 |
 |
Hi Niki, Sorry to hear about this sad case. New publications from the RCPath are included in the President's monthly e-newsletter - this one was noted in the one sent on 4th October 2017. I'm not sure if you have to opt in to receive these as a fellow, or if non-fellows can register on the mailing list. Best wishes, Sarah ________________________________________ From: Clinical biochemistry discussion list <[log in to unmask]> on behalf of Lesley Morgan <[log in to unmask]> Sent: 04 May 2018 16:03 To: [log in to unmask] Subject: Re: Friday afternoon case Hi Niki, Our Clinical Librarian sends us monthly publication updates from RCPath, Gov.UK, NICE, MHRA. You could contact your library and see if they offer this service. You might also be able to contact RCPath and see if they offer an RSS (Rich Site Summary) feed which will email you when a new publication is out. The other route would be to have those kinds of publications controlled in your document control system so that they are checked regularly for updates and then when there is an update this is distributed to appropriate staff. Best wishes, Lesley Lesley Morgan Quality Manager Clinical Biochemistry Severn Pathology Tel: 0117 4148428 Fax: 0117 4148438 Website: www.severnpathology.com -----Original Message----- From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Niki Meston Sent: 04 May 2018 15:35 To: [log in to unmask] Subject: Friday afternoon case 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/ DISCLAIMER: The information in this message is confidential and may be legally privileged. It is intended solely for the addressee. Access to this message by anyone else is unauthorised. If you are not the intended recipient, any disclosure, copying, or distribution of the message, or any action or omission taken by you in reliance on it, is prohibited and may be unlawful. Please immediately contact the sender if you have received this message in error. Thank you. ------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/ ******************************************************************************************************************** This message may contain confidential information. If you are not the intended recipient please inform the sender that you have received the message in error before deleting it. Please do not disclose, copy or distribute information in this e-mail or take any action in relation to its contents. To do so is strictly prohibited and may be unlawful. Thank you for your co-operation. NHSmail is the secure email and directory service available for all NHS staff in England and Scotland. NHSmail is approved for exchanging patient data and other sensitive information with NHSmail and other accredited email services. For more information and to find out how you can switch, https://portal.nhs.net/help/joiningnhsmail ------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/