JiscMail Logo
Email discussion lists for the UK Education and Research communities

Help for ACB-CLIN-CHEM-GEN Archives


ACB-CLIN-CHEM-GEN Archives

ACB-CLIN-CHEM-GEN Archives


ACB-CLIN-CHEM-GEN@JISCMAIL.AC.UK


View:

Message:

[

First

|

Previous

|

Next

|

Last

]

By Topic:

[

First

|

Previous

|

Next

|

Last

]

By Author:

[

First

|

Previous

|

Next

|

Last

]

Font:

Proportional Font

LISTSERV Archives

LISTSERV Archives

ACB-CLIN-CHEM-GEN Home

ACB-CLIN-CHEM-GEN Home

ACB-CLIN-CHEM-GEN  May 2018

ACB-CLIN-CHEM-GEN May 2018

Options

Subscribe or Unsubscribe

Subscribe or Unsubscribe

Log In

Log In

Get Password

Get Password

Subject:

Friday afternoon case

From:

Niki Meston <[log in to unmask]>

Reply-To:

Niki Meston <[log in to unmask]>

Date:

Fri, 4 May 2018 15:35:12 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (45 lines)

A 14 year old boy presents to GP with 2 weeks history of lethargy - request form states 'jaundice and lethargy'.
Sample for U&E's, FBC and liver profile received in lab 16:30 on a Friday in April, results electronically transmitted back to GP surgery at 19:00.

Na  122       (<121)
K  6.2           (>6.5)        
Urea  18.8    (>30)
Creat  106   
Bili  19

This wasn't flagged for 'phoning based on cut-offs from RCPath guidance Nov 2010 on 'Out-of-hours reporting of results requiring urgent clinical attention to primary care' (in brackets above), and the results auto-authorised.

The parents of the boy contacted the OOH service 3 times over the weekend. Results above were available and reviewed, but put down to 'artefactual change' and not repeated, despite the child becoming progressively more unwell.

The child then re-presented to ED on the Monday:

Na  114
K  7.0
Urea  24.7
Creat  150

No prizes for guessing his cortisol at that point was 169 nmol/L with an ACTH of 2817 ng/L (0-46). He was rapidly treated for newly presenting Addison's disease and made a good recovery.

My point is that we only then became aware of the new guidance from RCPath Oct 2017, updating 'phoning limits for children <16 years old in terms of Na, K, urea, creat and Glucose.

We instigated the new guidance within 24 hours of becoming aware of this case; the new cut-off for 'phoning Na at 130 mmol/L (and urea > 10 mmol/L) would have almost certainly lead to a more rapid diagnosis, and so treatment.

Am I missing some way of being advised of new relevant guidance from the RCPath - we have actually been awaiting this guidance for some time? 

I hope this case can serve to bring the new guidance to anyone else's attention who has yet to read them. 

Dr Niki Meston
Consultant Chemical Pathologist
Salisbury NHS Foundation Trust

------ACB discussion List Information--------
This is an open discussion list for the academic and clinical community working in clinical biochemistry.
Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content.
ACB Web Site
http://www.acb.org.uk
Green Laboratories Work
http://www.laboratorymedicine.nhs.uk
List Archives
http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html
List Instructions (How to leave etc.)
http://www.jiscmail.ac.uk/

Top of Message | Previous Page | Permalink

JiscMail Tools


RSS Feeds and Sharing


Advanced Options


Archives

May 2018
April 2018
March 2018
February 2018
January 2018
December 2017
November 2017
October 2017
September 2017
August 2017
July 2017
June 2017
May 2017
April 2017
March 2017
February 2017
January 2017
December 2016
November 2016
October 2016
September 2016
August 2016
July 2016
June 2016
May 2016
April 2016
March 2016
February 2016
January 2016
December 2015
November 2015
October 2015
September 2015
August 2015
July 2015
June 2015
May 2015
April 2015
March 2015
February 2015
January 2015
December 2014
November 2014
October 2014
September 2014
August 2014
July 2014
June 2014
May 2014
April 2014
March 2014
February 2014
January 2014
December 2013
November 2013
October 2013
September 2013
August 2013
July 2013
June 2013
May 2013
April 2013
March 2013
February 2013
January 2013
December 2012
November 2012
October 2012
September 2012
August 2012
July 2012
June 2012
May 2012
April 2012
March 2012
February 2012
January 2012
December 2011
November 2011
October 2011
September 2011
August 2011
July 2011
June 2011
May 2011
April 2011
March 2011
February 2011
January 2011
December 2010
November 2010
October 2010
September 2010
August 2010
July 2010
June 2010
May 2010
April 2010
March 2010
February 2010
January 2010
December 2009
November 2009
October 2009
September 2009
August 2009
July 2009
June 2009
May 2009
April 2009
March 2009
February 2009
January 2009
December 2008
November 2008
October 2008
September 2008
August 2008
July 2008
June 2008
May 2008
April 2008
March 2008
February 2008
January 2008
December 2007
November 2007
October 2007
September 2007
August 2007
July 2007
June 2007
May 2007
April 2007
March 2007
February 2007
January 2007
2006
2005
2004
2003
2002
2001
2000
1999
1998


JiscMail is a Jisc service.

View our service policies at https://www.jiscmail.ac.uk/policyandsecurity/ and Jisc's privacy policy at https://www.jisc.ac.uk/website/privacy-notice

Secured by F-Secure Anti-Virus CataList Email List Search Powered by the LISTSERV Email List Manager