David G.Brown wrote:
>During a recent audit of our NPT facilities, it became increasingly
>evident that, although ionised calcium was measured and recorded
>on the patient chart, almost always, no action is taken to correct
>or verify, (by sending a sample to the laboratory), even grossly
>abnormal results. Our Consultant Anaesthetists say they can't
>remember when they last thought a patient required a change in
>therapy on the basis of an ionised calcium (this included adult ICU,
>cardiac theatres and post operative ICU's. The assumption appears to
>be that ionised calcium is a test that is not required. Is this
>really the case? Or can somebody tell me differently, as these
>Consultants are now suggesting, after our findings, that we can
>remove the electrodes from their anaylsers.
A striking example of the alienation between the laboratories and the
clinicians! Ionized calcium is by no means unnecessary - to the contrary,
it should be measured considerably more frequent instead of using the
unreliable measurements of total or albumin-corrected calcium!
"no action is taken" is symtomatic: Why are we doing clever and precise
measurements when the results are ignored? This seems to be a disease of
all countries.
The advantages of ionized calcium over total or albumin-corrected are
overwhelmingly documented in the literature since more than 20 years,
but still this fact has obviously not reached the users of the results!
Short-sigted persons think that far objects should be fuzzy until they get
the appropriate glasses. Total calcium is more unreliable than ionized
due to both physiological and technical reasons. So let us eventually abandon
total calcium and adopt ionized calcium instead!
Mr Sten Öhman, PhD
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From: Mr Sten Öhman, PhD
Postal address: p.o. Box 133, S-590 70 Ljungsbro, Sweden
E-Mail address: [log in to unmask]
Phone: int: +46 13 219020, nat: 013-219020
Fax: int: +46 13 219021, nat: 013-219021
Personal home page: http://hem1.passagen.se/stoh7971/
Company home page: http://www.elfinilab.se/
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