Accuracy of Gasometry in Electrolyte Evaluation
What is the difference between the gasometry and the laboratory in the measurement of electrolytes?
DOI:
https://doi.org/10.25751/rspa.23929Keywords:
, Potassium, Chloride, Arterial Blood Gas, and Auto-analyser SodiumAbstract
Background: The measurement of sodium, potassium and chloride is widely used in clinical practice. It can be done through a serum or gasometric sample. The ease of blood collection and the fast availability of results would make gasometry the ideal method. However, the literature data on the accuracy of gasometry are not consensual, thus, the current method of choice is the serum sample. We intended to compare the accuracy of sodium, potassium and chloride measurement between the gasometry and the serum ionogram.
Methods: Prospective observational study of children aged 28 days to 17 years who underwent elective surgery at a Pediatric Surgery Service during one year. During the perioperative period, 3 laboratory evaluations were performed with ionogram analysis in a serum sample and gasometry and their results were compared.
Results: 65 children with a median age of 10 years (IQR 3.6-15), 77% male. 161 determinations of sodium, 154 of potassium and 143 of chloride were obtained. There was a mean difference in sodium, potassium and chloride values between the two methods of: 1±1.89 mmol/L, 0.3±0.19mmol/L and -5±1.81 mmol/L (p <0.001). There was a strong correlation between sodium (r=0.64) and chloride (r=0.78) and very strong with potassium (r=0.9). It was possible to establish a linear regression and obtain a correction factor between the two methods.
Conclusions: There was a strong correlation between the two methods, therefore, both can be used in clinical practice. A correction factor can be applied to the gasometry’s potassium and chloride results.
Downloads
References
Scott MG, LeGrys VA, Klutts JS. Electrolytes and blood gases. In: Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th edition. Edited by Burtis DE, Ashwood ER, Bruns DE. St Louis. Elsevier, 2006:983-1018.
Munger MA. New agents for managing hyponatremia in hospitalized patients. Am J Health-Syst Pharm. 2007;64:253-265.
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;4:216-222.
Vos G, Engel M, Ramsay G, Van Waardenburg D. Point-of-care blood analyzer during the interhospital transport of critically ill children. Eur J Emerg Med. 2006;13:304-307.
Budak YU, Huysal K, Polat M. Use of a blood gas analyzer and a laboratory autoanalyzer in routine practice to measure electrolytes in intensive care unit patients. BMC Anesthesiol. 2012:12-17.
Walton HG, Boucher DM, Marroquin R. Comparison of blood gas and electrolyte test results from the Gem-Premier and the ABL-70 versus a conventional laboratory analyzer. JECT. 2003;35:24-27.
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 Diagnostic Res. 2015;9(2):BC28-BC30.
Zhang JB, Lin J, Zhao XD. 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;10:1-11.
Jain A, Subhan I, Joshi M. Comparison of the point-of-care blood gas analyzer versus the laboratory auto-analyzer for the measurement of electrolytes. Int J Emerg Med. 2009;2(2):117-120.
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;32:1-5.
Lum G, Gambino SR. A comparison of serum versus heparinized plasma for routine chemistry tests. Am J Clin Pathol. 1974;61:108-113.
Jacobs E, Ancy JJ, Smith M. Multi-site Performance Evaluation of pH, Blood Gas, Electrolyte, Glucose, and Lactate Determinations With the GEM Premier 3000 Critical Care Analyzer. Point Care J Near-Patient Test Technol. 2002;1:135-144.
Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Different manufacturers of syringes: A new source of variability in blood gas, acid-base balance and related laboratory test?. Clin Biochem. 2012;45:683-687.
Baruah A, Goyal P, Sinha A, Ramesh KL, Datta R. Delay in specimen processing-major source of preanalytical variation in serum electrolytes. J Clin Diagnostic Res. 2014;8:CC01-CC03.
Ehrmeyer SS, Laessig RH, Leinweber JE, Oryall JJ. 1990 Medicare/CLIA final rules for proficiency testing: Minimum intralaboratory performance characteristics (CV and bias) needed to pass. Clin Chem. 1990;36:1736-1740.
Asirvatham JR, Moses V, Bjornson L. Errors in potassium measurement: A laboratory perspective for the clinician. N Am J Med Sci. 2013;5:255-259.
Sevastos N, Theodossiades G, Archimandritis AJ. Pseudohyperkalemia in serum: A new insight into an old phenomenon. Clin Med Res. 2008;6:30-32.
Rifkin SI. Pseudohyperkalemia in patients with chronic lymphocytic leukemia. Int J Nephrol. 2011:Article ID: 759749.
Polak R, Huisman A, Sikma MA, Kersting S. Spurious hypokalaemia and hypophosphataemia due to extreme hyperleukocytosis in a patient with a haematological malignancy. Ann Clin Biochem. 2010;47:179-181.
Sevastos N, Theodossiades G, Savvas SP, Tsilidis K, Efstathiou S, Archimandrite AJ. Pseudohyperkalemia in patients with increased cellular components of blood. Am J Med Sci. 2006;331:17-21.
Berend K, de Vries APJ, Gans ROB. Physiological Approach to Assessment of Acid–Base Disturbances. N Engl J Med. 2014;371:1434-1445.
Geerts N, Wlazlo N, Scharnhorst V. Between analyser differences in chloride measurements and thus anion gap cause different interpretations of the acid-base balance. Clin Chem Lab Med. 2016;54:e81-e84.
Goldsmith D, Gutteridge G. Comparison of point-of-care versus central laboratory measurement of electrolytes concentrations on calculations of the anion gap and the strong ion difference anesthesiology. 2003;5:1077-1084.
Makiishi T, Nishimura N, Yoshioka K, et al. Potential inaccuracies in chloride measurements in patients with severe metabolic acidosis. Int J Nephrol. 2012:Article ID: 768316.
Razavi S, Jafari A, Zaker H, Sadeghi A. Plasma and serum electrolyte levels correlation in the Pediatric ICU. Tanaffos. 2010;9:34-38.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Francisco José de Sousa, Sofia Cochito Sousa, Sara Vaz, Francisco Abecasis
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Articles are freely available to be read, downloaded and shared from the time of publication.
The RSPA reserves the right to commercialize the article as an integral part of the journal (in the preparation of reprints, for example). The author should accompany the submission letter with a declaration of copyright transfer for commercial purposes.
Articles are published under the terms of the Creative Commons Attribution Non-Commercial License (CC BY-NC).
After publication in RSPA, authors are allowed to make their articles available in repositories of their home institutions, as long as they always mention where they were published.
