1 and cyclin M2(CNNM2) mutations), Autosomal recessive isolated hypomagnesemia (EGF mutation), Renal malformations and early-onset diabetes mellitus (HNF1-β mutation) 5.Mixed: hyperaldosteronism(volume expansion, hypokalemia, ↓TRPM7(比TRPM6不重要)), CNI(↑Claudin 14, ↓TRPM6) 6.Any TIN... |
Nil | 1.Volume expansion(salt diuresis) | 1.MMF(nature?, 40% hypomagnesium) 2.Sepsis(原因複雜) 3.DM(因為poor GI absorption due to diabetic autonomic neuropathy, osmotic diuresis, insulin insufficiency本身導致TAL, distal tubules吸收Mg↓; 相對的hypomagnesium會↑insulin resistance-->惡性循環; 所以DM若有hypomagnesium要處理) |
| Hypermagnesemia | Nil | Nil | Nil | 1.poor GFR 2.FHH(only mildly↑SMg level) 3.Lithium intake(?, 猜測機轉類似FHH?) |
1.Dead Sea water intoxication 2.MgO, Mg enema 3.PUD, gastritis, colitis, GI obstruction(↑GI uptake) 4.MgSO4 for preeclampsia/eclampsia 5.Tumor lysis syndrome/hypercatabolism (但若malabsorption, diarrhea則hypomagnesium) |
1.Adrenal insufficiency | 1.Mg好像是唯一一個GI發炎卻有可能會↑吸收的... |
| Metabolic acidosis (Non-AG) | Nil | Hyperkalemia(also renal effects) | 1.Diarrhea 2.Cholestyramine(因為release Cl and bind HCO3) |
1.RTA, including CKD | 1.TPN(Arginine, lysine, 本身NH4Cl) 2.Renagel 3.Massive NaCl |
1.Dilutional | 1.Post-respiratory alkalosis(functional, transient) 2.Later phase in some high AG metabolic acidosis(DKA, D-lactic acidosis, Toluene) |
| Metabolic acidosis (High-AG) | Nil | Nil | Nil | 4.GFR↓ | Nil | Nil | 1.L-lactic acidosis(type A(local hypoxia(含ischemic bowel), shock, seizure, SpO2<50%, Hb<5, CO, MetHb), type B(Malignancy, liver failure, Beriberi, B2 deficiency(?, 會干擾電子傳遞鏈), alcohols(註:醇類代謝時會↑NADH, NADH會還原pyruvate to lactate), drugs(INH, metformin, Zyvox, propofol, NRTI, Aspirin intoxication))) 2.D-lactic acidosis(DKA, propylene glycol, (short bowel syndrome or GI malabsorption) with carbohydrate loading) 3.Ketone acidosis(alcoholism, DKA/HHS, starvation) 5.會代謝成酸的drugs/toxins |
| Metabolic alkalosis | Nil | Hypokalemia(also renal effects) | (loss of NaCl, KCl or HCl) 1.Vomiting/NG decompression 2.Chloride diarrhea(laxatives abuse, villous adenoma, congenital) 3.Cystic fibrosis(sweat loss NaCl and K; 一般人的sweat沒有那麼高濃度的NaCl)(可能也和ROMK dysfunction有關?) |
1.Diuretics 2.Bartter's/Gitelman's syndrome 3.Primary hyperaldosteronism or other mineralocorticoid excess syndromes(like cushing's)(註:GFR↓是maintenance factor) 4.Pendred syndrome |
1.Soda, citrate, lactate, acetate | 1.Dehydration/hemoconcentration(除非出血不然RBC mass不會變化所以可以用Hct算ECF volume change可知HCO3- level change; 如正常Hct 40%則ECF change 0%, 若Hct 50%則ECF變成2/3而HCO3-變成1.5X) 2.Hypomagnesemia(本身↑renin, 也因為hypokalemia) |
1.Post-hypercapnic(functional, transient) |
GI Secretion Concentration Table#
| Type of secretion | Volume (mL/24h) | Na (meq/L) | K (meq/L) | Cl (meq/L) | HCO₃ (meq/L) |
|---|---|---|---|---|---|
| Salivary | 1500 | 10 | 26 | 10 | 30 |
| Stomach | 1500 | 60 | 10 | 130 | 0 |
| Duodenum | 100–2000 | 140 | 5 | 80 | 0–10 |
| Ileum | 3000 | 140 | 5 | 104 | 30 |
| Colon | 100–800 | 60 | 30 | 40 | 0 |
| Pancreas | 1000–1500 (500–1500) | 140 | 5 | 75 | 115 |
| Bile | 50–800 | 145 | 5 | 100 | 35 |
