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Jeffery J, Millar H, Marrington R, MacKenzie F, George R. Artificially raised creatinine concentrations due to analytical interference for samples contaminated with total parenteral nutrition fluid. Ann Clin Biochem 2024; 61:32-38. [PMID: 37338174 DOI: 10.1177/00045632231186058] [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] [Indexed: 06/21/2023]
Abstract
BACKGROUND A sample received in the laboratory from a patient receiving total parenteral nutrition (TPN) indicated that the patient may have renal dysfunction, but the results were not considered to be reliable enough to report. Investigations using a reference method for measurement of creatinine confirmed positive interference in the creatinine assay and distribution of samples via an External Quality Assessment (EQA) Scheme showed that this positive interference was method dependent. METHODS Residual TPN fluid (Nutriflex Lipid Special) left in the bag after the patient had completed the infusion was collected and added to a patient serum pool in increasing amounts and distributed to different laboratories for analysis of creatinine and glucose through an EQA Scheme. RESULTS Positive interference in a number of different creatinine assays was identified as a result of a component in the TPN fluid. Positive interference from high concentrations of glucose has been demonstrated to be a cause for falsely high results in Jaffe creatinine assays. CONCLUSIONS The concern would be that a sample contaminated with TPN fluid would have both abnormal electrolytes and creatinine concentrations and give the impression that the patient was in renal failure due to analytical interference in the creatinine assay and laboratory staff need to be aware of this problem.
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Affiliation(s)
- Jinny Jeffery
- Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
| | - Helen Millar
- Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
| | - Rachel Marrington
- Birmingham Quality (UK NEQAS), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Finlay MacKenzie
- Birmingham Quality (UK NEQAS), University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Roanna George
- Derriford Combined Laboratory, Derriford Hospital, Plymouth, UK
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Liu WS, Lin CH, Li SY, Lin CC, Liu TY, Tan AC, Tsou HH, Chan HL, Lai YT. Perfluorooctanesulfonate Can Cause Negative Bias in Creatinine Measurement in Hemodialysis Patients Using Polysulfone Dialysis Membranes. MEMBRANES 2022; 12:778. [PMID: 36005693 PMCID: PMC9413667 DOI: 10.3390/membranes12080778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
Serum creatinine is an important clinical marker for renal clearance. However, two conventional methods (Jaffe and enzymatic) are prone to interferences with organic compounds as compared to the standard method (isotope dilution-liquid chromatography-mass spectrometry) and can cause a significant negative bias. Perfluorooctanesulfonate (PFOS) and perfluorooctanoic acid (PFOA) are two common perfluorochemicals (PFCs) that can easily be accumulated in humans. We aimed to verify whether this bias is the result of an accumulation of PFCs. The serum creatinine values of 124 hemodialysis patients were analyzed using the three methods. We also aimed to evaluate which biochemical parameters will influence the difference between the conventional methods and the standard method. We found that a significant underestimation occurred when using the conventional methods. Albumin is an independent factor associated with negative bias, but it loses this correlation after dialysis, likely due to the removal of protein-bound uremic toxins. PFOS can cause negative bias when using the enzymatic method. Furthermore, this linear correlation is more significant in patients who used polysulfone-based dialysis membranes, possibly due to the better clearance of other uremic toxins. The serum creatinine of uremic patients can be significantly underestimated when using conventional methods. PFCs, as well the type of dialysis membrane being used, can be influencing factors.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei City Hospital Zhongxing Branch, Taipei 103, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Department of Special Education, University of Taipei, Taipei 100, Taiwan
| | - Chien-Hung Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- College of Science and Engineering, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Szu-Yuan Li
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Chih-Ching Lin
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Tsung-Yun Liu
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
| | - Ann Charis Tan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Han-Hsing Tsou
- Institute of Food Safety and Health Risk Assessment, National Yang Ming Chiao Tung University, Hsinchu 300, Taiwan
- Kim Forest Enterprise Co., Ltd., New Taipei City 221, Taiwan
| | - Hsiang-Lin Chan
- Department of Child Psychiatry, Chang Gung Memorial Hospital and University, Taoyuan 333, Taiwan
| | - Yen-Ting Lai
- College of Medicine, National Taiwan University, Taipei 100, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu 300, Taiwan
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Powell D, Hassall L, Scholes D, Al-Jubouri M. False acute kidney injury alert due to model car fuel ingestion. BMJ Case Rep 2017; 2017:bcr-2017-221134. [PMID: 28963385 PMCID: PMC5652402 DOI: 10.1136/bcr-2017-221134] [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] [Accepted: 09/15/2017] [Indexed: 11/04/2022] Open
Abstract
We report a case of accidental ingestion of model car fuel (Optifuel) resulting in an apparent elevation of serum creatinine of 274 µmol/L (3.1 mg/dL) as measured by the Jaffe (alkaline picrate) reaction, which resulted in an acute kidney injury (AKI) stage 3 alert being reported. Optifuel contains nitromethane, which has been reported to interfere in the Jaffe reaction causing falsely high creatinine measurements. The laboratory staff were vigilant about this potential interfering substance so repeated the analysis of the creatinine using an enzymatic method that showed a markedly lower result of 47 µmol/L (0.5 mg/dL). This report highlights the ability of nitromethane to potentially mimic AKI and the importance of being aware of the limitations of biochemical tests to avoid misinterpretation of results and instigating inappropriate treatment.
