Point of Care Testing of Serum Electrolytes and Lactate in Sick Children

Aashima Dabas; Shipra Agrawal; Vernika Tyagi; Shikha Sharma; Vandana Rastogi; Urmila Jhamb; Pradeep Kumar Dabla

Point of Care Testing of Serum Electrolytes and Lactate in Sick Children

EJIFCC. 2021 Jun 29;32(2):158-166. eCollection 2021 Jun.

Authors

Aashima Dabas¹, Shipra Agrawal¹, Vernika Tyagi¹, Shikha Sharma², Vandana Rastogi³, Urmila Jhamb¹, Pradeep Kumar Dabla⁴

Affiliations

¹ Department of Pediatrics, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi, India.
² Department of Biochemistry, Chacha Nehru Bal Chikitsalya, New Delhi, India.
³ Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India.
⁴ Department of Biochemistry, Govind Ballabh Pant Institute of Postgraduate Education and Research, New Delhi, India.

PMID: 34421484
PMCID: PMC8343055

Abstract

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.

Keywords: abnormal electrolytes; hyperlactatemia; point of care testing; potassium; sodium.