Effects of duration of capture and sample handling on critical care blood analytes in free-ranging bottlenose dolphins

René A. Varela Ocean Embassy Inc, 6433 Pinecastle Blvd, Ste 2, Orlando, FL 32809

Search for other papers by René A. Varela in
Current site
Google Scholar
PubMed
Close
 MS, VMD
,
Lori Schwacke National Oceanic and Atmospheric Administration, Center for Coastal Environmental Health and Biomolecular Research, 219 Ft Johnson Rd, Charleston, SC 29412

Search for other papers by Lori Schwacke in
Current site
Google Scholar
PubMed
Close
 PhD
,
Patricia A. Fair National Oceanic and Atmospheric Administration, Center for Coastal Environmental Health and Biomolecular Research, 219 Ft Johnson Rd, Charleston, SC 29412

Search for other papers by Patricia A. Fair in
Current site
Google Scholar
PubMed
Close
 PhD
, and
Gregory D. Bossart Division of Marine Mammal Research and Conservation, Harbor Branch Oceanographic Institution, 5600 US 1 N, Fort Pierce, FL 34946

Search for other papers by Gregory D. Bossart in
Current site
Google Scholar
PubMed
Close
 VMD, PhD

Click on author name to view affiliation information

Abstract

Objective—To determine effects of duration of capture and sample-handling procedures on blood analytes in free-ranging bottlenose dolphins.

Design—Cross-sectional study.

Animals—154 free-ranging bottlenose dolphins of various ages and both sexes.

Procedures—Blood samples were drawn from each dolphin within 10 minutes of capture and before release and analyzed by use of a portable analyzer with a single-use 8-analyte disposable cartridge. Analyte values were compared according to duration between sample acquisition and analysis (time to run [TTR]) and duration between net encirclement and sample acquisition (time to bleed [TTB]).

Results—Neither TTB nor TTR significantly affected sodium or chloride concentration. Potassium concentration was not significantly affected by TTR, whereas the effect of TTB was significant. Glucose, total CO2, HCO3, Hct, and base excess of extracellular fluid values were significantly affected by TTR. Increased TTB resulted in significantly increased total CO2, HCO3, and base excess when TTR was kept within 10 minutes.

Conclusions and Clinical Relevance—The effect of TTB on certain acid-base and electrolyte values was readily measured in free-ranging bottlenose dolphins, and such values may provide a reference range for those variables.

Abstract

Objective—To determine effects of duration of capture and sample-handling procedures on blood analytes in free-ranging bottlenose dolphins.

Design—Cross-sectional study.

Animals—154 free-ranging bottlenose dolphins of various ages and both sexes.

Procedures—Blood samples were drawn from each dolphin within 10 minutes of capture and before release and analyzed by use of a portable analyzer with a single-use 8-analyte disposable cartridge. Analyte values were compared according to duration between sample acquisition and analysis (time to run [TTR]) and duration between net encirclement and sample acquisition (time to bleed [TTB]).

Results—Neither TTB nor TTR significantly affected sodium or chloride concentration. Potassium concentration was not significantly affected by TTR, whereas the effect of TTB was significant. Glucose, total CO2, HCO3, Hct, and base excess of extracellular fluid values were significantly affected by TTR. Increased TTB resulted in significantly increased total CO2, HCO3, and base excess when TTR was kept within 10 minutes.

Conclusions and Clinical Relevance—The effect of TTB on certain acid-base and electrolyte values was readily measured in free-ranging bottlenose dolphins, and such values may provide a reference range for those variables.

Bottlenose dolphins (Tursiops truncatus) are the most commonly stranded marine mammals on the east coast of the United States. Such dolphins often have multiple diseases of various etiologies.1,2 However, respiratory distress2 is a frequent finding in live stranded dolphins and may be the result of primary causes such as morbillivirus, parasitic pulmonary migration, thoracic trauma, and bacterial or fungal pneumonia.2 Secondary causes may include cardiogenic shock, heart failure, and airway obstruction. It is imperative for the responding veterinarian to quickly assess the ventilation and physical condition of the dolphin so that appropriate management can be pursued. This information may also be vital for assessing the potential for successful rehabilitation. In many ways, an increasing interest in bottlenose dolphins has driven a desire to understand the potential effects that handling may have on these dolphins. It is logically assumed that the sudden influence of gravity on aquatic mammals held out of the water may lead to gradual detrimental changes in their ventilation capacity. However, scant definitive data exist to establish a link between ventilation impairment and time out of water in cetacean species.

