(In)direct chloride ISE measurements, room for improvement

Kootstra‐Ros, Jenny E.; Hagen, Edward H.; Lantman, Marith van Schrojenstein; Thelen, Marc; Berkel, Miranda van

doi:10.1515/cclm-2022-0220

Cited by 2 publications

(4 citation statements)

References 8 publications

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“…Therefore, it cannot be excluded that the chloride measurements were influenced by the bicarbonate concentrations. 8,9 T A B L E 1 Arterial blood gas analysis performed with the ABL90 flex…”

Section: Discussionmentioning

confidence: 99%

“…Interference due to bicarbonate concentrations was not examined in these studies. Therefore, it cannot be excluded that the chloride measurements were influenced by the bicarbonate concentrations 8,9 …”

Section: Discussionmentioning

confidence: 99%

“…When both plasma chloride concentrations measured using the ABL90 flex and the Cobas 8000 are plotted on a graph with serum salicylate level, the suggestion can be made that chloride levels measured with the ABL90 follow roughly the same line as the salicylate level (Figure 1). However, at the same time, bicarbonate levels normalized during treatment and this might also have an impact on measured chloride concentrations 8,9 …”

Section: Discussionmentioning

confidence: 99%

“…However, at the same time, bicarbonate levels normalized during treatment and this might also have an impact on measured chloride concentrations. 8,9 We performed a spike experiment to investigate the impact of different salicylate levels and bicarbonate concentrations on the measured chloride concentration for both the direct (ABL90 flex) and indirect (Roche Cobas 8000) ISE methods. Chloride concentrations were measured at increasing levels of salicylate at 2 different levels of bicarbonate (Figure 2).…”

Section: Measurementmentioning

confidence: 99%

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Case report: Salicylate intoxication can present with a normal anion gap metabolic acidosis depending on method used for measuring chloride

Buisman

Riphagen

Kwant

et al. 2022

Brit J Clinical Pharma

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Severe salicylate intoxication usually presents with a high anion gap metabolic acidosis. We describe a patient with severe salicylate intoxication who presented with a surprisingly normal anion gap metabolic acidosis. Initial salicylate level was 594 mg/L (therapeutic range 50–300 mg/L). In this case, the anion gap was normal due to a falsely elevated chloride concentration measured using a direct ion‐selective electrode (ISE; ABL90‐flex). Since earlier case reports have shown that salicylate ions can interfere with chloride measurement using different ISEs, available samples were reanalysed using an indirect ISE (Roche Cobas 8000), in which salicylate levels up to 1000 mg/L were found to cause no significant interference. With this method, chloride concentration was found to be 115 instead of 122 mmol/L, leading to the expected elevated anion gap. We performed a spike experiment to investigate the impact of different salicylate levels and bicarbonate concentrations on the measured chloride concentration for both methods. This experiment showed that the difference between chloride concentrations was mainly explained by interference with bicarbonate. It is important for clinicians to be aware of this possible interference, since a high anion gap metabolic acidosis can be a clue to suspect salicylate poisoning and early recognition and appropriate treatment is important. The patient was successfully treated with haemodialysis and no rebound toxicity was observed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Measurementmentioning

confidence: 99%

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