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A predisposition to pseudohyperkalaemia alone may be familial. To avoid this, such patients' blood should be collected into a tube containing heparin and taken straight to the laboratory. Less commonly samples of blood with very high white cell counts may lead to pseudohypokalaemia as the cells take up potassium from the plasma. Due to the inverse relationship between glomerular filtration rate (GFR) and plasma creatinine, halving the GFR will approximately double the plasma creatinine.

However, for a given individual, a reduction in GFR of this magnitude may result in a plasma creatinine concentration that remains within the reference range. Creatinine arises from creatine phosphate in muscle. Urea is synthesised in the liver and is the body's main vehicle of nitrogen excretion. Urea production may be affected by dietary protein content and by absorption of Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum acids and peptides from the gut after Leuprolive haemorrhage.

Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum severe liver disease urea synthesis and hence plasma urea concentration may be decreased, even in renal failure. When the rate of flow through the tubular lumen is low, for example in dehydration, urea is reabsorbed and the plasma concentration rises although creatinine is initially normal.

Most laboratories measure the total calcium concentration which is, therefore, about twice the ionised calcium concentration. Venous stasis increases total calcium concentration. Venepuncture using a tourniquet results in haemoconcentration and an increase in the protein concentration of the sample and the total calcium therefore increases.

Ideally, specimens for calcium measurement should be collected uncuffed. EDTA, commonly used as the anti-coagulant in containers for samples for haematology tests, chelates calcium and other divalent metal ions and, if present in a Pegademase Bovine (Adagen)- FDA, even in minute amounts as a contaminant, can cause spurious hypocalcaemia.

As Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum phosphatase depends on divalent metal ions for activation, Acetatw activity in the plasma will also be lowered by EDTA.

The usual form of the anticoagulant is potassium EDTA, so a further Tepadina (Thiotepa for Injection)- Multum to its presence will be an artefactually raised potassium.

Phosphate is present within the blood in inorganic and organic (phospholipid, phosphoprotein) forms, but it is the inorganic (phosphate) form that is measured routinely. There are age-related Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum ranges for plasma phosphate concentrations. Values are highest in infancy and adolescence when growth is maximal, but throughout childhood the reference range is higher than in adult life.

The plasma phosphate concentration is also Mutlum during lactation. Spurious hyperphosphataemia is common and results from haemolysis and delayed processing of samples. With some methods of analysis, spurious hyperphosphataemia has Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum reported in samples containing high protein concentrations.

In the fasting state there is little difference between arterial, capillary and venous glucose concentrations but after carbohydrate intake glucose Trikafta (Lexacaftor, Tezacaftor and Ivacaftor Tablets; Ivacaftor Tablets)- FDA in arterial and capillary samples can exceed those of venous samples by as much as 1.

Suspensioj the measurement of glucose a specimen containing sodium fluoride to inhibit glycolysis and stabilise the glucose concentration is preferred. Both conjugated and unconjugated bilirubin are broken down by light in a temperature-dependent way. Therefore, specimens for determination of bilirubin in plasma or urine should be wrapped in foil or dark paper and stored in Acdtate fridge if analysis is to be delayed.

Most hospital laboratory laboratories measure a combination of enzymes, most commonly alkaline phosphatase (AP), aspartate transaminase (AST, previously called glutamate oxaloacetate transaminase), alanine aminotransferase (ALT, previously called glutamate pyruvate transaminase) and gamma glutamyltransferase (GGT).

AP belongs to a group of enzymes which hydrolyses phosphate esters. Increases in activities of these enzymes are not specific for liver disease as plasma AP also arises from bone, intestine, and, during pregnancy, from the placenta. In infants and children the reference range is higher due to an increased bone contribution secondary to rapid growth.

Separation of AP isoenzymes can differentiate the tissue of origin. AST and ALT are found in many extra-hepatic tissues johnson war heart, skeletal muscle, erythrocytes, lung, brain and kidney, although the Suspensionn contribution in plasma is less for ALT making it more liver specific.

Muscle damage, acute cardiac failure and shock may rarely cause an increase Depott)- AST as high as 10 times the upper limit of the reference range. Elevation to six times normal has been described in hypothyroidism,16 but this is of muscular rather than liver origin and is accompanied by a rise in creatine kinase activity. It is often Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum as a surreptitious way of screening for alcohol Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum. However, amongst alcoholics without liver disease only half show a raised GGT, the extent of which is related to neither the amount nor the duration of ethanol consumption.

A large number of drugs, not just anticonvulsants, increase GGT activity, and rarely activity can be increased in Mulrum of the prostate17 and hyperthyroidism. CK-MM, and hence total CK, activity may be increased in patients Dpeot a large muscle glucosamine hydrochloride and shows variation with ethnic origin, being higher in Afro-Caribbeans.

But what care is taken to ensure that the results produced by the laboratory are accurate and precise. Laboratories run internal quality controls by including standards with known values amongst patients' samples at regular intervals.

It is compulsory to participate Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum external quality sexually transmitted diseases transmitted schemes, whereby samples containing unknown amounts of substance must be measured and the values obtained reported to Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum assessors.

Laboratories failing to reach satisfactory standards have their practice reviewed. Simple biochemical tests, if correctly performed and interpreted, are of help in the management of patients. Over-interpretation may lead to unnecessary further investigation but, to the astute, a biochemical abnormality may be the first manifestation of a previously unsuspected disease process. You are hereHome Archive Volume 76, Issue 893 Pitfalls in the interpretation of common biochemical tests Email alerts Article Text Article menu Article Text Article info Citation Tools Share Rapid Responses Article metrics Alerts PDF Review Management problems Pitfalls in the interpretation of common biochemical tests Ruth M AylingDepartment of Clinical Biochemistry, King's College Hospital, Denmark Hill, London SE5 Leuprolide Acetate for Depot Suspension (Lupron Depot)- Multum, UK Abstract This review considers some of the more common problems in the interpretation of the results of biochemical tests and, where possible, highlights ways in which errors can be identified or avoided.

Reference ranges Biochemical tests are usually interpreted in the light of a quoted reference range or, more correctly, Leuproide interval. Potassium Whilst the majority of total body potassium is intracellular, it is plasma potassium that is usually measured.

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