A portable clinical analyzera has been used in several species with success, including humans,3–19 dogs,20,21 horses,22 and northern elephant seals.23 This system functions adequately even in nonconventional settings such as helicopter transport,6,11 outdoor endurance competitions,22 rugged backcountry settings,4 and a marine mammal rehabilitation facility23 even when used by untrained staff.3,5,7,8,10,12–17,19 The analyzer is also helpful when monitoring various disease states as well as acid-base and electrolyte imbalances.4,10,20

To evaluate use of the analyzer for critical care assessment of free-ranging bottlenose dolphins, the goals of the study reported here were to evaluate the effect of delayed sample analysis, which is often unavoidable under field conditions; to determine whether the duration between net encirclement and sample acquisition affected acid-base and electrolyte balance; and to determine a preliminary reference range for certain blood analytes.

Materials and Methods

Study sites—The study sites were located in the Indian River Lagoon, Fla, and in the estuarine waters of Charleston, SC, including the Stono River Estuary as well as Charleston Harbor and its main riverine tributaries (ie, the Ashley, Cooper, and Wando Rivers).

Dolphins—One hundred fifty-four free-ranging bottlenose dolphins were captured, examined, sampled, marked, and safely released in June (Indian River Lagoon) and August (Charleston) of 2003 and 2004. Dolphins were encircled with a net, and blood samples were collected from dolphins in the water after the dolphins were restrained by experienced handlers. Only samples from apparently healthy non-juvenile dolphins of both sexes were included in this study. Additionally, all dolphin-capture protocols were approved by the Harbor Branch Oceanographic Institution Institutional Animal Care and Use Committee.

Samples—Two blood samples per dolphin were drawn from the periarterial venous rete in the flukes. The goal was to obtain the first (postcapture) sample within 10 minutes of initial capture. The dolphin was then moved for the remainder of the clinical evaluation and sampling to a boat of sufficient size to hold the dolphin, dolphin handlers, monitoring personnel, and veterinary staff on an open deck surface. This processing boat was equipped with sufficient closed-cell foam padding to support the dolphin and staff, water buckets with sponges to maintain the dolphin in a moistened state, and an occlusive canvas shade covering to provide protection from direct sunlight. After the on-boat evaluation, dolphins were returned to the water and a second (prerelease) sample was obtained just prior to the dolphin's release. The blood-sampling site was prepared with an aseptic surgical scrub (2% chlorhexidine gluconate) and an alcohol-soaked gauze pad. A 19-gauge, 1.9-cm butterfly catheter with an attachmenta for an evacuated tube was used to collect blood samples.1

A 0.5- to 1.0-mL sample was collected into a 1.0-mL self-venting blood gas collection syringe with lyophilized heparinb directly from the butterfly catheter at the last step in the blood-sampling process. Hematologic variables were analyzed by use of a portable analyzer with a single-use 8-analyte disposable cartridge.b Manufacturer's guidelinesb for the collection system and operational processes were followed. Three to 4 drops of heparin anticoagulated blood was inserted into a single cartridge. Analytes measured were glucose, BUN, sodium, potassium, chloride, pH, and Hct. The Tco2, anion gap, hemoglobin, Pco2, HCO3, and BEecf are variables calculated by use of formulas for humans. The analyzer has only been calibrated for human erythrocytes; further analyses of Hct and hemoglobin values were not performed. Instead, Hct values were used to evaluate errors associated with sample processing only.

Times of day recorded for each dolphin included time of initial encirclement, time blood samples were taken, and time the samples were analyzed with the analyzer. For pH and Pco2 analysis, the analyzer should be used for processing blood samples within 10 minutes; for all other variables, the analyzer should be used for processing blood samples within 30 minutes.24 Duration between the sample being drawn and analyzed was referred to as the TTR. Duration from the dolphin's initial encirclement to blood sampling was referred to as TTB. The TTB was treated as a continuous timeline from the initial capture of the dolphin to either the postcapture blood sampling or the prerelease blood sampling. In this respect, the effect of time was measured from a common point of origin for both blood samples.

