N-acetylcysteine interference of Trinder-based assays

Jonathan R Genzen; Joshua J Hunsaker; Louis S Nelson; Brett A Faine; Matthew D Krasowski

doi:10.1016/j.clinbiochem.2015.10.005

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N-acetylcysteine interference of Trinder-based assays

Journal article

Peer reviewed

N-acetylcysteine interference of Trinder-based assays

Jonathan R Genzen, Joshua J Hunsaker, Louis S Nelson, Brett A Faine and Matthew D Krasowski

Clinical biochemistry, Vol.49(1-2), pp.100-104

01/2016

DOI: 10.1016/j.clinbiochem.2015.10.005

PMID: 26500003

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Abstract

The primary objective of this study was to evaluate potential interference of Trinder-based chemistry assays by N-acetylcysteine (NAC). A secondary objective was to look for evidence of interference in patients treated with NAC for acetaminophen (APAP) overdose. Dilutions of NAC in plasma were tested for interference using the following Roche Diagnostics Trinder-based assays on a cobas 8000 system: enzymatic creatinine (Cr), cholesterol (CHOL), high-density lipoprotein cholesterol (HDL-C), triglycerides (TRIG), and uric acid (UA). Two non-Trinder Roche assays — urea nitrogen (BUN) and glucose (GLUC) — were tested as controls. Sekisui N-geneous® low-density lipoprotein cholesterol (LDL-C) reagent was also evaluated. Retrospective chart review of APAP overdose cases over 49months was conducted to look for differences in plasma Cr before and after intravenous (IV) NAC administration. NAC concentrations (shown in parentheses) that caused ≥10% inhibition for individual assays were (in order of sensitivity to interference): TRIG (570mg/L)>CHOL (740mg/L)≈Cr (790mg/L)>UA (1100mg/L)>HDL-C (1760mg/L)>LDL-C (2900mg/L). Neither BUN nor GLUC achieved significant inhibition up to 10,000mg/L NAC. Evidence for relatively minor inhibition of Cr was observed in patients after NAC administration. NAC inhibition of the assays investigated typically occurs at concentrations higher than expected during IV and oral NAC therapy. •N-acetylcysteine (NAC) interference of Trinder-based assays has been reported.•Serial dilutions of NAC were created to characterize this interference.•Thresholds indicating 10% inhibition of Trinder-based assays by NAC were derived.•Intravenous (IV) NAC is used for the treatment of acetaminophen (APAP) overdose.•Minor inhibition of enzymatic creatinine (Cr) during such treatment was observed.

Paracetamol

Acetaminophen

Toxicity

Interference

Trinder reaction

Overdose

N-acetylcysteine

Details

Title: Subtitle: N-acetylcysteine interference of Trinder-based assays
Creators: Jonathan R Genzen - ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, 500 Chipeta Way, Salt Lake City, UT 84108, USA
Joshua J Hunsaker - ARUP Institute for Clinical and Experimental Pathology, Salt Lake City, UT, 500 Chipeta Way, Salt Lake City, UT 84108, USA
Louis S Nelson - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 200 Hawkins Drive, Iowa City, IA 52242, USA
Brett A Faine - Department of Emergency Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 200 Hawkins Drive, Iowa City, IA 52242, USA
Matthew D Krasowski - Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, 200 Hawkins Drive, Iowa City, IA 52242, USA
Resource Type: Journal article
Publication Details: Clinical biochemistry, Vol.49(1-2), pp.100-104
DOI: 10.1016/j.clinbiochem.2015.10.005
PMID: 26500003
NLM abbreviation: Clin Biochem
ISSN: 0009-9120
eISSN: 1873-2933
Publisher: Elsevier Inc
Language: English
Date published: 01/2016
Academic Unit: Pathology; Emergency Medicine; Pharmacy Practice and Science
Record Identifier: 9984046832702771

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