Matthew D Krasowski

University of Iowa, Iowa City, Iowa, United States

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Publications (113)428.67 Total impact

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    ABSTRACT: This case study over time describes five years of experience with interventions to improve laboratory test utilization at an academic medical center. The high-frequency laboratory tests showing the biggest declines in order volume post intervention were serum albumin (36%) and erythrocyte sedimentation rate (17%). Introduction of restrictions for 170 high-cost send-out tests resulted in a 23% decline in order volume. Targeted interventions reduced mis-orders involving several “look-alike” tests: 1,25-dihydroxyvitamin D, 25-hydroxyvitamin D; manganese, magnesium; beta-2-glycoprotein, beta-2-microglobulin. Lastly, targeted alerts reduced duplicate orders of germline genetic testing and orders of hepatitis B surface antigen within 2 weeks of hepatitis B vaccination. Electronic supplementary material The online version of this article (doi:10.1186/s12911-015-0137-7) contains supplementary material, which is available to authorized users.
    BMC Medical Informatics and Decision Making 12/2015; 15(1). DOI:10.1186/s12911-015-0137-7 · 1.50 Impact Factor
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    ABSTRACT: Thyroglobulin (Tg) is used as a tumor marker to monitor disease progression and recurrence of differentiated thyroid cancers. However, Tg measured by standard immunoassay (IMA) is not a reliable marker in the presence of anti-Tg antibodies (TgAbs) due to interference that may result in either false positive or false negative results. TgAbs concentrations are used to monitor for cancer recurrence thus making DTC in these cases more challenging. The levels of TgAbs can be high not only due to recurrence of thyroid cancer but also due to exogenous administration of immunoglobulins (Ig). We present an example of elevated Tg Abs due to administration of subcutaneous immunoglobulin (SCIg) in a patient with thyroid cancer. A 57 year old man was diagnosed with stage I papillary thyroid cancer (PTC). Tg Abs were negative prior to the diagnosis of thyroid cancer and became positive after thyroidectomy and radioactive iodine. A detailed work-up including whole body scan did not reveal recurrent disease. He had been diagnosed with CVID and dermatomyositis at the age of 50 and was started on immunoglobulin replacement therapy shortly after diagnosis. Tg was negative when assessed with a liquid chromatography-mass spectrometry assay (LC-MS/MS). Therefore, elevated Tg Ab titers were attributed to concomitant treatment with SCIg. We also demonstrated SCIg medication had Tg Ab activity that was removed by protein A column treatment. Dilutions of SCIg medication also caused positive IgG serologies for cytomegalovirus, herpes simplex, measles, mumps, rubella, and varicella-zoster viruses. Exogenous source of TgAbs from SCIg lead to extensive imaging work-up to assess for recurrence of PTC. LC-MS/MS is a conceptually attractive approach to overcome TgAb interference with Tg IMA measurement.
    Endocrine Practice 07/2015; DOI:10.4158/EP14533.CR · 2.59 Impact Factor
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    ABSTRACT: Clinical laboratories frequently receive orders to perform additional tests on existing specimens ('add-ons'). Previous studies have examined add-on ordering patterns over short periods of time. The objective of this study was to analyze add-on ordering patterns over an extended time period. We also analyzed the impact of a robotic specimen archival/retrieval system on add-on testing procedure and manual effort. In this retrospective study at an academic medical center, electronic health records from were searched to obtain all add-on orders that were placed in the time period of May 2, 2009 to December 31, 2014. During the time period of retrospective study, 880,359 add-on tests were ordered on 96,244 different patients. Add-on testing comprised 3.3 % of total test volumes. There were 443,411 unique ordering instances, leading to an average of 1.99 add-on tests per instance. Some patients had multiple episodes of add-on test orders at different points in time, leading to an average of 9.15 add-on tests per patient. The majority of add-on orders were for chemistry tests (78.8 % of total add-ons) with the next most frequent being hematology and coagulation tests (11.2 % of total add-ons). Inpatient orders accounted for 66.8 % of total add-on orders, while the emergency department and outpatient clinics had 14.8 % and 18.4 % of total add-on orders, respectively. The majority of add-ons were placed within 8 hours (87.3 %) and nearly all by 24 hours (96.8 %). Nearly 100 % of add-on orders within the emergency department were placed within 8 hours. The introduction of a robotic specimen archival/retrieval unit saved an average of 2.75 minutes of laboratory staff manual time per unique add-on order. This translates to 24.1 hours/day less manual effort in dealing with add-on orders. Our study reflects the previous literature in showing that add-on orders significantly impact the workload of the clinical laboratory. The majority of add-on orders are clinical chemistry tests, and most add-on orders occur within 24 hours of original specimen collection. Robotic specimen archival/retrieval units can reduce manual effort in the clinical laboratory associated with add-on orders.
