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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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2
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Corsello A, Malandrini S, Bianchetti MG, Agostoni C, Cantoni B, Meani F, Faré PB, Milani GP. Sodium assessment in neonates, infants, and children: a systematic review. Eur J Pediatr 2022; 181:3413-3419. [PMID: 35821131 PMCID: PMC9395449 DOI: 10.1007/s00431-022-04543-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/15/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022]
Abstract
Hyponatremia is a common disorder in childhood. The indirect and the direct potentiometry are currently the most popular techniques employed for sodium assessment, although discrepancies between the two techniques may be > 10 mmol/L. It is known that < 20% of the recently published articles report information about the technique used for sodium analysis, but no data are available on pediatric studies. This study aimed at investigating the laboratory technique employed for sodium measurement in studies conducted in childhood. A systematic literature search in PubMed, Embase, and Web of Science was undertaken to identify articles containing the word "hyponatremia" in the title between 2013 and 2020. Papers with < 10 subjects were excluded. A total of 565 articles were included. Information on the laboratory technique used for sodium analysis was more commonly (p = 0.035) reported in pediatric (n = 15, 28%) than in non-pediatric (n = 81, 16%) reports. The frequency of reports with and without information on the technique for sodium assessment was not different with respect to the study characteristics, the quartile of the journal where the paper was published, the country income setting, and the inclusion of neonates among the 54 pediatric studies. Conclusion: Most pediatric papers do not report any information on the technique used for sodium analysis. Although international authorities have recommended the implementation of direct potentiometry, a low awareness on this issue is still widespread in pediatric research. What is Known: • Direct potentiometry and indirect potentiometry are currently employed for sodium analysis in blood. • Direct potentiometry is more accurate. What is New: • Less than 30% of pediatric articles provide information on the technique employed for sodium analysis in blood. • Indirect potentiometry is more frequently employed than direct potentiometry in pediatric studies.
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Affiliation(s)
- Antonio Corsello
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
| | - Sabrina Malandrini
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Mario G. Bianchetti
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy ,Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Cantoni
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Francesco Meani
- Department of Gynecology and Obstetrics, Centro Di Senologia Della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Pietro B. Faré
- Department of Internal Medicine, Ente Ospedaliero Cantonale, 6600 Locarno, Switzerland
| | - Gregorio P. Milani
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy ,Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
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3
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Datta SK, Chopra P. Interference in Ion-Selective Electrodes Due to Proteins and Lipids. J Appl Lab Med 2021; 7:589-595. [PMID: 34751739 DOI: 10.1093/jalm/jfab125] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Ion-selective electrodes (ISE) have become the mainstay of electrolyte measurements in the clinical laboratory. In most automated analyzers used in large diagnostic laboratories, indirect ISE (iISE) -based electrolyte estimation is done; whereas direct ISE (dISE) -based equipment are mostly used in blood gas analyzers and in the point-of-care (PoC) setting. CONTENT Both the techniques, iISE as well as dISE, are scientifically robust; however, the results are often not interchangeable. Discrepancy happens between the two commonly due to interferences that affect the two measuring principles differently. Over the last decade, several studies have reported discrepancies between dISE and iISE arising due to abnormal protein and lipid contents in the sample. SUMMARY The present review endeavors to consolidate the knowledge accumulated in relation to interferences due to abnormal protein and lipid contents in sample with the principal focus resting on probable solutions thereof.
