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Electrolytes result validation guide

The document serves as a validation guide for ensuring accurate and reliable electrolyte test results, emphasizing best practices in blood collection, pre-analytical and analytical validation, and clinical correlation. It outlines common errors, effects of prolonged tourniquet application, and provides mnemonics and patterns for recognizing electrolyte imbalances. The guide concludes with a checklist for final decision-making before reporting results.

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Francis Francisco Johane Semana
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1 views

Electrolytes result validation guide

The document serves as a validation guide for ensuring accurate and reliable electrolyte test results, emphasizing best practices in blood collection, pre-analytical and analytical validation, and clinical correlation. It outlines common errors, effects of prolonged tourniquet application, and provides mnemonics and patterns for recognizing electrolyte imbalances. The guide concludes with a checklist for final decision-making before reporting results.

Uploaded by

Francis Francisco Johane Semana
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ELECTROLYTE RESULTS

VALIDATION GUIDE

ENSURING ACCURACY, RELIABILITY, AND CLINICAL RELEVANCE


A STEP-BY-STEP APPROACH

BY SCT AKINYEMI OLUBUNMI


OBJECTIVE

• Ensure accurate and reliable electrolyte test results.


• Prevent reporting errors.
• Correlate results with patient condition before final
validation.
BLOOD COLLECTION BEST
PRACTICES
Patient Preparation:

Ensure proper hydration before sample collection (dehydration may falsely elevate Na⁺ and
Cl⁻).

Avoid excessive hand squeezing (can increase K⁺ due to hemolysis).

Venipuncture Guidelines:

Use a clean venipuncture technique to avoid hemolysis (which falsely increases K⁺).

Minimize tourniquet time (<1 min) – prolonged use can cause false increases in K⁺ and
false decreases in HCO₃⁻ due to metabolic changes.
Use Lithium Heparin (Green-top) for urgent
plasma testing.
Use Gel Separator (SST, Gold-top) for routine
serum electrolytes.
Minimize processing delays (≤2 hrs) to prevent
false K⁺ increase and HCO₃⁻ loss
. Avoid hemolysis to prevent falsely elevated K⁺
levels.
Do NOT freeze whole blood for electrolyte
testing.
3. Storage Guidelines for Electrolytes
4. Common Errors and Their Effects on Electrolyte Results
1.PRE-ANALYTICAL.VALIDATION

Check for Hemolysis:


- False ↑ K⁺ (e.g., if K⁺ = 6.5 mmol/L but no clinical signs, recheck
sample).
Confirm Sample Type:
- Plasma vs. Serum: Some instruments use different reference
values.
Handling and Processing:
- Delay in processing (>30 min) can alter results.
Tourniquet Use:
- Prolonged use can falsely elevate K⁺ and affect Na⁺ levels.
GENERAL EFFECTS OF PROLONGED
TOURNIQUET APPLICATION

Hemoconcentration: Prolonged tourniquet use (>1 minute)


increases the concentration of electrolytes due to fluid shift from
plasma into surrounding tissues.

Hemolysis: Excessive pressure or prolonged application can rupture


red blood cells, releasing intracellular potassium (K⁺) into the
plasma.

pH Changes: Hemoconcentration may lead to metabolic changes,


affecting chloride (Cl⁻) and bicarbonate (HCO₃⁻) levels.
BEST PRACTICES TO AVOID
TOURNIQUET-INDUCED ERRORS
•Apply the tourniquet for ≤1 minute. If venipuncture is
delayed, release the tourniquet for 2 minutes before
reapplying.
•Avoid excessive fist clenching, as this can further increase
potassium (K⁺) levels.
•Choose a suitable vein quickly to minimize prolonged
application.
•If hemolysis is suspected, redraw the sample using proper
technique.
Specific Effects on Electrolytes
2. ANALYTICAL VALIDATION

Quality Control (QC) and Calibration:


- Example: If QC results show K⁺ consistently 0.5
mmol/L lower than expected, recalibrate the machine.

Comparison with Previous Results:


- Example: If patient’s Na⁺ was 138 mmol/L last test and
suddenly 165 mmol/L, confirm before reporting.

