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Carlton H, Shipman KE. Pitfalls in the diagnosis and management of acid-base disorders in humans: a laboratory medicine perspective. J Clin Pathol 2024:jcp-2024-209423. [PMID: 39025490 DOI: 10.1136/jcp-2024-209423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/04/2024] [Indexed: 07/20/2024]
Abstract
Diagnostic errors affect patient management, and as blood gas analysis is mainly performed without the laboratory, users must be aware of the potential pitfalls. The aim was to provide a summary of common issues users should be aware of.A narrative review was performed using online databases such as PubMed, Google Scholar and reference lists of identified papers. Language was limited to English.Errors can be pre-analytical, analytical or post-analytical. Samples should be analysed within 15 min and kept at room temperature and taken at least 15-30 min after changes to inspired oxygen and ventilator settings, for accurate oxygen measurement. Plastic syringes are more oxygen permeable if chilled. Currently, analysers run arterial, venous, capillary and intraosseous samples, but variations in reference intervals may not be appreciated or reported. Analytical issues can arise from interference secondary to drugs, such as spurious hyperchloraemia with salicylate and hyperlactataemia with ethylene glycol, or pathology, such as spurious hypoxaemia with leucocytosis and alkalosis in hypoalbuminaemia. Interpretation is complicated by result adjustment, for example, temperature (alpha-stat adjustment may overestimate partial pressure of carbon dioxide (pCO2) in hypothermia, for example), and inappropriate reference intervals, for example, in pregnancy bicarbonate, and pCO2 ranges should be lowered.Lack of appreciation for patient-specific and circumstance-specific reference intervals, including extremes of age and altitude, and transformation of measurements to standard conditions can lead to inappropriate assumptions. It is vitally important for users to optimise specimen collection, appreciate the analytical methods and understand when reference intervals are applicable to their specimen type, clinical question or patient.
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Affiliation(s)
- Henry Carlton
- Chemical Pathology, University Hospitals Sussex NHS Foundation Trust, Chichester, UK
| | - Kate E Shipman
- Chemical Pathology, University Hospitals Sussex NHS Foundation Trust, Chichester, UK
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, UK
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Tyagi N. ABG Analyzer for Electrolyte Measurement in ICU Patients: To Do or Not to Do. Indian J Crit Care Med 2024; 28:416-418. [PMID: 38738191 PMCID: PMC11080086 DOI: 10.5005/jp-journals-10071-24722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
How to cite this article: Tyagi N. ABG Analyzer for Electrolyte Measurement in ICU Patients: To Do or Not to Do. Indian J Crit Care Med 2024;28(5):416-418.
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Affiliation(s)
- Niraj Tyagi
- Institute of Critical Care Medicine, Sir Ganga Ram Hospital, New Delhi, India
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Tang S, Mei Z, Huang D, Liu L, Yang L, Yin D, Hu L. Comparative analysis of hemoglobin, potassium, sodium, and glucose in arterial blood gas and venous blood of patients with COPD. Sci Rep 2024; 14:5194. [PMID: 38431760 PMCID: PMC10908784 DOI: 10.1038/s41598-024-55992-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
The study aims to assess the accuracy of the arterial blood gas (ABG) analysis in measuring hemoglobin, potassium, sodium, and glucose concentrations in comparison to standard venous blood analysis among patients diagnosed with chronic obstructive pulmonary disease (COPD). From January to March 2023, results of ABG analysis and simultaneous venous blood sampling among patients with COPD were retrospectively compared, without any intervention being applied between the two methods. The differences in hemoglobin, potassium, sodium, and glucose concentrations were assessed using a statistical software program (R software). There were significant differences in the mean concentrations of hemoglobin (p < 0.001), potassium (p < 0.001), and sodium (p = 0.001) between the results from ABG and standard venous blood analysis. However, the magnitude of the difference was within the total error allowance (TEa) of the United States of Clinical Laboratory Improvement Amendments (US-CLIA). As for the innovatively studied glucose concentrations, a statistically significant difference between the results obtained from ABG (7.8 ± 3.00) mmol·L-1 and venous blood (6.72 ± 2.44) mmol·L-1 was noted (p < 0.001), with the difference exceeding the TEa of US-CLIA. A linear relationship between venous blood glucose and ABG was obtained: venous blood glucose (mmol·L-1) = - 0.487 + 0.923 × ABG glucose (mmol·L-1), with R2 of 0.882. The hemoglobin, potassium, and sodium concentrations in ABG were reliable for guiding treatment in managing COPD emergencies. However, the ABG analysis of glucose was significantly higher as compared to venous blood glucose, and there was a positive correlation between the two methods. Thus, a linear regression equation in this study combined with ABG analysis could be helpful in quickly estimating venous blood glucose during COPD emergency treatment before the standard venous blood glucose was available from the medical laboratory.
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Affiliation(s)
- Sitian Tang
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China
| | - Zhu Mei
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China
| | - Dongmei Huang
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China
| | - Ling Liu
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China
| | - Lunyu Yang
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China
| | - Dan Yin
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China.
| | - Liyi Hu
- People's Hospital of Chongqing Liang Jiang New Area, No. 199 Ren Xing Road, Chongqing, 401135, People's Republic of China.
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Elrobaa IH, Khan K, Mohamed E. The Role of Point-of-Care Testing to Improve Acute Care and Health Care Services. Cureus 2024; 16:e55315. [PMID: 38434607 PMCID: PMC10905651 DOI: 10.7759/cureus.55315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2024] [Indexed: 03/05/2024] Open
Abstract
Health care is one of the most important services that need to be provided to any community. Many challenges exist in delivering proper and effective health services, including ensuring timely delivery, providing adequate care through effective management and achieving good outcomes. Point-of-care testing (POCT) plays a crucial role in delivering urgent and appropriate health services, especially in peripheral communities, emergency situations, disaster areas and overcrowded areas. We collected and reviewed secondary data about point-of-care testing from PubMed, Scopus and Google Scholar. Our findings emphasize that POCT provides fast care with minimal waiting time, avoids unnecessary investigations, aids in triage, and provides decision-makers with a clear understanding of the patient's condition to make informed decisions. We recommend point-of-care testing as a frontline investigation in emergency departments, intensive care units, peripheral hospitals, primary health care centers, disaster areas and field hospitals. Point-of-care testing can improve the quality of health services and ensure the provision of necessary health care.
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Affiliation(s)
- Islam H Elrobaa
- Emergency Medicine, College of Medicine, Qatar University, Doha, QAT
- Emergency Medicine, Hamad Medical Corporation (HMC), Doha, QAT
| | - Keebat Khan
- Emergency Medicine, Hamad Medical Corporation (HMC), Doha, QAT
| | - Eslam Mohamed
- Emergency Medicine, Hamad Medical Corporation (HMC), Doha, QAT
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morsi RM, Mansour DS, Mousa AM. Ameliorative potential role of Rosmarinus officinalis extract on toxicity induced by etoposide in male albino rats. BRAZ J BIOL 2024; 84:e258234. [DOI: 10.1590/1519-6984.258234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 06/17/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract The present work was showed to assess the effect of administration of rosemary extract on etoposide-induced toxicity, injury and proliferation in male rats were investigated. Forty male albino rats were arranged into four equal groups. 1st group, control; 2nd group, etoposide; 3rd group, co-treated rosemary & etoposide; 4th group, rosemary alone. In comparison to the control group, etoposide administration resulted in a significant increase in serum ALT, AST, ALP, total bilirubin, total protein, and gamma GT. In contrast; a significant decrease in albumin level in etoposide group as compared to G1. G3 revealed a significant decrease in AST, ALT, ALP, total protein and total bilirubin levels and a significant rise in albumin level when compared with G2. Serum levels of urea, creatinine, potassium ions, and chloride ions significantly increased; while sodium ions were significantly decreased in G2 when compared with G1. Also, there was an increase of MDA level for etoposide treated group with corresponding control rats. However, there was a remarkable significant decrease in SOD, GPX and CAT levels in G2 as compared to G1. There was a significant increase in serum hydrogen peroxide (H2O2) and Nitric oxide (NO) levels in group treated with etoposide when compared to control group. It was noticeable that administrated by rosemary alone either with etoposide had not any effect on the levels of H2O2 and Nitric oxide. Serum level of T3 and T4 was significantly increased in etoposide-administered rats in comparison with G1. The administration of rosemary, either alone or with etoposide, increased the serum levels of T3 and T4 significantly when compared to control rats. The gene expression analysis showed significant downregulation of hepatic SOD and GPx in (G2) when compared with (G1). The treatment with rosemary extract produced significant upregulation of the antioxidant enzymes mRNA SOD and GPx. MDA gene was increased in (G2) when contrasted with (G1). Treatment of the etoposide- induced rats with rosemary extract delivered significant decrease in MDA gene expression when compared with etoposide group. Rats treated with etoposide showed significant decline in hepatic Nrf2 protein expression, when compared with G1. While, supplementation of Etoposide- administered rats with the rosemary produced a significant elevation in hepatic Nrf2 protein levels. Additionally, the liver histological structure displayed noticeable degeneration and cellular infiltration in liver cells. It is possible to infer that rosemary has a potential role and that it should be researched as a natural component for etoposide-induced toxicity protection.
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Collier BB, Brandon WC, Chappell MR, Kovach PM, Grant RP. Maximizing Microsampling: Measurement of Comprehensive Metabolic and Lipid Panels Using a Novel Capillary Blood Collection Device. J Appl Lab Med 2023; 8:1115-1126. [PMID: 37748757 DOI: 10.1093/jalm/jfad066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/08/2023] [Indexed: 09/27/2023]
Abstract
BACKGROUND Demand continues to grow for patient-centric sampling solutions that enable collection of small volumes of blood outside of healthcare facilities. Various technologies have been developed to facilitate sample collection but gaps in knowledge remain, preventing these technologies from replacing standard venipuncture. METHODS A novel blood collection device, Touch Activated Phlebotomy (TAP) II® from YourBio Health, and standard fingerstick collection using a BD Microtainer® were utilized to collect capillary serum samples. Measurements of a comprehensive metabolic and lipid panels were measured on these samples and compared to results from venous serum samples that were collected in parallel. Hemolysis was used to assess sample quality. Sample volumes obtained from self-collected TAP II samples were also determined. RESULTS Correlation of capillary serum with respect to venous serum was demonstrated (R > 0.9) for professionally collected TAP II samples, self-collected TAP II samples, and professionally collected fingerstick samples for alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, blood urea nitrogen, cholesterol, high-density lipoprotein, total bilirubin, and triglycerides. Results for creatinine demonstrated acceptable correlation, however, a consistent negative bias was observed. Biases (with unacceptable correlations) were also observed for measurements of carbon dioxide and potassium. Correlative results for albumin were not consistently acceptable across the collection techniques utilized while the remaining analytes tested did not demonstrate acceptable correlations under any condition. Correlation results, however, would improve with a wider distribution of analyte concentrations. CONCLUSIONS Collections of small volumes of liquid blood continue to show potential as a patient-centric solution.
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Affiliation(s)
| | | | | | - Peyton M Kovach
- Center for Esoteric Testing, Labcorp, Burlington, NC, United States
| | - Russell P Grant
- Center for Esoteric Testing, Labcorp, Burlington, NC, United States
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Bnaya A, Ganzel C, Shavit L. Pseudohyperkalemia in chronic lymphocytic leukemia: Prevalence, impact, and management challenges. Am J Med Sci 2023; 366:167-175. [PMID: 37285937 DOI: 10.1016/j.amjms.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 01/14/2023] [Accepted: 04/17/2023] [Indexed: 06/09/2023]
Abstract
The term pseudohyperkalemia refers to a false elevation in serum potassium levels due to potassium release from cells in vitro. Falsely elevated potassium levels have been reported in patients with thrombocytosis, leukocytosis, and hematologic malignancies. This phenomenon has been particularly described in chronic lymphocytic leukemia (CLL). Leukocyte fragility, extremely high leukocyte counts, mechanical stress, higher cell membrane permeability related to an interaction with lithium heparin in plasma blood samples, and metabolite depletion due to a high leukocyte burden have been reported to contribute to pseudohyperkalemia in CLL. The prevalence of pseudohyperkalemia is up to 40%, particularly in the presence of a high leukocyte count (>50 × 109/L). The diagnosis of pseudohyperkalemia is often overlooked, which may result in unnecessary and potentially harmful treatment. The use of whole blood testing and point-of-care blood gas analysis, along with thorough clinical evaluation, may help differentiate between true and pseudohyperkalemic episodes.
