Published: 2019-05-24

Significance of serum electrolyte imbalance and comparison between different testing methods in patients with altered sensorium presenting to tertiary care hospital

Harjit S. Dumra, Kautuk A. Patel, Gopal Raval, Mansi Dandnaik, Amrish Patel


Background: Electrolyte disorders are common in patients in the emergency department and intensive care unit, and have been associated with increased morbidity and mortality. In this respect sodium and potassium are the most important cations, whose improper adjustment may cause severe neuromuscular disorders. This study was designed to compare values obtained by laboratory and point-of-care testing and also to find most frequent electrolyte abnormalities.

Methods: Observational Study was done on 51 patients presenting to Tertiary care Hospital emergency department with altered sensorium between 1st January 2016 to 31st May 2017 fulfilling the inclusion criteria and willing for participation by giving written informed consent. Electrolytes were tested in patients with GCS 14 or less by both point of care system and in the laboratory.

Results: The distribution of mean sodium and potassium levels did not differ significantly between two techniques (P-value>0.05). The sodium and potassium levels by POC and laboratory techniques are significantly and positively correlated (P-value<0.001). The distribution of mean along with 95% CI of mean of amount of bias in the estimation of Sodium and Potassium levels by POC against Laboratory method is 3.50 [2.79-4.20] mEq/L and 0.83 [0.55-1.11] mEq/L respectively. The most common electrolyte abnormality was hyponatremia.

Conclusions: We concluded that it is advisable to do a point-of-care electrolyte in Emergency department and Intensive care unit. By use of point-of-care testing, we can identify electrolytes imbalance early in emergency department. Point-of-care electrolyte levels had a near comparable value with laboratory electrolyte levels.


Electrolyte abnormality Hyponatremia, Hyperkalaemia, Point-of-care

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Robert Ghosh. Patients presenting as emergency. In: Michael Glynn. Hutchison’s clinical methods. 23rd edition. Sounders Elsevier; 2012.

Bernat J, Wijdicks E. Coma, vegetative state, and brain death. In: Lee Goldman and Andrew Schafer. Goldman-Cecil Medicine. 25th Ed. Elsevier; 2012.

Allan H, Coma R. In: Dennis Kasper. Harrison’s principal of internal medicine. 19th Ed. McGraw Hill Education; 2012.

Howick J, Cals JW, Jones C, Price CP, Plüddemann A, Heneghan C, et al. Current and future use of point-of-care tests in primary care: an international survey in Australia, Belgium, The Netherlands, the UK and the USA. BMJ open. 2014;4(8):e005611.

Bland JM, Altman DG. Measuring agreement in method comparison studies. Statistical Methods Med Res. 1999;8(2):135-60.

Najeeb Q, Aziz R, Hamid S, Majid S, Ashraf R. Electrolyte abnormalities in patients admitted in emergency department of tertiary care institute: a cross sectional study. Age. 2014;41(19.03):11000.

Giordano M, Ciarambino T, Castellino P, Malatino L, Di Somma S, Biolo G, et al. Diseases associated with electrolyte imbalance in the ED: age-related differences. Am J Emerg Med. 2016;34(10):1923-6.

Singhi S, Dhawan A. Frequency and significance of electrolyte abnormalities in pneumonia. Indian Pediatr. 1992;29(6):735-40.

Allardet-Servent J, Lebsir M, Dubroca C, Fabrigoule M, Jordana S, Signouret T, et al. Point-of-care versus central laboratory measurements of hemoglobin, hematocrit, glucose, bicarbonate and electrolytes: a prospective observational study in critically ill patients. PloS one. 2017;12(1):e0169593.

Chacko B, Peter JV, Patole S, Fleming JJ, Selvakumar R. Electrolytes assessed by point- of-care testing-Are the values comparable with results obtained from the central laboratory? Indian journal of critical care medicine: peer-reviewed, official Pub Ind Soci Critical Care Med. 2011 Jan;15(1):24.

Morimatsu H, Rocktäschel J, Bellomo R, Uchino S, Goldsmith D, Gutteridge G. Comparison of point-of-care versus central laboratory measurement of electrolyte concentrations on calculations of the anion gap and the strong ion difference. J Ame Soci Anesthesiologists. 2003;98(5):1077-84.

Jain A, Subhan I, Joshi M. Comparison of the point-of-care blood gas analyzer versus the laboratory auto-analyzer for the measurement of electrolytes. Inter J Emerg Med. 2009;2(2):117-20.