    BMC Clinical Pathology 06/2015; 15(1):11. DOI:10.1186/s12907-015-0011-7
  • Stephanie L. Stauffer, Stephanie M. Wood, Matthew D. Krasowski
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    ABSTRACT: Detection of drugs in a child may be the first objective finding that can be reported in cases of suspected child abuse. Hair and urine toxicology testing, when performed as part of the initial clinical evaluation for suspected child abuse or maltreatment, may serve to facilitate the identification of at-risk children. Furthermore, significant environmental exposure to a drug (considered by law to constitute child abuse in some states) may be identified by toxicology testing of unwashed hair specimens. In order to determine the clinical utility of hair and urine toxicology testing in this population we performed a retrospective chart review on all children for whom hair toxicology testing was ordered at our academic medical center between January 2004 and April 2014. The medical records of 616 children aged 0-17.5 years were reviewed for injury history, previous medication and illicit drug use by caregiver(s), urine drug screen result (if performed), hair toxicology result, medication list, and outcome of any child abuse evaluation. Hair toxicology testing was positive for at least one compound in 106 cases (17.2%), with unexplained drugs in 82 cases (13.3%). Of these, there were 48 cases in which multiple compounds (including combination of parent drugs and/or metabolites within the same drug class) were identified in the sample of one patient. The compounds most frequently identified in the hair of our study population included cocaine, benzoylecgonine, native (unmetabolized) tetrahydrocannabinol, and methamphetamine. There were 68 instances in which a parent drug was identified in the hair without any of its potential metabolites, suggesting environmental exposure. Among the 82 cases in which hair toxicology testing was positive for unexplained drugs, a change in clinical outcome was noted in 71 cases (86.5%). Urine drug screens (UDS) were performed in 457 of the 616 reviewed cases. Of these, over 95% of positive UDS results could be explained by iatrogenic drug administration. There were no cases in which a urine drug screen alone altered the outcome of a case. In summary, hair toxicology testing proved clinically useful in the evaluation of a child for suspected abuse; in contrast, urine drug testing showed low clinical yield. Copyright © 2015 Elsevier Ltd and Faculty of Forensic and Legal Medicine. All rights reserved.
