The effects of intravenous administration of potassium phosphate in the treatment of diabetic ketoacidosis were studied in nine children, ages 9 9/12 to 17 10/12 yr. During phosphate infusion (20--40 meq/L of fluid), all children maintained normal serum concentrations of phosphorus. Transient hypocalcemia occurred in six and transient hypomagnesemia in five patients. One child developed carpopedal spasms refractory to intravenous infusion of calcium gluconate but responsive to intramuscular injection of magnesium sulfate. In three patients, serum levels of intact parathyroid hormone were low at the time of hypocalcemia, an observation that suggests transient hypoparathyroidism. This study indicates that the use of potassium phosphate as the sole source of potassium replacement might potentiate ketoacidosis-induced hypocalcemia through multiple mechanisms.

Adolescent↗

PubMedDate not supplied

Transition in quality: from quality assurance to strategic quality management.

The 1990s and beyond present formidable challenges to health-care providers, including clinical laboratories and pathology departments. However, numerous opportunities lie within these challenges. Discovering these opportunities and exploiting them will be critical success factors for future survival. Quality assurance, continuous quality improvement, and strategic and financial planning are all activities used to a varying extent by clinical laboratories. The cumulative potential benefits to an organization in which these activities are integrated can far exceed their sum as individual components. Coordinating these interdependent processes is the basis for managing strategically. The experience of one organization's efforts to plan and develop such a strategy is presented and discussed.

Budgets↗

PubMedDate not supplied

Parathyroid hormone: radioimmunoassay and clinical interpretation.

A radioimmunoassay for serum immunoreactive parathyroid hormone (iPTH), which has had widespread clinical use for five years, is described in detail. The iPTH results in large groups of patients are reported, and are discussed in relation to the specificity of the assay and in relation to other assays. The assay has excellent precision and is highly proficient in discrimination of groups of patients. Ninety-three percent of 412 patients with surgically proven primary hyperparathyroidism were confidently separated from normal subjects or patients with hypercalcemia owing to other causes, while 86 percent of 160 patients with chronic renal failure and secondary hyperparathyroidism had iPTH values more than 2 S.D. above the normal mean. Results in patients with ectopic hyperparathyroidism were lower than in primary hyperparathyroidism although these groups showed considerable overlap. The antiserum used in this assay for iPTH appears to be specific for the carboxy-terminal region of the secreted or intact form of PTH but recognizes predominantly the secreted form rather than carboxy-terminal fragments believed to be in the circulation. It does not recognize amino terminal fragments. The assay is useful in selective venous catheterization for preoperative localization of hyperfunctioning parathyroid tissue.

Adult↗

PubMedDate not supplied

Radioimmunoassay for intact and carboxyl-terminal parathyroid hormone: clinical interpretation and diagnostic significance.

The phenomenal growth in our knowledge of parathyroid hormone (PTH) physiology, chemistry and radioimmunoassay in the past 15 years has produced a significant increase in the use of the assay in the clinical laboratory evaluation of patients with disorders of calcium homeostasis. Recent experience with assays that have specificities for different regions of the amino acid sequence of the hormone and that can thus measure different portions of the total immunoreactivity in blood suggests that there may be different clinical applications for such assays. This report describes two different radioimmunoassay procedures and the clinical experience with each and suggests how each assay may be utilized in clinical evaluation of possible parathyroid dysfunction. The assay for carboxyl-terminal PTH is more useful in the differential diagnosis of the possible causes of hypercalcemia, the intact PTH assay is preferred in selective venous catheterization for preoperative localization of hyperfunctioning tissues, and both assays have usefulness in the evaluation of patients with hypocalcemia. In chronic renal failure, the considerations are more complex. In many patients, the intact PTH assay is preferred for monitoring the clinical course; however, in other patients the carboxyl-terminal PTH assay has been more useful. The best assay for each patient must be determined by initial evaluation with both assays.

Calcium↗

PubMedDate not supplied

Measurement of digoxin by radioimmunoassay.

A sensitive, specific and precise procedure for the measurement of digoxin by radioimmunoassay is presented. The method is rapid, convenient and highly reliable for this very important measurement. Studies designed to evaluate the validity and reproducibility of the assay are presented and discussed.

Adult↗