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.
This is (supposed to be) a reflective diary by a (not very) anonymous biomedical scientist who works somewhere in the south of England. One day this diary may well be submitted to the Health and Care Professions Council as evidence of ongoing continual professional development....
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
And there's a lot of ways in which you can get falsely high results. Must bear those in mind
8 July 2014 (Tuesday) - Duff Result
A
sodium result of over 200? And a potassium of over 10? It's just not
possible. On inspection electrolytes had been mistakenly requested
on a glucose sample. I've always known that the anticoagulant and
preservative in glucose samples is flouride oxalate. Buut today I
made the realisation that it's sodium
fluoride and
potassium
oxalate...
Rather
obvious really...
7 July 2014 (Monday) - Renal Failure
Here's
an interesting case - look at the potassium and creatinine.
- CARTMAN, ERIC 08/08/2014 15:55MR 22/05/1945 69 yrs M 667269 Northgate M/P CanterburyU NORCSpecimen No : AC660246W Selected Auth Level : S--------------------T-------------------T-------------------T-------------------NA 134 S000 |ALT 35 S000 | |K 8.2 S000 |CA 2.6 S000 | |KBIC 14 S008 |$CORCA 2.6 S000 | |CR 243 S000 |CRP 1 S000 | |_GFR 23 S000 |HINT ^0.1 S000 | |PROT 82 S000 |IINT ^16 S000 | |ALB 38 S000 |LINT ^0.1 S000 | |GLOB 44 S000 | | |TBIL 18 S000 | | |ALKP 73 S000 | | |--------------------T-------------------T-------------------
High
potassiums are always suspect; were samples taken in the wrong order
leading to EDTA contamination? In this case probably not - look at
the (if anything) raised calcium. Creatinine is seriously up; GFR
down. Renal failure?
Historically
there has been raised creatinine.
- CARTMAN, ERIC 08/08/2014 15:55MR 22/05/1945 69 yrs M 667269 Northgate M/P------T-----------------------------------------------------------------------]Date|07/07/2014 07/07/2014 07/07/2014 17/06/2014 15/06/2014 13/06/2014 |Time|u/k 19:50 15:55 08:45 u/k 11:00 |Spec|AC660200Q AC660186R AC660246W AC642143X AC640438G AC638999V ||BIO BIO BIO BIO BIO BIO |Test--+-----------------------------------------------------------------------{NA |131 H 134 139 137 139 |K |7.9 H 8.2 4.4 3.8 4.0 |KBIC |7 H 14 |CR |235 H 243 132 127 114 |_GFR |24 H 23 47 49 56 |PROT | H 82 79 80 |ALB |36 H 38 35 37 |GLOB | H 44 44 43 |TBIL | H 18 15 21 |ALKP |70 H 73 75 81 |ALT | H 35 16 14 |CA |2.6 H 2.6 |------T-----------------------------------------------------------------------]
Results were phoned;
patient admitted, repeat samples sent. The patient *was* in renal
failure
2 July 2014 (Wednesday) - Anti - D
Whilst issuing anti-D
this morning I found myself wondering if my knowledge on the subject
was as current as it might have been. I did a little literature
search and came up with a few references:
www.nice.org.uk/nicemedia/live/12047/41690/41690.pdf
http://www.bcshguidelines.com/documents/Anti-D_bcsh_07062006.pdf
http://www.rcog.org.uk/files/rcog-corp/GTG22AntiDJuly2013.pdf
The last reference was
perhaps for me the most interesting... it was from the obstetric
point of view, and I was approaching the topic from a laboratory
point of view. And it turned out that I was au-fait with current
policies and procedures for the ante-natal administration of anti-D.
Mind you the whole thing
is rather pertinent to me as I was watching when my daughter was
given an anti-D injection a couple of months ago.
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