    Journal of Forensic and Legal Medicine 04/2015; 33. DOI:10.1016/j.jflm.2015.04.010 · 0.99 Impact Factor
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    ABSTRACT: Meconium drug testing is performed to detect potentially harmful drug exposures in a newborn. Interpretation of meconium drug testing results can be complicated based on the patterns and proportional concentrations of the drug(s) and/or drug metabolite(s) detected. The objective of this study was to analyze meconium drug testing patterns in a de-identified dataset from a national reference laboratory (n=76,631) and in a subset of the data, wherein specimens originated at a single academic medical center for which detailed chart review was possible (n=3,635). Meconium testing was performed using eleven immunoassay-based drug screens. Specimens that were positive for one or more drug screens were reflexed to corresponding confirmation tests performed by gas- or liquid-chromatography with mass spectrometric detection, targeted to identify and quantitate specific parent drug(s) and metabolite(s). The positivity rate was highest for the cannabis metabolite 11-nor-9-carboxy-Δ-tetrahydrocannabinol (25.2%, n=18,643), followed by opiates/oxycodone (23.2%, n=17,778), amphetamine/methamphetamine (6.7%, n=5,134), cocaine metabolites (5.5%, n=4,205), methadone (5.3%, n=4,093), benzodiazepines (3.4%, n=2,603), barbiturates (1.1%, n=834), propoxyphene (1.0%, n=749), and phencyclidine (0.1%, n=44). Based on documented pharmacy history, drugs administered to either the mother or newborn during the birth hospitalization were detected in meconium, providing evidence that drugs can be incorporated into meconium rapidly. Drugs administered directly to the newborn after birth were recovered in meconium as both parent drug and metabolites, providing evidence of neonatal metabolism. Overall, patterns observed in meconium exhibited many similarities to those patterns commonly reported with urine drug testing. Interpretation of meconium drug testing results requires comparison of results with clinical and analytical expectations, including maternal admissions to drug use, pharmacy history, recognized metabolic patterns for drugs of interest, cutoff concentrations, and other performance characteristics of the test. Concentrations of drug(s) and drug metabolites(s) may not reliably predict timing of drug use, extent of drug use, or frequency of drug exposures.
    Therapeutic Drug Monitoring 01/2015; DOI:10.1097/FTD.0000000000000181 · 1.93 Impact Factor
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    ABSTRACT: The case study is a 33-year-old white female with persistently elevated serum human chorionic gonadotropin (hCG) levels following methotrexate treatment and emergency surgery for ectopic pregnancy. At the time of the first methotrexate dose, the serum hCG concentration was 27,995 IU/L. The laboratory was consulted 3.5 months after the surgery, because serum hCG levels had stopped declining and had leveled off to around 80 to 90 IU/L but with negative urine pregnancy tests. Laboratory studies ruled out heterophile antibody interference and hook effect by multiple methods including analysis by different serum hCG assays, treatment with heterophile antibody blocking agents, and dilution studies. Three additional doses of methotrexate over six months were required for serum hCG concentrations to decline to undetectable levels. This case illustrates challenges that may arise with serum hCG measurements in management of ectopic pregnancies. Close collaboration between the laboratory and clinical service is key for optimal patient care.
    Laboratory Medicine 01/2015; 46(3):254-258. DOI:10.1309/LMTDRFGJVJIM3VNM · 0.49 Impact Factor
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    ABSTRACT: Background: Pentobarbital is used for management of intractable seizures and for reducing elevated intracranial pressure. Dosing of pentobarbital can be aided by therapeutic drug monitoring (TDM). There is no commercially available automated assay for measurement of pentobarbital serum/plasma concentrations; consequently, chromatography-based assays are often used. Methods: Pentobarbital TDM was studied over a 14 year period at an academic medical center. 154 patients (94 adult, 60 pediatric) were identified that had pentobarbital levels ordered at least once during a hospital encounter. Chart review included patient diagnosis, indication for pentobarbital therapy, recent or concomitant medication with other barbiturates, patient disposition, organ donation, pentobarbital dosing changes, and neurosurgical procedures. Pentobarbital serum/plasma concentrations were determined on an automated clinical chemistry platform with a laboratory-developed test adapted from a urine barbiturates immunoassay. Results: Chart review showed therapeutic use of pentobarbital generally consistent with previously published literature. The most common errors observed involved confusion in barbiturate names (e.g., mix-up of pentobarbital and phenobarbital in test ordering or in provider notes) that appeared to have minimal impact on TDM effectiveness, with pentobarbital serum/plasma concentrations generally within target ranges. The laboratory-developed pentobarbital immunoassay showed cross-reactivity with phenobarbital and butalbital that was eliminated by alkaline and heat pre-treatment. The immunoassay was linear to 20 [mu]g/mL and correlated closely with gas chromatography/mass spectrometry measurements at a reference laboratory. Conclusions: Pentobarbital TDM can be performed by immunoassay on an automated clinical chemistry platform, providing an alternative to chromatography-based methods. Confusion in barbiturate names are common, especially pentobarbital and phenobarbital. Copyright
    Therapeutic Drug Monitoring 01/2015; DOI:10.1097/FTD.0000000000000217 · 1.93 Impact Factor
  • Gagan Mathur, Thomas H Haugen, Scott L Davis, Matthew D Krasowski
