Review of the effect of intravenous lipid emulsion on laboratory analyses

Grunbaum, Ami; Gilfix, Brian M.; Hoffman, Robert S.; Lavergne, Valéry; Morris, Martin; Miller-Nesbitt, Andrea; Gosselin, Sophie

doi:10.3109/15563650.2015.1115515

Cited by 45 publications

(24 citation statements)

References 50 publications

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“…In fact, lipid emulsion is occasionally used experimentally to conduct interference studies [7]. In a review of the effect of lipid emulsion therapy on laboratory values, many of the routine labs were found to be inaccurate [9].…”

Section: Discussionmentioning

confidence: 99%

Falsely elevated salicylate concentration in a patient with hypertriglyceridemia

Biary

Kremer

Goldfarb

et al. 2018

Toxicology Communications

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Because salicylism is a clinical diagnosis, the serum concentration should be interpreted in conjunction with the clinical presentation. A 26-year-old man presented to the Emergency Department with abdominal painand had extremely elevated serum triglycerides (>7000 mg/dL). Ethanol, acetaminophen, and salicylate concentrations were checked because of concern of selfinjurious behavior, which returned at 13.1 mg/dL, undetectable, and >100 mg/dL, respectively. His basic metabolic panel revealed a bicarbonate of 23 mEq/L and an anion gap of 11. An arterial blood gas showed a pH 7.39 and a PCO 2 of 36.6 mmHg. On physical examination, he was awake and alert, and had a respiratory rate of 12-14/min. The possible effect of hyperlipidemia to falsely

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Section: Discussionmentioning

confidence: 99%

Falsely elevated salicylate concentration in a patient with hypertriglyceridemia

Biary

Kremer

Goldfarb

et al. 2018

Toxicology Communications

Self Cite

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“…In our retrospective study, we analyzed a large data set for lipemic index (which is measured on all clinical chemistry specimens in our institutional core laboratory) and serum/plasma triglycerides (data only for specimens for which this testing was ordered for clinical purposes). Published literature has demonstrated assay interferences caused by lipemia [1] , [3] , [4] , [5] , [6] , [7] , [9] , [10] , [11] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] . Our data from an academic medical center revealed that the most common suspected causes of markedly elevated lipemic index were lipid emulsion (either for parenteral nutrition or as a diluent for poorly water-soluble medications) and diabetes mellitus, consistent with reports in other articles [1] , [2] , [5] , [7] , [10] , [27] , [29] , [30] , [33] , [42] , [43] .…”

Section: Discussionmentioning

confidence: 99%

Frequency and causes of lipemia interference of clinical chemistry laboratory tests

Mainali

Davis

Krasowski

2017

Practical Laboratory Medicine

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ObjectivesThe aims of this study were to identify the causes of severe lipemia in an academic medical center patient population and to determine the relationship between lipemia and hemolysis.Design and methodsRetrospective study was done on the data from the core clinical laboratory at an academic medical center. Lipemic indices were available for all chemistry specimens analyzed over a 16-month period (n=552,029 specimens) and for serum/plasma triglycerides concentrations ordered for clinical purposes over a 16-year period (n=393,085 specimens). Analysis was performed on Roche Diagnostics cobas 8000 analyzers. Extensive chart review was done for all specimens with lipemic index greater than 500 (severely lipemic) and for all specimens with serum/plasma triglycerides greater than 2000 mg/dL. We also determined the relationship between lipemia and hemolysis.ResultsThe most frequent suspected causes of very high lipemic index (>500) were found to be lipid-containing intravenous infusions (54.4% of total; fat emulsions for parenteral nutrition – 47%; propofol −7.4%) and diabetes mellitus (25% of total, mainly type 2). The most frequent suspected causes of very elevated serum/plasma triglycerides (>2000 mg/dL) was diabetes mellitus (64%, mainly type 2) and hyperlipidemia (16.9%). The frequency of hemolysis increased with increasing lipemic index.ConclusionsIntravenous lipid infusions and type 2 diabetes were the most common causes of severe lipemia in this study at an academic medical center. Given that iatrogenic factors are the most common cause of severe lipemia, education and intervention may be helpful in reducing frequency of severe lipemia in patient specimens.

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“…A final problem is the interference with therapeutic effects of the target or other drugs. In particular, charcoal can enhance total body clearance of many other drugs such as anticonvulsants and oral contraceptives, while ‘lipid rescue’ can potentially interfere with lipid soluble medications and many biochemical assays . For many antidotes, the risks can be managed safely when initiated in a closely monitored setting such as a critical care area or emergency department, where adverse effects are more easily identified and treated.…”

Section: Introductionmentioning

confidence: 99%

Who gets antidotes? choosing the chosen few

Buckley

Dawson

Juurlink

2016

Brit J Clinical Pharma

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An understanding of mechanisms, potential benefits and risks of antidotes is essential for clinicians who manage poisoned patients. Of the dozens of antidotes currently available, only a few are regularly used. These include activated charcoal, acetylcysteine, naloxone, sodium bicarbonate, atropine, flumazenil, therapeutic antibodies and various vitamins. Even then, most are used in a minority of poisonings. There is little randomized trial evidence to support the use of most antidotes. Consequently, decisions about when to use them are often based on a mechanistic understanding of the poisoning and the expected influence of the antidote on the patient's clinical course. For some antidotes, such as atropine and insulin, the doses employed can be orders of magnitude higher than standard dosing. Importantly, most poisoned patients who reach hospital can recover with supportive care alone. In low risk patients, the routine use of even low risk antidotes such as activated charcoal is unwarranted. In more serious poisonings, decisions regarding antidote use are generally guided by a risk/benefit assessment based on low quality evidence.

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Review of the effect of intravenous lipid emulsion on laboratory analyses

Cited by 45 publications

References 50 publications

Falsely elevated salicylate concentration in a patient with hypertriglyceridemia

Falsely elevated salicylate concentration in a patient with hypertriglyceridemia

Frequency and causes of lipemia interference of clinical chemistry laboratory tests

Who gets antidotes? choosing the chosen few

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