My thanks to all who responded to my question about detecting reducing substances in stools of newborns using the Clinitest tablets. The comments were interesting, helpful, and sometimes contradictory. I will try to summarize them.
None of the respondents performs this test at the point of care. One respondent shared that her institution had been cited by JCAHO for performing the test under a Waived Testing CLIA license. Dr. Nichols (Baystate Medical Center) noted that safety issues associated with the use of sodium hydroxide argued against performing this test at the point of care.
About half of the respondents offer the test in the clinical lab. Two previously offered the test but have since abandoned it. The procedure used at UTMB is available on their website (http://www2.utmb.edu/poc/SOP's/2002/MODERATE/SOP_StoolClinitest.PDF). Interestingly, they classify the test as "moderately complex," whereas several other institutions performing the test classify it as "highly complex." Dr. Ramirez (Panama) mentioned that Ames (which was purchased several years ago by Bayer) provided him with a procedure for using the Clinitest tablets with stool.
Some respondents questioned the usefulness and/or reliability of Clinitest with stool. Dr. Wulkan (Rotterdam), for example, warned that stool contains many potentially interfering bacterial degredation products, and that intestinal flora consume glucose. Although he didn't mention it specifically, I suspect that bilirubin would significantly interfere, as well. Dr. Tighe (Musgrove Park Hospital) pointed out that proper analysis for reducing substances in stool requires blanking, which is not part of the Clinitest procedure.
A appreciate all of these comments.
Roger
Roger L. Bertholf, Ph.D.
Associate Professor of Pathology
Director of Clinical Chemistry & Toxicology
University of Florida Health Science Center/Jacksonville