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Affiliation(s)
- Alon Bnaya
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah-Hebrew University Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
| | - Chezi Ganzel
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Department of Hematology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Linda Shavit
- Institute of Nephrology, Shaare Zedek Medical Center, Jerusalem, Israel; Hadassah-Hebrew University Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Harper JA, Gal A, Burchell RK, Summers JD, Starling J, Gerber K, Gummow B. Comparison of ionised calcium measured using a portable analyser to a reference method in healthy dogs. J Small Anim Pract 2023; 64:337-342. [PMID: 36733265 DOI: 10.1111/jsap.13588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 10/31/2022] [Accepted: 12/15/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To compare the ionised calcium measured on a portable analyser (iSTAT, Abbott) to a reference method. MATERIALS AND METHODS Blood samples from 39 apparently healthy dogs were analysed in duplicate using a portable analyser and a reference method (Radiometer ABL800 FLEX). Bland-Altman plots and Passing-Bablok regression were used to assess constant and proportional bias between the two instruments. A within-assay percentage coefficient of variation and total error (TE) was calculated for both analysers. The reference interval was calculated for the portable analyser using the robust method with confidence interval bootstrapping. RESULTS The Bland-Altman plot showed a -0.036 mmol/L difference between the two instruments (95% confidence limit -0.08 to 0.01 mmol/L; limits of agreement -0.07 to 0.006 mmol/L). Neither the Bland-Altman plot nor the Passing-Bablock regression (slope -0.03; 95% confidence interval -0.08 to 0.19 and intercept 1; 95% confidence interval 0.83 to 1.2) showed significant proportional bias. The coefficient of variation for the portable analyser was 1.08%, compared to 0.78% for the reference method with a total error of 3.5% for the portable analyser. The estimated population-based reference interval for ionised calcium using the portable analyser is 1.23 to 1.42 mmol/L. CLINICAL SIGNIFICANCE For the healthy dogs in this study, compared to the reference method, the portable analyser showed no significant bias for measurement of ionised calcium. Further studies including hyper and hypocalcaemic dogs are required to determine clinical impact of the use of this analyser.
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Affiliation(s)
- J A Harper
- North Coast Specialist and Referral Centre, 5/30 Chancellor Village, Sippy Downs, Sunshine Coast, Australia
| | - A Gal
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, Carle Illinois College of Medicine, University of Illinois, Urbana, Illinois, USA
| | - R K Burchell
- North Coast Specialist and Referral Centre, 5/30 Chancellor Village, Sippy Downs, Sunshine Coast, Australia
| | - J D Summers
- Gracemere Veterinary Surgery, 22 Laurie Street, Gracemere 4702, Australia
| | - J Starling
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - K Gerber
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - B Gummow
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Choi HY, Corder W, Tefera E, Abubakar KM. Comparison of Point-of-Care versus Central Laboratory Testing of Electrolytes, Hemoglobin, and Bilirubin in Neonates. Am J Perinatol 2022; 39:1786-1791. [PMID: 33757138 DOI: 10.1055/s-0041-1726125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Electrolyte, hemoglobin, and bilirubin values are routinely reported with point-of-care (POC) testing for blood gases. Results are rapidly available and require a small blood volume. Yet, these results are underutilized due to noted discrepancies between central laboratory (CL) and POC testing. The study aimed to determine the correlation between POC and CL measurement of electrolytes, hemoglobin, and bilirubin in neonates. STUDY DESIGN Electrolyte, hemoglobin, and bilirubin results obtained from capillary blood over a 4-month period were analyzed. Each CL value was matched with a POC value from the same sample or another sample less than 1-hour apart. Agreement was determined by measuring the mean difference (MD) between paired samples with 95% limits of agreement (LOA) and Lin's concordance correlation (LCC). RESULTS There were 355-paired sodium/potassium, 139 paired hemoglobin, and 197 paired bilirubin values analyzed. POC sodium values were lower (133.5 ± 5.8 mmol/L) than CL (140.2 ± 5.8 mmol/L), p <0.00001 with poor agreement (LCC = 0.49; MD = 6.7; 95% LOA: -13.6 to 0.14). POC potassium values were lower (4.6 ± 0.98 mmol/L) than CL (4.98 ± 1.24mEq/L), p < 0.0001, but with better concordance and agreement. (LCC = 0.6; MD = 0.4; 95% LOA: -2.3 to 1.4). There were no differences in hemoglobin between POC (14.3 ± 3.2 g/dL) and CL (14.4 ± 3.1 g/dL), p = 0.2 with good LCC (0.93) and in bilirubin values between POC (6.0 ± 3.2 mg/dL) and CL (5.8 ± 3.0 mg/dL), MD = 0.18, and p = 0.07. CONCLUSION POC Sodium values are lower than CL. POC potassium levels are also lower, but the differences may not be clinically important while hemoglobin and bilirubin levels are similar between POC and CL. As POC potassium, hemoglobin, and bilirubin levels closely reflect CL values, these results can be relied upon to make clinical judgments in neonates. KEY POINTS · Electrolyte, hemoglobin, and bilirubin are available as POC.. · POC sodium and potassium values are lower than CL results.. · Hemoglobin and bilirubin values are similar between POC and CL..
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Affiliation(s)
- Ha-Young Choi
- Division of Neonatology, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - William Corder
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Eshetu Tefera
- Statistics, MedStar Research Institute, Washington, District of Columbia
| | - Kabir M Abubakar
- Division of Neonatology, MedStar Georgetown University Hospital, Washington, District of Columbia
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Zamanabadi MN, Zamanabadi TN, Alizadeh R. Measuring serum sodium levels using blood gas analyzer and auto analyzer in heart and lung disease patients: A cross-sectional study. Ann Med Surg (Lond) 2022; 78:103713. [PMID: 35600187 PMCID: PMC9117252 DOI: 10.1016/j.amsu.2022.103713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/29/2022] [Accepted: 05/01/2022] [Indexed: 11/03/2022] Open
Abstract
Objective Methods Results Conclusion Emergency services require precise and rapid measurement of electrolytes to initiate treatment. Blood gas analyzers analyzes blood samples in seconds however, its accuracy is still debatable. Blood gas analyzer method has a high correlation with laboratory analyzer. In cases of hypernatremia, the blood gas analyzer method decreases and especially in acidosis. In patients with pulmonary problems, the difference with laboratory method increases.
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Mahmoud H, Jaffar Z, Al Alawi YM, Al Alsuhaimi F, Khoja MAA, Al-Ahmadi MA, Alattas AM, Alhusayni MF, Mahroos ME, Alrehaili MA. Accuracy of Potassium Measurement Using Blood Gas Analyzer. Cureus 2022; 14:e23653. [PMID: 35371883 PMCID: PMC8971128 DOI: 10.7759/cureus.23653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2022] [Indexed: 12/05/2022] Open
Abstract
Introduction: Newer blood gas analyzers can measure both blood gases and electrolytes in both arterial and venous blood samples. They are small, compact, and mobile point of care test (POCT) devices. They can produce results in as short as five minutes. We aimed at assessing the accuracy of potassium (K) level measured by gas analyzer (index test) by comparing that to the regular laboratory machine (reference standard) in our hospital. Our goal is to use POCT result of potassium so we may start insulin infusion within five to 10 minutes of arrival of diabetic ketoacidosis (DKA) patients to the emergency room (ER). It takes an average of 30 minutes to get the result using the reference standard machine. Potassium level is needed urgently in cases of DKA before initiating insulin infusion. That is true also during cardiopulmonary resuscitation (CPR) and while replacing K in severe hypokalemia and during the management of hyperkalemia. Methods: We looked into the potassium results from 265 patients who had venous blood gas (VBG) or arterial blood gas (ABG) samples and compared that to results of potassium in venous blood samples of these same patients done simultaneously or within two hours. All patients who had blood gas and venous blood drawn simultaneously or within two hours were eligible irrespective of gender, age, diagnosis, and location in the hospital. Data were collected between January 2019 and June 2019. We excluded all cases that were receiving IV fluids, diuretics, or potassium supplements. Samples examined were from all different areas of the hospital including emergency room (ER), intensive care unit (ICU), and general floors. All ages and all diagnoses were included. Results: We used the Bland-Altman method to analyze our data. More than 95% of the data fell within ± 2 standard deviations (S) of the mean difference strongly suggestive of agreement between the index test and the standard reference of the laboratory methods. The bias was 0.19. Lin’s concordance correlation coefficient was 0.6584. Conclusion: Findings of this study support the use of POCT blood gas analyzer for measuring potassium when the results are needed urgently. When measuring potassium, blood gas analyzers are as accurate as automated analyzers. They produce results in five minutes or so and can be relied upon when potassium level is needed urgently. They are cost-effective and may be available at the bedside.
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Lee B, Park H. Performance evaluation of the i‐Smart 300E cartridge for point‐of‐care electrolyte measurement in serum and plasma. J Clin Lab Anal 2022; 36:e24295. [PMID: 35156738 PMCID: PMC8993652 DOI: 10.1002/jcla.24295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/04/2022] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Background Electrolytes are measured regularly in a variety of clinical settings because electrolyte imbalance can be life‐threatening. Although arterial blood‐gas analysis reports electrolyte levels, the result often is discrepant with results from serum and plasma samples. Since prompt and accurate measurement of serum electrolyte levels could allow early treatment, point‐of‐care (POC) electrolyte analyzers would be beneficial. We evaluated a POC electrolyte analyzer cartridge based on the Clinical and Laboratory Standard Institute (CLSI) guidelines. Methods Precision and linearity were assessed according to the CLSI EP05‐A3 and EP06‐A guidelines, respectively. A comparison study was conducted with both serum and plasma samples according to the CLSI EP09‐A3. For serum, results from the i‐Smart 300E analyzer were compared with results from the Nova 8 and i‐Smart 30 analyzers. For plasma, results were compared among the i‐Smart 300E, Nova 8, i‐Smart 30, and Cobas c702 analyzers. Results Coefficients of variation in the precision analysis were all less than 5%. Linearity assessment demonstrated a coefficient of determination between 0.999 and 1.000 for all analytes. The comparison study showed a high Pearson's correlation coefficient greater than 0.9 for all analytes, instruments, and specimens. Conclusions The i‐Smart 300E demonstrated good analytical performance. Its use could be beneficial in terms of both efficiency and clinical outcome in point‐of‐care testing (POCT) for electrolyte levels from serum and plasma samples.
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Affiliation(s)
- Beomki Lee
- Department of Laboratory Medicine and Genetics Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
| | - Hyung‐Doo Park
- Department of Laboratory Medicine and Genetics Samsung Medical CenterSungkyunkwan University School of Medicine Seoul Korea
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Sahoo S, Sahoo J, Singh N, Hansda U, Guru S, Topno N. Point-of-care versus central laboratory measurements of electrolytes and hemoglobin: A prospective observational study in critically ill patients in a tertiary care hospital. Int J Crit Illn Inj Sci 2022; 12:160-164. [PMID: 36506927 PMCID: PMC9728077 DOI: 10.4103/ijciis.ijciis_2_22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/03/2022] [Accepted: 03/09/2022] [Indexed: 12/15/2022] Open
Abstract
Background A blood gas analyzer is a point-of-care (POC) testing device used in the Emergency Department (ED) to manage critically ill patients. However, there were differences in results found from blood gas analyzers for hemoglobin (Hgb) and electrolytes parameters. We conducted a comparative validity study in ED in patients who had requirements of venous gas analysis, complete blood count, and electrolytes. The objective was to find the correlation of Hgb, sodium (Na+), and potassium (K+) values between the blood gas analyzer and laboratory autoanalyzer. Methods A total of 206 paired samples were tested for Hgb, Na+, and K+. Total 4.6 ml of venous blood was collected from each participant, 0.6 ml was used for blood gas analysis as POC testing and 4 ml was sent to the central laboratory for electrolyte and Hgb estimation. Results The mean difference between POC and laboratory method was 0.608 ± 1.41 (95% confidence interval [CI], 0.41-0.80; P < 0.001) for Hgb, 0.92 ± 3.5 (95% CI, 0.44-1.40) for Na+, and 0.238 ± 0.62 (95% CI, -0.32-0.15; P < 0.001) for K+. POC testing and laboratory method showed a strong positive correlation with Pearson correlation coefficient (r) of 0.873, 0.928, and 0.793 for Hgb, Na+, and K+, respectively (P < 0.001). Conclusion Although there was a statistical difference found between the two methods, it was under the United States Clinical Laboratory Improvement Amendment range. Hence, starting the therapy according to the blood gas analyzer results may be beneficial to the patient and improve the outcome.
