Pseudohypobicarbonatemia Caused by an Endogenous Assay Interferent: A New Entity

Goldwasser, Philip; Manjappa, Nagarathna; Luhrs, Carol; Barth, Robert H.

doi:10.1053/j.ajkd.2011.06.003

Cited by 33 publications

(26 citation statements)

References 24 publications

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“…The interfering substance could not be identified. Goldwasser et al 10 also found interference with the enzymatic assay but not with the blood gas assay and suggested that the interference might be related to paraproteins in the patient's blood causing turbidity.…”

Section: Discussionmentioning

confidence: 99%

Factitious hypobicarbonatemia associated with profound hyperlipidemia

Rifkin

Shaub

2014

Renal Failure

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We describe a patient who presented on two occasions with severe hypobicarbonatemia and an associated high anion gap on enzymatic analysis. She also had profound hyperlipidemia. Her low bicarbonate was shown to be factitious by analysis of her blood using a direct ionselective electrode method. Reanalysis of blood samples after treatment with a lipid clearing agent resulted in marked improvement in the bicarbonate level. We suggest that the light scattering effect of the hyperlipidemia interfered with the photometric analysis causing this factitious phenomenon.

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Section: Discussionmentioning

confidence: 99%

Factitious hypobicarbonatemia associated with profound hyperlipidemia

Rifkin

Shaub

2014

Renal Failure

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“…In recent years, anions has attracted significant interest due to its important roles in environmental, clinical as well as in biological applications [3][4][5][6]. Sulfide anion is a toxic pollutant and can be widely found in water due to both the industrial processes and microbial reduction of sulfate by anaerobic bacteria or produced from the sulfur-containing amino acids in proteins [7].…”

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confidence: 99%

A water soluble and fast response fluorescent turn-on copper complex probe for H2S detection in zebra fish

Palanisamy

Lee

Wang

et al. 2016

Talanta

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“…Besides bicarbonate, the measurement includes a small amount of dissolved CO 2 , carbamino compounds, and carbonic acid. The U&E analyzers use either an electrode-based or enzymatic/ photometric method (5). Discordance between these two measurements has been reported previously, especially in the critically ill (1).…”

Section: Discussionmentioning

confidence: 91%

Pseudohypobicarbonatemia in a Patient Presenting with Suspected Diabetic Ketoacidosis

Cartier

Look

Dunn

2018

AACE Clinical Case Reports

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Objective:In the diagnosis of acid-base disturbances, an accurate assessment of bicarbonate is essential. It can be determined by measurement of a urea and electrolyte panel or calculated on a blood gas analysis. Discrepancies in these two values can be due to endogenous interferents. We report a case of pseudohypobicarbonatemia suspected due to hypertriglyceridemia, despite lipidemia being within the reported acceptable range for the analyzer.Methods: We detail the hospital course of a 33-yearold man who presented with presumed diabetic ketoacidosis based on new-onset hyperglycemia, positive ketones, and measured bicarbonate in the range 9 to 16 mmol/L. The latter caused the calculation of anion gap metabolic acidosis. We review bicarbonate metabolism and technical aspects of its measurement. Further, we review additional reports and research pertinent to our patient's diagnostic dilemma.Results: Based on our patient's initial presentation, he was placed on an insulin drip for approximately 30 hours. During the hospital course, his calculated bicarbonate levels from blood gases ranged from 20 to 26 mmol/L, significantly higher than the measured bicarbonates. On the insulin drip, his triglyceride levels fell slightly and his measured bicarbonate levels increased to more closely mirror the values obtained on blood gas analysis but still varied by greater than expected. Posthospitalization, when his triglycerides were near normal, his measured bicarbonate was normal.Conclusion: The current case highlights the importance of recognizing discordant measured and calculated bicarbonate and that endogenous interferents can lead to falsely low or high carbon dioxide values. (AACE Clinical Case Rep. 2018;4:e108-e111) Abbreviations: DKA = diabetic ketoacidosis; DM = diabetes mellitus; ED = emergency department; ICU = intensive care unit; TCO 2 = total carbon dioxide; U&E = urea and electrolyte Pseudohypobicarbonatemia, AACE Clinical Case Rep. 2018;4(No. 2) e109

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Pseudohypobicarbonatemia Caused by an Endogenous Assay Interferent: A New Entity

Cited by 33 publications

References 24 publications

Factitious hypobicarbonatemia associated with profound hyperlipidemia

Factitious hypobicarbonatemia associated with profound hyperlipidemia

A water soluble and fast response fluorescent turn-on copper complex probe for H2S detection in zebra fish

Pseudohypobicarbonatemia in a Patient Presenting with Suspected Diabetic Ketoacidosis

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