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    ABSTRACT: Background: Interfacing of clinical laboratory instruments with the laboratory information system (LIS) via “middleware” software is increasingly common. Our clinical laboratory implemented capillary electrophoresis using a Sebia® Capillarys-2™ (Norcross, GA, USA) instrument for serum and urine protein electrophoresis. Using Data Innovations Instrument Manager, an interface was established with the LIS (Cerner) that allowed for bi-directional transmission of numeric data. However, the text of the interpretive pathology report was not properly transferred. To reduce manual effort and possibility for error in text data transfer, we developed scripts in AutoHotkey, a free, open-source macro-creation and automation software utility. Materials and Methods: Scripts were written to create macros that automated mouse and key strokes. The scripts retrieve the specimen accession number, capture user input text, and insert the text interpretation in the correct patient record in the desired format. Results: The scripts accurately and precisely transfer narrative interpretation into the LIS. Combined with bar-code reading by the electrophoresis instrument, the scripts transfer data efficiently to the correct patient record. In addition, the AutoHotKey script automated repetitive key strokes required for manual entry into the LIS, making protein electrophoresis sign-out easier to learn and faster to use by the pathology residents. Scripts allow for either preliminary verification by residents or final sign-out by the attending pathologist. Conclusions: Using the open-source AutoHotKey software, we successfully improved the transfer of text data between capillary electrophoresis software and the LIS. The use of open-source software tools should not be overlooked as tools to improve interfacing of laboratory instruments.
    09/2014; 5:36. DOI:10.4103/2153-3539.141990
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    ABSTRACT: Background The objective of this study was to identify high-yield screening risk factors for detecting maternal non-medical drug use during pregnancy. Methods A four year retrospective analysis was conducted at an academic medical center. Detailed chart review of both the newborn and mother’s medical record was performed on all cases for which one or more drug(s) or metabolite(s) were identified and confirmed in meconium or urine. Results 229 (9.2%) of 2,497 meconium samples out of 7,749 live births confirmed positive for one or more non-medical drugs. History of maternal non-medical drug and/or tobacco use in pregnancy was present in 90.8% of non-medical drug use cases. Addition of social risk factors and inadequate prenatal care increased the yield to 96.9%. Conclusions Use of focused screening criteria based on specific maternal and social risk factors may detect many prenatal non-medical drug exposures. Electronic supplementary material The online version of this article (doi:10.1186/1471-2393-14-250) contains supplementary material, which is available to authorized users.
    BMC Pregnancy and Childbirth 07/2014; 14(1):250. DOI:10.1186/1471-2393-14-250 · 2.15 Impact Factor
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    ABSTRACT: Background Immunoassays are widely used in clinical laboratories for measurement of plasma/serum concentrations of steroid hormones such as cortisol and testosterone. Immunoassays can be performed on a variety of standard clinical chemistry analyzers, thus allowing even small clinical laboratories to do analysis on-site. One limitation of steroid hormone immunoassays is interference caused by compounds with structural similarity to the target steroid of the assay. Interfering molecules include structurally related endogenous compounds and their metabolites as well as drugs such as anabolic steroids and synthetic glucocorticoids. Methods Cross-reactivity of a structurally diverse set of compounds were determined for the Roche Diagnostics Elecsys assays for cortisol, dehydroepiandrosterone (DHEA) sulfate, estradiol, progesterone, and testosterone. These data were compared and contrasted to package insert data and published cross-reactivity studies for other marketed steroid hormone immunoassays. Cross-reactivity was computationally predicted using the technique of two-dimensional molecular similarity. Results The Roche Elecsys Cortisol and Testosterone II assays showed a wider range of cross-reactivity than the DHEA sulfate, Estradiol II, and Progesterone II assays. 6-Methylprednisolone and prednisolone showed high cross-reactivity for the cortisol assay, with high likelihood of clinically significant effect for patients administered these drugs. In addition, 21-deoxycortisol likely produces clinically relevant cross-reactivity for cortisol in patients with 21-hydroxylase deficiency, while 11-deoxycortisol may produce clinically relevant cross-reactivity in 11β-hydroxylase deficiency or following metyrapone challenge. Several anabolic steroids may produce clinically significant false positives on the testosterone assay, although interpretation is limited by sparse pharmacokinetic data for some of these drugs. Norethindrone therapy may impact immunoassay measurement of testosterone in women. Using two-dimensional similarity calculations, all compounds with high cross-reactivity also showed a high degree of similarity to the target molecule of the immunoassay. Conclusions Compounds producing cross-reactivity in steroid hormone immunoassays generally have a high degree of structural similarity to the target hormone. Clinically significant interactions can occur with structurally similar drugs (e.g., prednisolone and cortisol immunoassays; methyltestosterone and testosterone immunoassays) or with endogenous compounds such as 21-deoxycortisol that can accumulate to very high concentrations in certain disease conditions. Simple similarity calculations can help triage compounds for future testing of assay cross-reactivity.