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Affiliation(s)
- Sudip Kumar Datta
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Parul Chopra
- Department of Laboratory Medicine, All India Institute of Medical Sciences, New Delhi, India
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4
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Malandrini S, Lava SAG, Bianchetti MG, Meani F, Faré PB, Camozzi P, Cugliari M, Agostoni C, Milani GP. Which laboratory technique is used for the blood sodium analysis in clinical research? A systematic review. Clin Chem Lab Med 2021; 59:1501-1506. [PMID: 33915610 DOI: 10.1515/cclm-2021-0293] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 04/19/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Circulating sodium is analyzed by flame spectrometry and indirect or direct potentiometry. The differences between estimates returned by the three techniques are often relevant. It is unknown whether peer-reviewed international publications focusing on this parameter provide information about the technique. Objectives of the study were to ascertain if information about the employed technique is provided. CONTENT A search in the National Library of Medicine for articles whose title contains "hyponatr[a]emia" was performed. We restricted the search to clinical reports including 10 or more humans published in the 2013-2015 and 2017-2019 periods. Authors of papers not reporting the technique were contacted to obtain this information. The study design and journal quartile ranking of each article were also evaluated. SUMMARY For the final analysis, we included 361 articles (2013-2015, n=169; 2017-2019, n=192). Information about the laboratory technique was given in 61(17%) articles. Thanks to our inquiry, we collected this information for 116(32%) further reports. Indirect potentiometry was the most frequently used technique, followed by direct potentiometry. Spectrometry was used in a small minority of studies. Study design, journal ranking and study period did not modulate the mentioned frequency. OUTLOOK Most articles focusing on hyponatremia do not provide information on the laboratory technique. This parameter is nowadays analyzed by indirect or, less frequently, direct potentiometry. The figures are similar for high and low impact factor journals and for the 2013-2015 and the 2017-2019 periods. Many authors, reviewers and editors likely assume that the results of this parameter are not influenced by the technique.
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Affiliation(s)
- Sabrina Malandrini
- Family Medicine Institute, Faculty of Biomedical Science, Università della Svizzera italiana, Lugano, Switzerland.,Department of Internal Medicine, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Sebastiano A G Lava
- Department of Pediatrics, Pediatric Cardiology Unit, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland
| | - Mario G Bianchetti
- Family Medicine Institute, Faculty of Biomedical Science, Università della Svizzera italiana, Lugano, Switzerland.,Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Francesco Meani
- Department of Gynecology and Obstetrics, Centro di Senologia della Svizzera Italiana, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | - Pietro B Faré
- Infectious Diseases Unit, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Pietro Camozzi
- Department of Internal Medicine, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Marco Cugliari
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Agostoni
- Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - Gregorio P Milani
- Pediatric Institute of Southern Switzerland, Ente Ospedaliero Cantonale, Bellinzona, Switzerland.,Pediatric Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
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5
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Sodium monitoring in infants < 100 days of life. Eur J Pediatr 2020; 179:1167-1168. [PMID: 31732801 DOI: 10.1007/s00431-019-03471-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/05/2019] [Accepted: 09/10/2019] [Indexed: 10/25/2022]
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6
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Milani GP, Edefonti V, De Santis R, Agostoni C, Spolidoro GC, Pelucchi C, Bianchetti MG, Fossali EF. Disagreement between direct and indirect potentiometric Na+ determination in infancy and childhood. ACTA ACUST UNITED AC 2019; 58:e117-e119. [DOI: 10.1515/cclm-2019-0931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 10/28/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Gregorio P. Milani
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , 20122 Milan , Italy , Phone: 0039(0)255038727, Fax: +39(0)255032918
- Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy
| | - Valeria Edefonti
- Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy
| | - Raffaella De Santis
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Carlo Agostoni
- Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Giulia C.I. Spolidoro
- Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Claudio Pelucchi
- Department of Clinical Sciences and Community Health , University of Milan , Milan , Italy
| | - Mario G. Bianchetti
- Università della Svizzera Italiana , Lugano , Switzerland
- Pediatric Institute of Southern Switzerland, Ospedale San Giovanni , Bellinzona , Switzerland
| | - Emilio F. Fossali
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico , Milan , Italy
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7
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Pettit NR, De Jesus-Brugman N, Beardsley AL. Infant With Poor Feeding. Ann Emerg Med 2019; 72:102-112. [PMID: 29929645 DOI: 10.1016/j.annemergmed.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Nicholas R Pettit
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Andrew L Beardsley
- Section of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN
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8
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Abstract
Introduction: For the last few decades, electrolyte determinations in plasma or serum are carried out by reliable potentiometric methods. In recent years, a marked technical evolution has taken place, where the clinical analysis of common analytes (e.g. electrolytes) is partly moving from centralised clinical core laboratories to near-patient point-of-care testing. Methods: As the measuring principle used by point-of-care testing markedly differs from the one used in core laboratories, sodium results are not always interchangeable in critically ill patients due to the different sensitivity of the analytical methods for the electrolyte exclusion effect. Results: This effect mainly occurs in patients with decreased plasma protein values. The observed differences in generated test results might significantly affect the judgment and the treatment of electrolyte disturbances. As technical solutions are not likely to occur in the near future, clinicians and laboratorians should be well aware of this growing problem. Mathematical correction of the sodium results for plasma protein concentration may resolve the problem to a certain extent. Discussion: Although electrolyte determinations are generally very reliable, analytical interferences can occur for sodium rarely, mainly due to contamination by surfactants, benzalkonium in particular. For potassium, the major problem is hemolysis. To a lesser extent, leukocyte lysis and thrombocytopenia may also interfere. For chloride determination, the selectivity of the electrodes used is not ideal. Occasionally, false positive signals can be observed in presence of interfering ions (e.g. bromide).
