Clinically important factors influencing the diagnostic measurement of pleural fluid pH and glucose.
BACKGROUND
Accurate pleural fluid pH and glucose measurement is a key component in the diagnosis and management of patients with pleural effusion. Standardized methods of pleural fluid collection have not been defined.


OBJECTIVE
To assess the effect of common clinical factors that may distort measurement accuracy of pleural fluid pH and glucose.


METHODS
Ninety-two exudative pleural aspirates were collected in commercially available blood gas syringes.


RESULTS
Samples were analyzed immediately using a blood gas analyzer. The effects of residual air, lidocaine, heparin, and delay in analysis (24 h) on pH and glucose measurement accuracy were assessed. Pleural fluid pH was significantly increased by residual air (mean +/- SD, 0.08 +/- 0.07; 95% confidence interval [CI], 0.06 to 0.09; P < 0.001) and significantly decreased by residual lidocaine (0.2 ml; mean change in pH, -0.15 +/- 0.09; 95% CI, -0.13 to -0.18; P < 0.001) and residual heparin (mean change in pH, -0.02 +/- 0.05; 95% CI, -0.01 to -0.04; P = 0.027). Pleural fluid pH was stable at room temperature for 1 hour and significantly increased at 4 (mean +/- SD, 0.03 +/- 0.07; 95% CI, 0.01 to 0.04; P = 0.003) and 24 hours (0.05 +/- 0.12; 95% CI, 0.03 to 0.08; P < 0.001). Pleural fluid glucose concentration was not clinically significantly altered by residual air, lidocaine (up to 0.4 ml), or 24-hour analysis delay.


CONCLUSIONS
Accuracy of measured pleural pH is critically dependent on sample collection method. Residual air, lidocaine, and analysis delay significantly alter pH and may impact on clinical management. Pleural fluid glucose concentration is not significantly influenced by these factors. Protocols defining appropriate sampling and analysis methods are needed.
Oxford Centre for Respiratory Medicine and University of Oxford, Oxford, United Kingdom.
Najib M
NM
Rahman
Eleanor K
EK
Mishra
Helen E
HE
Davies
Robert J O
RJ
Davies
Y C Gary
YC
Lee
D000368:Aged; D000388:Air; D000779:Anesthetics, Local / Q000494:pharmacology; D000925:Anticoagulants / Q000494:pharmacology; D001784:Blood Gas Analysis / Q000379:methods*; D005260:Female; D005947:Glucose / Q000378:metabolism*; D006493:Heparin / Q000494:pharmacology; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D008012:Lidocaine / Q000494:pharmacology; D008297:Male; D010996:Pleural Effusion / Q000737:chemistry* / Q000175:diagnosis; D015203:Reproducibility of Results; D013048:Specimen Handling / Q000379:methods*; D013997:Time Factors
D000779:Anesthetics, Local; D000925:Anticoagulants; D006493:Heparin; D008012:Lidocaine; D005947:Glucose