    BMC Clinical Pathology 07/2014; 14:33. DOI:10.1186/1472-6890-14-33
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    ABSTRACT: Little is published about newborn drug testing in multiple gestations. The objective of this study was to review the results of meconium drug screening in multiple births to compare drug(s) and/or drug metabolite(s) detected. A retrospective analysis was conducted using data from a national reference laboratory and an academic medical center. The data were de-identified for the reference laboratory dataset. For the academic center data, a detailed chart review of the newborn and mother's medical record was performed on cases for which one or more drug(s) and/or metabolites(s) were identified and confirmed in meconium. Meconium was analyzed for amphetamine, methamphetamine, barbiturates, benzodiazepines, cannabinoid metabolites, cocaine metabolites, methadone, opiates, oxycodone, phencyclidine and propoxyphene. One hundred and forty-two of 1,084 sets of twins and 2 of 20 sets of triplets had mismatched results. The incidence of mismatched results among the individual drug or drug classes tested was 0.9% (208 of 23,848 total results). For the panel of drug testing performed, mismatches were seen in 13% (142 of 1,084) sets of twins and 10% (2 of 20) sets of triplets. Barbiturates (33%), opiates (30%) and benzodiazepines (28%) were the most common mismatches in the national reference laboratory dataset. Benzodiazepines (89%) and opiates (51%) were most common in the academic medical center dataset with most explained by iatrogenic medications administered to one infant but not the other. Mismatches for cannabinoids most often occurred when tetrahydrocannabinol metabolites were present at a low concentration (near lower reporting limit) in one infant but not the other. Mismatched results of meconium drug testing in multiples not explainable by differences in prescribed medications are uncommon and most often occur when an analyte is barely above reporting cutoff in only one infant. Administration of iatrogenic medications to one infant but not the other(s) is another frequent cause of such mismatches.
    Journal of analytical toxicology 06/2014; 38(7). DOI:10.1093/jat/bku061 · 2.63 Impact Factor
  • Matthew D Krasowski, Gwendolyn A McMillin
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    ABSTRACT: In the past twenty-one years, 17 new antiepileptic drugs have been approved for use in the United States and/or Europe. These drugs are clobazam, ezogabine (retigabine), eslicarbazepine acetate, felbamate, gabapentin, lacosamide, lamotrigine, levetiracetam, oxcarbazepine, perampanel, pregabalin, rufinamide, stiripentol, tiagabine, topiramate, vigabatrin and zonisamide. Therapeutic drug monitoring is often used in the clinical dosing of the newer anti-epileptic drugs. The drugs with the best justifications for drug monitoring are lamotrigine, levetiracetam, oxcarbazepine, stiripentol, and zonisamide. Perampanel, stiripentol and tiagabine are strongly bound to serum proteins and are candidates for monitoring of the free drug fractions. Alternative specimens for therapeutic drug monitoring are saliva and dried blood spots. Therapeutic drug monitoring of the new antiepileptic drugs is discussed here for managing patients with epilepsy.