Statistical analysis—An LME model was used to investigate the effect of TTB and TTR on each variable. Each individual dolphin was treated as a random effect, and postcapture and prerelease measurements were treated as replicates; TTB and TTR were treated as continuous covariates. Because of the number of variables, the overall experimentwise error was controlled by use of a Bonferroni-adjusted critical value for assessing significance (a = 0.005). After fitting the LME for each variable, residuals were examined for outliers by use of normal probability plots. If the effect of a variable (TTB or TTR) was not significant, that variable was removed from the model, and the analysis was repeated with only the single remaining covariate.

Intervals for each variable in the initial postcapture blood samples were estimated according to recommendations of the International Federation of Clinical Chemistry.25–27 When the LME indicated that TTR was an important factor for a given variable, only samples processed in ≤ 10 minutes were included for that variable. A nonparametric bootstrap procedure was used to estimate the interpercentile reference limits (2.5th and 97.5th percentiles) and their associated 90% confidence interval, as described.28,29 Briefly, the original (n = 114) observations were resampled with replacement to obtain n values, and percentile estimates were computed. The resampling procedure was repeated for 1,000 iterations, and the mean percentile values and 90% confidence limits were computed from the 1,000 estimates. Prior to the estimation of the reference intervals, outliers were identified by use of the method described by Horn et al.30 Because of skewness, glucose values were log transformed prior to the determination of outliers.

Results

Effect of TTR and TTB—Only dolphins for which postcapture and prerelease samples were obtained were included in the analysis (n = 114). In addition, samples for which the TTB or TTR were not recorded were omitted from the LME analysis, which resulted in 100 samples being analyzed. For none of the parameters was substantial deviation from model assumptions observed. Median TTB was 35 minutes (range, 16 to 146 minutes) for initial postcapture blood sampling and 117 minutes (range, 41 to 239 minutes) for prerelease blood sampling. Median TTR was 10 minutes (range, < 1 to 148 minutes) for initial postcapture blood sampling and 7 minutes (range, < 1 to 75 minutes) for prerelease blood sampling.

The LME analysis indicated that neither TTB nor TTR significantly affected values for sodium or chloride (Table 1). Similarly, TTR did not significantly affect potassium (P > 0.005). The effect of TTB was significant (P = 0.001) for potassium, but the regression coefficient was extremely small (–0.0012), indicating that the magnitude of the effect would not be biologically important. Increasing TTB and TTR significantly (P = 0.001) affected glucose, TCO2, HCO3, Hct, and BEecf values. Glucose, Tco2, HCO3, and BEecf were all significantly increased with increasing TTB and significantly decreased with increasing TTR. A significant decrease in Hct was detected with increasing TTB, whereas Hct significantly increased with increasing TTR. No effect of increasing TTB was observed for BUN, and a significant (P = 0.001) increase in BUN was detected with increasing TTR.

Table 1—

Results from an LME model of the effect of TTB and TTR on blood analytes in free-ranging bottlenose dolphins.

VariableTTBTTR
Direction of effectCoefficientP value*Direction of effectCoefficientP value*
Glucose0.282< 0.001−0.288< 0.001
BUNNS0.5890.135< 0.001
SodiumNS0.821NS0.016
Potassium−0.0010.001NS0.026
ChlorideNS0.921NS0.402
TCO20.027< 0.001−0.097< 0.001
HCO30.026< 0.001−0.090< 0.001
pHNS0.089NS0.010
BEecf0.029< 0.001−0.101< 0.001
Hct−0.030< 0.0010.265< 0.001

Values of P < 0.005 indicate a significant effect.

NS = Not significant.

