One of my colleagues would appreciate some help with the following:-
Patient admitted with UTI later found to have astrocytoma, on valproate,
prednisolone, ursodeoxycholic acid, amoxycillin. Abnormal LFTs with
bilirubin approx 340umol/l, alp 1080, alt 372
Found to have hyponatraemia on indirect ISEs, sample rather lipaemic so
direct ISEs done and discrepancy found (more than one would expect for
degree of lipaemia) Serum proteins also low. I would expect the two to
cancel each other out somewhat. We span the sample down hard and suceeded
in floating off the lipid. We took the clear infranatent and analysed by
direct and indirect ISE and got the same results as before spinning ie
despite removing the lipaemia the indirect ISE still gave a low result. We
repeated the same experiment on a series of his samples with the same
results see below. (2 normal samples included for comparison). The
osmolality results suggest that the direct ISE is correct, but we cannot
explain the discrepancy and the fact that it does not improve when the lipid
is removed.
Any suggestions?
Indirect ISE Indirect extra-spin Direct ISE Direct ISE
extra-spin Protein Trig Osmo
116 120 131 132
33 10.9 279
118 120 132 133
35 7.2 -
118 118 134 131
34 13.4 284
Normal samples
137 137 140 138
75 1.4
142 141 145 143
72 2.7
Many thanks
Clare Ford
Principal Biochemist
Dept Clinical Biochemistry
Royal Shrewsbury Hospital
Mytton Oak Rd
Shrewsbury
SY3 8PH
Tel: 01743 261000 X3536
Fax: 01743 261159
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