Annals of clinical biochemistry
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Hypokalaemic rhabdomyolysis is unusual, but the association between hypokalaemia and rhabdomyolysis can be overlooked if intracellular potassium leakage normalizes serum potassium by the time of presentation. This report describes a patient who presented with severe pain due to non-traumatic rhabdomyolysis and was found to have serum potassium of 1.4 mmol/L; magnesium 0.40 mmol/L; phosphate 1.40 mmol/L; adjusted calcium 1.87 mmol/L and creatine kinase 6421 U/L. In this case, intervention occurred before rhabdomyolysis could progress to the stage at which serum potassium may have self-corrected. ⋯ Initially, the patient denied alcohol abuse, but later admitted alcohol misuse prior to withdrawal three days before presentation. Hypokalaemia is associated with alcohol misuse, but abrupt withdrawal may exacerbate hypokalaemia and hypomagnesaemia. Acute or chronic myopathy is common in alcoholics due to alcohol toxicity and paradoxically the risk of rhabdomyolysis may be increased during periods of abrupt alcohol withdrawal.
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Ann. Clin. Biochem. · Jan 2007
The sweat test for the diagnosis of cystic fibrosis--a personal experience of guideline production.
The need for evidence-based guidelines as to how to conduct the sweat test in the UK was highlighted in 2000 by the National External Quality Assessment Scheme Specialist Advisory Committee. A Guideline Group supported by several professional bodies was subsequently convened and formal evidence-based guidelines were produced and published in 2003. ⋯ The emphasis for the future should be to assess the impact and value of evidence-based guidelines and promote their introduction into local practice as part of care pathways. A growing number of guideline initiatives emphasizes the importance of and a need for an overarching coordinating structure to overcome problems of duplication and enable interested professionals from different disciplines to work on related initiatives.
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Ann. Clin. Biochem. · Nov 2006
Comparative StudySodium measurement: effects of differing sampling and analytical methods.
It is recommended that children receiving intravenous fluids should have frequent biochemical monitoring, in some situations 4-6 hourly. Small changes in sodium must be detected, requiring very high precision from sodium analyses. Some children are monitored using venous blood analysed by indirect ion-selective electrode (ISE) interchangeably with capillary blood analysed by direct ISE. Our aim was to determine whether variability in sample collection together with variability in sodium measurement would lead to results which were unacceptable in the clinical setting. ⋯ Venous plasma using indirect ISE and capillary blood with direct ISE cannot be used interchangeably to detect small changes in plasma sodium concentrations. To avoid misinterpretation of results when monitoring sodium over short time periods, the use of single methods of sampling and analysis must be strongly encouraged.
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Ann. Clin. Biochem. · Jul 2006
Comparative StudyComparison of biomarker strategies for rapid rule out of myocardial infarction in the emergency department using ACC/ESC diagnostic criteria.
Creatine kinase MB isoenzyme (CK-MB) mass and rate of change of CK-MB have been proposed as superior to cardiac troponin measurement for very early exclusion of acute myocardial infarction (AMI). All three markers were examined prospectively in patients presenting to the Emergency Department (ED) for rule out of AMI. ⋯ cTnT at 6 h has high diagnostic sensitivity for AMI and is superior to CK-MB mass and DeltaCK-MB even using a low cut-off value.
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Ann. Clin. Biochem. · Jan 2006
ReviewNational Institute for Health and Clinical Excellence guidelines on preoperative tests: the use of routine preoperative tests for elective surgery.
Clinical Guideline CG3 from the National Institute for Health and Clinical Excellence (NICE) makes recommendations on appropriate clinical practice in preoperative testing for elective surgery. Unfortunately, there is minimal evidence on which the guidelines could be based and therefore they were constructed on the basis of professional opinion. This resulted in the construction of a decision matrix of Byzantine complexity built on foundations of sand: surgical risk is estimated using an unvalidated ad hoc risk estimation method; anaesthetic risk is estimated using the American Society of Anesthesiologists (ASA) risk method that has been demonstrated to be incapable of generating consistent risk assessments. The resultant matrix may be suitable for use as a template for future research, but is extremely complex and inadequately rigorous for routine use.