8 August 2014 - HCPC Newsletter

http://www.hcpc-uk.org/assets/documents/100047ADHCPCInFocus-Issue54.pdf

OK – I am a week late reading this….. but there is something of note here… an HCPC app. I’ve downloaded it into my new phone. Let’s see what I can do with it.

7 August 2014 - Citralock

An interesting case - the serum sodium was rather high; a chloride was then performed and found to be normal.

GRIFFIN, PETER                                          AB-      07/08/2014 08:00 MR    23/03/1944 70 yrs  M  0123456             Renal Unit Address, QUAHOG ESRF on HD                                            U Specimen No   :  AC673274G               Selected Auth Level : S --------------------T-------------------T-------------------T-------------------  NA     152    F000 |$CORCA 2.4    F000 |                   |  K      4.5    F000 |PO4    2.12   F000 |                   |  KCL    106    E000 |CRP    5      F000 |                   |  KBIC   20     F000 |HINT  ^0.1    F000 |                   |  U      24.0   F000 |IINT  ^9      F000 |                   |  CR     899    F000 |LINT  ^0.1    F000 |                   |  _GFR   5      F000 |                   |                   |  ALB    25     F000 |                   |                   |  ALKP   64     F000 |                   |                   |  CA     2.1    F000 |                   |                   | --------------------T-------------------T-------------------T------------------- LTG comments : EC,GFR,LFT,<RKOD>

This result is rather implausible - high sodium goes with high chloride; not with normal ones. Bearing in mind the source of the blood sample (renal dialysis unit) it is likely that the blood sample has been contaminated with citralok.

GRIFFIN, PETER                                          AB-      07/08/2014 08:00 MR    23/03/1944 70 yrs  M  0123456             Renal Unit Address, QUAHOG ESRF on HD                                            U Specimen No   :  AC673274G                  Routine Tests    LTG Comments :      Very high sodium with normal chloride:      is citralok contamination a possibility?

Citralock is something used to keep various infusion lines clear. Finding out about citralock made for interesting reading

 http://www.citra-lock.com/index.php/en/

July 2014 - Overdose

(dates may look awry – only just got round to writing this up…)

Here’s an interesting case – I didn’t really realise this… A two days post overdose case.Paracetamol levels are fine…. But look at the liver function tests. People often survive paracetamol overdoses only to die of complications of liver failure a few days later…

GRIFFIN, MEG                                                  17/07/2014 08:45 MISS  11/07/1995 19 yrs  F  01234567             Clinical Decision Unit QUAHOG                   Specimen No : AC669379A    Haematology & Chemistry        <PgUp/PgDn> for more -------------------------------------------------------------------------------- 17/07/2014 08:45  Serum/Plasma  Request Reason :     PARACETAMOL OD   Sodium                         139    mmol/L          (   133 to 146   ) Auth   Potassium                      3.6    mmol/L          (   3.5 to 5.3   ) Auth   Urea                           2.5    mmol/L          (   2.5 to 7.8   ) Auth   Creatinine                     61     umol/L          (    49 to 90    ) Auth   GFR (estimated)                >90    units=*                            Auth   Total Protein                  56     g/L             (    60 to 80    ) Auth   Albumin                        33     g/L             (    35 to 50    ) Auth   Globulin                       23     g/L             (    20 to 35    ) Auth   Total Bilirubin                14     umol/L          (     0 to 22    ) Auth   Alkaline Phosphatase           81     U/L             (    30 to 130   ) Auth   ALT                            915    U/L             (     0 to 50    ) Auth   Paracetamol                    <10    mg/L                               Auth   Haemolysis-Integra             ^0.0                                      Auth -------------------------------------------------------------------------------- 1 Spec  2 Patient  3 Date  4 pRint  5 cUm  6 DFT  7 Verbose  8 Options 9 eXit X  Di            Sect: CC            David Styles       SRE/APEX    Overtype

GRIFFIN, MEG                                                  17/07/2014 08:45 MISS  11/07/1995 19 yrs  F  01234567             Clinical Decision Unit QUAHOG                   Specimen No : AC669379A    Haematology & Chemistry        <PgUp/PgDn> for more ------T-----------------------------------------------------------------------]   Date|17/07/2014 16/07/2014 15/07/2014 07/07/2014 04/06/2014 03/06/2014      |   Time|08:45      16:30      u/k        10:40      04:30      02:51           |   Spec|AC669379A  AC668910W  AC668134L  AG213350F  AC630007S  AC628785T       |       |BIO        BIO        BIO        BIO        BIO        BIO             | Test--+-----------------------------------------------------------------------{ NA    |139        138        139        137        140        141             | K     |3.6        3.5        3.8        3.8        3.8        3.9             | U     |2.5        4.3                              1.7        3.3             | CR    |61         57         58         61         56         61              | _GFR  |>90        >90        >90        >90        >90        >90             | PROT  |56         60         61                    63         65              | ALB   |33         35         37                    36         38              | GLOB  |23         25         24                    27         27              | TBIL  |14         24         9                     19         9               | ALKP  |81         83         89                    76         84              | ALT   |915        79         26                    68         102             | PARA  |<10        <10        145                   <10                        | ------T-----------------------------------------------------------------------]   1 View   2 Graph   3 eXit  X                             Cursor Down for more                       More >>

25 July 2014 (K)

As part of my becoming a multi-disciplined BMS I had a tutorial on the metabolism of potassium. A very good reminder of physiology that, whilst I hadn't forgotten, certainly wasn't at the forefront of my memory.
And there's a lot of ways in which you can get falsely high results. Must bear those in mind