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Affiliation(s)
- Sangeeta Sahoo
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Jyotiranjan Sahoo
- Department of Community Medicine, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Neha Singh
- Department of Anesthesiology and Critical Care, AIIMS, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Upendra Hansda
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India,Address for correspondence: Dr. Upendra Hansda, Department of Trauma and Emergency, AIIMS, Bhubaneswar, Odisha, India. E-mail:
| | - Satyabrata Guru
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India
| | - Nitish Topno
- Department of Trauma and Emergency, IMS and SUM Hospital, Bhubaneswar, Odisha, India
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14
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Nelson C, Constable PD, Connolly SL. Comparison of selected serum biochemistry measurements between the Nova Prime Plus VET, Nova pHOx Ultra, and Beckman Coulter AU680 analyzers in dogs. Vet Clin Pathol 2021; 50:327-341. [PMID: 34545580 DOI: 10.1111/vcp.13010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/07/2021] [Accepted: 02/27/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Blood gas chemistry analyzers typically produce results faster and use smaller sample volumes than reference chemistry analyzers. However, results may not be comparable between blood gas chemistry analyzers and reference chemistry analyzers or between different models of blood gas chemistry analyzers. This could suggest the use of separate reference intervals and, thus, has implications when making clinical decisions. OBJECTIVE We aimed to perform method comparison studies to evaluate selected canine serum biochemical values obtained using the Nova Stat Profile Prime Plus VET (Prime Plus VET), Stat Profile Nova pHOx Ultra (Ultra), and Beckman Coulter AU680 (Beckman) analyzers. We hypothesized that the three analyzers would be identical within inherent imprecision. METHODS Jugular venous blood samples were collected from 103 endurance-trained sled dogs, and serum was harvested and stored for analysis. Results for serum chloride, potassium, sodium, creatinine, and urea nitrogen concentrations obtained from the Prime Plus VET and Ultra analyzers were compared with results from the Beckman analyzer, which was considered to be a reference method. Results for serum chloride, potassium, sodium, creatinine, urea nitrogen, and L-lactate concentrations obtained from the Prime Plus VET and Ultra analyzers were compared. Passing-Bablok regression and Bland-Altman plots were used for method comparison. RESULTS Significant (P < 0.05) constant or proportional bias was found for many analytes for all three method comparison studies. CONCLUSIONS Due to the presence of statistically significant differences between all three analyzers that may be clinically relevant, it is recommended that reference intervals be created for new blood gas analyzers, even when similar methodologies are used.
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Affiliation(s)
- Courtney Nelson
- Department of Pathobiology, College of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Peter D Constable
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
| | - Sara L Connolly
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois, Urbana, IL, USA
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15
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Gohel M, Makadia JS, Chakrabarti C. Effect of Hypoproteinemia on Electrolyte Measurement by Direct and Indirect Ion Selective Electrode Methods. J Lab Physicians 2021; 13:144-147. [PMID: 34483560 PMCID: PMC8409126 DOI: 10.1055/s-0041-1730821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective
The aim of this study was to see the effect of hypoproteinemia on electrolyte measurement by two different techniques, that is, direct ion selective electrode (ISE) and indirect ISE.
Material and Method
It was an observational study in which 90 serum samples with normal protein content (Group-1) were subjected to sodium (Na
+
) and potassium (K
+
) measurements by direct and indirect ISE methods. In the same way, 90 serum samples with total protein < 5 g/dL (Group-2) were subjected to Na
+
and K
+
measurements by direct and indirect ISE methods.
Result
In samples from Group-1 patients, average Na
+
was 138.1 ± 4.764 mmol/L by direct ISE method and 139.3 ± 3.887 mmol/L by indirect ISE method while average K
+
was 4.41 ± 0.644 mmol/L by direct ISE method and 4.40 ± 0.592 mmol/L by indirect ISE method. There was no statistically significant difference in Na
+
and K
+
values measured by different methods. In samples from Group-2 patients, measured value of Na
+
by direct ISE and indirect ISE was 134.57 ± 5.520 mmol/L and 138.64 ± 5.401 mmol/L, respectively. Difference between these two values was statistically significant with
p
-value of < 0.0001, but direct ISE and indirect ISE measured values of K
+
was 4.146 ± 0.9639 mmol/L and 4.186 ± 0.8989, respectively, with no significant difference.
Conclusion
Direct and indirect ISE methods are not comparable and showing significantly different results for Na
+
in case of hypoproteinemia. So, it is recommended that setups like intensive care unit or emergency department, where electrolyte values have significant treatment outcome, should follow direct ISE method and should compare its previous result with the same method. Both the methods should not be used interchangeably.
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Affiliation(s)
- Mukesh Gohel
- Department of Biochemistry, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Jemil S Makadia
- Department of Biochemistry, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
| | - Chandan Chakrabarti
- Department of Biochemistry, Smt NHL Municipal Medical College, Ahmedabad, Gujarat, India
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16
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Dabas A, Agrawal S, Tyagi V, Sharma S, Rastogi V, Jhamb U, Dabla PK. Point of Care Testing of Serum Electrolytes and Lactate in Sick Children. EJIFCC 2021; 32:158-166. [PMID: 34421484 PMCID: PMC8343055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To evaluate the electrolyte and lactate abnormalities in hospitalized children using a point of care testing (POCT) device and assess the agreement on the electrolyte abnormalities between POCT and central laboratory analyzer with venous blood. METHODS This observational study recruited hospitalized children aged 1 month to 12 years within two hours of admission. A paired venous sample and heparinized blood sample were drawn and analyzed by the central laboratory and POCT device (Stat Profile Prime Plus-Nova Biomedical, Waltham, MA, USA) for sodium and potassium. Lactate was measured on the POCT device only. The clinical and outcome parameters of children with electrolyte abnormalities or elevated lactate (>2mmol/L), and the agreement between POCT values and central laboratory values were assessed. RESULTS A total of 158 children with median (IQR) age 11 (6-10) months and PRISM score 5 (2-9) were enrolled. The proportion of children with abnormal sodium and potassium levels, and acidosis on POCT were 87 (55.1%), 47 (29.7%) and 73 (46.2%), respectively. The interclass coefficient between POCT and laboratory values of sodium and potassium values was 0.74 and 0.71 respectively; P<0.001. Children with hyperlactatemia (81, 51.3%) had higher odds of shock (OR 4.58, 95% CI: 1.6-12.9), mechanical ventilation (OR 2.7, 95% CI 1.1-6.6, P=0.02) and death (OR 3.1, 95% CI 1.3-7.5 P=0.01) compared to those with normal lactate. CONCLUSION POCT can be used as an adjunct for rapid assessment of biochemical parameters in sick children. Lactate measured by POCT was a good prognostic indicator.
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Affiliation(s)
- Aashima Dabas
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shipra Agrawal
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Vernika Tyagi
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Shikha Sharma
- Department of Biochemistry, Chacha Nehru Bal Chikitsalya, New Delhi, India
| | - Vandana Rastogi
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Urmila Jhamb
- Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India
| | - Pradeep Kumar Dabla
- Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Education and Research, New Delhi, India,Corresponding author: Prof. Pradeep Kumar Dabla Department of Biochemistry Govind Ballabh Pant Institute of Postgraduate Medical Education and Research (GIPMER) Associated Maulana Azad Medical College Delhi University New Delhi India Phone: +919718592467 E-mail:
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17
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Fukaguchi K, Yamagami H, Soeno S, Hara K, Shirakawa T, Sonoo T, Nakamura K, Goto T. Association of Initial Potassium Levels with the Type of Stroke in the Emergency Department. J Stroke Cerebrovasc Dis 2021; 30:105875. [PMID: 34062311 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 05/01/2021] [Indexed: 10/21/2022] Open
Abstract
Serum potassium levels are considered as a marker of cerebrovascular emergencies but there is less clarity on the association between initial serum potassium levels recorded on patient's arrival at the emergency department with the type of stroke. This is a case-control study using data of a tertiary care hospital in Japan from April 2018 to September 2019. We identified adult patients with hemorrhagic stroke including subarachnoid hemorrhage (cases) and those with ischemic stroke (controls). Data on age, sex, chief complaints, vital signs, and initial blood tests were collected. We analyzed the association between serum potassium levels and the type of stroke by drawing a LOWESS curve. Additionally, we fitted a logistic regression model to examine the association of interest. There were 416 stroke patients (158 hemorrhagic and 258 ischemic). The median age was 77 years (IQR: 68, 84), and 54% were male. The mean potassium level was 3.69 ± 0.55 mEq/L for hemorrhagic stroke and 4.08 ± 0.65 mEq/L for ischemic stroke. The LOWESS curve showed that the lower initial potassium level was linearly associated with a greater likelihood of hemorrhagic stroke. In the logistic regression model, the odds ratio for the risk of hemorrhagic stroke per 1 mEq/L lower potassium level was 3.31 (95% confidence interval [CI]: 2.24-5.04). This association remained significant in a multivariable model adjusting for other covariates (OR: 2.62 [95% CI: 1.70-4.16]). Initial potassium level was lower in patients with hemorrhagic stroke compared to those with ischemic stroke.
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Affiliation(s)
- Kiyomitsu Fukaguchi
- Department of Emergency Medicine, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura-shi, Kanagawa 247-0072, Japan; TXP Medical Co. Ltd., Japan.
| | - Hiroshi Yamagami
- Department of Emergency Medicine, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura-shi, Kanagawa 247-0072, Japan
| | - Shoko Soeno
- TXP Medical Co. Ltd., Japan; Department of Emergency Medicine, Southern Tohoku General Hospital, Japan
| | - Konan Hara
- TXP Medical Co. Ltd., Japan; Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Toru Shirakawa
- TXP Medical Co. Ltd., Japan; Department of Social Medicine, Osaka University Graduate School from Medicine, Japan
| | - Tomohiro Sonoo
- TXP Medical Co. Ltd., Japan; Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
| | - Kensuke Nakamura
- Department of Emergency and Critical Care Medicine, Hitachi General Hospital, Japan
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18
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Schmitz KL, Jeffery U, Heinz JA, Rutter CR. Evaluation of two benchtop blood gas analyzers for measurement of electrolyte concentrations in venous blood samples from dogs. Am J Vet Res 2021; 82:105-109. [PMID: 33480275 DOI: 10.2460/ajvr.82.2.105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess agreement between 2 benchtop blood gas analyzers developed by 1 manufacturer (BGA 1 and BGA 2 [a newer model with reduced maintenance requirements]) and a reference chemistry analyzer for measurement of electrolyte (sodium, chloride, and potassium) in blood samples from dogs. ANIMALS 17 healthy staff- and student-owned dogs and 23 client-owned dogs admitted to an emergency and intensive care service. PROCEDURES Blood collected by venipuncture was placed in lithium heparin-containing tubes. Aliquots were analyzed immediately with each BGA. Samples were centrifuged, and plasma was analyzed with the reference analyzer. Results for each BGA were compared with results for the reference analyzer by Passing-Bablok regression analysis. Percentage differences between BGA and reference analyzer results were compared with published guidelines for total allowable error. RESULTS Proportional bias was detected for measurement of chloride concentration (slope, 0.7; 95% CI, 0.7 to 0.8), and constant positive bias was detected for measurement of chloride (y-intercept, 34, mmol/L; 95% CI, 16.9 to 38 mmol/L) and potassium (y-intercept, 0.1 mmol/L; 95% CI, 0.1 to 0.2 mmol/L) concentrations with BGA 1. There was no significant bias for measurement of potassium or chloride concentration with BGA 2 or sodium concentration with either BGA. Differences from the reference analyzer result exceeded total allowable error guidelines for ≥ 1 sample/analyte/BGA, but median observed measurement differences between each BGA and the reference analyzer did not. CONCLUSIONS AND CLINICAL RELEVANCE Good agreement with reference analyzer results was found for measurement of the selected electrolyte concentrations in canine blood samples with each BGA.
