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Objectives: To develop an isotope dilution liquid chromatography tandem mass spectrometry (LC-IDMS/MS) method for the standardization of serum creatinine., Design and Methods: Supernatants obtained by protein precipitation were injected into a LC-MS/MS. Chromatography was performed on a cation exchanger pre-column in normal phase isocratic mode. Creatinine and creatinine-D(3) were quantified using ion transitions of m/z 114-->44 and 117-->47, respectively., Results: The method was calibrated with the NIST Standard Reference Material 914a and was found to be exact in analyzing the certified reference material SRM 967 from NIST (97.1+/-0.9% and 102.1+/-0.9% of target value for levels 1 and 2, respectively) and by calculating recuperation of spiked creatinine in 10 different patient samples (103.6+/-4.1%). Intra-assay imprecision was 0.9% at both 64.6 and 354 micromol/L creatinine, while inter-assay imprecisions were 1.9% and 1.8%. Absence of ion suppression was confirmed by spiking experiments. The method was shown to be free of carryover. A good correlation was obtained between the LC-MS/MS method and a Jaffe method run on an automated analyzer (r=0.999)., Conclusions: We have developed a fast and simple method for the quantification of serum creatinine by isotope dilution tandem mass spectrometry (IDMS/MS) and we propose that this method can be used as a reference method by laboratories that wish to validate their serum creatinine automated assay., (Published by Elsevier Inc.)

Objective: To assess the stability of PO2, PCO2 and pH in fresh individual blood samples drawn in a plastic syringe with low heparin and stored at 22 degrees C or on ice in relation to various biochemical and hematological parameters of the samples., Methods: PO2, PCO2, and pH were measured at determined times in samples kept at 22 degrees C or on ice. The magnitude of change in blood-gas parameters over time for each group of samples was determined. The change in PO2 was examined according to its initial value, the oxygen content (CaO2), the hemoglobin concentration, the leukocyte and platelet counts of each sample., Results: The changes in PO2, PCO2, and pH over time were about three times lower in samples stored on ice than in the ones at 22 degrees C. Nevertheless, rapid increases in PO2 were observed for samples stored on ice with an initial PO2 between 50 and 250 mm Hg. Samples with PO2 over 250 mmHg exhibited a decrease in PO2 over time. No correlation was observed between the change in PO2 and the oxygen content, the hemoglobin concentration or the leukocyte and platelet counts for both groups of samples stored at 22 degrees C or on ice., Conclusion: PO2 in samples with an initial PO2 between 50 and 250 mm Hg stored on ice should be analyzed within 30 min. However, PCO2 and pH didn't exhibit clinically significant changes within 60 min under similar conditions. The magnitude of change in PO2 for samples kept on ice was dependent on their hemoglobin capacity for buffering oxygen, which is in converse relation with the oxygen saturation level of hemoglobin (SatHbO2). It is believed that the alteration in PO2 for samples stored on ice is produced predominantly by diffusion of oxygen through the plastic wall of the syringe, whereas it would be mainly of metabolic origin in samples at room temperature.

We examined ciprofloxacin levels in the aqueous humor, vitreous, or subretinal fluid in 40 patients undergoing cataract extraction, vitrectomy, or scleral buckling. Ciprofloxacin, 750 mg, was administered orally an average of 17 1/2 and 5 1/2 hours preoperatively. We obtained mean ciprofloxacin levels of 0.53 microgram/ml in aqueous humor, 0.51 microgram/ml in vitreous, and 0.71 microgram/ml in subretinal fluid. These vitreous levels exceed the minimum inhibitory concentration (MIC)90 of Staphylococcus epidermidis, Propionibacterium species, Pseudomonas aeruginosa, Proteus mirabilis, and Haemophilus influenzae, as well as the MIC70 of S. aureus and Bacillus cereus. Therefore, ciprofloxacin may have a role in the management and prevention of endophthalmitis.

We have developed a reproducible HPLC method to determine serum pentamidine, which demonstrates good chromatographic performance, and is sensitive enough to measure therapeutic doses. Pentamidine is first extracted from serum by passage through a C-18 extraction cartridge. Potential interfering substances are then removed by washing with 100% methanol. Pentamidine is eluted from the extraction cartridge with 1-heptanesulfonic acid. The extract is chromatographed on a highly deactivated column for basic compounds in the presence of minimal concentrations of 1-heptanesulfonic acid as the pairing agent. Detection is by fluorescence. The method can determine serum pentamidine levels in the range of 15-600 ng/mL free of interference from other drugs. In monitoring pentamidine levels in AIDS patients with Pneumocystis carinii, we found that trough serum levels over 100 ng/mL were associated with toxicity (hypoglycemia or azotemia) in 100% of patients. With levels under 100 ng/mL, signs of toxicity were observed in only 29% of the patients. We conclude that dose adjustment based on serum levels reduces the incidence of toxicity and enhances pentamidine therapy.

1. We have studied the in vitro effect of 39 drugs on 17 biochemical parameters determined by a SMAC System. Only two drugs were found to interfere: ascorbic and theophyline. 2. The ascorbic acid lowers the glucose and the bilirubine values; it increases the creatinine and the uric acid concentration. At concentration smaller than 5 mg/dl of this drug, these effects are negligible. 3. We have found a new drug interference: theophylline inhibits the alkaline phosphatase and LDH activities. This effect is not negligible on alkaline phosphatase for therapeutic levels of this drug; the action on LDH can be ignored at normal therapeutic range. 4. For a given drug, we have found different interference with biochemical parameters determined with various commercial lyophlised control sera or a liquid pool of sera. This indicates that the type of sera used in drug interference studies must be described.

The Abbott-VP Bichromatic Analyzer was used for the determination of four antiepileptic drugs (phenobarbital, phenytoin, carbamazepine, primidone) in serum by means of a modified EMIT homogeneous enzyme immunoassay procedure. The main objective of the work was to examine the precision and the accuracy of the results obtained with this system and its cost effectiveness in comparison to the manual method. Day-to-day precision for all four drugs is excellent with coefficients of variation averaging around 5% in the therapeutic range of concentrations. Results for sera analyzed by this procedure and by a gas chromatographic method do not show any significant difference for phenytoin and phenobarbital. There are however slight differences between the two methods for carbamazepine and primidone. These small differences do not modify significantly the clinical interpretation of the results. The procedure is simple and rapid, and requires only one third of the reagents needed in the recommended manual EMIT procedure using the Gilford Stasar III, thus greatly reducing the operation costs.