Preventing pseudohyponatremia: Intralipid®-based lipemia cutoffs for sodium are inappropriate

Koch, Christopher D.; Vera, Michael A.; Messina, Jasmine; Price, Nathan L.; Durant, Thomas J S; El-Khoury, Joe M.

doi:10.1016/j.cca.2021.05.032

Cited by 11 publications

(7 citation statements)

References 9 publications

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“…12 It is not biochemically or structurally comparable to human lipoproteins and a recently published study in the United States has shown that it does not replicate the effect of endogenous lipaemia on sodium measuremement. 13 This has been reinforced by our study in a different patient population. Our analysis of 32 residual clinical samples has shown that at an (L)-index of 2000, we would expect a typical negative interference of 9%, that is, 13 mmol/L at a true sodium of level 140 mmol/L.…”

Section: Discussionsupporting

confidence: 66%

Investigating the effects of endogenous lipaemia on the measurement of sodium by indirect ion specific electrode potentiometry

et al. 2022

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Background The widely automated method using indirect ion specific electrodes (ISE) potentiometry for determination of sodium concentration is prone to interference from lipaemia. Manufacturer-specified lipaemic (L)-index cut offs may underestimate the effects of endogenous lipaemia. Methods We assessed the interference on sodium concentration caused by endogenous lipaemia in 32 residual samples (from 13 patients) using indirect ISE (Cobas® 8000 modular analyser with c702 module, Roche diagnostics) and direct ISE (GEM 4000 premier, Werfen) potentiometric methods. Regression analysis (linear and non-linear) was used to determine a reliable (L)-index cut off for reporting sodium concentration. Results There was a poor correlation observed between triglyceride concentration and (L)-index. There was significant negative interference caused by endogenous lipaemia within analysed samples. Non-linear regression demonstrated a negative interference of approximately 5% at an (L)-index of 250. Conclusion At present the manufacturer advises not to report sodium concentration by indirect ISE on the Cobas® 8000 modular analyser if the (L)-index is> 2000. However this has been determined by the addition of exogenous lipids (Intralipid®) and it is clear that this is not comparable to endogenous lipaemia. To ensure patient safety, clinical laboratories should consider lowering the cut off for (L)-index that they use for reporting sodium concentration.

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Section: Discussionsupporting

confidence: 66%

Investigating the effects of endogenous lipaemia on the measurement of sodium by indirect ion specific electrode potentiometry

et al. 2022

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“…Lipemia is defined as turbidity in a sample caused by the accumulation of lipoproteins, mainly very-low-density lipoproteins (VLDL) and chylomicrons. It causes an increase in the solid phase relative to the water phase component in the patient's serum samples, leading to pseudo hyponatremia, which occurs mainly in the indirect ion-selective electrodes (ISE) measurement method [7]. Additionally, some biochemistry analytes such as creatinine, potassium, sodium, chloride glucose, direct bilirubin, and urea will give variable results due to spectral interference and volume displacement effect of lipemia [6,8].…”

Section: Hemolysis Lipemic and Icteric Samplementioning

confidence: 99%

“…Unlike hemolyzed and icteric samples, lipemic samples can be further processed using high-speed or ultracentrifugation to obtain clear serum for analysis. Furthermore, an alternative method, such as direct ISE, can prevent pseudo hyponatremia in lipemic samples [7].…”

Section: Hemolyzed Icteric and Lipemic (Hil) Indexmentioning

confidence: 99%

Preanalytical Errors in Clinical Laboratory Testing at a Glance: Source and Control Measures

Nordin,

Ab Rahim,

Wan Omar

et al. 2024

Cureus

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The accuracy of diagnostic results in clinical laboratory testing is paramount for informed healthcare decisions and effective patient care. While the focus has traditionally been on the analytical phase, attention has shifted towards optimizing the preanalytical phase due to its significant contribution to total laboratory errors. This review highlights preanalytical errors, their sources, and control measures to improve the quality of laboratory testing. Blood sample quality is a critical concern, with factors such as hemolysis, lipemia, and icterus leading to erroneous results. Sources of preanalytical errors encompass inappropriate test requests, patient preparation lapses, and errors during sample collection, handling, and transportation. Mitigating these errors includes harmonization efforts, education and training programs, automated methods for sample quality assessment, and quality monitoring. Collaboration between laboratory personnel and healthcare professionals is crucial for implementing and sustaining these measures to enhance the accuracy and reliability of diagnostic results, ultimately improving patient care.

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“…Two methods, field mass spectrometry and enzymatic determination, are worth exploring: field mass spectrometry is a promising recent technology for measuring electrolyte concentrations in biological fluids [ 164 , 165 ]; its measurement of the sodium concentration based on specific enzyme (β-galactosidase) activation by sodium ions has been applied in certain clinical conditions, e.g., isolation laboratories for emerging infectious diseases [ 26 , 166 , 167 ]. The Supplementary Material Section S1 provides further information about conditions causing hyperlipidemia [ 153 , 154 , 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 ].…”

Section: Management Of Pseudohyponatremia—future Developmentsmentioning

confidence: 99%

“…The following supporting information can be downloaded at: , Section S1-Clinical conditions causing increased serum solid content [ 168 , 169 , 170 , 171 , 172 , 173 , 174 , 175 , 176 , 177 , 178 , 179 , 180 , 181 , 182 , 183 , 184 , 185 , 186 , 187 , 188 , 189 , 190 , 191 , 192 , 193 , 194 , 195 , 196 , 197 ].…”

mentioning

confidence: 99%

Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management

Aziz

Sam

Lew

et al. 2023

JCM

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Pseudohyponatremia remains a problem for clinical laboratories. In this study, we analyzed the mechanisms, diagnosis, clinical consequences, and conditions associated with pseudohyponatremia, and future developments for its elimination. The two methods involved assess the serum sodium concentration ([Na]S) using sodium ion-specific electrodes: (a) a direct ion-specific electrode (ISE), and (b) an indirect ISE. A direct ISE does not require dilution of a sample prior to its measurement, whereas an indirect ISE needs pre-measurement sample dilution. [Na]S measurements using an indirect ISE are influenced by abnormal concentrations of serum proteins or lipids. Pseudohyponatremia occurs when the [Na]S is measured with an indirect ISE and the serum solid content concentrations are elevated, resulting in reciprocal depressions in serum water and [Na]S values. Pseudonormonatremia or pseudohypernatremia are encountered in hypoproteinemic patients who have a decreased plasma solids content. Three mechanisms are responsible for pseudohyponatremia: (a) a reduction in the [Na]S due to lower serum water and sodium concentrations, the electrolyte exclusion effect; (b) an increase in the measured sample’s water concentration post-dilution to a greater extent when compared to normal serum, lowering the [Na] in this sample; (c) when serum hyperviscosity reduces serum delivery to the device that apportions serum and diluent. Patients with pseudohyponatremia and a normal [Na]S do not develop water movement across cell membranes and clinical manifestations of hypotonic hyponatremia. Pseudohyponatremia does not require treatment to address the [Na]S, making any inadvertent correction treatment potentially detrimental.

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Preventing pseudohyponatremia: Intralipid®-based lipemia cutoffs for sodium are inappropriate

Cited by 11 publications

References 9 publications

Investigating the effects of endogenous lipaemia on the measurement of sodium by indirect ion specific electrode potentiometry

Investigating the effects of endogenous lipaemia on the measurement of sodium by indirect ion specific electrode potentiometry

Preanalytical Errors in Clinical Laboratory Testing at a Glance: Source and Control Measures

Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management

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