Repeat Testing for Critical Values:


- Example: If K⁺ >6.5 or Na⁺ <120 mmol/L, repeat
before reporting.
3. REFERENCE RANGE COMPARISON

Electrolyte Normal Ranges:


• Sodium (Na⁺): 135–145 mmol/L
• Potassium (K⁺): 3.5–5.0 mmol/L
• Chloride (Cl⁻): 98–107 mmol/L

Example:
- If a result shows Na⁺ = 155, K⁺ = 5.6, Cl⁻ = 112 →
Consider hypernatremia and possible dehydration.
4. INTERNAL CONSISTENCY CHECK

Na⁺/K⁺ Ratio:
- Formula: Na⁺ ÷ K⁺
- Normal range: ~27:1 (25–35)
Example: - Na⁺ = 153, K⁺ = 5.4
- Ratio = 153 ÷ 5.4 = 28.3(Within range, valid result)
Chloride-Sodium Relationship:
- If Na⁺ is low, Cl⁻ should also be low. If Na⁺ = 125 but Cl⁻ = 110,
recheck sample.
ANION GAP CALCULATION

Anion Gap Calculation:


- AG = Na⁺ - (Cl⁻ + HCO₃⁻) - Example: If Na⁺ = 140, Cl⁻ =
100, HCO₃⁻ = 24 → AG = 140 - (100+24) = 16
(Normal). AG = Na⁺ - (Cl⁻ + HCO₃⁻)
Normal: 8–16 mmol/L
High (>16): Metabolic Acidosis (DKA, renal failure)
Low (<8): Hypoalbuminemia, lab error
Also check for dehydration, kidney disease, diabetes insipidus.
5. CLINICAL CORRELATION

Check if results match symptoms:

• Dehydration:** ↑ Na⁺, ↑ K⁺ (Example: Na⁺ = 155, K⁺ = 5.6 →


dehydration suspected)
• Vomiting/Diarrhea: ↓ K⁺, ↓ Cl⁻ (Example: Na⁺ = 134, K⁺ = 3.2, Cl⁻ =
92 → possible fluid loss)
• Kidney Disease: ↑ K⁺, abnormal Na⁺ (Example: K⁺ = 6.2, Na⁺ = 130
→ possible renal failure)
• Metabolic Acidosis: ↑ K⁺, ↓ HCO₃⁻ (Example: K⁺ = 5.8, HCO₃⁻ = 18
→ likely acidosis)
6. ADDITIONAL TESTING FOR
CONFIRMATION

If results are inconsistent, consider:

• Urine Electrolytes: Helps differentiate renal vs. extrarenal


causes.
• Blood Gas Analysis: Confirms acid-base status.
• Serum Osmolality: Useful in hypernatremia or
hyponatremia.
• Repeat Sample Collection: If sample handling errors are
suspected.
7. FINAL DECISION BEFORE
REPORTING

Before reporting, confirm:

Are the results physiologically possible?


Are instrument QC and calibration acceptable?
Are results consistent with patient condition?
Is repeat testing needed?

If all checks pass, results can be released.


ELECTROLYTE IMBALANCES: CAUSES
AND CLINICAL INTERPRETATION

Understanding Different Combinations of Sodium (Na⁺),


Potassium (K⁺), and Chloride (Cl⁻)
HIGH NA⁺, HIGH K⁺, HIGH CL⁻

Example:
Na⁺ = 155 mmol/L (↑)
K⁺ = 5.8 mmol/L (↑)
Cl⁻ = 112 mmol/L (↑)

Possible Causes:
• Dehydration
• Diabetes Insipidus
• Hypertonic Saline Infusion
High Na⁺, High K⁺, Normal Cl⁻

Example:
Na⁺ = 150 mmol/L (↑)
K⁺ = 5.5 mmol/L (↑)
Cl⁻ = 105 mmol/L (Normal)

Possible Causes:
• Acute Kidney Injury
• Hyperaldosteronism
• Metabolic Acidosis
HIGH NA⁺, LOW K⁺, HIGH CL⁻

Example:
Na⁺ = 148 mmol/L (↑)
K⁺ = 3.0 mmol/L (↓)
Cl⁻ = 110 mmol/L (↑)

