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A comparative study on reliability of point of care sodium and potassium estimation in a pediatric intensive care

Viswas Chhapola1, Sandeep Kumar Kanwal, Rajni Sharma

  • 1Division of PICU, Department of Pediatrics, Kalawati Saran Children's hospital and Lady Hardinge Medical College, New Delhi, India.

Indian Journal of Pediatrics
|February 9, 2013
PubMed

Insights

Point-of-care blood gas analyzers (BGA) underestimate sodium and potassium levels in pediatric intensive care units compared to laboratory analyzers. These discrepancies, particularly with liquid sodium heparin, present clinically unacceptable systematic bias.

Area of Science:

  • Clinical Chemistry
  • Pediatric Critical Care
  • Laboratory Medicine

Background:

  • Point-of-care testing (POCT) offers rapid results crucial for pediatric intensive care unit (PICU) management.
  • Accurate electrolyte measurements, specifically sodium (Na+) and potassium (K+), are vital for patient care.
  • Comparison between POCT devices like blood gas analyzers (BGA) and central laboratory auto-analyzers (AA) is essential for validation.

Purpose of the Study:

  • To compare sodium and potassium measurements obtained via Blood Gas Analyzer (BGA) at the point of care versus traditional laboratory electrolyte analyzers in a pediatric ICU setting.
  • To evaluate the clinical acceptability of discrepancies in electrolyte values between BGA and laboratory methods.

Main Methods:

  • A prospective method comparison study involving 59 pediatric patients in a tertiary care hospital's PICU.
  • Paired venous blood samples were collected for simultaneous testing on BGA and laboratory auto-analyzers (AA).
  • Data analysis followed CLSI guidelines (EP15-A2) using ACB method comparison software.

Main Results:

  • Blood Gas Analyzers (BGA) significantly underestimated sodium levels (mean difference: -8.76 mmol/L, p < 0.001) compared to auto-analyzers (AA).
  • Potassium levels were also underestimated by BGA (mean difference: -0.75 mmol/L, p < 0.0001) in most cases, except for hypokalemia.
  • Bland Altman analysis revealed statistically significant systematic bias and wide, clinically unacceptable limits of agreement for both sodium and potassium.

Conclusions:

  • Blood Gas Analyzers (BGA) demonstrate a tendency to underestimate sodium and potassium values when liquid sodium heparin is used for sampling.
  • The observed systematic bias and wide limits of agreement between BGA and laboratory electrolyte analyzers are not clinically acceptable for pediatric critical care.
  • Careful consideration of pre-analytical factors, such as anticoagulant choice, is crucial to ensure accurate electrolyte measurements in POCT.
Abstract

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