Hypocalcemia as a Cause of Complex Febrile Seizures in a Toddler

A 13-month-old boy had suffered three episodes of complex febrile seizures. At this admission, there were signs of hyperexcitability, such as Trousseau sign and QTc prolongation. A point of care blood gas analysis revealed severe hypocalcemia. Therefore, prior to administering intravenous calcium gluconate, we took blood samples to investigate the etiology of this hypocalcemia: magnesium, parathormone, and 25-hydroxyvitamin D. Since both parathormone and phosphate were significantly elevated and 25-hydroxyvitamin D was within the normal range, pseudohypoparathyroidism was diagnosed. After two years of follow-up, serum calcium had normalized in our patient under supplementation of vitamin D and calcium. He had been free of convulsions, although different febrile episodes had occurred.

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Point-of-care lab in out-of-hospital resuscitation: Feasibility and value of venous blood gas analysis on scene

10.26226/morressier.59b171e8d462b8028d8961d0 ◽

2017 ◽

Author(s):

Susanne Betz

Keyword(s):

Point Of Care ◽

Venous Blood ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Venous Blood Gas ◽

Venous Blood Gas Analysis

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Vitamin D Level Stability in Dystrophinopathy Patients on Vitamin D Supplementation

Journal of Neuromuscular Diseases ◽

10.3233/jnd-200625 ◽

2021 ◽

pp. 1-7

Author(s):

Naomi Vather-Wu ◽

Matthew D. Krasowski ◽

Katherine D. Mathews ◽

Amal Shibli-Rahhal

Keyword(s):

Vitamin D ◽

Retrospective Cohort ◽

Vitamin D Supplementation ◽

Hydroxyvitamin D ◽

Frequent Monitoring ◽

25 Hydroxyvitamin D ◽

The Mean ◽

Stable Maintenance ◽

Mean Time

Background: Expert guidelines recommend annual monitoring of 25-hydroxyvitamin D (25-OHD) and maintaining 25-OHD ≥30 ng/ml in patients with dystrophinopathies. Objective: We hypothesized that 25-OHD remains stable and requires less frequent monitoring in patients taking stable maintenance doses of vitamin D. Methods: We performed a retrospective cohort study, using the electronic health record to identify 26 patients with dystrophinopathies with a baseline 25-OHD ≥30 ng/mL and at least one additional 25-OHD measurement. These patients had received a stable dose of vitamin D for ≥3 months prior to their baseline 25-OHD measurement and throughout follow-up. The main outcome measured was the mean duration time the subjects spent with a 25-OHD ≥30 ng/mL. Results: Only 19% of patients dropped their 25-OHD to < 30 ng/ml, with a mean time to drop of 33 months and a median nadir 25-OHD of 28 ng/mL. Conclusions: These results suggest that measurement of 25-OHD every 2–2.5 years may be sufficient in patients with a baseline 25-OHD ≥30 ng/mL and who are on a stable maintenance dose of vitamin D. Other patients may require more frequent assessments.

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Prognostic Value of Oxygenated Hemoglobin Assessed during Acute Exacerbations of Chronic Pulmonary Disease

Respiration ◽

10.1159/000513440 ◽

2021 ◽

pp. 1-8

Author(s):

Clemens F. Hinke ◽

Rudolf A. Jörres ◽

Peter Alter ◽

Robert Bals ◽

Florian Bornitz ◽

...