Possible Causes:
• Cushing’s Syndrome
• Prolonged Vomiting
• Diuretic Use
LOW NA⁺, LOW K⁺, LOW CL⁻

Example:
Na⁺ = 125 mmol/L (↓)
K⁺ = 2.8 mmol/L (↓)
Cl⁻ = 95 mmol/L (↓)

Possible Causes:
• Vomiting/Diarrhea
• Diuretics
• Addison’s Disease
LOW NA⁺, HIGH K⁺, LOW CL⁻

Example:
Na⁺ = 128 mmol/L (↓)
K⁺ = 5.6 mmol/L (↑)
Cl⁻ = 95 mmol/L (↓)

Possible Causes:
• Adrenal Insufficiency
• Acidosis (DKA)
• Kidney Disease
NORMAL NA⁺, HIGH K⁺, HIGH CL⁻

Example:
Na⁺ = 140 mmol/L (Normal)
K⁺ = 6.0 mmol/L (↑)
Cl⁻ = 110 mmol/L (↑)

Possible Causes:
• Metabolic Acidosis
• Renal Tubular Acidosis
• Excess Potassium Intake
NORMAL NA⁺, LOW K⁺, HIGH CL⁻

Example:
Na⁺ = 138 mmol/L (Normal)
K⁺ = 3.0 mmol/L (↓)
Cl⁻ = 108 mmol/L (↑)

Possible Causes:
• Chronic Diarrhea
• Bartter Syndrome
• Gitelman Syndrome
HIGH NA⁺, LOW K⁺, NORMAL CL⁻

Example:
Na⁺ = 150 mmol/L (↑)
K⁺ = 2.9 mmol/L (↓)
Cl⁻ = 102 mmol/L (Normal)

Possible Causes:
• Conn’s Syndrome
• Diuretics (Thiazides)
• Laxative Abuse
FAST MEMORY TECHNIQUES FOR
ELECTROLYTE IMBALANCES

Mnemonics, Patterns, and Quick Recall Strategies


MNEMONICS FOR ELECTROLYTE
IMBALANCES
• Hypernatremia (High Na⁺) → "MODEL"
- Medications, Osmotic diuresis, Diabetes insipidus, Excessive water
loss, Low water intake
• Hyponatremia (Low Na⁺) → "NO Na+
- Na⁺ loss, Overload of fluids, Nephrotic syndrome, Addison’s,
SIADH
• Hyperkalemia (High K⁺) → "MACHINE
- Medications, Acidosis, Cellular destruction, Hypoaldosteronism,
Intake, Nephron failure, Excretion impaired
• Hypokalemia (Low K⁺) → "DITCH
- Drugs, Inadequate intake, Too much water, Cushing’s, Heavy fluid
loss
PATTERN RECOGNITION FOR
ELECTROLYTES

• High Na⁺ and High Cl⁻ → Dehydration or Hypertonic fluids


• High K⁺ with Low Na⁺ → Adrenal Insufficiency or Kidney
Failure
• Low K⁺ with High Na⁺ → Diuretics, Cushing’s,Vomiting
• All three Low (Na⁺, K⁺, Cl⁻) → Fluid Loss, Diuretics, Addison’s
Disease
VISUAL MEMORY AIDS

• Hyperkalemia (High K⁺) = Think of a cramping muscle


(neuromuscular effects)
• Hyponatremia (Low Na⁺) = Think of swollen brain cells
(causing confusion, seizures)
• Dehydration (High Na⁺, Cl⁻) = Think of a dry, cracked
desert
• Hypokalemia (Low K⁺) = Think of weakness and arrhythmias
(muscle fatigue)
PRACTICE WITH CASE SCENARIOS

Example 1:
• A dehydrated patient has Na⁺ 155, K⁺ 5.8, Cl⁻ 112 →
Hypernatremia from water loss

Example 2:
• A vomiting patient has Na⁺ 128, K⁺ 3.0, Cl⁻ 95 →
Hypokalemia from acid loss

Example 3:
• A kidney failure patient has Na⁺ 130, K⁺ 6.2, Cl⁻ 98 →
Hyperkalemia due to excretion failure

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