Initial postcapture values were graphed against the values for the same dolphin's subsequent prerelease values to determine changes attributable to increasing TTB within individuals (Figure 1). A 45° line was drawn on the graphs to better illustrate patterns of agreement. With the exception of a few outlying data points, BUN values were located along the 45° line, indicating little effect of handling time on BUN values. In contrast, data points for glucose were primarily above the line, indicating an increase in most individuals' glucose values between samples obtained early versus later. An increase in Tco2 was also detected between postcapture and subsequent prerelease samples, although the increase was detected more commonly in individuals with lower values in the initial sample. A similar pattern was detected for other blood gases. The differences in Hct values between postcapture and prerelease blood samples were more difficult to interpret because of the strong and simultaneous effect of TTR. When both blood samples were processed in 10 minutes or less (TTR ≤ 10), the Hct values were in fairly good agreement. However, if TTR for either of the samples was extended, the Hct values were erroneously increased, and correlation between the 2 samples was substantially diminished.

Figure 1—
Figure 1—

Values for 4 blood analytes in 154 free-ranging bottlenose dolphins obtained immediately after capture (postcapture) and just before release (prerelease). The 45° line indicates perfect agreement between each pair of values.

Citation: Journal of the American Veterinary Medical Association 229, 12; 10.2460/javma.229.12.1955

Given the effect of TTR on blood gas measurements, analysis was performed to examine the potential impact of not meeting the recommended processing times of ≤ 10 minutes for pH and Pco2 and ≤ 30 minutes for all other variables.24 To further investigate the effect of processing time, samples were allocated into 3 TTR groups: samples tested ≤ 10 minutes after collection, samples tested in > 10 to ≤ 20 minutes, and samples tested > 20 minutes after collection (Figure 2). A 2-factor ANOVA for Tco2 using blood-sampling group (postcapture vs prerelease) and TTR group (as described) as factors was performed. Results indicated that TTR group significantly affected Tco2 values (F test, P < 0.001). Comparison between the first versus the second groups revealed that the effect was significant (Tukey honestly significant difference test, P = 0.017). Analysis was repeated for other blood gases and yielded similar results. Because of the observed effect of TTR on glucose, BUN, CO2, HCO3, pH, and BEecf, the data set used for estimation of ranges for these variables was limited to those samples that were tested ≤ 10 minutes after blood collection (n = 128; Table 2).

Table 2—

Proposed reference ranges (2.5th to 97.5th percentile values [90% confidence intervals]) for various analytes in heparinized blood of bottlenose dolphins (n = 50 to 111 dolphins) and published values derived from serum samples.

AnalyteNo.RangePublished range1
MinimumMaximum 
Glucose (mg/dL)5378.22 (76.00–81.33)122.3 (116.7–132.0)62–139
BUN (mg/dL)5547.0 (45.0–52.4)82.3 (79.3–86.0)45–72
Sodium (mmol/L)111143 (142–145)158 (157–160)151–158
Potassium (mmol/L)1043.2 (3.2–3.3)4.2 (4.1–4.3)3.2–4.4
Chloride (mmol/L)112110.4 (109.0–112.2)124.8 (124.0–125.4)108–118
TCO2 (mmol/L)5421.5 (21.0–23.0)37.9 (35.3–39.0)NA
Anion gap (mmol/L)54−7 (–9 to –3)24 (20–26)NA
pH1087.17 (7.15–7.21)7.43 (7.42–7.44)NA
PCO2 (mm Hg)5539.2 (38.2–41.8)64.0 (61.5–68.9)NA
HCO3 (mmol/L)5420.0 (19.0–22.0)36.0 (33.6–37.0)NA

NA = Not available.

Figure 2—
Figure 2—

Mean ± SE Tco2 values in samples from free-ranging bottlenose dolphins obtained immediately after capture (circles) and just before release (squares), grouped on the basis of TTR.

Citation: Journal of the American Veterinary Medical Association 229, 12; 10.2460/javma.229.12.1955