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19
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Gomez DE, Buczinski S, Darby S, Palmisano M, Beatty SSK, Mackay RJ. Agreement of 2 electrolyte analyzers for identifying electrolyte and acid-base disorders in sick horses. J Vet Intern Med 2020; 34:2758-2766. [PMID: 32965055 PMCID: PMC7694849 DOI: 10.1111/jvim.15889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Use of different analyzers to measure electrolytes in the same horse can lead to different interpretation of acid-base balance when using the simplified strong ion difference (sSID) approach. OBJECTIVE Investigate the level of agreement between 2 analyzers in determining electrolytes concentrations, sSID variables, and acid-base disorders in sick horses. ANIMALS One hundred twenty-four hospitalized horses. METHODS Retrospective study using paired samples. Electrolytes were measured using a Beckman Coulter AU480 Chemistry analyzer (PBMA) and a Nova Biomedical Stat Profile (WBGA), respectively. Calculated sSID variables included strong ion difference, SID4 ; unmeasured strong ions, USI; and total nonvolatile buffer ion concentration in plasma (Atot ). Agreement between analyzers was explored using Passing-Bablok regression and Bland-Altman analysis. Kappa (κ) test evaluated the level of agreement between analyzers in detecting acid-base disorders. RESULTS Methodologic differences were identified in measured Na+ and Cl- and calculated values of SID4 and USI. Mean bias (95% limits of agreement) for Na+ , Cl- , SID4 , and USI were: -1.2 mmol/L (-9.2 to 6.8), 4.4 mmol/L (-4.4 to 13), -5.4 mmol/L (-13 to 2), and -6.2 mmol/L (-14 to 1.7), respectively. The intraclass correlation coefficient for SID4 and USI was .55 (95%CI: -0.2 to 0.8) and .2 (95%CI: -0.15 to 0.48), respectively. There was a poor agreement between analyzers for detection of SID4 (κ = 0.20, 95%CI, 0.1 to 0.31) or USI abnormalities (κ = -0.04, 95%CI, -0.11 to 0.02). CONCLUSIONS AND CLINICAL IMPORTANCE Differences between analyzer methodology in measuring electrolytes led to a poor agreement between the diagnosis of acid-base disorders in sick horses when using the sSID approach.
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Affiliation(s)
- Diego E Gomez
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Department of Clinical Studies, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Sébastien Buczinski
- Département de Sciences Cliniques, Faculté de Médecine Vétérinaire, Université de Montréal, Montréal, Quebec, Canada
| | - Shannon Darby
- Department of Clinical Studies, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Megan Palmisano
- Department of Clinical Studies, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Sarah S K Beatty
- Department of Comparative, Diagnostic & Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
| | - Robert J Mackay
- Department of Clinical Studies, College of Veterinary Medicine, University of Florida, Gainesville, Florida, USA
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20
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Chopra P, Datta SK. Discrepancies in Electrolyte Measurements by Direct and Indirect Ion Selective Electrodes due to Interferences by Proteins and Lipids. J Lab Physicians 2020; 12:84-91. [PMID: 32905238 PMCID: PMC7467836 DOI: 10.1055/s-0040-1713690] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives
We aim to report the simultaneous effect of different protein and lipid concentrations on sodium (Na
+
) and potassium (K
+
) measurement by direct and indirect ion selective electrodes (dISE and iISE) in patient samples.
Materials and Methods
Na
+
and K
+
were measured in 195 serum samples received in the laboratory using iISE by Roche Modular P800 autoanalyzer and using dISE by XI-921 ver. 6.0 Caretium electrolyte analyzer. Serum total protein (TP), cholesterol (Chol), and triglycerides (TG) were measured using conventional photometric methods on Roche Modular P800 autoanalyzer. Differences for each pair of results for Na
+
(Diff_Na
+
= [Na
+dISE–
Na
+iISE
]) and K
+
(Diff_K
+
= [K
+dISE–
K
+iISE
]) were calculated. Patient subgroups with high, normal, or low TP (< 5, 5–7.9, or ≥ 8 g/dL), Chol (< 150, 150–299, or ≥300 mg/dL), or TG (< 150, 150–299, or ≥300 mg/dL) were compared using analysis of variance. Note that 95% confidence interval of Diff_Na
+
and Diff_K
+
were calculated to see the number of samples showing clinically significant differences.
Results
Diff_Na
+
(
p
= 0.007) and Diff_K
+
(
p
= 0.002) were found significant between samples with normal and high TP. However, effect of TG was not significant. Chol concentration affected Diff_Na
+
significantly between low versus normal (
p
= 0.002), and high versus normal (
p
= 0.031) Chol groups. Diff_K
+
was significant (
p
= 0.009) between low versus normal Chol. Clinically relevant disagreement of ≥|5| mmol/L for Na
+
was observed in high percentage of samples including all subcategories; however, for K
+
only 3.6% of the total samples showed disagreement of ≥ |0.5| mmol/L. A multivariate regression equation based on fit regression model was also derived.
Conclusion
Summarily, interchangeable use of electrolyte results from dISE and iISE is not advisable, especially in a setting of hyperproteinemia (≥8 g/dL) or hypercholesterolemia (≥300 mg/dL); more so for Na
+
.
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Affiliation(s)
- Parul Chopra
- Department of Hematology and Immunology, Dr. Lal PathLabs, New Delhi, India
| | - Sudip Kumar Datta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
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21
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Chothia MY, Kassum P, Zemlin A. A method comparison study of a point-of-care blood gas analyser with a laboratory auto-analyser for the determination of potassium concentrations during hyperkalaemia in patients with kidney disease. Biochem Med (Zagreb) 2020; 30:030702. [PMID: 32774124 PMCID: PMC7394258 DOI: 10.11613/bm.2020.030702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 05/28/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction Hyperkalaemia is a common electrolyte disorder that may cause life-threatening cardiac arrythmias. We aimed to determine the agreement of potassium concentrations between GEM premier 3500 point-of-care blood gas analyser (POC-BGA) and Roche Cobas 6000 c501 auto-analyser in patients with hyperkalaemia. Methods A prospective, cross-sectional study of all consecutive adult patients referred to the Renal Unit with a serum potassium concentration ≥ 5.5 mmol/L was performed. A total of 59 paired venous blood samples were included in the final statistical analysis. Passing-Bablok regression and Bland Altman analysis were used to compare the two methods. Results The median laboratory auto-analyser potassium concentration was 6.1 (5.9-7.1) mmol/L as compared to the POC-BGA potassium concentration of 5.7 (5.5-6.8) mmol/L with a mean difference of - 0.43 mmol/L and 95% upper and lower limits of agreement of 0.35 mmol/L and - 1.21 mmol/L, respectively. Regression analysis revealed proportional systematic error. Test for linearity did not indicate significant deviation (P = 0.297). Conclusion Although regression analysis indicated proportional systematic error, on Bland Altman analysis, the mean difference appeared to remain relatively constant across the potassium range that was evaluated. Therefore, in patients presenting to the emergency department with a clinical suspicion of hyperkalaemia, POC-BGA potassium concentrations may be considered a surrogate for laboratory auto-analyser measurements once clinicians have been cautioned about this difference.
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Affiliation(s)
- Mogamat-Yazied Chothia
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Patricia Kassum
- Division of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Annalise Zemlin
- Division of Chemical Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University and National Health Laboratory Service (NHLS), Tygerberg Hospital, Cape Town, South Africa
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22
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Lim SY, Bodagh N, Scott G, Hill NE. Hyponatraemia: the importance of obtaining a detailed history and corroborating point-of-care analysis with laboratory testing. BMJ Case Rep 2019; 12:12/12/e229221. [PMID: 31822529 DOI: 10.1136/bcr-2019-229221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We describe a 67-year-old man admitted from a mental health unit with an incidental finding of hyponatraemia on routine blood tests. Laboratory investigations were in keeping with syndrome of inappropriate antidiuretic hormone secretion (SIADH). He had been recently commenced on mirtazapine. During his inpatient stay, he became increasingly confused. Review of a previous admission with hyponatraemia raised the possibility of voltage-gated potassium channel antibody-associated limbic encephalitis, although subsequent investigations deemed this unlikely as a cause of hyponatraemia. Although his sodium levels improved with fluid restriction, serial point-of-care testing proved misleading in monitoring the efficacy of treatment as inconsistencies were seen in comparison with laboratory testing. The cause of hyponatraemia may have been medication-induced SIADH and/or polydipsia. This case highlights the importance of collating detailed histories and laboratory blood testing to guide management in cases of hyponatraemia of unknown aetiology.
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Affiliation(s)
- Su Yin Lim
- Acute Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Neil Bodagh
- Acute Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Gregory Scott
- Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Neil E Hill
- Endocrinology & Diabetes, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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23
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Howitt SH, Grant SW, Campbell NG, Malagon I, McCollum C. Are Serum Potassium and Magnesium Levels Associated with Atrial Fibrillation After Cardiac Surgery? J Cardiothorac Vasc Anesth 2019; 34:1152-1159. [PMID: 31948890 DOI: 10.1053/j.jvca.2019.10.045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 10/22/2019] [Accepted: 10/26/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVES Potassium and magnesium are frequently administered after cardiac surgery to reduce the risk of atrial fibrillation (AF). The evidence for this practice is unclear. This study was designed to evaluate the relationship between serum potassium and magnesium levels and AF after cardiac surgery. DESIGN Observational cohort study. SETTING A cardiac intensive care unit in the United Kingdom. PARTICIPANTS Patients undergoing cardiac surgery between January 2013 and November 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Cardiac rhythm was assessed using continuous electrocardiogram (ECG) monitoring in 3,068 patients on the cardiac intensive care unit. Associations between serum potassium and magnesium concentrations extracted from hospital databases and postoperative AF were assessed using univariable and multivariable analyses. The association between electrolyte supplementation therapy and AF was also analyzed. AF developed within 72 hours of cardiac surgery in 545 (17.8%) of the 3,068 patients. After adjusting for logistic EuroSCORE, surgery type, cardiopulmonary bypass time and age, mean serum potassium concentration <4.5 mmol/L was associated with an increased risk of AF (odds ratio [OR] 1.43 (95% confidence interval (CI): 1.17-1.75), p < 0.001). Mean magnesium concentration <1.0 mmol/L was not associated with an increased risk of AF (OR 0.89, 0.71-1.13, p = 0.342), but the administration of magnesium was associated with increased risk of developing AF (OR 1.61, 1.33-1.96, p < 0.001). CONCLUSIONS Maintaining a serum potassium concentration ≥4.5 mmol/L after cardiac surgery may reduce the incidence of postoperative AF. Magnesium supplementation was associated with an increased risk of postoperative AF. Prospective randomized trials are required to clarify these associations.
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Affiliation(s)
- Samuel H Howitt
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom; Department of Cardiothoracic Anesthesia and Critical Care, Wythenshawe Hospital, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom.
| | - Stuart W Grant
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom
| | - Niall G Campbell
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom
| | - Ignacio Malagon
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom; Department of Cardiothoracic Anesthesia and Critical Care, Wythenshawe Hospital, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom
| | - Charles McCollum
- Division of Cardiovascular Sciences, University of Manchester, ERC, Manchester University Hospitals Foundation Trust, Manchester, United Kingdom
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24
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Determination of Electrolytes in Critical Illness Patients at Different pH Ranges: Whom Shall We Believe, the Blood Gas Analysis or the Laboratory Autoanalyzer? Crit Care Res Pract 2019; 2019:9838706. [PMID: 31396417 PMCID: PMC6664556 DOI: 10.1155/2019/9838706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/01/2019] [Indexed: 12/15/2022] Open
Abstract
Introduction The determination of the electrolytes sodium and potassium is essential in critical care. In daily clinical practice, both the blood gas analyzer (ABG) and the laboratory autoanalyzer (AA) are generally applied. However, there is still uncertainty regarding the convergence of the prementioned assays, and data about the comparability dependent on the pH value are still lacking. Materials and Methods One hundred samples from intensive care unit patients with a range in pH values between 7.20 and 7.49 were evaluated in this retrospective cohort study. All patients suffered an infarct-related cardiogenic shock and were intubated and not under therapeutical hypothermia at the time of blood collection. We used scatter plots to compare different distributions of sodium and potassium values between the methods. Comparability of the analyses was assessed using the Bland–Altmann approach, and intraclass correlations (ICC) as estimates of interrater reliability were calculated. Results The mean potassium level measured on ABG was 4.33 mmol/L (SD 0.48 mmol/L), and the value obtained using the AA was 4.40 mmol/L (SD 0.55 mmol/L). A Bland–Altman comparison for total potassium measurements revealed that the limits of agreement were small (−0.241 to 0.391 mmol/L). Total ICC displayed a very good correlation of 0.949. For sodium, we found average values of 140 mmol/L (SD 5.20 mmol/L) in the AA and 140 mmol/L (SD 5.80 mmol/L) in the ABG assessment. Contrarily, the Bland–Altman comparison for sodium displayed that the 95% limits of agreement were very wide (−5.99 to 6.59 mmol/L) for total measurements as well as in every pH subgroup. Total ICC only reached a value of 0.830. Conclusion Data from our single-center study indicate that urgent and vital decisions based on potassium measurements can be made by trusting the value obtained on the ABG machine irrespective of pH values.
