Cepeda Patricia, Dixon John, Owies Ahmed
Critical Care and Anesthesiology, Epsom and St Helier University Hospitals NHS Trust, Carshalton, GBR.
Critical Care, Epsom and St Helier University Hospitals NHS Trust, Carshalton, GBR.
Cureus. 2025 Mar 28;17(3):e81387. doi: 10.7759/cureus.81387. eCollection 2025 Mar.
Bilirubin measurements are commonly performed using a blood gas analyzer and are particularly useful in managing neonatal hyperbilirubinemia. This report presents a case of a white British man in his 40s who was treated for a mixed drug overdose involving cocaine, mirtazapine, fentanyl, codeine, methadone, morphine, and diazepam. His bilirubin levels measured on the blood gas analyzer were elevated at 63 µmol/L, whereas the normal range is 1.71-20.5 µmol/L. However, a formal laboratory bilirubin test returned a normal value of 21 µmol/L. Given the absence of jaundice or signs of liver disease, the unexpectedly high bilirubin reading on the blood gas analyzer prompted further investigation. Laboratory analysis involved scanning the absorbance of three serum samples received on the same day and comparing them with the absorbance of the blood gas analyzer. A significant peak at approximately 400 nm was detected in the first sample, corresponding to the wavelengths used for blood gas bilirubin measurement. Native bilirubin exhibits a broad absorbance spectrum between 350 and 500 nm, overlapping with the absorbance spectra of diazepam and pregabalin. This interference likely contributed to the false-positive bilirubin elevation. Currently, little is known about the relationship between false-positive bilirubin elevations and drugs of abuse. This case highlights potential causes of isolated bilirubin elevation, particularly interference from substances with overlapping absorbance spectra. While the interference is suspected, it has not been definitively proven. The findings underscore the limitations of arterial blood gas analysis and the potential for interference from other substances, particularly drugs of abuse. Clinicians should exercise caution when interpreting blood gas bilirubin concentrations in patients with a history of substance misuse. Consulting the laboratory is advisable when encountering unexpected discrepancies in bilirubin levels.
胆红素测量通常使用血气分析仪进行，在管理新生儿高胆红素血症方面特别有用。本报告介绍了一名40多岁的英国白人男子的病例，他因混合药物过量接受治疗，涉及可卡因、米氮平、芬太尼、可待因、美沙酮、吗啡和地西泮。他在血气分析仪上测得的胆红素水平升高至63µmol/L，而正常范围是1.71 - 20.5µmol/L。然而，正式的实验室胆红素检测结果为正常的21µmol/L。鉴于没有黄疸或肝病迹象，血气分析仪上意外出现的高胆红素读数促使进一步调查。实验室分析包括扫描同一天收到的三份血清样本的吸光度，并将它们与血气分析仪的吸光度进行比较。在第一个样本中检测到约400nm处有一个明显的峰值，这与用于血气胆红素测量的波长相对应。天然胆红素在350至500nm之间呈现出广泛的吸光光谱，与地西泮和普瑞巴林的吸光光谱重叠。这种干扰可能导致了胆红素假阳性升高。目前，关于假阳性胆红素升高与滥用药物之间的关系知之甚少。这个病例突出了孤立性胆红素升高的潜在原因，特别是来自具有重叠吸光光谱的物质的干扰。虽然怀疑存在干扰，但尚未得到明确证实。这些发现强调了动脉血气分析的局限性以及其他物质，特别是滥用药物产生干扰的可能性。临床医生在解释有药物滥用史患者的血气胆红素浓度时应谨慎。遇到胆红素水平意外差异时，建议咨询实验室。
