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Point of Care Testing of Serum Electrolytes and Lactate in Sick Children
Aashima Dabas1, Shipra Agrawal1, Vernika Tyagi1
1Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
Insights
Point-of-care testing (POCT) aids rapid assessment of electrolyte and lactate abnormalities in hospitalized children. Elevated lactate levels detected by POCT indicate higher risks of shock, ventilation, and death.
Area of Science:
- Pediatric critical care medicine
- Clinical pathology
- Biomedical engineering
Background:
- Electrolyte and lactate abnormalities are common in critically ill children.
- Rapid assessment of these parameters is crucial for timely intervention.
- Point-of-care testing (POCT) offers a potential solution for rapid biochemical analysis.
Purpose of the Study:
- To evaluate electrolyte and lactate abnormalities in hospitalized children using a POCT device.
- To assess the agreement between POCT and central laboratory results for electrolytes.
- To determine the prognostic value of lactate levels measured by POCT.
Main Methods:
- Observational study of 158 hospitalized children (1 month to 12 years).
- Paired venous blood samples analyzed by central laboratory and POCT device (Stat Profile Prime Plus).
- POCT measured sodium, potassium, and lactate; central lab measured sodium and potassium.
Main Results:
- High prevalence of abnormal sodium (55.1%), potassium (29.7%), and acidosis (46.2%) by POCT.
- Good agreement between POCT and central lab for sodium (ICC 0.74) and potassium (ICC 0.71).
- Hyperlactatemia (51.3%) associated with increased odds of shock, mechanical ventilation, and death.
Conclusions:
- POCT is a valuable adjunct for rapid biochemical assessment in pediatric patients.
- Lactate measurement by POCT serves as a significant prognostic indicator in sick children.
Objective:
To evaluate the electrolyte and lactate abnormalities in hospitalized children using a point of care testing (POCT) device and assess the agreement on the electrolyte abnormalities between POCT and central laboratory analyzer with venous blood.
Methods:
This observational study recruited hospitalized children aged 1 month to 12 years within two hours of admission. A paired venous sample and heparinized blood sample were drawn and analyzed by the central laboratory and POCT device (Stat Profile Prime Plus-Nova Biomedical, Waltham, MA, USA) for sodium and potassium. Lactate was measured on the POCT device only. The clinical and outcome parameters of children with electrolyte abnormalities or elevated lactate (>2mmol/L), and the agreement between POCT values and central laboratory values were assessed.
Results:
A total of 158 children with median (IQR) age 11 (6-10) months and PRISM score 5 (2-9) were enrolled. The proportion of children with abnormal sodium and potassium levels, and acidosis on POCT were 87 (55.1%), 47 (29.7%) and 73 (46.2%), respectively. The interclass coefficient between POCT and laboratory values of sodium and potassium values was 0.74 and 0.71 respectively; P<0.001. Children with hyperlactatemia (81, 51.3%) had higher odds of shock (OR 4.58, 95% CI: 1.6-12.9), mechanical ventilation (OR 2.7, 95% CI 1.1-6.6, P=0.02) and death (OR 3.1, 95% CI 1.3-7.5 P=0.01) compared to those with normal lactate.
Conclusion:
POCT can be used as an adjunct for rapid assessment of biochemical parameters in sick children. Lactate measured by POCT was a good prognostic indicator.
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