Discussion

Electrolytes were not appreciably affected by TTB or TTR. This pattern was not surprising for sodium and chloride because both electrolytes are in highest concentration in serum, but are maintained in a fairly tight range and would not be expected to be immediately influenced by short-term stress from capture and handling. In fact, only major physiologic phenomena such as vomiting, diarrhea, dehydration, and renal failure appear to cause clinically observable changes in electrolyte values.2 Although the effect of TTB on potassium values was significant, the model coefficient was small, suggesting that the effect was not biologically important. For example, even a 1-hour increase in TTB would be expected to cause only a 0.07 mEq/L decrease in potassium value. Previous studies reveal that capture and transport stress lead to increased serum glucose concentrations in brushtail possum,31 coral trout,32 green sea turtles with green turtle fibropapillomatosis,33 snapper,34 wild bighorn sheep,35 wild beluga whales,36 and wild grizzly bears.37 In addition, stress-induced catecholamine-associated increases of serum potassium concentrations in snapper,34 wild bighorn sheep,35 wild beluga whales,36 and grizzly bears37 are described. However, in each instance, the increase was reported to be transient. Increased serum sodium and chloride concentrations are also reported in association with capture stress in snapper34 and wild grizzly bears,37 and grizzly bears also have increased BUN concentration. The analytes Tco2, HCO3, and BEecf increased significantly during handling, (ie, between the initial blood sample and the subsequent sample obtained just prior to release), which may be a direct physiologic response to decreased CO2 displacement during respiration over time. Although dolphinhandling protocols required that adequate respirations were maintained throughout the evaluation process that was performed out of the water, this finding was not surprising because the effect of gravity on these aquatic mammals is likely to be greater with increased time the dolphin remains out of the water. In all likelihood, there was a gradually increasing ventilation-perfusion mismatch because respirations remained constant, less perfused portions of the lungs received most of the inhaled gas, and the more highly perfused dependent portions of the lungs were unable to adequately exchange gases. However, validation of human-based formulas for use in marine mammals was not undertaken in this study and could play a role in the discrepancies between the blood gas measurements and the measurement of pH. It is surprising that blood pH was not appreciably altered during TTB. This counterintuitive phenomenon may represent a higher than expected buffering capacity in dolphins that stabilizes blood pH during periods of extended breath holding. Of concern is the possibility that when the respiratory rate is not adequately maintained by dolphin care staff, the ventilation-perfusion mismatch will increase dangerously and overwhelm this buffering system. Helpful remedial or preventative measures include decreasing the time out of water, regularly repositioning the dolphin, or intervening medically by providing a respiratory stimulant such as doxapram hydrochloride.c Other causes of ventilation-perfusion mismatch, however, must be ruled out prior to medical intervention. These causes include, but are not limited to, respiratory disease, cardiac disease, cardiopulmonary shock, respiratory tract obstruction, severe thoracic trauma, or CNS-mediated respiratory depression. These causes may be ruled out through the combined use of a physical examination and prudent use of the analyzer used in the study reported here.

Delay in processing samples (ie, TTR) was in many instances greater than the goal of ≤ 10 minutes. Unfortunately, the realities of a study in the field compromised the timeline of sample processing on several occasions. Results indicated that a failure to process samples in ≤ 10 minutes for pH and Pco2 analysis and 30 minutes for all other variables can effectively mask changes in blood gas values. The literature indicates that allowing blood to stand (without exposure to air) before testing allows Pco2 to increase and pH to decrease because of metabolic processes, which will cause HCO3 and Tco2 to be overestimated.24 Also, glucose values decrease in blood samples over time.24 If heparinized blood is allowed to stand before testing, potassium values will first decrease slightly, then increase over time.24 The effects of increased TTR and increased TTB were in opposite directions; values increased with increased TTB and decreased with increased TTR. Further investigations are required to determine which effects predominate and realistic time frames for blood collection.

For several variables measured with the analyzer reported here, there are published serum reference values. Among these, several interesting and important findings were observed. Sodium values obtained with the present analyzer were lower than those published for free-ranging bottlenose dolphins.1 This suggested that the 7 to 9 mmol/L discrepancy in sodium values between the 2 techniques represented incomparable results.23 However, results of a previous study38 in dogs and horses indicated that there was a poor correlation between the analyzer used in our study and automated chemistry analyzers, although only heparinized blood was used in both machines. Regardless, caution should definitely be taken when comparing sodium values obtained via different instruments. As with any analyte, it is advisable to interpret laboratory values in the context of instrument- and sample-specific reference ranges.

