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International Journal of Nephrology
Volume 2012 (2012), Article ID 768316, 7 pages
http://dx.doi.org/10.1155/2012/768316
Clinical Study

Potential Inaccuracies in Chloride Measurements in Patients with Severe Metabolic Acidosis

1Division of Nephrology, Department of Internal Medicine, Otsu Red Cross Hospital, 1-1-35 Nagara, Shiga Otsu 520-8511, Japan
2Department of Clinical Laboratory, Otsu Red Cross Hospital, 1-1-35 Nagara, Shiga Otsu 520-8511, Japan
3Department of Cardiology, Otsu Red Cross Hospital, 1-1-35 Nagara, Shiga Otsu 520-8511, Japan

Received 19 March 2012; Accepted 17 April 2012

Academic Editor: James E. Springate

Copyright © 2012 Tetsuya Makiishi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background. To address the cause(s) of the significant differences in chloride (Cl-) concentrations between point-of-care blood gas analyzers and central laboratory analyzers. Methods. Cl- concentrations measured simultaneously by a blood gas analyzer (ABL800 FLEX) and a central laboratory analyzer (Hitachi7600) were collected in patients with severe acidemia ( p H < 7 . 2 0 ) ( 𝑛 = 3 2 ) and were examined for correlations between differences in Cl- and factors associated with the acid-base status. Cl- concentrations were measured with both analyzers for samples with different concentrations of lactate, inorganic phosphate, or bicarbonate ( H C O − 3 ). Results. The differences in Cl- concentrations were correlated with H C O − 3 concentrations ( 𝑟 = 0 . 7 2 , 𝑃 < 0 . 0 0 0 1 ) and anion gap ( 𝑟 = 0 . 6 9 , 𝑃 < 0 . 0 0 0 1 ). Only the addition of H C O − 3 proportionately increased Cl- levels measured by a Hitachi7600, but it did not affect those measured by an ABL800FLEX. Conclusion. Cl- measurements with some analyzers may be influenced by H C O − 3 concentrations, which could result in the observed discrepancies.