Point of care testing provides an accurate measurement of creatinine, anion gap, and osmolal gap in ex-vivo whole blood samples with nitromethane.

Abstract

CONTEXT:

Nitromethane interferes with Jaffé measurements of creatinine, potentially mimicking acute kidney injury.

OBJECTIVES:

We determined the proportional contribution of nitromethane in blood samples to creatinine measured by the Jaffé colorimetric and the point-of-care (POC) reactions and determined whether the difference can reliably estimate the concentration of nitromethane. Additionally, we determined whether the presence of nitromethane interferes with anion/osmolal gaps and ascertained the stability of nitromethane in serum after 7 days.

METHODS:

Nitromethane was added to whole blood from four healthy volunteers to achieve concentrations of 0, 0.25, 0.5, 1, and 2 mmol/L. The following tests were performed: creatinine (Jaffé and POC), electrolytes (associated with Jaffé and POC), osmolality and nitromethane concentration (gas chromatography [GC]). Remaining samples were refrigerated and reanalyzed using GC at 7 days. Anion and osmolal gaps were calculated. Proportional recovery and degradation of nitromethane were measured using GC. Data were analyzed for agreement with single-factor ANOVA (p = 0.05).

RESULTS:

Mean creatinine for POC and Jaff methods were 0.93 vs. 0.76 mg/dL, respectively. Jaff creatinine concentrations increased linearly with increasing nitromethane concentrations (R(2) = 1, p = 0.01): measured creatinine (mg/dL) = 7.1*nitromethane (mmol/L) = 0.79. POC creatinine remained unchanged across the range of nitromethane concentrations (p = 0.99). Anion and osmolal gaps also remained unchanged. Nitromethane was reliably identified in all sample concentrations using GC on Day 0. Detection of 0.25 mmol/L nitromethane was not consistently recovered on Day 7. Nitromethane degradation was most pronounced at 2 mmol/L concentrations (81% recovery).

CONCLUSIONS:

Nitromethane alters apparent concentration of creatinine using the Jaffé reaction in a linear fashion but not when using the POC reaction. Measured difference between Jaffé and POC creatinine may identify the presence and estimate concentration of nitromethane. Presence of nitromethane did not alter the anion or osmolal gap; thus it would not potentially interfere with the diagnosis of co-exposure to a toxic alcohol.

• Authors: D Cao, S Maynard, A M Mitchell, W P Kerns 2nd, M Beuhler
• Journal: Clinical toxicology (Philadelphia, Pa.) (Clin Toxicol (Phila)) Vol. 52 Issue 6 Pg. 611-7 (Jul 2014) ISSN: 1556-9519 [Electronic] England
• PMID: 24844579 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Nitroparaffins
• Creatinine
• Methane
• nitromethane

Topics

• Acid-Base Equilibrium (drug effects)
• Adolescent
• Adult
• Chromatography, Gas
• Colorimetry
• Creatinine (blood)
• Female
• Humans
• Male
• Methane (analogs & derivatives, blood, pharmacokinetics, pharmacology)
• Nitroparaffins (blood, pharmacokinetics, pharmacology)
• Osmolar Concentration
• Point-of-Care Systems
• Young Adult