CC BY-NC-ND 4.0 · J Lab Physicians 2022; 14(04): 373-376
DOI: 10.1055/s-0042-1757228
Original Article

Impact of Time Delay in the Analysis of Serum Ionized Calcium, Sodium, and Potassium

Prakruti Dash
1   Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Rajlaxmi Tiwari
1   Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
2   Department of Biochemistry, Institute of Medical Sciences (IMS) and SUM Hospital, Bhubaneswar, Odisha, India
,
Saurav Nayak
1   Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
,
Manaswini Mangaraj
1   Department of Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
› Author Affiliations

Abstract

Introduction Delay in the analysis of serum electrolytes along with clot contact time can lead to difference in results significant enough to affect clinical decisions. This study was undertaken to evaluate the effect of time lag between centrifugation and analysis on levels of serum sodium, potassium, and ionized calcium in a tertiary level health care set up.

Materials and Methods In this cross-sectional study, 70 serum samples were analyzed for ionized calcium, sodium, and potassium under different conditions with respect to time lag and clot contact time. The analysis of ionized calcium was done on Eschweiler Combiline 2, a direct ion-selective electrode (ISE) analyzer. Serum sodium and potassium were analyzed on fully automated chemistry analyzer, which is an indirect ISE analyzer. The statistical analysis was done in IBM SPSS software version 21.

Results The results for intergroup comparison with different time lag and clot contact time between all the four groups for sodium, potassium, and ionized calcium were statistically significant, as obtained by application of Kruskal–Wallis test. There was consistent decrease in the concentration of sodium and ionized calcium, and an increase in serum potassium with increased delay in analysis and clot contact time.

Conclusion The accurate measurement of electrolytes is of paramount importance for the treatment and better prognosis of critically ill patients. This can be accomplished by better management of the preanalytical phase of analysis by maintaining a standard protocol in the laboratory and sample transportation.

Ethical Approval

The study has been approved by the Institutional Ethics Committee, AIIMS, Bhubaneswar (T/IM-NF/Biochem/18/04).


Authors' Contributions

P.D. and R.T. were responsible for substantial contributions to the conception and design of the work, case selection, sample collection, analysis, storage, and interpretation of data along with patient interaction and consent taking. S.N. was instrumental in statistical analysis of the data and their correct interpretation. M.M. was meticulously involved in the drafting of the work, revising it critically for important intellectual content, and final approval of the version to be published.




Publication History

Article published online:
20 October 2022

© 2022. The Indian Association of Laboratory Physicians. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Baruah A, Goyal P, Sinha S, Ramesh KL, Datta R. Delay in specimen processing-major source of preanalytical variation in serum electrolytes. J Clin Diagn Res 2014; 8 (12) CC01-CC03
  • 2 Plebani M. Errors in clinical laboratories or errors in laboratory medicine?. Clin Chem Lab Med 2006; 44 (06) 750-759
  • 3 Hedayati M, Razavi SA, Boroomand S, Kheradmand Kia S. The impact of pre-analytical variations on biochemical analytes stability: a systematic review. J Clin Lab Anal 2020; 34 (12) e23551
  • 4 Hamroun A, Pekar JD, Lionet A. et al. Ionized calcium: analytical challenges and clinical relevance. J Lab Precis Med 2020; 5: 22
  • 5 Selvakumar C, Madhubala V. Effect of sample storage and time delay (delayed processing) on analysis of common clinical biochemical parameters. Int J Clin Biochem Res 2017; 4 (03) 295-298
  • 6 Kalasker V, Sudhamadhuri A. Effect of serum clot contact time as a major source of preanalytical variation in serum electrolytes international. J Res Health Sci 2015; 3 (02) 278-281
  • 7 Donnelly JG, Soldin SJ, Nealon DA, Hicks JM. Stability of twenty-five analytes in human serum at 22 degrees C, 4 degrees C, and -20 degrees C. Pediatr Pathol Lab Med 1995; 15 (06) 869-874
  • 8 Killilea DW, Rohner F, Ghosh S. et al. Identification of a hemolysis threshold that increases plasma and serum zinc concentration. [published correction appears in J Nutr 2021 Jun 1;151(6):1675] J Nutr 2017; 147 (06) 1218-1225
  • 9 Ranjitkar P, Greene DN, Baird GS, Hoofnagle AN, Mathias PC. Establishing evidence-based thresholds and laboratory practices to reduce inappropriate treatment of pseudohyperkalemia. Clin Biochem 2017; 50 (12) 663-669 . PMID: 28288853
  • 10 Zhang DJ, Elswick RK, Miller WG, Bailey JL. Effect of serum-clot contact time on clinical chemistry laboratory results. Clin Chem 1998; 44 (6 Pt 1): 1325-1333
  • 11 Kachhawa K, Kachhawa P, Varma M, Behera R, Agrawal D, Kumar S. Study of the stability of various biochemical analytes in samples stored at different predefined storage conditions at an accredited laboratory of India. J Lab Physicians 2017; 9 (01) 11-15
  • 12 Dimeski G, Treacy O. The influence of albumin and pH on total and ionized calcium and magnesium. Point Care 2018; 17: 123-126
  • 13 Boink AB, Buckley BM, Christiansen TF. et al. IFCC recommendation on sampling, transport and storage for the determination of the concentration of ionized calcium in whole blood, plasma and serum. J Automat Chem 1991; 13 (05) 235-239
  • 14 Bazydlo LAL, Needham M, Harris NS. Calcium, magnesium, and phosphate. Lab Med 2014; 45: e44-e50
  • 15 Perović A, Njire Bratičević M. Time-dependent variation of ionized calcium in serum samples. Biochem Med (Zagreb) 2019; 29 (03) 030708