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9
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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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Moen V, Brudin L, Tjernberg I, Rundgren M, Irestedt L. Feto-maternal osmotic balance at term. A prospective observational study. J Perinat Med 2018; 46:183-189. [PMID: 28862988 DOI: 10.1515/jpm-2016-0425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/19/2017] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We performed the present study to investigate the feto-maternal osmotic relationship at term with the hypothesis that, in contrast to the literature, maternal plasma osmolality is lower than fetal levels. In a previous study, we found that maternal plasma sodium at delivery was consistently lower than the sodium in the umbilical artery. Our aim was to corroborate these results with analysis of osmolality. METHODS Blood was sampled from 30 women immediately before cesarean section and from the umbilical artery and vein before cord clamping and osmolality, sodium and albumin were analyzed. RESULTS Maternal osmolality was (mean; 95% confidence interval) 287.0 (285.8-288.2) mOsmkg/kg, arterial cord osmolality was 289.4 (287.9-291.0) mOsm/kg and venous cord osmolality was 287.3 (286.0-288.5) mOsm/kg. The paired difference between maternal and umbilical arterial osmolality was mean (SD) -2.4 (3.3) mOsm/kg (P<0.001), between maternal and umbilical vein -0.3 (3.0) mOsm/kg (P=0.63) and between umbilical artery and vein -2.1 (2.8) mOsm/kg (P<0.001). CONCLUSION Maternal osmolality was significantly lower than arterial cord osmolality confirming our previous results. The feto-maternal osmotic gradient favors water transport from the mother to the fetus and may increase the fetal risk of water intoxication when the mother ingests or is administered large volumes of electrolyte free solutions.
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Affiliation(s)
- Vibeke Moen
- Department of Anaesthesiology and Intensive Care, Kalmar County Hospital, S-39185 Kalmar, Sweden
| | - Lars Brudin
- Department of Medicine and Health Sciences, University Hospital Linköping, Linköping, S-58185, Sweden
| | - Ivar Tjernberg
- Department of Clinical Chemistry and Transfusion Medicine, Kalmar County Hospital, Kalmar County Council, S-39185 Kalmar, Sweden
| | - Mats Rundgren
- Department of Physiology and Pharmacology, Karolinska Institutet, S-17177 Stockholm, Sweden
| | - Lars Irestedt
- Section of Anaesthesiology and Intensive Care, Department of Physiology and Pharmacology, Karolinska Institutet, S-17177 Stockholm, Sweden
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11
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Banerjee A, Mehrotra G. Role of Correction Factor in Minimizing Errors While Calculating Electrolyte Values between Blood-gas Analyzer and Laboratory Autoanalyzer: A Comparative Study. Indian J Crit Care Med 2018; 22:34-39. [PMID: 29422731 PMCID: PMC5793020 DOI: 10.4103/ijccm.ijccm_406_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Aims: Electrolytes are charged elements that play important functions in the body. They are measured by both arterial blood–gas (ABG) analyzers and autoanalyzers (AA). In this study, we tried to find out the correction factor for sodium and potassium to establish the concordance between ABG and AA values. Materials and Methods: We prospectively studied 100 samples of patients, and for validation of the result, we applied our result on 30 patients later. 1.5 ml of blood collected in the 2.0 ml syringe preflushed with heparin and analyzed using blood–gas analyzer (ABG). Another sample was sent, to central laboratory, where serum Na+ and K+ concentrations were analyzed. Means, standard deviations, and coefficients of variation with Karl Pearson's correlation coefficients were found out. Deming regression analysis was performed and Bland–Altman plots were also constructed. Results: The mean sodium and potassium were 130.27 ± 7.85 mmol/L and 3.542 ± 0.76 mmol/L using ABG and 139.28 ± 7.89 mmol/L and 4.196 ± 0.72 mmol/L using AA. Concordance between ABG and AA is done by adding the correction factor: for sodium, correction factor is 9.01, standard error = 1.113, class interval = 6.815–11.205; and for potassium (K+), correction factor is 0.654, standard error = 0.1047, class interval = 0.4475–0.8605. Conclusion: The instrument type and calibration methods differ in different hospitals, so it is important that each center conducts an in-hospital study to know the correction factor before installation of an ABG, and the factor should be used accordingly to minimize all errors.
