Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Department of Gastroenterology and Nutrition, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK.
Clin Nutr ESPEN. 2021 Apr;42:339-347. doi: 10.1016/j.clnesp.2021.01.010. Epub 2021 Feb 4.
The home parenteral nutrition (HPN) population face many challenges, especially with respect to fluid balance management. A low urinary sodium concentration of <20 mmol/L is commonly used as an indicator of dehydration that requires clinical assessment in these patients. The Quantab titrator dipstick measures chloride concentration of a solution and correlates with sodium concentration. We assessed whether it would be feasible to use the Quantab dipstick in the HPN population and explored relationships between Quantab dipstick estimated chloride concentration and quality of life (QOL).
Patients on HPN were asked to collect urine samples at 5 specific times points (day 0,7,14, 21 and 28) to send to the laboratory for formal electrolyte analysis. The participant and a member of laboratory staff tested these samples with the Quantab dipstick to estimate urinary chloride concentration. Participants were instructed to complete a QOL questionnaire at each of the 5 time-points in addition to a baseline demographic questionnaire and an end-of-study questionnaire. Six participants completed an interview at the end of the study period. The relationship between participant-derived and laboratory-derived data was assessed using rank correlation coefficients. QOL assessment was correlated with urine dipstick measurements.
10 patients on HPN completed the study. Data on chloride concentration as estimated by the dipstick (assessed by participants and by the laboratory) and sodium concentration from the laboratory were available for 47 urine samples. There was a positive relationship between participant dipstick estimated chloride concentration and laboratory sodium (Kendall's τ = 0.45; P < 0.001; Spearman's r = 0.58 P < 0.001; 47 pairs). There was a strong correlation between chloride concentrations estimated by dipstick in the laboratory and by participants (Kendall 0.58 p < 0.001, Spearman's 0.69 p < 0.001; 47 pairs). In exploratory analyses, there was no relationship between QOL and dipstick estimated chloride concentration. Participants had no issues collecting urine samples but some difficulties were reported with determining the dipstick reading.
Patients on HPN are able to collect urine specimens, complete QOL questionnaires, and are capable of using the Quantab dipstick to estimate urinary chloride concentration. The Quantab dipstick correlates with laboratory measured sodium and chloride concentrations. Further work is required to fully establish whether this point-of-care test could be used to guide fluid balance management in the HPN population.
接受家庭肠外营养（HPN）治疗的患者面临许多挑战，尤其是在液体平衡管理方面。尿钠浓度低（<20mmol/L）通常被用作这些患者需要临床评估的脱水指标。Quantab 比色计条可测量溶液中的氯浓度，并与钠浓度相关。我们评估了在 HPN 人群中使用 Quantab 比色计条的可行性，并探讨了 Quantab 比色计条估计的氯浓度与生活质量（QOL）之间的关系。
要求接受 HPN 治疗的患者在 5 个特定时间点（第 0、7、14、21 和 28 天）收集尿液样本，并送往实验室进行电解质分析。参与者和实验室工作人员使用 Quantab 比色计条对这些样本进行测试，以估计尿液中的氯浓度。参与者被要求在每个 5 个时间点都完成 QOL 问卷，以及基线人口统计学问卷和研究结束时的问卷。6 名参与者在研究结束时接受了访谈。使用秩相关系数评估参与者和实验室获得的数据之间的关系。QOL 评估与尿比色计测量结果相关。
10 名接受 HPN 治疗的患者完成了研究。可用于 47 个尿液样本的比色计条（由参与者和实验室评估）和实验室钠离子浓度的氯浓度数据。参与者估计的氯浓度与实验室钠浓度呈正相关（Kendall τ=0.45；P<0.001；Spearman r=0.58 P<0.001；47 对）。实验室和参与者用比色计条估计的氯浓度之间存在很强的相关性（Kendall 0.58 p<0.001，Spearman 0.69 p<0.001；47 对）。在探索性分析中，QOL 与比色计条估计的氯浓度之间没有关系。患者能够收集尿液样本，但在确定比色计条读数方面存在一些困难。
接受 HPN 治疗的患者能够收集尿液样本，完成 QOL 问卷，并且能够使用 Quantab 比色计条来估计尿液中的氯浓度。Quantab 比色计条与实验室测量的钠和氯浓度相关。需要进一步研究以充分确定这种即时检测测试是否可用于指导 HPN 人群的液体平衡管理。
