Fascinating. It seemed unlikely that there was enough acetoacetate  
around with the clinical story and that anion gap.

Jonathan


On Wednesday, May 7, 2003, at 13:57 Europe/London, Robertson, Stuart  
wrote:

> Thanks to all who responded.
> It would appear that the most likely interferant is nitromethane, a  
> constituent (with methanol) of model airplane fuel.
> See: De Leacy et al  Clin Chem 35/8, 1772-1774 (1989).
> The patient in this paper had an apparent serum creatinine of 8000  
> umol/L (similar to our patient), when measured by the Jaffe reaction.
>
> We have now had our patient's creatinine measured by an enzymatic  
> method (Ektachem), with a result of 151 umol/L.
>
> Stuart Robertson
> Clinical Biochemistry Dept
> Hull Royal Infirmary
> Hull
> HU3 2JZ
>
>
> ----------
> From:   David Morrell[SMTP:[log in to unmask]]
> Reply To:       David Morrell
> Sent:   07 May 2003 12:50
> To:     [log in to unmask]
> Subject:        Re: Gross interference in Jaffe reaction
>
> A few papers on PubMed suggest source of interference is nitromethane  
> found
> in model engine (and drag racer) fuel
> (http://www.ncbi.nlm.nih.gov:80/entrez/ 
> query.fcgi?db=PubMed&cmd=Display&dopt
> =pubmed_pubmed&from_uid=6848263, refs 2-4)
>
> David Morrell
>
> Reproductive Medicine Laboratory
> Edinburgh Fertility and Reproductive Endocrine Centre
> Centre for Reproductive Health
> Royal Infirmary of Edinburgh - Little France
> 51 Little France Crescent
> Edinburgh
> EH16 4SA
>
> Tel: 0131-242 2462
> Fax: 0131-242 2464
> e-mail: [log in to unmask] on 7/5/03 11:37 am, Ballieux, B.E.P.B.  
> (CKCL)
> at [log in to unmask] wrote:
>
> "It is certainly true that automated methods have improved since 1991."
>
> I wouldnt be to sure about that! see:
>
>
> Kemperman FA, Weber JA, Gorgels J, van Zanten AP, Krediet RT, Arisz L.
> The influence of ketoacids on plasma creatinine assays in diabetic
> ketoacidosis.
> J Intern Med. 2000 Dec;248(6):511-7.
>
> Dr. B.E.P.B. Ballieux
> Clinical Biochemist
> Leiden University Medical Centre
> P.O.box 9600
> 2300 RC Leiden
> The Netherlands
> Tel:+3171-5262165/2278
> Fax: +3171-5266753
> email: [log in to unmask]
>
> -----Original Message-----
> From: Hogan, Tim [mailto:[log in to unmask]]
> Sent: woensdag 7 mei 2003 12:26
> To: [log in to unmask]
> Subject: Re: Gross interference in Jaffe reaction
>
> Interferences in Current Methods for Measurements of Creatinine
> Weber et al  CLIN CHEM 37/5,695-700 (1991)
>
> gives Carbonyl compounds (especially acetoacetic acid) , dopamine, and
> cephalosporines as the major problems with the cephalosprines giving  
> the
> most positive interference.
> They also noted that the magnitude of the interference varies widely  
> from
> method to method.
> It is certainly true that automated methods have improved since 1991.
>
>
> Tim
> [log in to unmask]
> -----Original Message-----
> From: Robertson, Stuart [mailto:[log in to unmask]]
> Sent: 06 May 2003 16:50
> To: [log in to unmask]
> Subject: Gross interference in Jaffe reaction
>
>
> 62 year old male patient, admitted following alleged  
> consumption/inhalation
> of grandson's model engine fuel (methanol). Consequential aspiration
> pneumonia, CCF, collapse and death within 24 hours.
>
> Biochem results on admission to hospital:
>
> Sodium                        143      mmol/L     (135 - 144)
> Potassium                      3.5      mmol/L     (3.5 - 5.3)
> Chloride                              114      mmol/L   * (96 - 109)
> Bicarbonate                    20       mmol/L   * (24 - 32)
> Urea                                  6.9      mmol/L     (2.1 - 7.6)
> Creatinine                    Interfering substances present  #
> Calcium                               2.22     mmol/L     (2.20 - 2.60)
> Adjusted Calcium                      2.30    mmol/L     (2.20 - 2.60)
> Phosphate                             1.39    mmol/L     (0.70 - 1.50)
> Bilirubin                                    114     umol/L   * (7 -  
> 23)
> Alkaline Phosphatase                 75      iu/L       (30 - 125)
> Alanine Aminotransferase             17      iu/L       (5 - 45)
> Total Protein                        64      g/L        (62 - 78)
> Albumin                              38      g/L        (36 - 48)
> (Anion Gap)                          13       mmol/l     (10 - 20)
> Glucose                      7.7    mmol/L
> CK                          93     U/L
>
> #  'Creatinine' by Jaffe reaction on Beckman LX20 was measured as 8800
> umol/L
>
> Any ideas on what the Jaffe reaction is measuring?
>
> Stuart Robertson
> Clinical Biochemistry Dept
> Hull Royal Infirmary
> Hull
> HU3 2JZ
>
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