Displaying publications 1 - 20 of 204 in total

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  1. The yield of laboratory investigations for infective agents - a pilot study findings on foreign workers
    Anuar Zaini MZ, the Pilot Immigrant Health ST
    JUMMEC, 1998;3:61-62.
    A total of 245 foreign workers was screened for various microbial and parasitic infections, as part of the pilot study on the health problems of foreign workers. The sample comprising of Indonesian and Bangladeshi workers, was selected on a non-probability basis from two sources, i.e. University Hospital and a private sector. This investigation revealed substantive number of workers with positive cases to some of the microbial and parasitic infections. KEYWORDS: Pilot study, infective agents, foreign workers
    Matched MeSH terms: Laboratories
  2. Organisation of laboratory services in Malaysia
    Jegathesan M, de Witt GF
    Malays J Pathol, 1982 Aug;5:1-5.
    PMID: 7187452
    Matched MeSH terms: Laboratories/organization & administration*
  3. Fulltext Data Descriptor: Daily observations of stable isotope ratios of rainfall in the tropics
    Munksgaard NC, Kurita N, Sánchez-Murillo R, Ahmed N, Araguas L, Balachew DL, et al.
    Sci Rep, 2019 10 08;9(1):14419.
    PMID: 31595004 DOI: 10.1038/s41598-019-50973-9
    We present precipitation isotope data (δ2H and δ18O values) from 19 stations across the tropics collected from 2012 to 2017 under the Coordinated Research Project F31004 sponsored by the International Atomic Energy Agency. Rainfall samples were collected daily and analysed for stable isotopic ratios of oxygen and hydrogen by participating laboratories following a common analytical framework. We also calculated daily mean stratiform rainfall area fractions around each station over an area of 5° x 5° longitude/latitude based on TRMM/GPM satellite data. Isotope time series, along with information on rainfall amount and stratiform/convective proportions provide a valuable tool for rainfall characterisation and to improve the ability of isotope-enabled Global Circulation Models to predict variability and availability of inputs to fresh water resources across the tropics.
    Matched MeSH terms: Laboratories
  4. Fulltext Influenza A (H1N1) pandemic: Pahang experience
    Sapian, M., Sahhir, K., Rosnah, I., Ardi, A., Rohida, T., Azura, M, et al.
    Malaysian Journal of Public Health Medicine, 2010;10(1):62-69.
    MyJurnal
    On 24th April 2009 the World Health Organisation (WHO) announced Pandemic Influenza A (H1N1) alert phase 4 which was later raised to phase 6 on 11th June 2009. By 11th October 2009, 199 countries were affected with 399,232 laboratory confirmed cases resulting in 4735 death. In Pahang, the state and district operation rooms were activated on the 28th April and 5th May 2009 respectively to monitor surveillance, control and preventives measures carried out. This study was done to describe the situation of Pandemic Influenza A (H1N1) in Pahang from 28th April 2009 till 10th October 2009 in terms of laboratory confirmed cases and clusters reported, Influenza-Like Illness (ILI) surveillance, Severe Acute Respiratory Infection (sARI) surveillance and health education activities. During the period, 490 laboratory confirmed Influenza A (H1N1) cases were registered with 5 deaths. The age ranges from less than 1 year to 76 years with median of 16 years old. 207 ILI clusters were recorded, 139 (67.5%) were Influenza A (H1N1) clusters. For surveillance activity, 11,570 (2.2%) of outpatient attendances were ILI cases while 966 (2.0 %) of total admissions were sARI cases. There were 14,927 health education activities carried out during the period. The number of people affected by Pandemic Influenza A (H1N1) in Pahang reached its peak in mid August 2009 and later showed a downward trend. ILI surveillance was a useful tool to detect Influenza A (H1N1) activity in Pahang.
    Study site: Klinik kesihatan, outpatient clinics, hospitals, Pahang, Malaysia
    Matched MeSH terms: Laboratories
  5. Fulltext Analysis of Phase-Shift Pulse Brillouin Optical Time-Domain Reflectometry
    Horiguchi T, Masui Y, Zan MSD
    Sensors (Basel), 2019 Mar 27;19(7).
    PMID: 30934806 DOI: 10.3390/s19071497
    Distributed strain and temperature can be measured by using local Brillouin backscatter in optical fibers based on the strain and temperature dependence of the Brillouin frequency shift. The technique of analyzing the local Brillion backscatter in the time domain is called Brillouin optical time domain reflectometry (BOTDR). Although the best spatial resolution of classic BOTDR remains at around 1 m, some recent BOTDR techniques have attained as high as cm-scale spatial resolution. Our laboratory has proposed and demonstrated a high-spatial-resolution BOTDR called phase-shift pulse BOTDR (PSP-BOTDR), using a pair of probe pulses modulated with binary phase-shift keying. PSP-BOTDR is based on the cross-correlation of Brillouin backscatter and on the subtraction of cross-correlations obtained from the Brillouin scatterings evoked by each phase-modulated probe pulse. Although PSP-BOTDR has attained 20-cm spatial resolution, the spectral analysis method of PSP-BOTDR has not been discussed in detail. This article gives in-depth analysis of the Brillouin backscatter and the correlations of the backscatters of the PSP-BOTDR. Based on the analysis, we propose new spectral analysis methods for PSP-BOTDR. The analysis and experiments show that the proposed methods give better frequency resolution than before.