Keyword(s):

Pulmonary Disease ◽

Predictive Value ◽

Hemoglobin Concentration ◽

Blood Gas Analysis ◽

Study Data ◽

Gas Analysis ◽

Chronic Obstructive ◽

Acute Exacerbations ◽

All Cause Mortality

Background: Oxygenated hemoglobin(OxyHem) is a simple-to-measure marker of oxygen content capable of predicting all-cause mortality in stable chronic obstructive pulmonary disease (COPD). Objectives: We aimed to analyze its predictive value during acute exacerbations of COPD (AECOPD). Methods: In this retrospective study, data from 227 patients discharged after severe AECOPD at RoMed Clinical Center Rosenheim, Germany, between January 2012 and March 2018, was analyzed. OxyHem (hemoglobin concentration [Hb] × fractional SpO2, g/dL) was calculated from oxygen saturation measured by pulse oximetry and hemoglobin assessed within 24 h after admission. The follow-up (1.7 ± 1.5 years) covered all-cause mortality, including readmissions for severe AECOPD. Results: During the follow-up period, 127 patients died, 56 due to AECOPD and 71 due to other reasons. Survivors and non-survivors showed differences in age, FVC % predicted, C-reactive protein, hemoglobin, Cr, Charlson Comorbidity Index (CCI), and OxyHem (p < 0.05 each). Significant independent predictors of survival were BMI, Cr or CCI, FEV1 % predicted or FVC % predicted, Hb, or OxyHem. The predictive value of OxyHem (p = 0.006) was superior to that of Hb or SpO2 and independent of oxygen supply during blood gas analysis. OxyHem was also predictive when using a cutoff value of 12.1 g/dL identified via receiver operating characteristic curves in analyses including either the CCI (hazard ratio 1.85; 95% CI 1.20, 2.84; p = 0.005) or Cr (2.04; 95% CI 1.35, 3.10; p = 0.001) as covariates. Conclusion: The concentration of OxyHem provides independent, easy-to-assess information on long-term mortality risk in COPD, even if measured during acute exacerbations. It therefore seems worth to be considered for broader clinical use.

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StatPal II pH and Blood Gas Analysis System evaluated

Clinical Chemistry ◽

10.1093/clinchem/40.1.124 ◽

1994 ◽

Vol 40 (1) ◽

pp. 124-129 ◽

Cited By ~ 7

Author(s):

R J Wong ◽

J J Mahoney ◽

J A Harvey ◽

A L Van Kessel

Keyword(s):

Point Of Care ◽

Blood Gases ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Portable Instrument ◽

Blood Gas ◽

Target Value ◽

Analysis System

Abstract We evaluated a new portable instrument, the PPG StatPal II pH and Blood Gas Analysis System, designed for "point-of-care" measurements of blood gases and pH. Inaccuracy (% of target value) and imprecision (CV%) were assessed by blood tonometry and comparison with a Corning 178. Within-day results for PCO2 inaccuracy and imprecision ranged from 98.2% to 102.9% and 3.3% to 3.9%, respectively; for PO2, these were 95.5% to 102.3% and 2.3% to 3.0%, respectively. Between-day results for PCO2 inaccuracy and imprecision ranged from 99.2% to 99.3% and from 2.9% to 3.2%, respectively; for PO2, the ranges were 96.2% to 98.2% and 2.6% to 3.0%, respectively. Two PCO2 outliers (in 645 samples = 0.3%) were observed. In general, tonometry recovery, measurement stability, and pH bias results for the StatPal II and Corning 178 were comparable. We conclude that the StatPal II performs within acceptable ranges of inaccuracy and imprecision.

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Effect of interval between serum draw and follow-up period on relative risk of cancer incidence with respect to 25-hydroxyvitamin D level; implications for meta-analyses and setting vitamin D guidelines

Dermato-Endocrinology ◽

10.4161/derm.15364 ◽

2011 ◽

Vol 3 (3) ◽

pp. 199-204 ◽

Cited By ~ 62

Author(s):

William B. Grant

Keyword(s):

Vitamin D ◽

Relative Risk ◽

Cancer Incidence ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Meta Analyses ◽

Risk Of Cancer

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Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

Acta Biochimica Polonica ◽

10.18388/abp.2020_5178 ◽

2020 ◽

Author(s):