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Megahed AA, Hiew M, Grünberg W, Trefz FM, Constable PD. Evaluation of the analytical performance of a portable ion-selective electrode meter for measuring whole-blood, plasma, milk, abomasal-fluid, and urine sodium concentrations in cattle. J Dairy Sci 2019; 102:7435-7444. [PMID: 31202658 DOI: 10.3168/jds.2018-16198] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/23/2019] [Indexed: 11/19/2022]
Abstract
A portable ion-selective electrode (ISE) meter (LAQUAtwin B-722; Horiba Instruments Inc., Irvine, CA) is available for measuring the sodium ion concentration ([Na]) in biological fluids. The objective of this study was to characterize the analytical performance of the ISE meter in measuring [Na] in whole-blood, plasma, milk, abomasal fluid, and urine samples from cattle. Method comparison studies were performed using whole-blood and plasma samples from 106 sick calves and 11 sick cows admitted to a veterinary teaching hospital, 80 milk and 206 urine samples from 16 lactating Holstein-Friesian cows with experimentally induced free water, electrolyte, and acid-base imbalances, and 67 abomasal fluid samples from 7 healthy male Holstein-Friesian calves fed fresh milk with or without an oral electrolyte solution. Deming regression and Bland-Altman plots were used to determine the accuracy of the meter against reference methods. The meter used in direct mode on undiluted samples measured whole-blood [Na] 9.7 mmol/L (7.3%) lower than a direct ISE reference method and plasma [Na] 16.7 mmol/L (12.7%) lower than an indirect ISE reference method. The meter run in direct mode measured milk [Na] 3.1 mmol/L lower and abomasal fluid [Na] 9.0% lower than indirect ISE reference methods. The meter run in indirect mode on diluted samples accurately measured urine [Na] compared with an indirect ISE reference method. We conclude that, after adjustment for the bias determined from Bland-Altman plots, the LAQUAtwin ISE meter provides a clinically useful and low-cost cow-side instrument for measuring [Na] in whole blood, plasma, milk, and abomasal fluid.
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Affiliation(s)
- A A Megahed
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign 61802; Department of Animal Medicine (Internal Medicine), Faculty of Veterinary Medicine, Benha University Moshtohor-Toukh, Kalyobiya, Egypt 13736
| | - M Hiew
- Department of Veterinary Clinical Studies, Faculty of Veterinary Medicine, Universiti Putra, Selangor, Malaysia 43400
| | - W Grünberg
- Department of Veterinary Clinical Sciences, Purdue University, College of Veterinary Medicine, West Lafayette, IN 47907
| | - F M Trefz
- Clinic for Ruminants with Ambulatory and Herd Health Services at the Center of Veterinary Clinical Medicine, LMU Munich, 85764 Oberschleißheim, Germany
| | - P D Constable
- Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign 61802.
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Triplett KE, Wibrow BA, Norman R, Hince DA, Hardy LE, Tan S, Ho KM, Anstey MH. Can the blood gas analyser results be believed? A prospective multicentre study comparing haemoglobin, sodium and potassium measurements by blood gas analysers and laboratory auto-analysers. Anaesth Intensive Care 2019; 47:120-127. [DOI: 10.1177/0310057x19840046] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Blood gas analysers are point-of-care testing devices used in the management of critically ill patients. Controversy remains over the agreement between the results obtained from blood gas analysers and laboratory auto-analysers for haematological and biochemistry parameters. We conducted a prospective analytical observational study in five intensive care units in Western Australia, in patients who had a full blood count (FBC), urea, electrolytes and creatinine (UEC), and a blood gas performed within 1 h of each other during the first 24 h of their intensive care unit admission. The main outcome measure was to determine the agreement in haemoglobin, sodium, and potassium results between laboratory haematology and biochemistry auto-analysers and blood gas analysers. A total of 219 paired tests were available for haemoglobin and sodium, and 215 for potassium. There was no statistically significant difference between the results of the blood gas and laboratory auto-analysers for haemoglobin (mean difference –0.35 g/L, 95% confidence interval (CI) –1.20 to 0.51, P = 0.425). Although the mean differences between the two methods were statistically significant for sodium (mean difference 1.49 mmol/L, 95% CI 1.23–1.76, P < 0.0001) and potassium (mean difference 0.19 mmol/L, 95% CI 0.15–0.24, P < 0.0001), the mean biases on the Bland–Altman plots were small and independent of the magnitude of the measurements. The two methods of measurement for haemoglobin, sodium and potassium agreed with each other under most clinical situations when their values were within or close to normal range suggesting that routine concurrent blood gas and formal laboratory testing for haemoglobin, sodium and potassium concentrations in the intensive care unit is unwarranted.
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Affiliation(s)
| | - Bradley A Wibrow
- Intensive Care, Sir Charles Gairdner Hospital, Western Australia
- School of Medicine and Pharmacology, University of Western Australia, Western Australia
| | - Richard Norman
- School of Public Health, Curtin University, Western Australia
| | - Dana A Hince
- The Institute for Health Research, University of Notre Dame, Western Australia
| | - Liesel E Hardy
- Intensive Care, Joondalup Health Campus, Western Australia
| | - Samantha Tan
- Intensive Care, Rockingham General Hospital, Western Australia
| | - Kwok M Ho
- School of Population and Global Health, University of Western Australia, Western Australia
| | - Matthew H Anstey
- Intensive Care, Sir Charles Gairdner Hospital, Western Australia
- School of Medicine and Pharmacology, University of Western Australia, Western Australia
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Bijapur MB, Kudligi NA, Asma S. Central Venous Blood Gas Analysis: An Alternative to Arterial Blood Gas Analysis for pH, PCO 2, Bicarbonate, Sodium, Potassium and Chloride in the Intensive Care Unit Patients. Indian J Crit Care Med 2019; 23:258-262. [PMID: 31435143 PMCID: PMC6698350 DOI: 10.5005/jp-journals-10071-23176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Aims Arterial blood gas (ABG) analysis is a frequently ordered test in intensive care unit (ICU) and can analyze electrolyte in addition to pH and blood gases. Venous blood gas (VBG) analysis is a safer procedure and may be an alternative for ABG. Electrolyte estimation by auto analyzer usually takes 20–30 minutes. This study was aimed to investigate the correlation of pH, PCO2, bicarbonate, sodium, potassium, and chloride (electrolytes) between ABG and central VBG in ICU patients. Materials and methods This was a prospective observational study conducted in medical college hospital ICU. Adult patients requiring ABG and electrolyte estimation as a part of their clinical care were consecutively included in the study. Patients having any intravenous infusion or who were pregnant were excluded. Venous samples were taken within 2 minutes of arterial sampling from in situ central line. Data were analyzed using Bland-Altman methods. Results A total of 110 patients' paired blood samples were analyzed. The mean difference between arterial and central venous values of pH, PCO2, bicarbonate, sodium, potassium, and chloride was 0.04 units, –5.84 mm Hg, 0.89 mmol/L, –1.8 mEq/L, –0.04 mEq/L, and –0.89 mEq/L, respectively. The correlation coefficients for pH, PCO2, HCO3−, sodium, potassium, and chloride were 0.799, 0.831, 0.892, 0.652, 0.599 and 0.730, respectively. Limits of agreement (95%) were within acceptable limits. Conclusion Central venous pH, PCO2, and bicarbonate may be an acceptable substitute for ABG in patients admitted in the ICU. However caution should be exercised while applying electrolyte measurements. How to cite this article Bijapur MB, Kudligi NA, Asma S. Central Venous Blood Gas Analysis: An Alternative to Arterial Blood Gas Analysis for pH, PCO2, Bicarbonate, Sodium, Potassium and Chloride in the Intensive Care Unit Patients. Indian J Crit Care Med 2019;23(6):258–262.
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Affiliation(s)
- Mubina Begum Bijapur
- Department of Anaesthesiology and Critical Care, Al Ameen Medical College, Vijayapura, Karnataka, India
| | - Nazeer Ahmed Kudligi
- Department of Anaesthesiology and Critical Care, Al Ameen Medical College, Vijayapura, Karnataka, India
| | - Shaik Asma
- Department of Anaesthesiology and Critical Care, Al Ameen Medical College, Vijayapura, Karnataka, India
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Ustundağ Y, Huysal K, Ozgunay ŞE, Turkoğlu AR. Interchangeability of Sodium and Potassium Result Values of Arterial Blood Gas with Laboratory Analyzer: Narrative Review. Indian J Crit Care Med 2019; 23:35-42. [PMID: 31065207 PMCID: PMC6481262 DOI: 10.5005/jp-journals-10071-23110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The major extracellular electrolytes, sodium, and potassium are often requested together and form a large percentage of the requested tests in routine clinical chemistry laboratories. Two types of devices that use direct and indirect ion-selective electrode (ISE) methods are used in hospitals for electrolyte measurements: blood gas analyzers (BGA), which use direct ISE technology, and the indirect ISE method, which is often used in a central-laboratory autoanalyzer (AA). We aimed to summarize the current scientific knowledge based on whether the electrolyte test results, using Na and K test results obtained with BGA and an AA, can be used interchangeably. We searched Medline (PubMed), Google Scholar, and Web of Science up to 31st March 2018. In addition, references of the included studies were also examined. Fourteen studies with a risk of bias were included in the analysis. Limits of agreement differences were variable among BGA and AA sodium and potassium test results in clinical practice. The results of both BGA and AA measures should not be used interchangeably under the assumption that they are equivalent to each other.
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Affiliation(s)
- Yasemin Ustundağ
- Department of Clinical Biochemistry, University of Health Sciences, Bursa YuksekIhtisas Training and Research Hospital, Bursa, Turkey
| | - Kağan Huysal
- Department of Clinical Biochemistry, University of Health Sciences, Bursa YuksekIhtisas Training and Research Hospital, Bursa, Turkey
| | - Şeyda E Ozgunay
- Department of Anestesiology and Reanimation, University of Health Sciences, Bursa YuksekIhtisas Training and Research Hospital, Bursa, Turkey
| | - Ali R Turkoğlu
- Department of Urology, University of Health Sciences, Bursa YuksekIhtisas Training and Research Hospital, Bursa, Turkey
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Virk MS, Dean NP, Wong ECC. Severe Underestimation of Serum Na following IVIG Treatment. Lab Med 2018; 49:372-376. [PMID: 29897485 DOI: 10.1093/labmed/lmy025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Current chemistry analyzers measure ion concentration using ion- selective electrodes; however, may differ in the specific technology at the bedside versus the central laboratory. Instruments utilized for point-of-care testing (POCT) at the bedside use direct ion-selective electrodes, whereas central-laboratory analyzers use indirect ion-selective electrodes. Under most circumstances, these instruments will deliver the same result; however, various substances can cause interferences in one or the other. An 18-year-old Hispanic woman with a history of immune thrombocytopenic purpura (ITP) presented at Children's National Medical Center (CNMC) with a severe headache and required intravenous immunoglobulin (IVIG) therapy. Because a discrepancy developed between her point-of-care and central-laboratory sodium values, another instrument was used to retest the central-laboratory plasma specimens. The results were more in agreement with those from the point-of-care instrument and revealed a unique interference in sodium measurement related to IVIG use.