    Clinica Chimica Acta 06/2014; 436. DOI:10.1016/j.cca.2014.06.002 · 2.82 Impact Factor
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    Matthew D Krasowski, Sean Ekins
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    ABSTRACT: Background A challenge for drug of abuse testing is presented by ‘designer drugs’, compounds typically discovered by modifications of existing clinical drug classes such as amphetamines and cannabinoids. Drug of abuse screening immunoassays directed at amphetamine or methamphetamine only detect a small subset of designer amphetamine-like drugs, and those immunoassays designed for tetrahydrocannabinol metabolites generally do not cross-react with synthetic cannabinoids lacking the classic cannabinoid chemical backbone. This suggests complexity in understanding how to detect and identify whether a patient has taken a molecule of one class or another, impacting clinical care. Methods Cross-reactivity data from immunoassays specifically targeting designer amphetamine-like and synthetic cannabinoid drugs was collected from multiple published sources, and virtual chemical libraries for molecular similarity analysis were built. The virtual library for synthetic cannabinoid analysis contained a total of 169 structures, while the virtual library for amphetamine-type stimulants contained 288 compounds. Two-dimensional (2D) similarity for each test compound was compared to the target molecule of the immunoassay undergoing analysis. Results 2D similarity differentiated between cross-reactive and non-cross-reactive compounds for immunoassays targeting mephedrone/methcathinone, 3,4-methylenedioxypyrovalerone, benzylpiperazine, mephentermine, and synthetic cannabinoids. Conclusions In this study, we applied 2D molecular similarity analysis to the designer amphetamine-type stimulants and synthetic cannabinoids. Similarity calculations can be used to more efficiently decide which drugs and metabolites should be tested in cross-reactivity studies, as well as to design experiments and potentially predict antigens that would lead to immunoassays with cross reactivity for a broader array of designer drugs.
    Journal of Cheminformatics 05/2014; 6:22. DOI:10.1186/1758-2946-6-22 · 4.54 Impact Factor
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    ABSTRACT: Background: Autoverification is a process of using computer-based rules to verify clinical laboratory test results without manual intervention. To date, there is little published data on the use of autoverification over the course of years in a clinical laboratory. We describe the evolution and application of autoverification in an academic medical center clinical chemistry core laboratory. Subjects and Methods: At the institution of the study, autoverification developed from rudimentary rules in the laboratory information system (LIS) to extensive and sophisticated rules mostly in middleware software. Rules incorporated decisions based on instrument error flags, interference indices, analytical measurement ranges (AMRs), delta checks, dilution protocols, results suggestive of compromised or contaminated specimens, and ‘absurd’ (physiologically improbable) values. Results: The autoverification rate for tests performed in the core clinical chemistry laboratory has increased over the course of 13 years from 40% to the current overall rate of 99.5%. A high percentage of critical values now autoverify. The highest rates of autoverification occurred with the most frequently ordered tests such as the basic metabolic panel (sodium, potassium, chloride, carbon dioxide, creatinine, blood urea nitrogen, calcium, glucose; 99.6%), albumin (99.8%), and alanine aminotransferase (99.7%). The lowest rates of autoverification occurred with some therapeutic drug levels (gentamicin, lithium, and methotrexate) and with serum free light chains (kappa/lambda), mostly due to need for offline dilution and manual filing of results. Rules also caught very rare occurrences such as plasma albumin exceeding total protein (usually indicative of an error such as short sample or bubble that evaded detection) and marked discrepancy between total bilirubin and the spectrophotometric icteric index (usually due to interference of the bilirubin assay by immunoglobulin (Ig) M monoclonal gammopathy). Conclusions: Our results suggest that a high rate of autoverification is possible with modern clinical chemistry analyzers. The ability to autoverify a high percentage of results increases productivity and allows clinical laboratory staff to focus attention on the small number of specimens and results that require manual review and investigation.
