Joel M. Topf, MD FACP Profile picture
Saying the product of the kidneys is urine is like saying the product of a factory is pollution. Urine is a by-product. The product is homeostasis COI: link👇🏼

Apr 14, 2023, 9 tweets

Lab guy from Yale up next Joe El Khoury He is on YouTube. Episode 1 was on pseudohyponatemia
209 subscribers. Clinical Chemistry with Joe El-Khoury

Here is the YouTube channel: youtube.com/@ClinChemJoe

https://t.co/LWupt0HWN1 #NKFClinicals

Despite calling it “laboratory error”, a lot of the problem happens long before the sample gets to the lab. #NKFClinicals

75% of errors happen before sample gets to the lab! #NKFClinicals

It is almost never an analytical issue. Because these guys are careful.

Case 1/6 K was 6 and normal in ER, this happens every January. The outpatient winter K is too high. He was symptomatic. Also occurs with sister.

Familial Pseudohyperkalemia, they have fast leak in response to cooling and time.

If you spin the sample first to separate the cells from the plasma.

Case 2/6
Unexplained low CO2 in an infant
History of diarrhea
First sample 11 2 hours later it was 18.
The small ample in a big tube allows CO2 to escape resulting in artifact.

Case 3
Elevations in lactate of 10 after surgery
On antibiotics.
Not concordat with clinical picture
Routine labs and ABG

3 days and 8 doctors to figure out they were drawing the labs downstream from an LR infusion 🤦🏼‍♂️ #NKFClinicals

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