Home Medicine Patient hydration: a major source of laboratory uncertainty
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Patient hydration: a major source of laboratory uncertainty

  • Robert F. Ritchie , Thomas B. Ledue and Wendy Y. Craig
Published/Copyright: February 1, 2007
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Volume 45 Issue 2

Abstract

Movement of body water from compartment to compartment during any time period is attributable to forces active within and upon each space. The result of these forces leads to transfer of water between intravascular and extravascular compartments, as well as shifts between extracellular and intracellular spaces. The importance of these shifts and of the associated mechanism was described by Ernest Starling in 1896 in very much the same manner as it is viewed today. The end result of fluid transfer and its physiological and laboratory consequences has not been fully appreciated. Despite awareness that fluid shifts can affect laboratory analytical results, little recent investigation has addressed the problem in the routine clinical laboratory. Thus, the potential for significant misinterpretation remains. For example, it is known that individual laboratory test values can vary widely, depending on many factors including the subject's posture during and immediately before phlebotomy, leading to significant changes in the interpretation of blood analyte values. Furthermore, a variety of ubiquitous environmental effects have additional impact on fluid distribution and thus on test values. In other words, patient hydration status is a major pre-analytical variable that needs to be addressed by the clinical laboratory.

The need to adjust data for patient hydration status is especially important in the case of colloid analytes for which the dynamic range includes a narrow “gray zone” where hydration changes of a few percentage points can change the clinical implications. The crucial importance of this adjustment is underscored by the fact that neither the testing laboratory nor the clinician are aware of this unseen circumstance and are thus compelled to work with data that do not necessarily reflect the clinical situation.

Clin Chem Lab Med 2007;45:158–66.

Keywords: clinical interpretation; osmolality; patient hydration; serum protein; Starling's hypothesis
:
Corresponding author: Robert F. Ritchie, Foundation for Blood Research, 8 Science Park Road, P.O. Box 190, Scarborough, ME 04070-0190, USA Phone: +1-207-883-4131, Fax: +1-207-885-0807,

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Published Online: 2007-02-01
Published in Print: 2007-02-01

©2007 by Walter de Gruyter Berlin New York

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  2. Hyperhomocysteinemia and cardiovascular risk in postmenopausal women: the role of folate supplementation
  3. Association of vitamin B12, folate and homocysteine with functional and pathological characteristics of the elderly in a mountainous village in Sicily
  4. Association of thyroid dysfunction with vitamin B12, folate and plasma homocysteine levels in the elderly: a population-based study in Sicily
  5. Desmond (Des) Kenny MSc MCB FICI FRCPath Eur Clin Chem, 1941–2006
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https://doi.org/10.1515/CCLM.2007.052
Keywords for this article
clinical interpretation; osmolality; patient hydration; serum protein; Starling's hypothesis

Articles in the same Issue

  1. Associations between folate, vitamin B12, homocysteine and pathologies related to aging: the need to consider complex nutrient-nutrient and gene-nutrient interactions and the functional and socio-economic determinants in population-based studies
  2. Hyperhomocysteinemia and cardiovascular risk in postmenopausal women: the role of folate supplementation
  3. Association of vitamin B12, folate and homocysteine with functional and pathological characteristics of the elderly in a mountainous village in Sicily
  4. Association of thyroid dysfunction with vitamin B12, folate and plasma homocysteine levels in the elderly: a population-based study in Sicily
  5. Desmond (Des) Kenny MSc MCB FICI FRCPath Eur Clin Chem, 1941–2006
  6. Antibodies to citrullinated peptides: a significant step forward in the early diagnosis of rheumatoid arthritis
  7. Patient hydration: a major source of laboratory uncertainty
  8. Determination of the hepatitis C virus subtype: comparison of sequencing and reverse hybridization assays
  9. Quantification of relative changes in specific mRNAs from frozen whole blood – methodological considerations and clinical implications
  10. HER-2 protein concentrations in breast cancer cells increase before immunohistochemical and fluorescence in situ hybridization analysis turn positive
  11. Distinct alleles of mannose-binding lectin (MBL) and surfactant proteins A (SP-A) in patients with chronic cavitary pulmonary aspergillosis and allergic bronchopulmonary aspergillosis
  12. Novel molecular defect in the platelet ADP receptor P2Y12 of a patient with haemorrhagic diathesis
  13. Retrospective study of monoclonal gammopathies detected in the clinical laboratory of a Spanish healthcare district: 14-year series
  14. Renal impairment compromises the use of total homocysteine and methylmalonic acid but not total vitamin B12 and holotranscobalamin in screening for vitamin B12 deficiency in the aged
  15. Diagnostic value of calculated testosterone indices in the assessment of polycystic ovary syndrome
  16. Amniotic fibronectin fragmentation and expression of its domains, sialyl and fucosyl glycotopes associated with pregnancy complicated by intrauterine infection
  17. Predicted influence of sample hematocrit on injected mass of internal standard in mass spectrometry assays utilizing simple protein precipitation for sample preparation
  18. Evaluation of cardiovascular risk factors and related clinical markers in healthy young Japanese adults
  19. Cardiac natriuretic peptides after myocardial infarction: relationship with infarct size, left ventricular function and remodelling assessed by 99mTc-sestamibi gated-single photon emission tomography
  20. Plasma homocysteine cutoff values for venous thrombosis
  21. Lipid transfer protein activities in subjects with impaired glucose tolerance
  22. Heat shock protein 70-1 gene expression in pediatric heart surgery using blood cardioplegia
  23. Biochemical reference intervals for sex hormones with a new AutoDelfia method in aged men
  24. The Italian External Quality Control Programme for cystic fibrosis molecular diagnosis: 4 years of activity
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