    03/2014; 5(1):13. DOI:10.4103/2153-3539.129450
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    Alexandra Ehlers, Cory Morris, Matthew D Krasowski
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    ABSTRACT: A rapid headspace-gas chromatography (HS-GC) method was developed for the analysis of ethylene glycol and propylene glycol in plasma and serum specimens using 1,3-propanediol as the internal standard. The method employed a single-step derivitization using phenylboronic acid, was linear to 200 mg/dL and had a lower limit of quantitation of 1 mg/dL suitable for clinical analyses. The analytical method described allows for laboratories with HS-GC instrumentation to analyze ethanol, methanol, isopropanol, ethylene glycol, and propylene glycol on a single instrument with rapid switch-over from alcohols to glycols analysis. In addition to the novel HS-GC method, a retrospective analysis of patient specimens containing ethylene glycol and propylene glycol was also described. A total of 36 patients ingested ethylene glycol, including 3 patients who presented with two separate admissions for ethylene glycol toxicity. Laboratory studies on presentation to hospital for these patients showed both osmolal and anion gap in 13 patients, osmolal but not anion gap in 13 patients, anion but not osmolal gap in 8 patients, and 1 patient with neither an osmolal nor anion gap. Acidosis on arterial blood gas was present in 13 cases. Only one fatality was seen; this was a patient with initial serum ethylene glycol concentration of 1282 mg/dL who died on third day of hospitalization. Propylene glycol was common in patients being managed for toxic ingestions, and was often attributed to iatrogenic administration of propylene glycol-containing medications such as activated charcoal and intravenous lorazepam. In six patients, propylene glycol contributed to an abnormally high osmolal gap. The common presence of propylene glycol in hospitalized patients emphasizes the importance of being able to identify both ethylene glycol and propylene glycol by chromatographic methods. Electronic supplementary material The online version of this article (doi:10.1186/2193-1801-2-203) contains supplementary material, which is available to authorized users.
    SpringerPlus 12/2013; 2(1):203. DOI:10.1186/2193-1801-2-203
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    ABSTRACT: Testing for 25-hydroxyvitamin D [25(OH)D] has increased dramatically in recent years. The present report compares overall utilization and results for 25(OH)D orders at two academic medical centers - one in New York and one in Iowa -- in order to characterize the vitamin D status of our inpatient and outpatient populations. Results are also compared to those from a national reference laboratory to determine whether patterns at these two institutions reflect those observed nationally. Retrospective data queries of 25(OH)D orders and results were conducted using the laboratory information systems at Weill Cornell Medical College / New York Presbyterian Hospital (WCMC), University of Iowa Hospitals and Clinics (UIHC), and ARUP Laboratories (ARUP). Chart review was conducted for cases with very high or low serum 25(OH)D levels in the WCMC and UIHC datasets. The majority of tests were ordered on females and outpatients. Average serum 25(OH)D levels were higher in female versus male patients across most ages in the WCMC, UIHC, and ARUP datasets. As expected, average serum 25(OH)D levels were higher in outpatients than inpatients. Serum 25(OH)D levels showed seasonal periodicity, with average levels higher in summer than winter and correlating to regional UV index. Area plots demonstrated a peak of increased 25(OH)D insufficiency / deficiency in adolescent females, although overall worse 25(OH)D status was found in male versus female patients in the WCMC, UIHC, and ARUP datasets. Surprisingly, improved 25(OH)D status was observed in patients starting near age 50. Finally, chart review of WCMC and UIHC datasets revealed over-supplementation (especially of >= 50,000 IU weekly doses) in the rare cases of very high 25(OH)D levels. General nutritional deficiency and/or severe illness was found in most cases of severe 25(OH)D deficiency. 25(OH)D status of patients seen by healthcare providers varies according to age, gender, season, and patient location. Improved 25(OH)D status was observed later in life, a finding that may reflect the previously described increased use of vitamin D-containing supplements in such populations. Severe vitamin D deficiency is much more common than vitamin D toxicity.
