title: Pseudometabolic acidosis caused by underfill of Vacutainer tubes.
abstract: OBJECTIVE
  To determine how serum bicarbonate and anion gap are affected by sample size in a 10-mL red-top (clot) Vacutainer tube at the fixed sample volumes of 10, 3, and 1 mL.
  
  
  METHODS
  Venous phlebotomy on consecutive emergency department patients; three tubes drawn in random order. The first 20 patients had unvented tubes, and the last ten had the tubes vented within one minute of the draw.
  
  
  METHODS
  University hospital ED.
  
  
  METHODS
  Thirty ED patients.
  
  
  METHODS
  All blood samples had electrolytes determined within one hour of phlebotomy. To approximate the ED setting, the time to analysis was not controlled, but each triple draw had simultaneous analysis.
  
  
  RESULTS
  Mean bicarbonate in mmol/L (with sample size) was 21.7 (10 mL), 19.4 (3 mL), and 16.3 (1 mL) (r2 = .86, P = .0001). Anion gap in mmol/L was 16.7 (10 mL), 17.5 (3 mL), and 19.1 (1 mL) (r2 = .84, P = .0077). Venting of Vacutainer tubes did not significantly change these results.
  
  
  CONCLUSIONS
  Underfill of 10-mL Vacutainer tubes causes a significant decline in bicarbonate and an increase in anion gap that may be mistaken for a metabolic acidosis. To correct for these effects, the bicarbonate should be increased by 0.5 to 0.6 mmol/L, and the anion gap should be decreased by 0.2 to 0.3 mmol/L for every milliliter of air above the sample in a 10-mL Vacutainer tube. Venting the tubes will not correct this effect. All tubes should be filled completely to avoid creating a pseudometabolic acidosis.
authors.affiliation: Division of Emergency Medicine, University of Utah Medical Center, Salt Lake City.
authors.forename: R D
authors.initials: RD
authors.lastname: Herr
authors.forename: T
authors.initials: T
authors.lastname: Swanson
mesh_terms: D000136:Acid-Base Equilibrium; D000138:Acidosis / Q000097:blood* / Q000175:diagnosis / Q000378:metabolism; D001639:Bicarbonates / Q000097:blood*; D001774:Blood Chemical Analysis / Q000295:instrumentation*; D003951:Diagnostic Errors; D006801:Humans
chemical_list: D001639:Bicarbonates