CL - 4 Art: 714175-00K Rev. Date: 12-Jul-11
Notes:
1) Acetylcysteine has been tested at two levels; the CLSI recommended level and a concentration of 0.30
mmol/L. The latter is 3 times the peak plasma therapeutic concentration associated with treatment to
reverse acetaminophen poisoning. APOC has not identified a therapeutic condition that would lead to levels
consistent with the CLSI recommended level. Acetylcysteine at a concentration of 10.2 mmol/L decreased
i-STAT chloride results, while an acetylcysteine concentration of 0.30 mmol/L did not significantly interfere
with i-STAT chloride results.
2) Bromide has been tested at two levels; the CLSI recommended level and a therapeutic plasma
concentration level of 2.5 mmol/L. The latter is the peak plasma concentration associated with halothane
anesthesia, in which bromide is released. APOC has not identified a therapeutic condition that would lead
to levels consistent with the CLSI recommended level. Bromide at a concentration of 37.5 mmol/L and 2.5
mmol/L increased i-STAT chloride results.
3) Salicylate has been shown to interfere at a concentration proscribed by the CLSI guideline, 4.34
mmol/L, which represents a toxic concentration. Salicylate at 0.5 mmol/L, which represents the upper end
of the therapeutic concentration, has been shown not to significantly interfere with i-STAT chloride results.
*It is possible that other interfering substances may be encountered. The degree of interference at concentrations other than those listed might not be
predictable.
References
1. N.W. Tietz, E.L. Pruden, O. Siggaard-Andersen, ”Electrolytes ” in Tietz Textbook of Clinical Chemistry—
Second Edition, C.A. Burtis and E.R. Ashwood, eds. (Philadelphia: W.B. Saunders Company, 1994).
2. D.S. Young, Effects of Drugs on Clinical Laboratory Tests, 3rd ed. (Washington, DC: American
Association of Clinical Chemistry, 1990).
3. B.E. Statland, Clinical Decision Levels for Lab Tests (Oradell, NJ: Medical Economic Books, 1987).
4. CLSI. Method Comparison and Bias Estimation Using Patient Samples; Approved Guideline. CLSI
document EP9-A [ISBN 1-56238-283-7]. CLSI, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania
19087-1898, USA 1995.
5. P.J. Cornbleet and N. Gochman, “Incorrect Least-Squares Regression Coefficients in Method-
Comparison Analysis,” Clinical Chemistry 25:3, 432 (1979).
6. See Reference 7.
7.
Clinical and Laboratory Standards Institute (CLSI). Interference Testing in Clinical Chemistry;
Approved Guideline-Second Edition. CLSI document EP7-A2 (ISBN 1-56238-584-4). Clinical and
Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898,
USA 2005.
8. Kharasch E.D, Hankins D., Mautz D., Thummel K.E.. Identification of the enzyme responsible for
oxidative halothane metabolism: implications for prevention of halothane hepatitis. Lancet 1996; 347:1367-
71.
9. Morrison J.E., Friesen R.H., Elevated serum bromide concentrations following repeated halothane
anaesthesia in a child. Can J Asaesth 1990; 37 (7): 801-803
10. Hankins D.C, Kharasch E.D., Determination of the halothane metabolites trifluoroacetic acid and
bromide in plasma and urine by ion chromatography. J of Chromatography B. 692 (1997) 413-418.
11. Raftos JE, Chapman B, Kuchel PW. Role of N-acetylcysteine and cystine in glutathione synthesis in
human erythrocytes. Redox Rep. 2009;14(3):115-24.
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