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Affiliation(s)
- Abhinav Banerjee
- Department of Anesthesiology and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
| | - Gesu Mehrotra
- Department of Anesthesiology and Critical Care, Tata Main Hospital, Jamshedpur, Jharkhand, India
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12
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Florkowski C, Don-Wauchope A, Gimenez N, Rodriguez-Capote K, Wils J, Zemlin A. Point-of-care testing (POCT) and evidence-based laboratory medicine (EBLM) - does it leverage any advantage in clinical decision making? Crit Rev Clin Lab Sci 2017; 54:471-494. [PMID: 29169287 DOI: 10.1080/10408363.2017.1399336] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Point-of-care testing (POCT) is the analysis of patient specimens outside the clinical laboratory, near or at the site of patient care, usually performed by clinical staff without laboratory training, although it also encompasses patient self-monitoring. It is able to provide a rapid result near the patient and which can be acted upon immediately. The key driver is the concept that clinical decision making may be delayed when samples are sent to the clinical laboratory. Balanced against this are considerations of increased costs for purchase and maintenance of equipment, staff training, connectivity to the laboratory information system (LIS), quality control (QC) and external quality assurance (EQA) procedures, all required for accreditation under ISO 22870. The justification for POCT depends upon being able to demonstrate that a more timely result (shorter turnaround times (TATs)) is able to leverage a clinically important advantage in decision making compared with the central laboratory (CL). In the four decades since POCT was adapted for the self-monitoring of blood glucose levels by subjects with diabetes, numerous new POCT methodologies have become available, enabling the clinician to receive results and initiate treatment more rapidly. However, these instruments are often operated by staff not trained in laboratory medicine and hence are prone to errors in the analytical phase (as opposed to laboratory testing where the analytical phase has the least errors). In some environments, particularly remote rural settings, the CL may be at a considerable distance and timely availability of cardiac troponins and other analytes can triage referrals to the main centers, thus avoiding expensive unnecessary patient transportation costs. However, in the Emergency Department, availability of more rapid results with POCT does not always translate into shorter stays due to other barriers to implementation of care. In this review, we apply the principles of evidence-based laboratory medicine (EBLM) looking for high quality systematic reviews and meta-analyses, ideally underpinned by randomized controlled trials (RCTs), looking for evidence of whether POCT confers any advantage in clinical decision making in different scenarios.
