To Investigate the Effect of Using Ethanol Containing Wipes in Collecting Blood for the Measurement of Alcohol Concentration

This study was aimed to establish whether the skin preparation using ethanol-containing skin antiseptics causes ethanol contamination through blood collection. Venous blood was collected from 40 healthy volunteers according to the national guidelines for blood sampling, with four sequential procedures as follows: 1) collecting blood immediately (within 5 seconds) after cleaning the skin with an individually packaged type of ethanol-containing wipe, 2) collecting blood 1 minute after cleaning the skin with an individually packaged type of ethanol-containing wipe, 3) collecting immediately (within 5 seconds) after cleaning the skin with a traditional cleaning method (thoroughly ethanol-impregnated wipe, and 4) collecting 1 minute after cleaning the skin with a traditional cleaning method. Each sequential procedure was performed with and without the ethanol-containing wipe used for skin cleaning on the puncture site on their right and left arms at the time the needle was withdrawn, respectively. The collected specimens were subjected to the determination of ethanol by using headspace gas chromatography-mass spectrometry. In every 80 blood specimens obtained from 40 participants, ethanol was undetectable (<0.001 mg/mL). This study demonstrates that disinfection using ethanol-containing skin antiseptics is unlikely to cause ethanol contamination through blood collection regardless of skin preparation technique according to the guidelines for blood sampling. This may have implications in forensic science.

A Super-Aged Case with Marked Hyponatremia Reaching 98 mEq/L;Clinical Implications of Low Serum Sodium

A 79-year-old man, an in-patient at a long-term hospital suffers from Alzheimer dementia and thyroid hypofunction. Recently, he had also suffered from pneumonia followed by impaired consciousness and referred to our hospital for further examination. At the time of admission, the level of consciousness was JCS III-200 and other vital signs were normal. He had no edema on his limbs but had dry skin. According to chest CT, we detected pneumonia. Based on the laboratory data on admission, we detected low osmolality of 206 mOsm/kg of water and serum Na 98 mEq/L, beside urinary Na 54.1 mEq/L. We confirmed severe hyponatremia of hypersecretion type. Fluid replacement therapy was started mainly with Ringer’s solution which is similar to extracellular fluid. We diagnosed it as SIADH induced by adrenal crisis based on the significant lower serum Na value and low blood sugar. Consequently, the patient was administered Hydrocortisone and Fludrocortisone acetate. On the 14th day, serum Na level improved from 98 mEq/L to 140 mEq/L. After daily monitoring of serum Na and urinary Na, administration of fludrocortisone acetate was terminated. The patient was discharged on 25th day, since serum Na was stabilized with oral administration of hydrocortisone and oral salt supplement. This case report shows that adrenal crisis can be triggered by pneumonia. In cases of impaired consciousness, if hyponatremia and hypoglycemia are observed, we may have to suspect the possibility of adrenal crisis. Therefore, urinary biochemical examination is an important part of the laboratory tests.