A Comparative Study on Reliability of Point of Care Sodium and Potassium Estimation in a Pediatric Intensive Care Unit
Abstract
Objective To compare sodium and potassium levels in children as done with Blood Gas Analyzer (BGA) at point of care testing in pediatric ICU vs. that done in laboratory electrolyte analyzer. Methods This prospective method comparison study was done from February to April 2012 in Pediatric ICU of tertiary care hospital at Delhi. Sixty consecutive patients were tested during the period. Paired blood samples for venous blood gas to be tested on BGA and serum electrolytes to be tested on auto-analyzers (AA) were taken as per standard technique. Data was collected and 59 paired samples were analyzed for sodium and potassium levels. They were analyzed according to CLSI document EP15-A2 using ACB method comparison software. Results Mean sodium measured on the BGA was 132.8 ± 12.2 mmol/L where as measured by AA was 141.5 ± 11.1 mmol/L. The mean difference between the two was -8.76 mmol/L (p Conclusions Blood gas analyzers underestimates Na + and K + values if sampling is done using liquid sodium heparin and if all other potential pre-analytical errors of testing are taken care of. The Bland Altman's analysis in the present study showed a significant systematic bias and very wide limits of agreement for both sodium and potassium, which is not clinically acceptable.
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Whole-blood POCT analyzers tend to report slightly elevated potassium levels compared to serum-based laboratory systems due to differences in sample handling and electrode sensitivity.
“This minor overestimation bias is consistent with earlier work by Chhapola et al. [3] and Jain et al. [4], who observed that whole-blood POCT analyzers tend to report slightly elevated K⁺ levels compared to serum-based lab systems due to differences in sample handling and electrode sensitivity.”
From Reliability of Point-of-Care Venous Blood Gas Testing for Potassium and Sodium Compared to Central Laboratory Results in Emergency Patients: A Clinical Audit (2025) · cites this paper as Chhapola et al. [3]
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References 13 · Cited by 33
- Authors
- Chhapola, V., Kanwal, S. K., Sharma, R., & Kumar, V.
- Affiliations
- Lady Hardinge Medical College (IN)
- Corresponding author
- Kanwal, Sandeep Kumar
- Venue
- The Indian Journal of Pediatrics
- Published
- 2013-02-08
- Volume
- 80
- Issue
- 9
- Pages
- 731-735
- ISSN
- 0019-5456 (ISSN-L)
- 0973-7693
- OpenAlex
- W2028707862
- Cited by
- 33
- References
- 13
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 3 · 2023: 1 · 2022: 2 · 2021: 2 · 2020: 2 · 2019: 4 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 4 · 2014: 6 · 2013: 1
- FWCI
- 2.78
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- The Indian Journal of Pediatrics (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Electrolyte and hormonal disorders
- Social Sciences › Decision Sciences › Statistics, Probability and Uncertainty › Reliability and Agreement in Measurement
- Keywords
- point-of-care testing, blood gas analyzer, sodium determination, potassium measurement, electrolyte measurement, pediatric intensive care, method comparison, pre-analytical errors, sodium heparin, hyponatremia, hypokalemia, hyperkalemia, systematic bias
- MeSH terms
- Autoanalysis, Blood Gas Analysis, Child, Humans, Hyperkalemia, Hypernatremia, Hypokalemia, Hyponatremia, Potassium, Predictive Value of Tests, Prospective Studies, Sensitivity and Specificity, Sodium, Intensive Care Units, Pediatric, Cohort Studies, Point-of-Care Systems
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