Spuriously raised serum creatinine associated with an excipient present in an intravenous dexamethasone formulation

Annals of Clinical Biochemistry
Denise DarbyPhillip J Monaghan

Abstract

Although the active pharmaceutical ingredient remains constant, the excipients used will vary according to the manufacturer. This case report is of spuriously raised serum creatinine due to an excipient in one particular intravenous dexamethasone formulation. A patient had three serum creatinine measurements of 102, 369 and 91 μmol/L over a four-hour period. The second result was believed to be spurious and appropriate investigations were instigated. The patient had received dexamethasone intravenously between the first and second blood samples. This was administered as a bolus via a cannula in the dorsum of the hand, and the blood sample was taken by venepuncture of the antecubital fossa of the same arm approximately five minutes later. The dexamethasone used (Hospira UK Ltd) contained creatinine at a concentration of 70,720 μmol/L, with a total of 170 μmol of creatinine given to the patient. Assuming a volume of distribution of 40 L in a 70-kg man, an increase in serum creatinine of 4-5 μmol/L would be expected once equilibrated. It is thought that the serum creatinine result observed was a consequence of the creatinine excipient in the dexamethasone not having completely distributed throughout the body and still being at rel...Continue Reading

Citations

Dec 4, 2014·American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation·Minami NakajimaMasaomi Nangaku
Dec 3, 2014·Veterinary Clinical Pathology·Jean-Pierre BraunCathy Trumel
Mar 31, 2015·PloS One·Fahim MohamedNicholas Buckley
May 24, 2017·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Thilini Madushanka WijerathnaNicholas Alan Buckley
Nov 21, 2019·Journal of Environmental Science and Health. Part. B, Pesticides, Food Contaminants, and Agricultural Wastes·Mukdawan SukhangKlintean Wunnapuk

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