TY - JOUR
T1 - Falsely increased chloride and missed anion gap elevation during treatment with sodium thiosulfate
AU - Wendroth, Scott M.
AU - Heady, Tiffany N.
AU - Haverstick, Doris M.
AU - Bachmann, Lorin M.
AU - Scott, Mitchell G.
AU - Boyd, James C.
AU - Bruns, David E.
PY - 2014/4/20
Y1 - 2014/4/20
N2 - Background: Sodium thiosulfate (STS) is used to treat calciphylaxis and cyanide poisoning, but can lead to a serious anion-gap acidosis. We suspected that the calculated anion gap in a patient treated with STS for calciphylaxis was decreased to normal by a falsely increased chloride, and we hypothesized that STS directly interfered with chloride measurements. Methods: Plasma pools were prepared with 12 concentrations of STS from 0 to 20. mmol/l. Chloride was measured in each sample on 9 analyzers: Architect 16200, StatProfile pHOx Plus, RapidLab 1265®, Vitros 350®, Advia 1800, Roche Modular, iSTAT1, RAPIDpoint 500, and Radiometer ABL735. Results: Statistically significant, dose-dependent increases in reported chloride concentrations were seen with all analyzers except the RAPIDpoint 500 and Vitros. The increases ranged from 5 to 75. mmol/l at the peak thiosulfate concentrations (33. mmol/l) expected in treated patients. The CLIA-allowable error of 5% was exceeded by 4 analyzers (Architect 16200, iSTAT1, StatProfile pHOx Plus, and Radiometer ABL735). The RAPIDpoint 500 showed a 3-mmol/l decrease in measured chloride over the tested range. The Vitros analyzer showed no interference. Conclusions: Interference of STS in chloride measurement in several common analyzers may lead to erroneous anion-gap calculations and confound the diagnosis of STS-induced anion-gap acidosis.
AB - Background: Sodium thiosulfate (STS) is used to treat calciphylaxis and cyanide poisoning, but can lead to a serious anion-gap acidosis. We suspected that the calculated anion gap in a patient treated with STS for calciphylaxis was decreased to normal by a falsely increased chloride, and we hypothesized that STS directly interfered with chloride measurements. Methods: Plasma pools were prepared with 12 concentrations of STS from 0 to 20. mmol/l. Chloride was measured in each sample on 9 analyzers: Architect 16200, StatProfile pHOx Plus, RapidLab 1265®, Vitros 350®, Advia 1800, Roche Modular, iSTAT1, RAPIDpoint 500, and Radiometer ABL735. Results: Statistically significant, dose-dependent increases in reported chloride concentrations were seen with all analyzers except the RAPIDpoint 500 and Vitros. The increases ranged from 5 to 75. mmol/l at the peak thiosulfate concentrations (33. mmol/l) expected in treated patients. The CLIA-allowable error of 5% was exceeded by 4 analyzers (Architect 16200, iSTAT1, StatProfile pHOx Plus, and Radiometer ABL735). The RAPIDpoint 500 showed a 3-mmol/l decrease in measured chloride over the tested range. The Vitros analyzer showed no interference. Conclusions: Interference of STS in chloride measurement in several common analyzers may lead to erroneous anion-gap calculations and confound the diagnosis of STS-induced anion-gap acidosis.
KW - Acidosis
KW - Anion gap
KW - Calciphylaxis
KW - Chloride
KW - Interference
KW - Thiosulfate
UR - http://www.scopus.com/inward/record.url?scp=84893957422&partnerID=8YFLogxK
U2 - 10.1016/j.cca.2014.01.020
DO - 10.1016/j.cca.2014.01.020
M3 - Article
C2 - 24508994
AN - SCOPUS:84893957422
VL - 431
SP - 77
EP - 79
JO - Clinica Chimica Acta
JF - Clinica Chimica Acta
SN - 0009-8981
ER -