Spuriously elevated inorganic phosphate level in a multiple myeloma patient

Barutçuoğlu, Burcu; Parildar, Zuhal; Mutaf, Isil; Habif, Sara; Bayındır, Özün

doi:10.1046/j.1365-2257.2003.00524.x

Cited by 31 publications

(13 citation statements)

References 21 publications

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“…Pseudohyperphosphatemia secondary to assay interference has been described in the setting of paraproteinemia, hyperbilirubinemia, and hyperlipidemia [16][17][18][19]. We report our investigation of the previously unrecognized occurrence of extreme pseudohyperphosphatemia due to therapy with high-dose liposomal amphotericin B.…”

Section: Introductionmentioning

confidence: 93%

Pseudohyperphosphatemia associated with high-dose liposomal amphotericin B therapy

Lane

Rehak

Hortin

et al. 2008

Clinica Chimica Acta

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Background-Acute increases in serum inorganic phosphorus (Pi) up to 4.75 mmol/l in the absence of hypocalcemia and tissue deposition of calcium phosphate were noted in 3 patients receiving liposomal amphotericin B (L-AMB). We investigated L-AMB as a possible cause of pseudohyperphosphatemia.Methods-Serum samples from the index patient were analyzed for Pi content by our laboratory's primary analyzer (Synchron LX20 ) and by an alternate analyzer (Vitros). Clear and lipemic serum pools, and normal saline, were spiked with L-AMB and analyzed by the LX20 Pi method. Ultrafiltration studies were performed on patient and spiked sera.Results-Increased Pi values were obtained only from the LX20 analyzer. There was a direct linear relationship between the concentration of L-AMB in the spiked samples and the LX20 Pi results, indicating a 0.9 mmol/l Pi increase for every 100 mg/l increase in L-AMB. Ultrafiltration normalized the Pi results.Conclusion-Serum Pi results may be falsely increased in patients receiving L-AMB when measured by the LX20 analyzer. This novel cause of pseudohyperphosphatemia is due to interference of L-AMB with the method and is corrected by ultrafiltration of the specimen. Since the LX20 1 Presented in part at the

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Section: Introductionmentioning

confidence: 93%

Pseudohyperphosphatemia associated with high-dose liposomal amphotericin B therapy

Lane

Rehak

Hortin

et al. 2008

Clinica Chimica Acta

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“…In fact, the majority of investigations used routine colorimetric techniques for determining P levels in plasma that are not highly accurate, particularly due to the use of strong acids in routine laboratory procedures to determine the phosphomolybdate complex. 7,8 These strong acids, although in contact with the plasma only very briefly, produce an immediate breakdown of proteins in plasma and/or serum with P release and overestimation of its actual levels. 9 The multicompartmental distribution of P and its slow shift from the intracellular to the extracellular compartment and to plasma, render the postdialysis P rebound complex and difficult to define in terms of quantity and duration.…”

Section: Dialysismentioning

confidence: 99%

Phosphate control in dialysis

Cupisti¹,

Gallieni²,

Rizzo³

et al. 2013

IJNRD

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Prevention and correction of hyperphosphatemia is a major goal of chronic kidney disease-mineral and bone disorder (CKD-MBD) management, achievable through avoidance of a positive phosphate balance. To this aim, optimal dialysis removal, careful use of phosphate binders, and dietary phosphate control are needed to optimize the control of phosphate balance in well-nourished patients on a standard three-times-a-week hemodialysis schedule. Using a mixed diffusive-convective hemodialysis tecniques, and increasing the number and/or the duration of dialysis tecniques are all measures able to enhance phosphorus (P) mass removal through dialysis. However, dialytic removal does not equal the high P intake linked to the high dietary protein requirement of dialysis patients; hence, the use of intestinal P binders is mandatory to reduce P net intestinal absorption. Unfortunately, even a large dose of P binders is able to bind approximately 200-300 mg of P on a daily basis, so it is evident that their efficacy is limited in the case of an uncontrolled dietary P load. Hence, limitation of dietary P intake is needed to reach the goal of neutral phosphate balance in dialysis, coupled to an adequate protein intake. To this aim, patients should be informed and educated to avoid foods that are naturally rich in phosphate and also processed food with P-containing preservatives. In addition, patients should preferentially choose food with a low P-to-protein ratio. For example, patients could choose egg white or protein from a vegetable source. Finally, boiling should be the preferred cooking procedure, because it induces food demineralization, including phosphate loss. The integrated approach outlined in this article should be actively adapted as a therapeutic alliance by clinicians, dieticians, and patients for an effective control of phosphate balance in dialysis patients.

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“…Pseudohyperphosphatemia secondary to assay interference has been described in the setting of hyperglobulinemia (due to multiple myeloma, Waldenström's macroglobulinemia, or monoclonal gammopathy), hyperbilirubinemia, and hyperlipidemia [58,59,60,61,62]. In fact, extreme hyperphosphatemia of 31.6 mg/dl [10.2 mmol/l, normal values 2.5-4.3 mg/dl (0.8-1.4 mmol/l)] has been reported in a patient with multiple myeloma [63].…”

Section: Pseudohyperphosphatemiamentioning

confidence: 99%

Spurious Electrolyte Disorders: A Diagnostic Challenge for Clinicians

et al. 2013

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Spurious electrolyte disorders refer to an artifactually elevated or decreased serum electrolyte values that do not correspond to their actual systemic levels. When a clinician is confronted with a case of electrolyte disturbance, the first question should be whether it is an artifact. Spurious electrolyte disorders (pseudohyponatremia, pseudohypernatremia, pseudohypokalemia, pseudohyperkalemia, pseudohypomagnesemia, pseudohypophosphatemia, pseudohyperphosphatemia, pseudohypocalcemia and pseudohypercalcemia) are not infrequently observed in clinical practice. The recognition that an electrolyte disturbance may be an artifact may prevent inappropriate therapeutic interventions that could potentially have unfavorable outcomes. Clinicians must be alert to the possibility of spurious laboratory abnormalities when faced with conflicting laboratory values or measurements that are discordant with the clinical presentation. Moreover, in the presence of conditions that predispose to spurious electrolyte disorders, the normal measured electrolyte levels should raise the suspicion that true electrolyte disorders may be present.

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Spuriously elevated inorganic phosphate level in a multiple myeloma patient

Cited by 31 publications

References 21 publications

Pseudohyperphosphatemia associated with high-dose liposomal amphotericin B therapy

Pseudohyperphosphatemia associated with high-dose liposomal amphotericin B therapy

Phosphate control in dialysis

Spurious Electrolyte Disorders: A Diagnostic Challenge for Clinicians

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