Potassium values obtained by use of the analyzer were comparable to those previously reported for free-ranging bottlenose dolphins.1 The values obtained in our study were 0.1 to 0.3 mmol/L lower than that in the previous study. This was consistent with findings in humans, in which rupture of platelets during coagulation can increase serum potassium concentrations by 0.1 to 0.7 mmol/L.39

The chloride values obtained in the study reported here were consistently higher than those of published values for free-ranging bottlenose dolphins.1 The substantial overestimation in blood chloride concentration that resulted from use of the analyzer in this study was consistent with findings of previous studies7,12 in other species. Discrepancies in chloride values have been attributed to the narrow range of values for chloride,7 sensitivity of chloride ion–selective electrode systems to the effects of protein,12 and increased concentrations of BUN. In a study18 of humans in hemodialysis units, mild increases in BUN concentration resulted in large (> 6 mmol/L) increases in chloride values obtained with the analyzer used in the present study. As a result, the large differences in chloride concentrations observed in this study, compared with published results, were presumed to be caused by combined sample and analyzer effects.

Values obtained in the present study for BUN concentration were somewhat higher, compared with published serum values for free-ranging bottlenose dolphins.1 This discrepancy is consistent with findings in humans14 regarding analysis with the instrument used in our study. In the present study, differences from those of the published literature were small, apparently consistent, and unlikely to be of clinical importance.

The glucose values obtained in this study were well within the published serum ranges for free-ranging bottlenose dolphins (Table 2).1 The published serum range extends further on the lower end, likely as a result of technique differences. An important difference between techniques was that the heparinized blood samples were processed within 10 minutes, whereas the serum samples were obtained by first allowing coagulation to occur over a 20- to 40-minute period, prior to harvesting the serum. This longer period, during which serum is exposed to the glycolytic activity of blood cells, can result in falsely lowered serum glucose concentrations.1

An important source of potential variation, the duration between sample collection and processing (TTR), was evaluated in this study. Time to run was a major confounder, with strong potential to affect blood variables for a given dolphin. Given this potential source of error, every effort should be made to adhere to the manufacturer's recommendation of sample processing within 10 minutes of obtaining the sample. When TTR was included as a covariate in the statistical model to control for delay in processing of some samples, a clear effect on blood analytes was observed in association with the duration of dolphin handling. Nevertheless, results provided preliminary range values for the examined variables in bottlenose dolphins, as determined by use of the instruments and methodology used here.

The point-of-care blood analyzer used in this study was easily portable and dependable and offered an additional diagnostic modality for use by marine mammal practitioners. Its use may substantially improve real-time monitoring of cetaceans in captive care facilities or field stranding conditions.

ABBREVIATIONS

BEecf

Base excess of extracellular fluid

TTR

Time to run

TTB

Time to bleed

LME

Linear mixed effects

Tco2

Total blood CO2

a.

Becton-Dickinson, Franklin Lakes, NJ.

b.

Heska Corp, Fort Collins, Colo.

c.

Dopram-V, Fort Dodge Animal Health, Kansas City, Mo.

References

  • 1.

    Bossart GD, Reidarson TH, Dierauf LA, et al. Clinical pathology. In: Gulland FM, Dierauf LA, eds. CRC handbook of marine mammal medicine. 2nd ed. Washington, DC: CRC Press, 2001;383436.

    • Search Google Scholar
    • Export Citation
  • 2.

    Bossart G, Meisner R, Varela R, et al. Pathologic findings in stranded Atlantic bottlenose dolphins (Tursiops truncatus) from the Indian River Lagoon, Florida. Fla Scientist 2003;66:226238.

    • Search Google Scholar
    • Export Citation
  • 3.

    Adams DA, Buus-Frank M. Point-of-care technology: the i-STAT system for bedside blood analysis. J Pediatr Nurs 1995;10:194198.

  • 4.

    Backer HD, Collins S. Use of a handheld, battery-operated chemistry analyzer for evaluation of heat-related symptoms in the backcountry of Grand Canyon National Park: a brief report. Ann Emerg Med 1999;33:418422.

    • Search Google Scholar
    • Export Citation
  • 5.

    Bingham D, Kendall J, Clancy M. The portable laboratory: an evaluation of the accuracy and reproducibility of i-STAT. Ann Clin Biochem 1999;36:6671.

    • Search Google Scholar
    • Export Citation
  • 6.

