Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report
Abstract Introduction Nitromethane is a primary nitroalkane used as a solvent and a fuel that may be toxic by ingestion, inhalation, or contact. Its presence can be detected in serum of exposed persons, but levels are not readily available to guide patient care. Nitromethane has been shown to falsel...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-04-01
|
| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12689 |
| _version_ | 1818013880147771392 |
|---|---|
| author | David R. Derkits William J. Meggs Jennifer L. Parker Cote |
| author_facet | David R. Derkits William J. Meggs Jennifer L. Parker Cote |
| author_sort | David R. Derkits |
| collection | DOAJ |
| description | Abstract Introduction Nitromethane is a primary nitroalkane used as a solvent and a fuel that may be toxic by ingestion, inhalation, or contact. Its presence can be detected in serum of exposed persons, but levels are not readily available to guide patient care. Nitromethane has been shown to falsely elevate serum creatinine when clinical laboratories use Jaffe assays to measure creatinine; enzymatic assays are not affected. Ex vivo experiments have demonstrated a linear relationship between serum nitromethane and the elevation in Jaffe assay creatinine. This case report demonstrates an elevation of creatinine measured by Jaffe assay with normal creatinine measurement by enzymatic assay after exposure to nitromethane. Case report A 21‐month‐old girl ingested an unmeasured quantity of a hobby fuel, a fuel containing methanol, nitromethane (20%), and lubricants used in miniature internal combustion engines, such as remote‐controlled cars. She was initially evaluated at a community hospital, treated empirically for methanol toxicity with fomepizole and folic acid, and transferred to a university hospital for further management. By 19 hours after ingestion, methanol was below detection, but a serum creatinine of 2.63 mg/dl raised concern for kidney injury. Toxicology consultation recognized that the creatinine had been measured using a Jaffe assay and recommended a repeat creatinine using an enzymatic assay, which was within normal limits. The patient remained an inpatient for further evaluation, which permitted trending of her Jaffe assay creatinine over a 3‐day period. The Jaffe assay creatinine demonstrated a gradual decline; repeat enzymatic assay creatinine remained within normal limits. Discussion The decline in this pediatric patient's Jaffe assay creatinine is consistent with first‐order clearance of nitromethane, which has been previously described in adult exposures. This case demonstrates how Jaffe assay–derived serum creatinine may be useful in the pediatric population to establish, quantify, and trend nitromethane exposure with essential concurrent use of an enzymatic assay to determine actual creatinine. |
| first_indexed | 2024-04-14T06:38:45Z |
| format | Article |
| id | doaj.art-d487e9e296a64af0b0428296c2c8cca5 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2024-04-14T06:38:45Z |
| publishDate | 2022-04-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-d487e9e296a64af0b0428296c2c8cca52022-12-22T02:07:24ZengWileyJournal of the American College of Emergency Physicians Open2688-11522022-04-0132n/an/a10.1002/emp2.12689Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case reportDavid R. Derkits0William J. Meggs1Jennifer L. Parker Cote2Department of Emergency Medicine Brody School of Medicine at East Carolina University Greenville North Carolina USADepartment of Emergency Medicine Brody School of Medicine at East Carolina University Greenville North Carolina USADepartment of Emergency Medicine Brody School of Medicine at East Carolina University Greenville North Carolina USAAbstract Introduction Nitromethane is a primary nitroalkane used as a solvent and a fuel that may be toxic by ingestion, inhalation, or contact. Its presence can be detected in serum of exposed persons, but levels are not readily available to guide patient care. Nitromethane has been shown to falsely elevate serum creatinine when clinical laboratories use Jaffe assays to measure creatinine; enzymatic assays are not affected. Ex vivo experiments have demonstrated a linear relationship between serum nitromethane and the elevation in Jaffe assay creatinine. This case report demonstrates an elevation of creatinine measured by Jaffe assay with normal creatinine measurement by enzymatic assay after exposure to nitromethane. Case report A 21‐month‐old girl ingested an unmeasured quantity of a hobby fuel, a fuel containing methanol, nitromethane (20%), and lubricants used in miniature internal combustion engines, such as remote‐controlled cars. She was initially evaluated at a community hospital, treated empirically for methanol toxicity with fomepizole and folic acid, and transferred to a university hospital for further management. By 19 hours after ingestion, methanol was below detection, but a serum creatinine of 2.63 mg/dl raised concern for kidney injury. Toxicology consultation recognized that the creatinine had been measured using a Jaffe assay and recommended a repeat creatinine using an enzymatic assay, which was within normal limits. The patient remained an inpatient for further evaluation, which permitted trending of her Jaffe assay creatinine over a 3‐day period. The Jaffe assay creatinine demonstrated a gradual decline; repeat enzymatic assay creatinine remained within normal limits. Discussion The decline in this pediatric patient's Jaffe assay creatinine is consistent with first‐order clearance of nitromethane, which has been previously described in adult exposures. This case demonstrates how Jaffe assay–derived serum creatinine may be useful in the pediatric population to establish, quantify, and trend nitromethane exposure with essential concurrent use of an enzymatic assay to determine actual creatinine.https://doi.org/10.1002/emp2.12689creatinineenzymatic assayfalsely elevated creatinineingestionJaffe assaynitromethane |
| spellingShingle | David R. Derkits William J. Meggs Jennifer L. Parker Cote Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report Journal of the American College of Emergency Physicians Open creatinine enzymatic assay falsely elevated creatinine ingestion Jaffe assay nitromethane |
| title | Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report |
| title_full | Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report |
| title_fullStr | Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report |
| title_full_unstemmed | Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report |
| title_short | Trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion: A case report |
| title_sort | trending of a falsely elevated serum creatinine after a pediatric nitromethane ingestion a case report |
| topic | creatinine enzymatic assay falsely elevated creatinine ingestion Jaffe assay nitromethane |
| url | https://doi.org/10.1002/emp2.12689 |
| work_keys_str_mv | AT davidrderkits trendingofafalselyelevatedserumcreatinineafterapediatricnitromethaneingestionacasereport AT williamjmeggs trendingofafalselyelevatedserumcreatinineafterapediatricnitromethaneingestionacasereport AT jenniferlparkercote trendingofafalselyelevatedserumcreatinineafterapediatricnitromethaneingestionacasereport |