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Affiliation(s)
- Mrigender S Virk
- Department of Pathology and Laboratory Medicine, Medstar Georgetown University Hospital, Washington, DC
| | - Nathan P Dean
- Division of Critical Care Medicine, Children's National Medical Center, Washington, DC
| | - Edward C C Wong
- Division of Laboratory Medicine and Hematology, Children's National Medical Center, Washington, DC
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López A, García B, Gómez A, González L, González N, Martín L, Jaime G. Concordance of the ions and GAP anion obtained by gasometry vs standard laboratory in critical care. Med Intensiva 2018; 43:521-527. [PMID: 30193741 DOI: 10.1016/j.medin.2018.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the differences observed in ion and GAP anion determinations obtained by point-of-care (POC) blood gas versus laboratory biochemical testing, and to analyze the possible errors according to the limits of normality. MATERIAL AND METHODS A descriptive, cross-sectional retrospective study was made to assess concordance between two diagnostic tests in patients admitted to the Critical Care Unit of Ourense University Hospital Complex (Spain), between July and November 2015, involving at least one coinciding biochemical test and POC determination. Patients under 18years of age were excluded. RESULTS A total of 1,073 samples were analyzed. Lin's concordance correlation coefficients for sodium, potassium and chlorine were 0.87, 0.84 and 0.72, respectively. Kappa concordance of the normality limits for sodium, potassium and chlorine was 0.63, 0.74 and 0.32. The results indicated poor correlation of the anion GAP and null concordance between POC and biochemical testing, including the value corrected for albumin. CONCLUSIONS Poor concordance was observed between the ion values as determined by biochemistry and blood gases; the two methods are therefore not interchangeable. Kappa agreement with normality limits was good for sodium and potassium, and weak for chlorine. Possible validity was noted in orienting the classification within the ion limits, with the exception of chlorine. No agreement was recorded in relation to the anion GAP, even that corrected for albumin.
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Affiliation(s)
- A López
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España.
| | - B García
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesiología, Reanimación y Terapia del Dolor, Hospital Costa del Sol, Marbella, Málaga, España
| | - A Gómez
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - L González
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - N González
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - L Martín
- Grupo de Investigación en Anestesia y Cuidados Críticos, Instituto de Investigación Sanitaria Galicia SUR (ISS Galicia Sur), SERGAS-UVIGO, Vigo, Pontevedra, España; Servicio de Anestesia y Reanimación, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
| | - G Jaime
- Servicio de Análisis Clínicos, Complexo Hospitalario Universitario de Ourense (CHUO), SERGAS, Ourense, España
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Altunok İ, Aksel G, Eroğlu SE. Correlation between sodium, potassium, hemoglobin, hematocrit, and glucose values as measured by a laboratory autoanalyzer and a blood gas analyzer. Am J Emerg Med 2018; 37:1048-1053. [PMID: 30131206 DOI: 10.1016/j.ajem.2018.08.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/19/2018] [Accepted: 08/14/2018] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Blood gas analyzers can be alternatives to laboratory autoanalyzers for obtaining test results in just a few minutes. We aimed to find out whether the results from blood gas analyzers are reliable when compared to results of core laboratory autoanalyzers. MATERIALS AND METHODS This retrospective, single-centered study examined the electronic records of patients admitted to the emergency department of a tertiary care teaching hospital between May 2014 and December 2017. Excluded from the study were patients under 18 years old, those lacking data, those who had any treatment before the laboratory tests, those whose venous gas results were reported more than 30 minutes after the blood sample was taken and for whom any of the laboratory tests were performed at a different time, and recurrent laboratory results from a single patient. RESULTS Laboratory results were analyzed from a total of 31,060 patients. The correlation coefficients for sodium, potassium, hemoglobin, hematocrit, and glucose levels measured by a blood gas analyzer and a laboratory autoanalyzer were 0.725, 0.593, 0.982, 0.958, and 0.984, respectively; however, there were no good, acceptable agreement limits for any of the parameters. In addition, these results did not change according to the different pH stages (acidosis, normal pH and alkalosis). CONCLUSION The two types of measurements showed a moderate correlation for sodium and potassium levels and a strong correlation for glucose, hemoglobin, and hematocrit levels, but none of the levels had acceptable agreement limits. Clinicians should be aware of the limitations of blood gas analyzer results.
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Affiliation(s)
- İbrahim Altunok
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
| | - Gökhan Aksel
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey.
| | - Serkan Emre Eroğlu
- University of Health Sciences, Umraniye Training and Research Hospital, Department of Emergency Medicine, Istanbul, Turkey
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Gibbons M, Klim S, Mantzaris A, Dillon O, Kelly AM. How closely do blood gas electrolytes and haemoglobin agree with serum values in adult emergency department patients: An observational study. Emerg Med Australas 2018; 31:241-246. [PMID: 30027670 DOI: 10.1111/1742-6723.13133] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 05/21/2018] [Accepted: 06/03/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aims of this study were to establish the bias (mean difference) and 95% limits of agreement (LoA) between electrolyte values (sodium and potassium) and haemoglobin between whole blood analysed by the ED resuscitation room blood gas analyser and specimens analysed using standard techniques in the central hospital laboratory and to determine the proportion of analyses falling outside defined clinically acceptable LoA and pathology expert defined standards. METHODS Prospective cohort study. Paired blood gas analyser and laboratory samples taken no more than 10 min apart were included. The primary outcome of interest was bias and 95% LoA by Bland-Altman analysis. Subgroup analyses for values outside the normal range were also conducted. RESULTS Three hundred and fifty-two sample pairs were included in the analysis. For sodium concentration the bias was 0.6 mmol/L (95% LoA -3.3 to 4.6 mmol/L). For potassium concentration the bias was 0.21 mmol/L (95% LoA -0.36 to 0.79 mmol/L). For haemoglobin concentration the bias was -1.6 g/dL (95% LoA -10.2 to 6.9 g/dL). For sodium and haemoglobin concentrations, >95% of results fell within the defined clinically acceptable limits. For potassium concentration, >90% of results fell within the defined clinically acceptable limits. In general, serum sodium and potassium concentrations were slightly higher than blood gas levels and for haemoglobin serum levels were slightly lower. CONCLUSION Agreement between blood gas analysis and laboratory analysis for sodium, potassium and haemoglobin concentrations shows acceptable agreement for use in time critical clinical decision-making in ED.
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Affiliation(s)
| | - Sharon Klim
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia
| | - Arthur Mantzaris
- Emergency Department, Western Health, Melbourne, Victoria, Australia
| | | | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Victoria, Australia.,School of Medicine-Western Clinical School, The University of Melbourne, Melbourne, Victoria, Australia
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Prakash S, Bihari S, Lim ZY, Verghese S, Kulkarni H, Bersten AD. Concordance between point-of-care blood gas analysis and laboratory autoanalyzer in measurement of hemoglobin and electrolytes in critically ill patients. J Clin Lab Anal 2018; 32:e22425. [PMID: 29500827 DOI: 10.1002/jcla.22425] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 02/08/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND We tested the hypothesis that the results of the same test performed on point-of-care blood gas analysis (BGA) machine and automatic analyzer (AA) machine in central laboratory have high degree of concordance in critical care patients and that the two test methods could be used interchangeably. METHODS We analyzed 9398 matched pairs of BGA and AA results, obtained from 1765 patients. Concentration pairs of the following analytes were assessed: hemoglobin, glucose, sodium, potassium, chloride, and bicarbonate. We determined the agreement using concordance correlation coefficient (CCC) and Bland-Altman analysis. The difference in results was also assessed against the United States Clinical Laboratory Improvement Amendments (US-CLIA) 88 rules. The test results were considered to be interchangeable if they were within the US-CLIA variability criteria and would not alter the clinical management when compared to each other. RESULTS The median time interval between sampling for BGA and AA in each result pair was 5 minutes. The CCC values ranged from 0.89(95% CI 0.89-0.90) for chloride to 0.98(95% CI 0.98-0.99) for hemoglobin. The largest bias was for hemoglobin. The limits of agreement relative to bias were largest for sodium, with 3.4% of readings outside the US-CLIA variation rule. The number of readings outside the US-CLIA acceptable variation was highest for glucose (7.1%) followed by hemoglobin (5.9%) and chloride (5.2%). CONCLUSION We conclude that there is moderate to substantial concordance between AA and BGA machines on tests performed in critically ill patients. However, the two tests methods cannot be used interchangeably, except for potassium.
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Affiliation(s)
- Shivesh Prakash
- Department of Intensive care, Flinders Medical Centre, Bedford Park, SA, Australia.,Flinders University, Bedford Park, SA, Australia
| | - Shailesh Bihari
- Department of Intensive care, Flinders Medical Centre, Bedford Park, SA, Australia.,Flinders University, Bedford Park, SA, Australia
| | - Zhan Y Lim
- Flinders University, Bedford Park, SA, Australia
| | - Santosh Verghese
- Department of Intensive care, Flinders Medical Centre, Bedford Park, SA, Australia
| | - Hemant Kulkarni
- South Texas Diabetes and Obesity Institute, University of Texas Rio Grande Valley, Brownsville, TX, USA
| | - Andrew D Bersten
- Department of Intensive care, Flinders Medical Centre, Bedford Park, SA, Australia.,Flinders University, Bedford Park, SA, Australia
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Shin J, Lim YS, Kim K, Lee HJ, Lee SJ, Jung E, You KM, Yang HJ, Kim JJ, Kim J, Jo YH, Lee JH, Hwang SY. Initial blood pH during cardiopulmonary resuscitation in out-of-hospital cardiac arrest patients: a multicenter observational registry-based study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2017; 21:322. [PMID: 29268775 PMCID: PMC5740770 DOI: 10.1186/s13054-017-1893-9] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/20/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND When an out-of-hospital cardiac arrest (OHCA) patient receives cardiopulmonary resuscitation (CPR) in the emergency department (ED), blood laboratory test results can be obtained by using point-of-care testing during CPR. In the present study, the relationship between blood laboratory test results during CPR and outcomes of OHCA patients was investigated. METHODS This study was a multicenter retrospective analysis of prospective registered data that included 2716 OHCA patients. Data from the EDs of three university hospitals in different areas were collected from January 2009 to December 2014. Univariate and multivariable analyses were conducted to elucidate the factors associated with survival to discharge and neurological outcomes. A final analysis was conducted by including patients who had no prehospital return of spontaneous circulation and those who underwent rapid blood laboratory examination during CPR. RESULTS Overall, 2229 OHCA patients were included in the final analysis. Among them, the rate of survival to discharge and a good Cerebral Performance Categories Scale score were 14% and 4.4%, respectively. The pH level was independently related to survival to hospital discharge (adjusted OR 6.287, 95% CI 2.601-15.197; p < 0.001) and good neurological recovery (adjusted OR 15.395, 95% CI 3.439-68.911; p < 0.001). None of the neurologically intact patients had low pH levels (< 6.8) or excessive potassium levels (> 8.5 mEq/L) during CPR. CONCLUSIONS Among the blood laboratory test results during CPR of OHCA patients, pH and potassium levels were observed as independent factors associated with survival to hospital discharge, and pH level was considered as an independent factor related to neurological recovery.
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Affiliation(s)
- Jonghwan Shin
- Department of Emergency Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Yong Su Lim
- Department of Emergency Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea.
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Hui Jai Lee
- Department of Emergency Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Se Jong Lee
- Department of Emergency Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Euigi Jung
- Department of Emergency Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Kyoung Min You
- Department of Emergency Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, Republic of Korea
| | - Hyuk Jun Yang
- Department of Emergency Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Jin Joo Kim
- Department of Emergency Medicine, Gachon University Gil Medical Center, 21, Namdong-daero 774 Beon-gil, Namdong-gu, Incheon, 21565, Republic of Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, 82, Gumi-ro 173 Beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, Republic of Korea
| | - Seong Youn Hwang
- Department of Emergency Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, 158, Palyong-ro, Masanhoewon-gu, Changwon-si, Gyeongsangnam-do, 51353, Republic of Korea
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Comparison of point-of-care versus central laboratory measurement of hematocrit, hemoglobin, and electrolyte concentrations. Heart Lung 2017; 46:246-250. [DOI: 10.1016/j.hrtlng.2017.04.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/01/2017] [Accepted: 04/06/2017] [Indexed: 11/20/2022]
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Yilmaz S, Uysal HB, Avcil M, Yilmaz M, Dağlı B, Bakış M, Ömürlü IK. Comparison of different methods for measurement of electrolytes in patients admitted to the intensive care unit. Saudi Med J 2017; 37:262-7. [PMID: 26905347 PMCID: PMC4800889 DOI: 10.15537/smj.2016.3.13539] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To investigate whether electrolyte levels measured by using blood gas analyzers (ABG) and auto-analyzers (AA) are equivalent and can be used interchangeably. METHODS This observational prospective study was conducted in 100 patients admitted to the Intensive Care Unit, Adnan Menderes University School of Medicine, Aydin, Turkey, between March and August 2014. Samples for both AA and ABG analyzers were collected simultaneously from invasive arterial catheters of patients. The electrolyte levels were measured by using 2 methods. RESULTS The mean sodium level measured by ABG was 136.1 ± 6.3 mmol/L and 137.8 ± 5.4 mmol/L for AA (p=0.001). The Pearson's correlation coefficient was 0.561 (p less than 0.001). The Bland-Altman 95% limits of agreement were -9.4 to 12.6 mmol/L. The mean potassium levels measured by ABG was 3.4 ± 0.7 mmol/L and AA was 3.8 ± 0.7 mmol/L (p=0.001). The Bland-Altman comparison limits were -0.58 to 1.24 and the associated Pearson's correlation coefficient was 0.812 (p less than 0.001). CONCLUSION The results of the 2 analyzing methods, in terms of sodium, were not equivalent and could not be used interchangeably. However, according to the statistical analyses results, by including, but not blindly trusting these findings, urgent and vital decisions could be made by the potassium levels obtained from the BGA, but a simultaneous follow-up sample had to be sent to the central laboratory for confirmation.