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Affiliation(s)
| | | | | | | | - Julien Wils
- e Department of Pharmacology , University Hospital of Rouen , Rouen , France
| | - Annalise Zemlin
- f University of Stellenbosch and National Health Laboratory Service (NHLS), Tygerberg Hospital , Cape Town , South Africa
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13
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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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Lava SAG, Bianchetti MG, Milani GP. Testing Na + in blood. Clin Kidney J 2016; 10:147-148. [PMID: 28396732 PMCID: PMC5381209 DOI: 10.1093/ckj/sfw103] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 09/02/2016] [Indexed: 11/15/2022] Open
Abstract
Both direct potentiometry and indirect potentiometry are currently used for Na+ testing in blood. These measurement techniques show good agreement as long as protein and lipid concentrations in blood remain normal. In severely ill patients, indirect potentiometry commonly leads to relevant errors in Na+ estimation: 25% of specimens show a disagreement between direct and indirect potentiometry, which is ≥4 mmol/L (mostly spuriously elevated Na+ level due to low circulating albumin concentration). There is a need for increased awareness of the poor performance of indirect potentiometry in some clinical settings.
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Affiliation(s)
- Sebastiano A G Lava
- Department of Pediatrics, University Children's Hospital of Bern, Inselspital, Bern, Switzerland; Pediatric Pharmacology and Pharmacogenetics, Hôpital Robert Debré, Paris, France
| | - Mario G Bianchetti
- Pediatric Department of Southern Switzerland, Bellinzona, Switzerland; Università della Svizzera Italiana, Lugano, Switzerland
| | - Gregorio P Milani
- Foundation IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Pediatric Emergency Department, Milan, Italy
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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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Goldwasser P, Ayoub I, Barth RH. Pseudohypernatremia and pseudohyponatremia: a linear correction. Nephrol Dial Transplant 2014; 30:252-7. [DOI: 10.1093/ndt/gfu298] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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Abstract
Electrolyte disorders can result in life-threatening complications. The kidneys are tasked with maintaining electrolyte homoeostasis, yet the low glomerular filtration rate of neonatal kidneys, tubular immaturity, and high extrarenal fluid losses contribute to increased occurrence of electrolyte disorders in neonates. Understanding the physiologic basis of renal electrolyte handling is crucial in identifying underlying causes and initiation of proper treatment. This article reviews key aspects of renal physiology, the diagnostic workup of disorders of plasma sodium and potassium, and the appropriate treatment, in addition to inherited disorders associated with neonatal electrolyte disturbances that illuminate the physiology of renal electrolyte handling.
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Affiliation(s)
- Detlef Bockenhauer
- UCL Institute of Child Health, Great Ormond Street Hospital for Children NHS Foundation Trust, Nephrology Unit, 30 Guilford Street, London WC1 3EH, UK.
| | - Jakub Zieg
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, V Úvalu 84, 15006 Praha 5, Czech Republic
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Levene I. Towards evidence based medicine for paediatricians. Question 1: Is measurement of sodium from capillary blood accurate enough for clinical decision making? Arch Dis Child 2014; 99:481-2. [PMID: 24719171 DOI: 10.1136/archdischild-2013-305890] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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A comparative study on reliability of point of care sodium and potassium estimation in a pediatric intensive care unit. Indian J Pediatr 2013; 80:731-5. [PMID: 23392748 DOI: 10.1007/s12098-013-0977-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer. METHODS This prospective method comparison study was done from February to April 2012 in Pediatric ICU of tertiary care hospital at Delhi. Sixty consecutive patients were tested during the period. Paired blood samples for venous blood gas to be tested on BGA and serum electrolytes to be tested on auto-analyzers (AA) were taken as per standard technique. Data was collected and 59 paired samples were analyzed for sodium and potassium levels. They were analyzed according to CLSI document EP15-A2 using ACB method comparison software. RESULTS Mean sodium measured on the BGA was 132.8 ± 12.2 mmol/L where as measured by AA was 141.5 ± 11.1 mmol/L. The mean difference between the two was -8.76 mmol/L (p < 0.001). The difference was statistically significant in all three subgroups of hypernatremia, isonatremia and hyponatremia (p < 0.001). Potassium level in BGA was 3.53 ± 0.81 mmol/L and AA was 4.28 ± 1.05 mmol/L. The mean difference between the BGA and AA was -0.75 mmol/L (p < 0.0001). The difference was statistically significant in patients with normokalemia and hyperkalemia (p < 0.0001). The difference was non significant in patients with hypokalemia (p = 0.051). CONCLUSIONS Blood gas analyzers underestimates Na + and K + values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman's analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.
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