    BMC Endocrine Disorders 11/2013; 13(1):52. DOI:10.1186/1472-6823-13-52 · 1.67 Impact Factor
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    ABSTRACT: Ethylene glycol is a toxic organic solvent implicated in thousands of accidental and intentional poisonings each year. Osmotic demyelination syndrome (ODS) is traditionally known as a complication of the rapid correction of hyponatremia. Our aim was to describe how patients with ethylene glycol toxicity may be at risk for developing ODS in the absence of hyponatremia. A 64-year old female patient was comatose upon presentation and laboratory results revealed an anion gap of 39, a plasma sodium of 150 mEq/L, a plasma potassium of 3.5 mEq/L, an osmolal gap of 218, an arterial blood gas pH of 7.02, whole blood lactate of 32 mEq/L, no measurable blood ethanol, and a plasma ethylene glycol concentration of 1055.5 mg/dL. The patient was treated for ethylene glycol poisoning with fomepizole and hemodialysis. Despite having elevated serum sodium levels, the patient's hospital course was complicated by ODS. Rapid changes in serum osmolality from ethylene glycol toxicity or its subsequent treatment can cause ODS independent of serum sodium levels.
    Journal of Emergency Medicine 11/2013; 46(3). DOI:10.1016/j.jemermed.2013.08.068 · 1.18 Impact Factor
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    ABSTRACT: A method for qualitative detection of 57 drugs and metabolites in umbilical cord tissue using liquid chromatography time-of-flight (TOF) mass spectrometry is described. Results from 32 deidentified positive specimens analyzed by an outside laboratory using "screen with reflex to confirmation" testing were compared with TOF results. In addition, 57 umbilical cord tissue specimens paired with corresponding chart review data and 37 with meconium test results were analyzed by TOF. Urine drug test results from mother (n = 18) and neonate (n = 30) were included if available. Cutoff concentrations, recovery, and matrix effects were determined by analyzing fortified drug-free cord tissue and negative specimens. Cutoffs (in nanograms per gram) ranged from 1 to 10 for opioids and opioid antagonists, 5-10 for benzodiazepines and nonbenzodiazepine hypnotics, 20-40 for barbiturates, 8 for stimulants, and 4 for phencyclidine. Adequate sensitivity for the detection of cannabis exposure could not be realized with this method. Liquid chromatography time-of-flight mass spectrometry can provide accurate and sensitive detection of in utero drug exposure using umbilical cord tissue.
    Therapeutic drug monitoring 09/2013; 36(1). DOI:10.1097/FTD.0b013e3182a0d18c · 1.93 Impact Factor
  • Matthew D. Krasowski, Kelly E. Wood, Lori Sinclair
    48th Annual Meeting of; 09/2013
  • 48th Annual Meeting of; 09/2013

Publication Stats

4k Citations
428.67 Total Impact Points

Institutions

  • 2010–2015
    • University of Iowa
      Iowa City, Iowa, United States
    • University of North Carolina at Chapel Hill
      North Carolina, United States
  • 2010–2014
    • University of Iowa Children's Hospital
      Iowa City, Iowa, United States
  • 2013
    • University of Utah
      • Department of Pathology
      Salt Lake City, Utah, United States
  • 2005–2011
    • University of Pittsburgh
      • • Department of Pathology
      • • Division of Clinical Chemistry
      Pittsburgh, Pennsylvania, United States
  • 2008–2009
    • University of California, San Diego
      • Department of Medicine
      San Diego, CA, United States
    • UPMC
      Pittsburgh, Pennsylvania, United States
  • 1995–2007
    • University of Chicago
      • • Department of Medicine
      • • Department of Human Genetics
      • • Committee on Neurobiology
      • • Department of Anesthesia & Critical Care
      Chicago, IL, United States
  • 2002–2003
    • The University of Chicago Medical Center
      • Department of Anesthesia and Critical Care
      Chicago, Illinois, United States
  • 2000
    • Columbia University
      • Department of Anesthesiology
      New York City, NY, United States
  • 1997–2000
    • University of Illinois at Chicago
      Chicago, Illinois, United States