Lukasz Krzych ◽

Olga Wojnarowicz ◽

Paweł Ignacy ◽

Julia Dorniak

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Point Of Care ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Acid Base Balance ◽

Arterial Blood Gas ◽

Arterial Blood ◽

The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

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A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis

Biochemia Medica ◽

10.11613/bm.2019.011003 ◽

2018 ◽

Vol 29 (1) ◽

pp. 169-172

Author(s):

Gian Luca Salvagno ◽

Davide Demonte ◽

Giuseppe Lippi

Keyword(s):

Reference Range ◽

Point Of Care ◽

Venous Blood ◽

Blood Gas Analysis ◽

Plasma Potassium ◽

Gas Analysis ◽

Blood Gas ◽

High Potassium ◽

Plastic Tube ◽

History Of

A 51-year old male patient was admitted to the hospital with acute dyspnea and history of chronic asthma. Venous blood was drawn into a 3.0 mL heparinized syringe and delivered to the laboratory for blood gas analysis (GEM Premier 4000, Instrumentation Laboratory), which revealed high potassium value (5.2 mmol/L; reference range on whole blood, 3.5-4.5 mmol/L). This result was unexpected, so that a second venous blood sample was immediately drawn by direct venipuncture into a 3.5 mL lithium-heparin blood tube, and delivered to the laboratory for repeating potassium testing on Cobas 8000 (Roche Diagnostics). The analysis revealed normal plasma potassium (4.6 mmol/L; reference range in plasma, 3.5-5.0 mmol/L) and haemolysis index (5; 0.05 g/L). Due to suspicion of spurious haemolysis, heparinized blood was transferred from syringe into a plastic tube and centrifuged. Potassium and haemolysis index were then measured in this heparinized plasma, confirming high haemolysis index (50; 0.5 g/L) and pseudohyperkalemia (5.5 mmol/L). Investigation of this case revealed that spurious haemolysis was attributable to syringe delivery in direct ice contact for ~15 min. This case emphasizes the importance of avoiding sample transportation in ice and the need of developing point of care analysers equipped with interference indices assessment.

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COMPARISON BETWEEN THE 5,6-CIS AND 5,6-TRANS ISOMERS OF 25-HYDROXYVITAMIN D3 IN CHRONIC HYPOPARATHYROIDISM

Acta Endocrinologica ◽

10.1530/acta.0.0860784 ◽

1977 ◽

Vol 86 (4) ◽

pp. 784-793 ◽

Cited By ~ 2

Author(s):

Gerd Offermann ◽

Dieter Kraft

Keyword(s):

Serum Calcium ◽

Calcium Release ◽

Calcium Absorption ◽

Intestinal Calcium Absorption ◽

Normal Range ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

One Year ◽

Hydroxyproline Excretion ◽

Chronic Hypoparathyroidism

ABSTRACT Five patients with chronic post-operative hypoparathyroidism were treated with 450 μg/day 5,6-trans-25-hydroxyvitamin D3 (5,6-trans-25OHD3) for 14 days, and the treatment was continued with 150 μg/day for one year. At the end of this period the patients received 450 μg/day 5,6-cis-25-hydroxyvitamin D3 (5,6-cis-25OHD3) for 14 days. Comparison of the effects of both isomers revealed a similar ability to enhance intestinal calcium absorption and to normalize serum calcium; serum phosphate and alkaline phosphatase, however, remained unaffected. Urinary phosphate and hydroxyproline excretion decreased on the cis-isomer and increased on the trans-isomer. During treatment with the lower dose of 5,6-trans-25OHD3 intestinal calcium absorption remained in the normal range for one year, whereas the serum calcium decreased to the levels observed before administration of 450 μg/day within 6 weeks. The results suggest that in hypoparathyroidism 5,6-cis-25OHD3 and 5,6-trans-25OHD3 are equally effective on serum calcium and on intestinal calcium absorption, but that their mode of action on renal phosphate handling and on calcium release from bone is different.

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