Clinical application in blood gas
NKDEP's Creatinine Standardization Program
National Kidney Disease Educational Program (NKDP) provides clinical laboratories with information on how to accurately report estimated GFR based on serum creatinine, understand the NKDEP initiative to standardize the measurement of serum creatinine and communicate with healthcare providers about the implications of new serum creatinine values that will result from the creatinine standardization initiative.
Is FDA ready to tighten up accuracy standards?
The controversy over BGM accuracy comes on the heels of an intense debate in the medical community about the benefits and safety of tight glycemic control (TGC) in hospitals. Stakeholders have argued that recent studies such as Normoglycaemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR; NEJM 2009;360:1283–1297), which cast doubt on TGC, were flawed due to use of imprecise BGMs. In fact, the original studies that first demonstrated the value of TGC in intensive care settings used very accurate arterial blood gas instruments. Now, some defenders of TGC have become critics of BGMs, lamenting their common use in TGC protocols.
Malone B. Blood Glucose Meters. Is FDA Ready to Tighten Up Accuracy Standards? May 2010 Clinical Laboratory News
Intensive insulin therapy to control hyperglycemia in the critically ill: a look back at the evidence shapes the challenges ahead
Recently published data detailing the deleterious effect of hypoglycemia are discussed, as is the emerging body of literature describing the important impact of glycemic variability on the risk of mortality in heterogeneous populations of acutely ill and severely ill patients.
Krinsley J, Preiser JP. Intensive insulin therapy to control hyperglycemia in the critically ill: a look back at the evidence shapes the challenges ahead. Crit Care 2010, 14:330
Perspectives tight glucose control in the intensive care unit: are glucose meters up to the task?
The original TGC study by Van den Berghe et al. used a precise arterial blood gas instrument for glucose measurement and obtained arterial blood samples for testing. In other studies, some showing benefit for TGC and others not, blood glucose meters and capillary blood samples have been used to measure glucose.
Mitchell GS, Bruns DE, Boyd JC, Sacks DB. Perspectives Tight Glucose Control in the Intensive Care Unit: Are Glucose Meters up to the Task? Clin Chem 2009:1 18–20
Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill
Hyperlactatemia is common in diverse populations of critical ill patients. Its presence at presentation or its de novo development during ICU stay is associated with an increased risk of death. In this study an ABL735 was used to measure lactate on 13.932 admissions in ICU. The lactate measurement from arterial/venous blood greater than 2 mmol/L was deemed to represent hyperlactatemia. The data suggest that there is predictive merit in routine measurement of lactate at presentation to the ICU as hyperlactatemia occurs in app. 50% of patients admitted to the ICU.
Khosravani H, Shahpori R, Stelfox HT, Kirkpatrick AW, and Laupland KB. Occurrence and adverse effect on outcome of hyperlactatemia in the critically ill. Crit Care. 2009;13, 3, R90.
Lactate and lactic acidosis
A review article of the lactate metabolism and the biochemical background of hyperlactemia (blood lactate >1.5 mmol/L) and lactic acidosis (lactate > 5 mmol/L and pH < 7.35). Lactic acidosis is the most common cause of metabolic acidosis. Type A and type B lactic acidosis is described. A short description of the biochemistry of sepsis and septic shock, which is related to lactic acidosis, is included. Clinical significance of hyperlactemia is discussed and the value of measuring lactate has been documented in many patients groups.
Higgins C. Lactate and lactic acidosis. www.acutecaretesting.org