With regard to pleural fluid, I was under the impression (perhaps incorrectly) that there is evidence to suggest glucose analysis, whilst not as good as pH analysis, has a place in assessment of whether drainage is required for parapneumonic infections. The point about comparing with plasma concentrations is an interesting one. Given that blood gas analyser manufacturers are not happy for pleural fluids to be put through their machines I wonder how labs have dealt with the BTS recommendations for pH analysis?
Khaleel Sergeant
King George Hospital
Goodmayes
Essex
-----Original Message-----
From: Clinical biochemistry discussion list
[mailto:[log in to unmask]]On Behalf Of Williams David G
(RLN) City Hospitals Sunderland - Clinical Scientist
Sent: 29 March 2007 14:46
To: [log in to unmask]
Subject: Drowning in Various Fluids
Many thanks to those who responded (as ever) to this question.
I gather (from some respondents) that there seems to be a marked increase in
requesting an increasing munber of analytes on pleuritic and ascitic fluids.
The consensus seems to be that there is not a great deal of evidence to
justify such multiple requests
There was a paper published in the Annals a few years back about this:-
Annals of Clin Biochem 2001 Vol 38 p311-322 for a good review of
pleural fluid testing.
I append the results of audits carried out by list members, I assume that
they will not object to them being posted out to the list (if not then my
apologies)
I also append the British Thoracic Societies Guidelines from 2003 which
basically recommend pH, LDH, protein and glucose and nothing else
biochemical, except that cholesterol and triglycerides may be required in
the case of a suspected chylothorax.
One point that seems to be ignored is that the levels of analytes in pleural
fluid at least need to be compared with current plasma levels of he same
analytes, so a sample of blood should accompany any request for fluid
measurements.
Once again, many thanks
David G Williams
<<Fluid Audit Summary 0305.doc>> <<Fluid Standards 0305.doc>>
<<PleuraDiseaseEffusion BTS Guidelines.pdf>> <<PLEURAL FLUID AUDIT
STANDARDS.doc>>
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------ACB discussion List Information--------
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community working in clinical biochemistry.
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