    Burritt MF, Santrach PJ, Hankins DG, et al. Evaluation of the i-STAT portable clinical analyzer for use in a helicopter. Scand J Clin Lab Invest 1996;56:121128.

    • Search Google Scholar
    • Export Citation
  • 7.

    Erickson KA, Wilding P. Evaluation of a novel point-of-care system, the i-STAT portable clinical analyzer. Clin Chem 1993;39:283287.

  • 8.

    Gault MH, Harding CE. Evaluation of i-STAT portable clinical analyzer in a hemodialysis unit. Clin Biochem 1996;29:117124.

  • 9.

    Gray TE, Pratt MC, Cusick PK. Determination of agreement between laboratory instruments. Contemp Top Lab Anim Sci 1999;38:5659.

  • 10.

    Green RP, Landt M. Home sodium monitoring in patients with diabetes insipidus. J Pediatr 2002;141:618624.

  • 11.

    Herr DM, Newton NC, Santrach PJ, et al. Airborne and rescue point-of-care testing. Am J Clin Pathol 1995;104:S54S58.

  • 12.

    Jacobs E, Vadasdi E, Sarkozi L, et al. Analytical evaluation of i-STAT portable clinical analyzer and use by nonlaboratory healthcare professionals. Clin Chem 1993;39:10691074.

    • Search Google Scholar
    • Export Citation
  • 13.

    Mock T, Morrison D, Yatscoff R. Evaluation of the i-STAT system: a portable chemistry analyzer for the measurement of sodium, potassium, chloride, urea, glucose, and hematocrit. Clin Biochem 1995;28:187192.

    • Search Google Scholar
    • Export Citation
  • 14.

    Murthy JN, Hicks JM, Soldin SJ. Evaluation of i-STAT portable clinical analyzer in a neonatal and pediatric intensive care unit. Clin Biochem 1997;30:385389.

    • Search Google Scholar
    • Export Citation
  • 15.

    Ng VL, Kraemer R, Hogan C, et al. The rise and fall of i-STAT point-of-care blood gas testing in an acute care hospital. Am J Clin Pathol 2000;114:128138.

    • Search Google Scholar
    • Export Citation
  • 16.

    Papadea C, Foster J, Grant S, et al. Evaluation of the i-STAT portable clinical analyzer for point-of-care blood testing in the intensive care units of a university children's hospital. Ann Clin Lab Sci 2002;32:231243.

    • Search Google Scholar
    • Export Citation
  • 17.

    Pidetcha P, Ornvichian S, Chalachiva S. Accuracy and precision of the i-STAT portable clinical analyzer: an analytical point of view. J Med Assoc Thai 2000;83:445450.

    • Search Google Scholar
    • Export Citation
  • 18.

    Pinckard JK, Zahn J, Ashby L, et al. Falsely increased i-STAT chloride results for blood samples with increased urea. Clin Chem 2001;47:20642066.

    • Search Google Scholar
    • Export Citation
  • 19.

    Sediame S, Zerah-Lancner F, d'Ortho MP, et al. Accuracy of the i-STAT bedside blood gas analyzer. Eur Respir J 1999;14:214217.

  • 20.

    Ozaki J, Tanimoto N, Kuse H, et al. Comparison of arterial blood gases and acid-base balance in young and aged Beagle dogs, with regard to postprandial alkaline tide. J Toxicol Sci 2000;25:205211.

    • Search Google Scholar
    • Export Citation
  • 21.

    Verwaerde P, Malet C, Lagente M, et al. The accuracy of the i-STAT portable analyzer for measuring blood gases and pH in wholeblood samples from dogs. Res Vet Sci 2002;73:7175.

    • Search Google Scholar
    • Export Citation
  • 22.

    Silverman SC, Birks EK. Evaluation of the i-STAT hand-held chemical analyzer during treadmill and endurance exercise. Equine Vet J Suppl 2002;34:551554.

    • Search Google Scholar
    • Export Citation
  • 23.

    Larsen RS, Haulena M, Grindem CB, et al. Blood values of juvenile northern elephant seals (Mirounga angustirostris) obtained using a portable clinical analyzer. Vet Clin Pathol 2002;31:106110.

