Architect clinical chemistry carbon dioxide reagent lot number was not provided.Evaluation of the customer issue included a review of the complaint text, a search for similar complaints, device history review, and labeling review.No adverse trend was identified for the customer issue.Device history review did not identify any issues that may have caused the customer issue.Labeling was reviewed and found to be adequate.The architect system operations manual, section 7 (operational precautions and limitations, limitations of result interpretation) states, assay results must be used with other clinical data, for example, symptoms, other test results, patient history, clinical impressions, information available from clinical evaluation, and other diagnostic procedures.All data must be considered for patient care management.If assay results are inconsistent with clinical evidence, additional testing is suggested to confirm the result.The carbon dioxide reagent package insert (interfering substance section) states that interferences from medications or endogenous substances may affect results.Based on all available information and abbott diagnostics complaint investigation, no systematic issue was identified and no product deficiency was found.Literature reference: bowman, christopher, wiencek, joesph, sussman, craig richard, adams, brad, sephel, gregory, colby, jennifer, nichols, james, woodworth, alison, vanderbilt university medical center, nashville, tn, united states pseudometabolic acidosis in patient with severe hypertriglyceridemia endocrine reviews, suppl.Supplement 1 38.3 (jun 2017) (endocrine society meetings, presentation number sat 520, date of presentation april 1, 2017).
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A literature article included falsely depressed carbon dioxide (co2) results generated using architect clinical chemistry co2 reagents.The following information was included in the article.A (b)(6) male with past medical history of type 2 diabetes mellitus, coronary artery disease (cad), and hypertriglyceridemia presented to the pre-op clinic for routine evaluation prior to carpal tunnel surgery.A basic metabolic panel (reference interval in parentheses) showed a sodium 124 mmol/l (136 to 144), potassium 4.3 mmol/l (3.3 to 4.8), chloride 92 mmol/l (98 to 107), co2 6 mmol/l (23 to 31), and glucose 392 mg/dl (70 to 99).The patient was admitted for diabetic keto-acidosis (dka) and treated with an insulin infusion and iv fluids.Urinalysis was negative for ketones, lactic acid was mildly elevated at 2.6 meq/l, and urine drug screen was negative.The lipid panel (mg/dl) showed triglycerides greater than 5680 (less than 149), hdl 17 (greater than 40), ldl 47 (1 to 129), and cholesterol 814 (0 to 199).Lipase was within the reference interval, however no specific lipase results were provided.Patient denied any nausea, vomiting, or shortness of breath.He was treated with insulin infusion, fenofibrate, fish oil, and rosuvastatin.Review of previous discharge summary for the patient showed a routine office visit with asymptomatic serum co2 less than 5 mmol/l leading to a hospital admission.He was treated for dka over 4 days and metformin was discontinued.Of note, during both admissions, his venous blood gases showed ph 7.39 to 7.43 (7.35 to 7.45) with serum bicarbonate (hco3) 24 to 26 mmol/l (21 to 28).The discordant results between serum basic metabolic panel and blood gas analysis were further investigated.The abstract authors concluded that the pseudometabolic acidosis is due to severe hypertriglyceridemia interference within the spectrophotometric method leading to falsely low co2 concentrations.
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