Polsky Tracey G, Salmon Eloise, Welsh Sarah S, Lim Derick, Feng Sheng, Ballester Lance, Ehlayel Abdulla M, Hewlett Jennifer L, Denburg Michelle R, Boyer Donald L, Beier Ulf H
Department of Pathology and Laboratory Medicine at The Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, PA.
Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
Crit Care Explor. 2020 Jan 29;2(1):e0073. doi: 10.1097/CCE.0000000000000073. eCollection 2020 Jan.
We observed that patients treated with continuous vecuronium or esmolol infusions showed elevated plasma sodium measurements when measured by the routine chemistry analyzer as part of the basic metabolic panel (Vitros 5600; Ortho Clinical Diagnostics, Raritan, NJ), but not by blood gas analyzers (RAPIDLab 1265; Siemens, Tarrytown, NY). Both instruments use direct ion-selective electrode technology, albeit with different sodium ionophores (basic metabolic panel: methyl monensin, blood gas: glass). We questioned if the basic metabolic panel hypernatremia represents artefactual pseudohypernatremia.
We added vecuronium bromide or esmolol hydrochloric acid to pooled plasma samples and compared sodium values measured by both methodologies. We queried sodium results from the electronic medical records of patients admitted at Children's Hospital of Philadelphia from 2016 to 2018 and received vecuronium and/or esmolol infusion treatment during their admissions.
PICU of a quaternary, free-standing children's hospital.
Children admitted to the hospital who received vecuronium and/or esmolol infusion.
Sodium was measured in pooled plasma samples by basic metabolic panel and blood gas methodologies after adding vecuronium bromide or esmolol hydrochloric acid, leading to a dose-response increase in basic metabolic panel sodium measurements. A repeated measures regression analysis of our electronic medical records showed that the vecuronium dose predicted the Δ sodium (basic metabolic panel-blood gas) sodium within 12 hours of the vecuronium administration ( < 0.0018). Esmolol showed a similar trend ( = 0.13). This occurred primarily in central line samples with continuous vecuronium or esmolol infusions.
Vecuronium and esmolol can falsely elevate direct ion-selective electrode sodium measurements on Vitros chemistry analyzers. Unexpectedly high sodium measurements in patients receiving vecuronium and/or esmolol infusions should be further investigated with an alternate sample type (i.e., peripheral blood) or measurement methodology (i.e., blood gas) to guide treatment decisions.
我们观察到，在作为基础代谢指标检测的常规化学分析仪（Vitros 5600；奥瑟诊断公司，拉里坦，新泽西州）上测量时，接受维库溴铵或艾司洛尔持续输注治疗的患者血浆钠测量值升高，但在血气分析仪（RAPIDLab 1265；西门子公司，塔里敦，纽约州）上测量时则不然。两种仪器均使用直接离子选择电极技术，尽管使用的钠离子载体不同（基础代谢指标检测：甲基莫能菌素，血气检测：玻璃）。我们质疑基础代谢指标检测中的高钠血症是否代表人为的假性高钠血症。
我们向混合血浆样本中添加溴化维库溴铵或盐酸艾司洛尔，并比较两种方法测量的钠值。我们查询了2016年至2018年在费城儿童医院住院并在住院期间接受维库溴铵和/或艾司洛尔输注治疗的患者的电子病历中的钠检测结果。
一家独立的四级儿童医院的儿科重症监护病房。
住院并接受维库溴铵和/或艾司洛尔输注的儿童。
在向混合血浆样本中添加溴化维库溴铵或盐酸艾司洛尔后，通过基础代谢指标检测和血气分析方法测量钠，导致基础代谢指标检测的钠测量值呈剂量反应性增加。对我们的电子病历进行的重复测量回归分析表明，维库溴铵剂量可预测维库溴铵给药后12小时内的钠差值（基础代谢指标检测 - 血气检测）（<0.0018）。艾司洛尔呈现类似趋势（=0.13）。这种情况主要发生在接受维库溴铵或艾司洛尔持续输注的中心静脉血样本中。
维库溴铵和艾司洛尔可在Vitros化学分析仪上错误地升高直接离子选择电极法测量的钠值。对于接受维库溴铵和/或艾司洛尔输注的患者，意外的高钠测量值应通过另一种样本类型（即外周血）或测量方法（即血气分析）进一步调查，以指导治疗决策。