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Affiliation(s)
- Sinan Yilmaz
- Department of Anesthesiology and Reanimation, Adnan Menderes University School of Medicine, Aydin, Turkey. E-mail.
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Point-of-Care Versus Central Laboratory Measurements of Hemoglobin, Hematocrit, Glucose, Bicarbonate and Electrolytes: A Prospective Observational Study in Critically Ill Patients. PLoS One 2017; 12:e0169593. [PMID: 28072822 PMCID: PMC5224825 DOI: 10.1371/journal.pone.0169593] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 12/18/2016] [Indexed: 12/02/2022] Open
Abstract
Introduction Rapid detection of abnormal biological values using point-of-care (POC) testing allows clinicians to promptly initiate therapy; however, there are concerns regarding the reliability of POC measurements. We investigated the agreement between the latest generation blood gas analyzer and central laboratory measurements of electrolytes, bicarbonate, hemoglobin, hematocrit, and glucose. Methods 314 paired samples were collected prospectively from 51 critically ill patients. All samples were drawn simultaneously in the morning from an arterial line. BD Vacutainer tubes were analyzed in the central laboratory using Beckman Coulter analyzers (AU 5800 and DxH 800). BD Preset 3 ml heparinized-syringes were analyzed immediately in the ICU using the POC Siemens RAPIDPoint 500 blood gas system. We used CLIA proficiency testing criteria to define acceptable analytical performance and interchangeability. Results Biases, limits of agreement (±1.96 SD) and coefficients of correlation were respectively: 1.3 (-2.2 to 4.8 mmol/L, r = 0.936) for sodium; 0.2 (-0.2 to 0.6 mmol/L, r = 0.944) for potassium; -0.9 (-3.7 to 2 mmol/L, r = 0.967) for chloride; 0.8 (-1.9 to 3.4 mmol/L, r = 0.968) for bicarbonate; -11 (-30 to 9 mg/dL, r = 0.972) for glucose; -0.8 (-1.4 to -0.2 g/dL, r = 0.985) for hemoglobin; and -1.1 (-2.9 to 0.7%, r = 0.981) for hematocrit. All differences were below CLIA cut-off values, except for hemoglobin. Conclusions Compared to central Laboratory analyzers, the POC Siemens RAPIDPoint 500 blood gas system satisfied the CLIA criteria of interchangeability for all tested parameters, except for hemoglobin. These results are warranted for our own procedures and devices. Bearing these restrictions, we recommend clinicians to initiate an appropriate therapy based on POC testing without awaiting a control measurement.
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Plasma sodium measurements by direct ion selective methods in laboratory and point of care may not be clinically interchangeable. J Clin Monit Comput 2016; 31:1103-1109. [PMID: 27683272 DOI: 10.1007/s10877-016-9938-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 09/26/2016] [Indexed: 10/20/2022]
Abstract
An estimated 25 % of indirect ion selective electrode (ISE) ICU plasma sodium measurements differ from corresponding direct ISE values by at least 4 mmol/L, the dominant factor being indirect ISE over-estimation driven by hypoproteinemia. Since direct measurements are considered unaffected by protein concentrations, we investigated whether direct ISE plasma sodium measurements in the laboratory and at point of care in ICU show sufficient agreement to be clinically interchangeable. From a 5 year clinical chemistry database, 9910 ICU plasma samples were assessed for agreement between direct ISE sodium measurements in ICU (ABL 700) and in the central laboratory (Vitros Fusion). The relationship between differences in paired plasma sodium measurements (Vitros-ABL) and total plasma protein concentrations was evaluated by generalized estimating equation linear regression. Patients were hypo-proteinemic [mean (SD) total protein concentration 56.9 (9.04) g/L]. Mean (SD) paired Vitros-ABL sodium measurements was -0.087 (1.74) mmol/L, range -14 to +10 mmol/L. Disagreement at ≥|4|mmol/L, ≥|3|mmol/L and ≥|2|mmol/L was present in 409 (4.1 %), 1333 (13.4 %) and 3591 (36.2 %) pairs respectively. Test-retest disagreement estimates within either source alone were substantially lower. Small negative Vitros-ABL differences associated with low plasma protein concentrations were reversed at high protein concentrations. Disagreement between plasma sodium concentrations monitored by two common direct ISE analyzers was substantially less than reported between direct and indirect ISE devices, although a protein influence of low clinical importance persisted. Disagreement was sufficient to jeopardize safe interchangeable interpretation in situations with a low tolerance for imprecision, such as hyponatremia correction.
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Megahed A, Hiew M, Grünberg W, Constable P. Evaluation of 2 portable ion-selective electrode meters for determining whole blood, plasma, urine, milk, and abomasal fluid potassium concentrations in dairy cattle. J Dairy Sci 2016; 99:7330-7343. [DOI: 10.3168/jds.2015-10821] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2015] [Accepted: 04/05/2016] [Indexed: 11/19/2022]
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Abstract
BACKGROUND Phlebotomy is a significant cause of iatrogenic anemia in the critical care environment. It is estimated that one-third of all transfusions of packed red blood cells in intensive care units (ICU) result from phlebotomy. The aims of this study were to determine if utilizing the 1mL blood gas syringe for an adult population would impact the rate at which specimens were acceptable for testing and result reporting based on lab specimen rejection criteria; and to compare blood utilization between the 2 different syringes. METHODS This study was conducted in 1 of the adult ICUs at the University of Utah Hospital. Over a baseline period a standard adult 3 mL blood gas syringe was utilized. Subsequently the standard adult syringe was replaced by a 1 mL syringe produced by the same manufacturer with the same heparin concentration. RESULTS The change to the 1 mL syringe had no effect on specimen integrity in regards to laboratory's ability to process the specimen. With use of the 1 mL syringe there was a 60% reduction in the volume of blood drawn compared with the baseline period. CONCLUSION Standardizing the 1 mL syringe for Blood Gas Laboratory tests will reduce patient blood loss without appreciably affecting specimen rejection relative to current rates.
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Affiliation(s)
| | - Boaz A Markewitz
- Department of Internal Medicine, Section of Respiratory, Critical Care, Occupation (Pulmonary) Medicine, University of Utah Health Sciences, Salt Lake City, UT
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Gupta S, Gupta AK, Singh K, Verma M. Are sodium and potassium results on arterial blood gas analyzer equivalent to those on electrolyte analyzer? Indian J Crit Care Med 2016; 20:233-7. [PMID: 27303138 PMCID: PMC4906340 DOI: 10.4103/0972-5229.180044] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objectives: The present study was conducted with the aim to compare the sodium (Na) and potassium (K) results on arterial blood gas (ABG) and electrolyte analyzers both of which use direct ion selective electrode technology. Materials and Methods: This was a retrospective study in which data were collected for simultaneous ABG and serum electrolyte samples of a patient received in Biochemistry Laboratory during February to May 2015. The ABG samples received in heparinized syringes were processed on Radiometer ABL80 analyzer immediately. Electrolytes in serum sample were measured on ST-100 Sensa Core analyzer after centrifugation. Data were collected for 112 samples and analyzed with the help of Excel 2010 and Statistical software for Microsoft excel XLSTAT 2015 software. Results: The mean Na level in serum sample was 139.4 ± 8.2 mmol/L compared to 137.8 ± 10.5 mmol/L in ABG (P < 0.05). The mean difference between the results was 1.6 mmol/L. Mean K level in serum sample was 3.8 ± 0.9 mmol/L as compared to 3.7 ± 0.9 mmol/L in ABG sample (P < 0.05). The mean difference between the results was 0.14 mmol/L. Statistically significant difference was observed in results of two instruments in low Na (<135 mmol/L) and normal K (3.5-5.2 mmol/L) ranges. The 95% limit of agreement for Na and K on both instruments was 9.9 to −13.2 mmol/L and 0.79 to −1.07 mmol/L respectively. Conclusions: The clinicians should be cautious in using the electrolyte results of electrolyte and ABG analyzer in inter exchangeable manner.
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Affiliation(s)
- Shalini Gupta
- Department of Biochemistry, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Ashwani K Gupta
- Department of Pharmacology, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Kamaljit Singh
- Department of Biochemistry, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
| | - Minni Verma
- Department of Biochemistry, Gian Sagar Medical College and Hospital, Patiala, Punjab, India
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Acikgoz SB, Genc AB, Sipahi S, Yildirim M, Cinemre B, Tamer A, Solak Y. Agreement of serum potassium measured by blood gas and biochemistry analyzer in patients with moderate to severe hyperkalemia. Am J Emerg Med 2016; 34:794-7. [DOI: 10.1016/j.ajem.2016.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 01/05/2016] [Indexed: 10/22/2022] Open
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Solak Y. Comparison of serum sodium levels measured by blood gas analyzer and biochemistry autoanalyzer in patients with hyponatremia, eunatremia, and hypernatremia. Am J Emerg Med 2016; 34:1473-9. [PMID: 27211806 DOI: 10.1016/j.ajem.2016.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Blood gas analyzer (BGA) electrolyte measurements are frequently used in emergency departments (EDs) pending biochemistry laboratory autoanalyzer (BLA) results. There is lack of data in the literature in terms of agreement of these 2 measurement methods of sodium. We aimed to comprehensively evaluate the agreement in hyponatremia, eunatremia, and hypernatremia groups. METHODS Retrospectively, adult subjects who presented to ED of a tertiary care teaching hospital and had simultaneous BGA and BLA results were included in the study. Blood pairs were grouped into hyponatremia, eunatremia, and hypernatremia according to BLA results. Agreement of sodium measurements between the methods were evaluated by Bland-Altman plots and Passing and Bablok regression analysis. RESULTS A total of 2557 blood pairs (1326 males [51.8%]) were included. Median age of the patients was 66 years (18-103). The numbers of patients with hyponatremia, eunatremia, and hypernatremia were 487 (19%), 1943 (76%), and 127 (5%), respectively. The minimum and maximum serum sodium levels measured by biochemistry analyzer were 106 and 171 mmol/L, respectively. The Pearson linear correlation coefficient between BGA and BLA for sodium measurements were 0.574, 0.358, and 0.562 in hyponatremia, eunatremia, and hypernatremia groups, respectively. The absolute mean difference for the 3 groups was greater than 4 mmol/L. Biochemistry laboratory autoanalyzer tended to measure serum sodium higher than BGA in all sodium groups. Passing and Bablok regression analysis showed significant differences between the 2 methods in all sodium groups. CONCLUSION This is the first comprehensive evaluation of agreement between BGA and BLA in distinct sodium groups. Significant differences should be taken into account when these patients are managed in the ED.
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Affiliation(s)
- Yalcin Solak
- Division of Nephrology, Department of Internal Medicine, Sakarya Research and Training Hospital, Sakarya, Turkey.
