Clinical and analytical considerations in the utilization of cholinesterase measurements

McQueen, Matthew

doi:10.1016/0009-8981(95)06067-n

Cited by 60 publications

(41 citation statements)

References 30 publications

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“…Serum ChE predicted high MELD status at a cut-off of 1484 IU/L, with 71% sensitivity and 73% specificity, Serum ChE levels have been shown to reflect liver function adequacy in various clinical situations. 9 For example in familial intrahepatic cholestasis, following successful external biliary diversion, increasing levels of serum ChE have been shown to be a marker of successful surgery. 10 Follow-up data was available for 25 patients, collected within 1-6 months after the initial enrolment.…”

Section: Serum Che As a Predictor Of Meldmentioning

confidence: 99%

Serum cholinesterase is an excellent biomarker of liver cirrhosis

Ramachandran¹

2014

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Section: Serum Che As a Predictor Of Meldmentioning

confidence: 99%

Serum cholinesterase is an excellent biomarker of liver cirrhosis

Ramachandran¹

2014

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“…Patients exposed to substances that produce cholinergic response can be screened for the presence of low pseudocholinesterase activity (101 ). However, this test is not specific for cholinergics, as depressed activity can be attributable to genetic variability and chronic liver diseases (102 ). The dibucaine inhibition test can identify such variants.…”

Section: H Pesticidesmentioning

confidence: 99%

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

et al. 2003

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Background: Exposure to drugs and toxins is a major cause for patients' visits to the emergency department (ED).Methods: Recommendations for the use of clinical laboratory tests were prepared by an expert panel of analytical toxicologists and ED physicians specializing in clinical toxicology. These recommendations were posted on the world wide web and presented in open forum at several clinical chemistry and clinical toxicology meetings. Results: A menu of important stat serum and urine toxicology tests was prepared for clinical laboratories who provide clinical toxicology services. For drugs-ofabuse intoxication, most ED physicians do not rely on results of urine drug testing for emergent management decisions. This is in part because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor-intensive. Ethyl alcohol is widely tested in the ED, and breath testing is a convenient procedure. Determinations made within the ED, however, require oversight by the clinical laboratory. Testing for toxic alcohols is needed, but rapid commercial assays are not available. The laboratory must provide stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs, such as lithium and digoxin. Exposure to other heavy metals requires laboratory support for specimen collection but not for emergent testing. Conclusions: Improvements are needed for immunoassays, particularly for amphetamines, benzodiazepines, opioids, and tricyclic antidepressants. Assays for new drugs of abuse must also be developed to meet changing abuse patterns. As no clinical laboratory can provide services to meet all needs, the National Academy of Clinical Biochemistry Committee recommends establishment of regional centers for specialized toxicology testing. © 2003 American Association for Clinical Chemistry PreambleThis is the ninth in the series of Laboratory Medicine Practice Guidelines sponsored by the National Academy Clinical Chemistry 49:3 357-379 (2003) Special Report 357of Clinical Biochemistry (NACB). 10 An expert Committee of emergency department (ED) physicians and clinical laboratory medicine toxicologists was assembled and prepared recommendations on the use of clinical laboratory tests to support the diagnosis and management of the poisoned patient who presents to the ED. Excluded from these discussions were drug testing conducted for the workplace, forensic and medical examiner toxicology, athletic drug testing, and testing for various compliance programs (e.g., criminal justice, psychiatric, and physician health). Many of these other programs are guided by other recommendations and regulations, such as the Substance Abuse and Mental Health Services Administration, the American Academy of Forensic Sciences, and the International Olympic Committee. Recommendations for detection of drugs in pregnant women and newborns exposed during the intrauterine period are discussed in a previous NACB guidelines (1 ). Som...

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“…We excluded pregnant women and women trying to become pregnant, patients with a Cockroft-Gault-estimated creatinine clearance Ͻ50 ml/min (17) or low plasma cholinesterase (reference value, Ն3.5 units/l) (18), and patients with congestive heart failure (New York Heart Association class III/IV) or other serious medical or psychiatric diseases.…”

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confidence: 99%

Combination of Insulin and Metformin in the Treatment of Type 2 Diabetes

et al. 2002

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OBJECTIVE -To investigate the metabolic effects of metformin, as compared with placebo, in type 2 diabetic patients intensively treated with insulin.RESEARCH DESIGN AND METHODS -Metformin improves glycemic control in poorly controlled type 2 diabetic patients. Its effect in type 2 diabetic patients who are intensively treated with insulin has not been studied. A total of 390 patients whose type 2 diabetes was controlled with insulin therapy completed a randomized controlled double-blind trial with a planned interim analysis after 16 weeks of treatment.The subjects were selected from three outpatient clinics in regional hospitals and were randomly assigned to either the placebo or metformin group, in addition to insulin therapy. Intensive glucose monitoring with immediate insulin adjustments according to strict guidelines was conducted. Indexes of glycemic control, insulin requirements, body weight, blood pressure, plasma lipids, hypoglycemic events, and other adverse events were measured.RESULTS -Of the 390 subjects, 37 dropped out (12 in the placebo and 25 in the metformin group). Of those who completed 16 weeks of treatment, metformin use, as compared with placebo, was associated with improved glycemic control (mean daily glucose at 16 weeks 7.8 vs. 8.8 mmol/l, P ϭ 0.006; mean GHb 6.9 vs. 7.6%, P Ͻ 0.0001); reduced insulin requirements (63.8 vs. 71.3 IU, P Ͻ 0.0001); reduced weight gain (Ϫ0.4 vs. ϩ1.2 kg, P Ͻ 0.01); and decreased plasma LDL cholesterol (Ϫ0.21 vs. Ϫ0.02 mmol/l, P Ͻ 0.01). Risk of hypoglycemia was similar in both groups.CONCLUSIONS -In type 2 diabetic patients who are intensively treated with insulin, the combination of insulin and metformin results in superior glycemic control compared with insulin therapy alone, while insulin requirements and weight gain are less.

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Clinical and analytical considerations in the utilization of cholinesterase measurements

Cited by 60 publications

References 30 publications

Serum cholinesterase is an excellent biomarker of liver cirrhosis

Serum cholinesterase is an excellent biomarker of liver cirrhosis

National Academy of Clinical Biochemistry Laboratory Medicine Practice Guidelines: Recommendations for the Use of Laboratory Tests to Support Poisoned Patients Who Present to the Emergency Department

Combination of Insulin and Metformin in the Treatment of Type 2 Diabetes

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