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Affiliation(s)
- Darren Powell
- Department of Clinical Biochemistry, St. Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Louise Hassall
- Department of Clinical Biochemistry, St. Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - David Scholes
- Department of Acute Medicine, St. Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, UK
| | - Mohammad Al-Jubouri
- Department of Clinical Biochemistry, St. Helens & Knowsley Teaching Hospitals NHS Trust, Prescot, UK
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Murphy CM, Devlin JJ, Beuhler MC, Cheifetz P, Maynard S, Schwartz MD, Kacinko S. Detection of ingested nitromethane and reliable creatinine assessment using multiple common analytical methods. Clin Toxicol (Phila) 2017; 56:237-244. [PMID: 28814126 DOI: 10.1080/15563650.2017.1360497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AIM Nitromethane, found in fuels used for short distance racing, model cars, and model airplanes, produces a falsely elevated serum creatinine with standard creatinine analysis via the Jaffé method. Erroneous creatinine elevation often triggers extensive testing, leads to inaccurate diagnoses, and delayed or inappropriate medical interventions. Multiple reports in the literature identify "enzymatic assays" as an alternative method to detect the true value of creatinine, but this ambiguity does not help providers translate what type of enzymatic assay testing can be done in real time to determine if there is indeed false elevation. METHODS We report seven cases of ingested nitromethane where creatinine was determined via Beckman Coulter® analyser using the Jaffé method, Vitros® analyser, or i-Stat® point-of-care testing. Nitromethane was detected and semi-quantified using a common clinical toxic alcohol analysis method, and quantified by headspace-gas chromatography-mass spectrometry. RESULTS When creatinine was determined using i-Stat® point-of-care testing or a Vitros® analyser, levels were within the normal range. Comparatively, all initial creatinine levels obtained via the Jaffé method were elevated. Nitromethane concentrations ranged from 42 to 310 μg/mL. CONCLUSIONS These cases demonstrate reliable assessment of creatinine through other enzymatic methods using a Vitros® analyser or i-STAT®. Additionally, nitromethane is detectable and quantifiable using routine alcohols gas chromatography analysis and by headspace-gas chromatography-mass spectrometry.
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Affiliation(s)
- Christine M Murphy
- a Department of Emergency Medicine , Carolinas Medical Center , Charlotte , NC , USA
| | | | | | - Paul Cheifetz
- d Metrolina Nephrology Associates , PA, Charlotte , NC , USA
| | | | | | - Sherri Kacinko
- f Forensic Science Department , NMS Laboratories , Willow Grove , PA , USA
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Cao D, Maynard S, Mitchell AM, Kerns WP, Beuhler M. Point of care testing provides an accurate measurement of creatinine, anion gap, and osmolal gap in ex-vivo whole blood samples with nitromethane. Clin Toxicol (Phila) 2014; 52:611-7. [PMID: 24844579 DOI: 10.3109/15563650.2014.918628] [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] [Indexed: 11/13/2022]
Abstract
CONTEXT Nitromethane interferes with Jaffé measurements of creatinine, potentially mimicking acute kidney injury. OBJECTIVES We determined the proportional contribution of nitromethane in blood samples to creatinine measured by the Jaffé colorimetric and the point-of-care (POC) reactions and determined whether the difference can reliably estimate the concentration of nitromethane. Additionally, we determined whether the presence of nitromethane interferes with anion/osmolal gaps and ascertained the stability of nitromethane in serum after 7 days. METHODS Nitromethane was added to whole blood from four healthy volunteers to achieve concentrations of 0, 0.25, 0.5, 1, and 2 mmol/L. The following tests were performed: creatinine (Jaffé and POC), electrolytes (associated with Jaffé and POC), osmolality and nitromethane concentration (gas chromatography [GC]). Remaining samples were refrigerated and reanalyzed using GC at 7 days. Anion and osmolal gaps were calculated. Proportional recovery and degradation of nitromethane were measured using GC. Data were analyzed for agreement with single-factor ANOVA (p = 0.05). RESULTS Mean creatinine for POC and Jaff methods were 0.93 vs. 0.76 mg/dL, respectively. Jaff creatinine concentrations increased linearly with increasing nitromethane concentrations (R(2) = 1, p = 0.01): measured creatinine (mg/dL) = 7.1*nitromethane (mmol/L) = 0.79. POC creatinine remained unchanged across the range of nitromethane concentrations (p = 0.99). Anion and osmolal gaps also remained unchanged. Nitromethane was reliably identified in all sample concentrations using GC on Day 0. Detection of 0.25 mmol/L nitromethane was not consistently recovered on Day 7. Nitromethane degradation was most pronounced at 2 mmol/L concentrations (81% recovery). CONCLUSIONS Nitromethane alters apparent concentration of creatinine using the Jaffé reaction in a linear fashion but not when using the POC reaction. Measured difference between Jaffé and POC creatinine may identify the presence and estimate concentration of nitromethane. Presence of nitromethane did not alter the anion or osmolal gap; thus it would not potentially interfere with the diagnosis of co-exposure to a toxic alcohol.
