Division of Medical Biochemistry, Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
Clin Toxicol (Phila). 2012 Nov;50(9):812-7. doi: 10.3109/15563650.2012.731509.
Lipid resuscitation therapy using intravenous lipid emulsion (IVLE) for drug overdoses has gained widespread use. However, there is little information regarding its adverse effects.
We performed lipemic interference studies on typical automated platforms to investigate the potential of lipid resuscitation therapy to interfere with the reliability and turnaround time of analytes that would be of interest in acute intoxications. We also tested methods to minimize interferences.
Serum pools were supplemented with increasing concentrations of Intralipid-20%(®) (0-30%). Analyses were performed on Beckman-Coulter DXC800 and DXI and Roche Modular-P. Analytes demonstrating significant interference were re-measured after centrifugation (14 000 × g for 10 minutes).
Triglyceride and glycerol-blanked triglyceride concentrations were similar in IVLE-free samples. However, with addition of IVLE, concentrations were markedly different (139 vs. 76 mmol/L). There was no appreciable interference on the troponin-I, sodium, potassium, chloride, calcium, bicarbonate or urea assays. Albumin and magnesium assays demonstrated significant interference. Amylase, lipase, phosphate, creatinine, total protein, ALT, CK and bilirubin became unmeasurable in IVLE-supplemented samples. Whereas glucose measurement by potentiometry was free of interference, colorimetric methodology was error prone. Centrifugation removed > 90% of glycerol-blanked triglyceride (max = 5.8 mmol/L), dramatically reducing lipid interferences.
IVLE results in appreciable analytical interferences at concentrations demonstrated in lipid resuscitation therapy. Of particular concern is the marked interference on glucose and magnesium, which may result in unsuccessful and potentially harmful interventions. Major implications for patient care include reporting of incorrect results and delays in the reporting of time-sensitive results. Whenever possible, blood samples should be collected prior to initiating lipid therapy. Interferences can be minimized by brief centrifugation at relatively low speeds on equipment readily available in most core labs.
静脉内使用脂肪乳剂（IVLE）进行脂质复苏治疗在药物过量中已得到广泛应用。然而，关于其不良反应的信息却很少。
我们在典型的自动化平台上进行脂血干扰研究，以研究脂质复苏治疗可能会干扰在急性中毒中感兴趣的分析物的可靠性和周转时间。我们还测试了最小化干扰的方法。
在血清池（pool）中添加递增浓度的 Intralipid-20%（®）（0-30%）。在 Beckman-Coulter DXC800 和 DXI 以及 Roche Modular-P 上进行分析。在离心（14000×g 离心 10 分钟）后，对表现出显著干扰的分析物进行重新测量。
在无 IVLE 的样品中，甘油三酯和甘油空白甘油三酯浓度相似。然而，添加 IVLE 后，浓度明显不同（139 与 76mmol/L）。肌钙蛋白-I、钠、钾、氯、钙、碳酸氢盐或尿素检测均无明显干扰。白蛋白和镁检测显示出显著干扰。在添加 IVLE 的样本中，淀粉酶、脂肪酶、磷酸盐、肌酐、总蛋白、ALT、CK 和胆红素均无法测量。虽然通过比色法测量葡萄糖不受干扰，但通过电位法测量葡萄糖则容易出错。离心去除了>90%的甘油空白甘油三酯（最大值=5.8mmol/L），大大减少了脂质干扰。
在脂质复苏治疗中所显示的浓度下，IVLE 会导致明显的分析干扰。特别值得关注的是对葡萄糖和镁的明显干扰，这可能导致干预失败且潜在地对患者造成伤害。这对患者护理有重大影响，包括报告不正确的结果和延迟报告时间敏感的结果。在可能的情况下，应在开始脂质治疗之前采集血液样本。通过在大多数核心实验室都可获得的设备上以相对较低的速度进行短暂离心，可以将干扰降至最低。
