Agreement of Measurement between Arterial and Venous Electrolyte Levels in Neonates in a Tertiary Care Hospital

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Abstract

Context Venous or arterial blood is used for the estimation of electrolytes in neonates in neonatal intensive care unit (NICU). In addition to the measurement of blood gases and bicarbonate in the arterial blood, arterial blood gas analysis also estimates electrolytes thus circumventing the need to collect a venous sample for electrolytes. The literature survey revealed studies comparing the electrolyte levels in arterial and venous blood in adults and older children, but to our knowledge none were found in neonates, hence the study.

Aims The aim of the study is to compare the electrolytes in arterial and venous samples in neonates in a critical care set up and derive in-house prediction equation to correlate the arterial and venous electrolytes.

Settings and Design Hospital-based, retrospective cross-sectional study done in critically ill neonates.

Materials and Methods All the newborns (age ≤28 days) admitted in NICU from July 2016 to June 2018 were selected for the study and data collected with the help of Hospital Information System.

Statistical Analysis MedCalc and NCSS 12 (trial version) software was used. Deming Regression and Bland Altman analysis were performed.

Results A strong positive correlation between the arterial and venous blood electrolytes observed. An in-house prediction equation was derived for the venous electrolytes. Deming regression analysis showed that only potassium levels are statistically equivalent between the instruments and the sample type. Bland Altman Analysis between the arterial and venous electrolytes showed a mean difference which was well within the accepted Clinical Laboratory Improvement Amendment guidelines.

Conclusion The electrolyte levels estimated by arterial blood in neonates can be used in an interchangeable manner only for potassium levels, whereas sodium and chloride estimation necessitates one to be cautious.

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Most cited references 14

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Ion Selective Electrodes (ISEs) and interferences--a review.

Goce Dimeski, Tony Badrick, Andrew John (2010)

Ion Selective Electrodes (ISEs) are used to measure some of the most critical analytes on clinical laboratory and point-of-care analysers. These analytes which include Na(+), K(+), Cl(-), Ca(2+), Mg(2+) and Li(+) are used for rapid patient care decisions. Although the electrodes are very selective, they are not free of interferences. It is important for laboratories to have an understanding of the type and extent of interferences in order to avoid incorrect clinical decisions and treatment. Copyright 2009 Elsevier B.V. All rights reserved.

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Electrolytes assessed by point-of-care testing – Are the values comparable with results obtained from the central laboratory?

Binila Chacko, John V Peter, Shalom Patole … (2011)

Background and Aims: When dealing with very sick patients, the speed and accuracy of tests to detect metabolic derangements is very important. We evaluated if there was agreement between whole blood electrolytes measured by a point-of-care device and serum electrolytes measured using indirect ion-selective electrodes. Materials and Methods: In this prospective study, electrolytes were analyzed in 44 paired samples drawn from critically ill patients. Whole blood electrolytes were analyzed using a point-of-care blood gas analyzer and serum electrolytes were analyzed in the central laboratory on samples transported through a rapid transit pneumatic system. Agreement was summarized by the mean difference with 95% limits of agreement (LOA) and Lin’s concordance correlation (p c). Results: There was a significant difference in the mean (±standard deviation) sodium value between whole blood and serum samples (135.8 ± 5.7 mmol/L vs. 139.9 ± 5.4 mmol/L, P < 0.001), with the agreement being modest (p c = 0.71; mean difference −4.0; 95% LOA −8.78 to 0.65). Although the agreement between whole blood and serum potassium was good (p c = 0.96), and the average difference small (−0.3; 95% LOA −0.72 to 0.13), individual differences were clinically significant, particularly at lower potassium values. For potassium values <3.0 mmol/L, the concordance was low (p c = 0.53) and the LOA was wide (1.0 to −0.13). The concordance for potassium was good (p c = 0.96) for values ≥3.0 (mean difference −0.2; 95% LOA −0.48 to 0.06). Conclusions: Clinicians should be aware of the difference between whole blood and serum electrolytes, particularly when urgent samples are tested at point of care and routine follow-up electrolytes are sent to the central laboratory. A correction factor needs to be determined at each center.

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Use of a blood gas analyzer and a laboratory autoanalyzer in routine practice to measure electrolytes in intensive care unit patients

Yasemin U Budak, Kagan Huysal, Murat Polat (2012)

Background Electrolyte values are measured in most critically ill intensive care unit (ICU) patients using both an arterial blood gas analyzer (ABG) and a central laboratory auto-analyzer (AA). The aim of the present study was to investigate whether electrolyte levels assessed using an ABG and an AA were equivalent; data on sodium and potassium ion concentrations were examined. Methods We retrospectively studied patients hospitalized in the ICU between July and August 2011. Of 1,105 test samples, we identified 84 instances of simultaneous sampling of arterial and venous blood, where both Na+ and K+ levels were measured using a pHOx Stat Profile Plus L blood gas analyzer (Nova Biomedical, Waltham MA, USA) and a Roche Modular P autoanalyzer (Roche Diagnostics, Mannheim, Germany). Statistical measures employed to compare the data included Spearman's correlation coefficients, paired Student’s t-tests, Deming regression analysis, and Bland-Altman plots. Results The mean sodium concentration was 138.1 mmol/L (SD 10.2 mmol/L) using the ABG and 143.0 mmol/L (SD 10.5) using the AA (p < 0.001). The mean potassium level was 3.5 mmol/L (SD 0.9 mmol/L) using the ABG and 3.7 mmol/L (SD 1.0 mmol/L) using the AA (p < 0.001). The extent of inter-analyzer agreement was unacceptable for both K+ and Na+, with biases of 0.150-0.352 and −0.97-10.05 respectively; the associated correlation coefficients were 0.88 and 0.90. Conclusions We conclude that the ABG and AA do not yield equivalent Na+ and K+ data. Concordance between ABG and AA should be established prior to introduction of new ABG systems.

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Journal

Journal ID (nlm-ta): J Lab Physicians

Journal ID (iso-abbrev): J Lab Physicians

Journal ID (doi): 10.1055/s-00044881

Title: Journal of Laboratory Physicians

Publisher: Thieme Medical and Scientific Publishers Private Ltd. (A-12, Second Floor, Sector -2, NOIDA -201301, India )

ISSN (Print): 0974-2727

ISSN (Electronic): 0974-7826

Publication date (Print): March 2020

Publication date (Electronic): 15 June 2020

Volume: 12

Issue: 1

Pages: 20-26

Affiliations

[1 ]Department of Biochemistry, JSS Medical College and JSS Hospital, JSSAHER, Mysuru, Karnataka, India

Author notes

Address for correspondence Kusuma Kasapura Shivashankar Department of Biochemistry, JSS Medical College and JSS Hospital MG Road, Mysuru 570004, KarnatakaIndia kusumaks@ 123456jssuni.edu.in

Article

Publisher ID: JLP200015

DOI: 10.1055/s-0040-1713061

PMC ID: 7426183

SO-VID: 111185a9-d9d9-4b18-91e4-f08ab3111c58

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This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.

Agreement of Measurement between Arterial and Venous Electrolyte Levels in Neonates in a Tertiary Care Hospital

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Most cited references 14

Ion Selective Electrodes (ISEs) and interferences--a review.

Electrolytes assessed by point-of-care testing – Are the values comparable with results obtained from the central laboratory?

Use of a blood gas analyzer and a laboratory autoanalyzer in routine practice to measure electrolytes in intensive care unit patients

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