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Affiliation(s)
- D Cao
- Rocky Mountain Poison and Drug Center , Denver, CO , USA
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Liu WS, Chung YT, Yang CY, Lin CC, Tsai KH, Yang WC, Chen TW, Lai YT, Li SY, Liu TY. Serum creatinine determined by Jaffe, enzymatic method, and isotope dilution-liquid chromatography-mass spectrometry in patients under hemodialysis. J Clin Lab Anal 2012; 26:206-14. [PMID: 22628238 DOI: 10.1002/jcla.21495] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Serum creatinine is an important clinical marker for renal clearance. However, the Jaffe method had much interference and the accuracy had not been tested in patients under hemodialysis (HD) with standard isotope dilution-liquid chromatography-mass spectrometry (IDLCMS) method. The validity of enzymatic method is also unknown. METHODS The predialysis serum creatinine levels of 126 patients under regular HD for 3 months were checked by Jaffe, enzymatic, and IDLCMS methods. We compared the value of the Jaffe and enzymatic to that of IDLCMS in linear regression model. And we also tried to find the clinical parameters that influence the difference between Jaffe vs. IDLCMS and enzymatic vs. IDLCMS method. RESULTS We found significant underestimate serum creatinine in uremic patients by Jaffe and enzymatic methods. Serum glucose and globulin are positive biases, whereas albumin, potassium, and phosphorus are negative biases. Enzymatic method is less affected by serum glucose and serum protein. Albumin acts differently in uremic serum compared to the results of mixing them with normal serum. CONCLUSIONS For uremic patients, in whom creatinine level is high and many of them suffered from diabetes mellitus, serum creatinine can be either under- or overestimated by Jaffe method. Enzymatic method is less affected and may be a better method.
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Affiliation(s)
- Wen-Sheng Liu
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Lakin BD, Booth E, McCann SJ, Garr R. Can a spuriously raised creatinine by Jaffe method be helpful in poisoning? Pediatr Int 2011; 53:e20-1. [PMID: 21851491 DOI: 10.1111/j.1442-200x.2011.03371.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Padmanabhan P, Spiller HA, Ross MP, Bosse GM. Is elevated creatinine a reliable marker for methanol toxicity in nitromethane-containing model fuel ingestions in children? Clin Toxicol (Phila) 2011; 49:45-7. [DOI: 10.3109/15563650.2010.549131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Apparent Elevated Creatinine After Ingestion of Nitromethane: Interference With the Jaffe reaction. Ther Drug Monit 2011; 33:1-2. [DOI: 10.1097/ftd.0b013e3181fe7e52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Case files of the California poison control system, San Francisco division: blue thunder ingestion: methanol, nitromethane, and elevated creatinine. J Med Toxicol 2010; 6:67-71. [PMID: 20352541 PMCID: PMC2861177 DOI: 10.1007/s13181-010-0042-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
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Rastogi A, Itagaki B, Bajwa M, Kraut JA. Spurious elevation in serum creatinine caused by ingestion of nitromethane: implication for the diagnosis and treatment of methanol intoxication. Am J Kidney Dis 2008; 52:181-7. [PMID: 18589218 DOI: 10.1053/j.ajkd.2007.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2007] [Accepted: 12/12/2007] [Indexed: 11/11/2022]
Affiliation(s)
- Anjay Rastogi
- Division of Nephrology, UCLA Center for Health Sciences and David Geffen School of Medicine, Los Angeles, CA 90073, USA
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Patel S, Dikkala S, Marcus RJ. Nitromethane-containing fuel toxicity causing falsely elevated serum creatinine. Clin Kidney J 2008; 1:30-31. [PMID: 30792781 PMCID: PMC6375239 DOI: 10.1093/ndtplus/sfm018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Accepted: 11/06/2007] [Indexed: 12/05/2022] Open
Affiliation(s)
- Satish Patel
- Division of Nephrology and Hypertension, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, PA, USA
| | - Sudharani Dikkala
- Department of Internal Medicine, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, PA, USA
| | - Richard J Marcus
- Division of Nephrology and Hypertension, Allegheny General Hospital, West Penn Allegheny Health System, Pittsburgh, PA, USA
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Creatinine Elevation Associated with Nitromethane Exposure: A Marker of Potential Methanol Toxicity. J Emerg Med 2007; 33:249-53. [DOI: 10.1016/j.jemermed.2007.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 06/16/2006] [Accepted: 11/08/2006] [Indexed: 11/23/2022]
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