    • Search Google Scholar
    • Export Citation
  • 24.

    Abbott point-of-care i-STAT Web site. Cartridge and test information sheets. Available at: www.i-stat.com/products/ctisheets/. Accessed May 14, 2006.

    • Search Google Scholar
    • Export Citation
  • 25.

    Solberg HE. International Federation of Clinical Chemistry (IFCC), Scientific Committee, Clinical Section, Expert Panel on Theory of Reference Values, and International Committee for Standardization in Haematology (ICSH), Standing Committee on Reference Values. Approved Recommendation (1986) on the theory of reference values. Part 5. Statistical treatment of collected reference values. Determination of reference limits. J Clin Chem Clin Biochem 1987;25:645656.

    • Search Google Scholar
    • Export Citation
  • 26.

    Solberg HE. The IFCC recommendation on estimation of reference intervals. The RefVal program. Clin Chem Lab Med 2004;42:710714.

  • 27.

    Solberg HE, Lahti A. Detection of outliers in reference distributions: performance of Horn's algorithm. Clin Chem 2005;51:23262332.

  • 28.

    Linnet K. Nonparametric estimation of reference intervals by simple and bootstrap-based procedures. Clin Chem 2000;46:867869.

  • 29.

    Lahti A, Petersen P, Boyd J, et al. Partitioning of nongaussian-distributed biochemical reference data into subgroups. Clin Chem 2004;50:891900.

    • Search Google Scholar
    • Export Citation
  • 30.

    Horn PS, Feng L, Li Y, et al. Effect of outliers and nonhealthy individuals on reference interval estimation. Clin Chem 2001;47:21372145.

    • Search Google Scholar
    • Export Citation
  • 31.

    Presidente PJA, Correa J. Haematology, plasma electrolytes and serum biochemical values of Trichosurus vulpecula (Kerr) (Marsupialia: Phalangeridae). Aust J Zool 1981;29:507517.

    • Search Google Scholar
    • Export Citation
  • 32.

    Frisch AJ, Anderson TA. The response of coral trout (Plectropomus leopardus) to capture, handling and transport and shallow water stress. Fish Physiol Biochem 2000;23:2334.

    • Search Google Scholar
    • Export Citation
  • 33.

    Swimmer JY. Biochemical responses to fibropapilloma and captivity in the green turtle. J Wildl Dis 2000;36:102110.

  • 34.

    Wells RM, McIntyre RH, Morgan AK, et al. Physiological stress responses in big gamefish after capture: observations on plasma chemistry and blood factors. Comp Biochem Physiol A 1986;84:565571.

    • Search Google Scholar
    • Export Citation
  • 35.

    Kock MD, Jessup DA, Clark RK, et al. Effects of capture on biological parameters in free-ranging bighorn sheep (Ows canadensis): evaluation of drop-net, drive-net, chemical immobilization and the net-gun. J Wildl Dis 1987;23:641651.

    • Search Google Scholar
    • Export Citation
  • 36.

    St Aubin DJ, Geraci JR. Adaptive changes in hematologic and plasma chemical constituents in captive beluga whales, Delphinapterus leucas. Can J Fish Aquat Sci 1989;46:796803.

    • Search Google Scholar
    • Export Citation
  • 37.

    Cattet M, Christison K, Caulkett N, et al. Physiologic responses of grizzly bears to different methods of capture. J Wildl Dis 2003;39:649654.

    • Search Google Scholar
    • Export Citation
  • 38.

    Looney AL, Ludders J, Erb HN, et al. Use of a handheld device for analysis of blood electrolyte concentrations and blood gas partial pressures in dogs and horses. J Am Vet Med Assoc 1998;213:526530.

    • Search Google Scholar
    • Export Citation
  • 39.

    Tietz NP, Pruden EL, Siggaard-Andersen O. Electrolytes. In: Burtis CA, Ashwood ER, eds. Tietz fundamentals of clinical chemistry. 4th ed. Philadelphia: WB Saunders Co, 1996;497505.

    • Search Google Scholar
    • Export Citation
All Time Past Year Past 30 Days
Abstract Views 43 0 0
Full Text Views 664 652 97
PDF Downloads 50 41 6
Advertisement