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Uysal E, Acar YA, Kutur A, Cevik E, Salman N, Tezel O. How reliable are electrolyte and metabolite results measured by a blood gas analyzer in the ED? Am J Emerg Med 2015; 34:419-24. [PMID: 26658635 DOI: 10.1016/j.ajem.2015.11.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 10/04/2015] [Accepted: 11/12/2015] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Blood gas analysis is a frequently ordered test in emergency departments for many indications. It is a rapid technique that can analyze electrolyte and metabolites in addition to pH and blood gases. The aim of this study was to investigate the correlation of electrolyte and metabolite results measured by blood gas and core laboratory analyzers. METHODS This was a prospective, single-center observational study conducted in a tertiary care center's emergency department. All adult patients requiring arterial/venous blood gas analysis and core laboratory tests together for any purpose were consecutively included in the study between April 2014 and July 2015. Patients younger than 16 years, having any intravenous infusion or blood transfusion prior to sampling, or who were pregnant were excluded. RESULTS A total of 1094 patients' (male = 547, female = 547) paired blood samples were analyzed. The mean age was 58.10 ± 21.35 years, and there was no difference between arterial and venous sampling groups by age, pH, or sex (P = .93, .56, and .41, respectively). Correlation coefficients for hemoglobin, hematocrit, glucose, potassium, sodium, and chloride levels measured by blood gas analyzer and core laboratory analyzers were 0.922, 0.896, 0.964, 0.823, 0.854, and 0.791, respectively. CONCLUSION Blood gas analysis results were strongly correlated for hemoglobin, hematocrit, glucose, potassium, and sodium levels but were only moderately correlated for chloride levels. These parameters as measured by a blood gas analyzer seem reliable in critical decision making but must be validated by core laboratory results.
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Affiliation(s)
- Emin Uysal
- Department of Emergency Medicine, Bagcilar Training and Research Hospital, Bağcılar Eğitim ve Araştırma Hastanesi, Bağcılar, Istanbul, Turkey.
| | - Yahya Ayhan Acar
- Department of Emergency Medicine, Etimesgut Military Hospital, Etimesgut Asker Hastanesi, Etimesgut, Ankara, Turkey.
| | - Ahmet Kutur
- Department of Emergency Medicine, Bagcilar Training and Research Hospital, Bağcılar Eğitim ve Araştırma Hastanesi, Bağcılar, Istanbul, Turkey.
| | - Erdem Cevik
- Department of Emergency Medicine, Van Military Hospital, Van Askeri Hastanesi, Altıntepe, Van, Turkey.
| | - Necati Salman
- Department of Emergency Medicine, Etimesgut Military Hospital, Etimesgut Asker Hastanesi, Etimesgut, Ankara, Turkey.
| | - Onur Tezel
- Department of Emergency Medicine, Etimesgut Military Hospital, Etimesgut Asker Hastanesi, Etimesgut, Ankara, Turkey.
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Analysis of bias in measurements of potassium, sodium and hemoglobin by an emergency department-based blood gas analyzer relative to hospital laboratory autoanalyzer results. PLoS One 2015; 10:e0122383. [PMID: 25849375 PMCID: PMC4388527 DOI: 10.1371/journal.pone.0122383] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 02/22/2015] [Indexed: 11/19/2022] Open
Abstract
Objective The emergency departments (EDs) of Chinese hospitals are gradually being equipped with blood gas machines. These machines, along with the measurement of biochemical markers by the hospital laboratory, facilitate the care of patients with severe conditions who present to the ED. However, discrepancies have been noted between the Arterial Blood Gas (ABG) analyzers in the ED and the hospital laboratory autoanalyzer in relation to electrolyte and hemoglobin measurements. The present study was performed to determine whether the ABG and laboratory measurements of potassium, sodium, and hemoglobin levels are equivalent, and whether ABG analyzer results can be used to guide clinical care before the laboratory results become available. Materials and Methods Study power analyses revealed that 200 consecutive patients who presented to our ED would allow this prospective single-center cohort study to detect significant differences between ABG- and laboratory-measured potassium, sodium, and hemoglobin levels. Paired arterial and venous blood samples were collected within 30 minutes. Arterial blood samples were measured in the ED by an ABL 90 FLEX blood gas analyzer. The biochemistry and blood cell counts of the venous samples were measured in the hospital laboratory. The potassium, sodium, and hemoglobin concentrations obtained by both methods were compared by using paired Student’s t-test, Spearman’s correlation, Bland-Altman plots, and Deming regression. Results The mean ABG and laboratory potassium values were 3.77±0.44 and 4.2±0.55, respectively (P<0.0001). The mean ABG and laboratory sodium values were 137.89±5.44 and 140.93±5.50, respectively (P<0.0001). The mean ABG and laboratory Hemoglobin values were 12.28±2.62 and 12.35±2.60, respectively (P = 0.24). Conclusion Although there are the statistical difference and acceptable biases between ABG- and laboratory-measured potassium and sodium, the biases do not exceed USCLIA-determined limits. In parallel, there are no statistical differences and biases beyond USCLIA-determined limits between ABG- and laboratory-measured hemoglobin. Therefore, all three variables measured by ABG were reliable.
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Geoghegan P, Koch CD, Wockenfus AM, Harrison AM, Dong Y, Kashani KB, Karon BS. Agreement between whole blood and plasma sodium measurements in profound hyponatremia. Clin Biochem 2015; 48:525-8. [PMID: 25773258 DOI: 10.1016/j.clinbiochem.2015.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We compared two different methods of whole blood sodium measurement to plasma sodium measurement using samples in the profoundly hyponatremic range (Na < 120 mmol/L). DESIGN AND METHODS Whole blood pools with a range of low sodium values were generated using combinations and dilutions of pooled electrolyte-balanced lithium heparin samples submitted for arterial blood gas analysis. Each pool was analyzed five times on a Radiometer 827 blood gas analyzer and iSTAT analyzer. Pools were centrifuged to produce plasma, which was analyzed five times on a Roche Cobas c501 chemistry analyzer. An additional 40 fresh (analyzed on day of collection) excess lithium heparin arterial blood gas samples from 36 patients were analyzed on the Radiometer 827, iSTAT, and Cobas c501 as described above. The setting was a tertiary referral center. Blood samples were collected from a combination of patients in the intensive care unit, operating theaters and emergency room. RESULTS All methods demonstrated excellent precision, even in the profoundly hyponatremic measurement range (Na < 120 mmol/L using a plasma reference method). However, agreement between the methods varied with the degree of hyponatremia. In the profoundly hyponatremic range, Radiometer whole blood sodium values were nearly identical to plasma reference sodium, while iSTAT whole blood sodium showed a consistent positive bias relative to plasma sodium in this range. CONCLUSION If whole blood direct sodium measurements are compared with plasma sodium in profoundly hyponatremic patients consideration should be given to the use of Radiometer blood gas analyzers over iSTAT since the latter shows a positive bias relative to a plasma comparative method.
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Affiliation(s)
- Pierce Geoghegan
- Department of Anaesthesia and Critical Care, Tallaght Hospital, Dublin, Ireland; Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Mayo Clinic, Rochester, MN, USA.
| | - Christopher D Koch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Amy M Wockenfus
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew M Harrison
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Mayo Clinic, Rochester, MN, USA; Medical Scientist Training Program, Mayo Clinic, Rochester, MN, USA
| | - Yue Dong
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Mayo Clinic, Rochester, MN, USA; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kianoush B Kashani
- Multidisciplinary Epidemiology and Translational Research in Intensive Care (M.E.T.R.I.C.), Mayo Clinic, Rochester, MN, USA; Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Brad S Karon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Central Laboratory Service and Point-of-Care Testing in Germany—From Conflicting Notions to Complementary Understandings. POINT OF CARE 2015. [DOI: 10.1097/poc.0000000000000043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Nanda SK, Ray L, Dinakaran A. Agreement of arterial sodium and arterial potassium levels with venous sodium and venous potassium in patients admitted to intensive care unit. J Clin Diagn Res 2015; 9:BC28-30. [PMID: 25859448 PMCID: PMC4378730 DOI: 10.7860/jcdr/2015/12418.5602] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/08/2015] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Electrolyte abnormalities are one of the common causes of morbidity and mortality in critically ill patients. The turnaround time for electrolyte reporting should be as low as possible. Electrolytes are measured conventionally in serum obtained from venous blood by electrolyte analyser which takes 20 to 30 min. Point of care analysers are now available where in electrolytes can be measured in arterial blood within 5 min. This study was done to study the agreement of arterial sodium and arterial potassium with venous sodium and venous potassium levels. MATERIALS AND METHODS Venous sodium and venous potassium levels and arterial sodium and arterial potassium levels were analysed on 206 patient samples admitted to Intensive Care Unit (ICU). The venous values were compared with the arterial values for correlation. Venous sodium was compared with arterial sodium by spearman correlation. Venous potassium was compared with arterial potassium by pearson correlation. RESULTS The mean value of arterial sodium was 134 and venous sodium was 137. The mean value of arterial potassium was 3.6 and venous potassium was 4.1. The correlation coefficient obtained for sodium was 0.787 and correlation coefficient obtained for potassium was 0.701. There was positive correlation of arterial sodium and arterial potassium with venous sodium and venous potassium indicating agreement between the parameters. CONCLUSION Arterial sodium and arterial potassium can be used instead of venous sodium and venous potassium levels in management of critically ill patients.
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Affiliation(s)
- Sunil Kumar Nanda
- Associate Professor, Department of Biochemistry, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Lopamudra Ray
- Assistant Professor, Department of Biochemistry, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Asha Dinakaran
- Tutor, Department of Biochemistry, Pondicherry Institute of Medical Sciences, Pondicherry, India
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Batra P, Dwivedi AK, Thakur N. Bedside ABG, electrolytes, lactate and procalcitonin in emergency pediatrics. Int J Crit Illn Inj Sci 2014; 4:247-52. [PMID: 25337488 PMCID: PMC4200552 DOI: 10.4103/2229-5151.141467] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Point of care testing, is the term commonly applied to the bedside tests performed in sick patients. Common clinical conditions encountered in pediatric emergency rooms are respiratory, gastro-intestinal, infections and cardiac. Emergencies at most of the places, especially developing countries are overburdened. Availability of tests like arterial blood gas, lactate, electrolytes and procalcitonin, bedside tests or point of care tests can help identify sick patients quickly. Abnormalities like acid-base disturbances and dyselectrolytemias can be dealt with instantly, thus improving the overall prognosis. Lactate levels in emergency give the earliest clue to cardiovascular compromise and poor tissue perfusion. Procalcitonin has recently gained significant importance as an acute phase reactant for early identification of sepsis. Decisions for initiating or withholding antibiotic therapy can also be taken based on procalcitonin levels in emergency. Bedside estimation of serum electrolytes, blood gas analysis and procalcitonin thus facilitate the clinical evaluation and management of critical patients. An extensive literature review of current status of these investigations as point of care tests is appraised here.
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Affiliation(s)
- Prerna Batra
- Department of Pediatrics, University College of Medical Sciences (University of Delhi) and GTB Hospital, New Delhi, India
| | - Ajeet Kumar Dwivedi
- Department of Pediatrics, University College of Medical Sciences (University of Delhi) and GTB Hospital, New Delhi, India
| | - Neha Thakur
- Department of Pediatrics, Kalawati Saran Children Hospital, New Delhi, India
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Kapoor D, Srivastava M, Singh P. Point of care blood gases with electrolytes and lactates in adult emergencies. Int J Crit Illn Inj Sci 2014; 4:216-22. [PMID: 25337483 PMCID: PMC4200547 DOI: 10.4103/2229-5151.141411] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Point-of-care testing (POCT) is one of the formidable concept introduce in the field of critical care settings to deliver decentralized, patient-centric health care to the patients. Rapid provision of blood measurements, particularly blood gases and electrolytes, may translate into improved clinical outcomes. Studies shows that POCT carries advantages of providing reduced therapeutic turnaround time (TTAT), shorter door-to-clinical-decision time, rapid data availability, reduced preanalytic and postanalytic testing errors, self-contained user-friendly instruments, small sample volume requirements, and frequent serial whole-blood testing. However, still there is a noticeable debate that exists among the laboratorians, clinicians, and administrators over concerns regarding analyzer inaccuracy, imprecision and performance (interfering substances), poorly trained non-laboratorians, high cost of tests, operator-dependent quality of testing, and difficulty in integrating test results with hospital information system (HIS). On search of literature using Medline/Pubmed and Embase using the key phrases "ppoint-of-care test," "central laboratory testing," "electrolytes," "blood gas analysis," "lactate," "emergency department," "intensive care unit," we found that POCT of blood gases and selected electrolytes may not entirely replace centralized laboratory testing but may transfigure the clinical practice paradigm of emergency and critical care physicians. We infer that further comprehensive, meaningful and rigorous evaluations are required to determine outcomes which are more quantifiable, closely related to testing events and are associated with effective cost benefits.
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Affiliation(s)
- Dheeraj Kapoor
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Meghana Srivastava
- Department of Anaesthesia and Intensive Care, Government Medical College and Hospital, Chandigarh, India
| | - Pritam Singh
- Department of General Medicine, Government Medical College and Hospital, Chandigarh, India
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