    Matched MeSH terms: Laboratories
  6. External quality assurance in Malaysia
    Nawawi H, Lim HH, Zakiah I
    Southeast Asian J. Trop. Med. Public Health, 1999;30 Suppl 3:39-45.
    PMID: 10926257
    An activity supportive of the MOH QA Programme, the National EQAS for clinical chemistry monitors for analytical performance in core routine biochemical testing by the pathology laboratories, with unsatisfactory performance scores serving to alert against deficiencies or problems and the scores in subsequent challenges providing the feedback of effectiveness of remedial actions taken. While unacceptable individual analyte performance score (variance index score, VIS) indicated problems in instruments, reagent and calibrators, or the use of inherently poorer methods, repeated occurrence of unsatisfactory OMRVIS was traceable to generally poor laboratory management of usually inadequately-equipment small laboratories. The outcome has been one of slow but gradual improvement in the overall performance of participating laboratories, with a move towards methods upgrading and standardization to achieve greater concordance of results. Presently, the programme is limited to 61 government and 4 private hospital laboratories in the country for 12 commonly assayed clinical biochemistry analytes. It is hoped that the NEQAS could be extended to the other private laboratories and that of academic institutions. However, this is dependent to a large extent on the manpower and financial support obtainable by the organizing body of the programme in the future. Belk and Sunderman, 1947 demonstrated that laboratories participating in an quality assessment scheme could rapidly and dramatically improve their analytical performance. In some countries, participation has become mandatory, and acceptable performance is a requirement in laboratory accreditation. The need and value of the NEQAP is, therefore, evident. While there may be limitations in the national programme. efforts are being made at improving the programme within the means and resources of the organising body. The goals of the NEQAP are not just to monitor performance but also to educate. On this, matters related to and supportive of these goals have also been pursued. The annual workshop/forum on quality controls had allowed exchange of information between representatives of participating laboratories and the organising body. Recently in the 1997 MOH Quality Improvement evaluation, Quality Control has been evaluated together with the other 17 such activities. The study on knowledge, attitude and practice has provided the necessary feedback and will be used for future planning in making efforts at increasing the effectiveness and benefits of the all QC activities including this NEQAP for clinical chemistry. In addition, there is a need to look into areas such as selection of methods and test systems, and improvement of continuing education, training as well as research in quality improvement as suggested by the Quality Improvement evaluation.
    Matched MeSH terms: Laboratories, Hospital/standards*
  7. Fulltext The Use of M2-Pyruvate Kinase as a Stool Biomarker for Detection of Colorectal Cancer in Tertiary Teaching Hospital: A Comparative Study
    Che Alhadi S, Wan Zain WZ, Zahari Z, Md Hashim MN, Syed Abd Aziz SH, Zakaria Z, et al.
    Ann Coloproctol, 2020 Dec;36(6):409-414.
    PMID: 32972105 DOI: 10.3393/ac.2020.08.27
    PURPOSE: Guaiac fecal occult blood test (gFOBT) has been the standard for colorectal screening but it has low sensitivity and specificity. This study evaluated the use of fecal tumor M2-pyruvate kinase (M2-PK) for detection of colorectal cancer and to compare with the current surveillance tool; gFOBT in symptomatic adult subjects underwent colonoscopy.

    METHODS: Stool samples were collected prospectively from symptomatic adults who had elective colonoscopy from September 2014 to January 2016 and were analyzed with the ScheBo M2-PK Quick test and laboratory detection of fecal hemoglobin.

    RESULTS: The results were correlated to the colonoscopy findings and/or histopathology report. Eighty-five subjects (age of 56.8 ± 15.3 years [mean ± standard deviation]) were recruited with a total of 17 colorectal cancer (20.0%) and 10 colorectal adenoma patients (11.8%). The sensitivity of M2-PK test in colorectal cancer detection was higher than gFOBT (100% vs. 64.7%). M2-PK test had a lower specificity when compared to gFOBT (72.5% vs. 88.2%) in colorectal cancer detection. The positive and negative predictive values were 47.2% and 100% for M2-PK test and 57.9% and 90.9% for gFOBT.

    CONCLUSION: Fecal M2-PK Quick test has a high sensitivity for detection of colorectal cancer when compared to gFOBT, making it the potential choice for colorectal tumor screening biomarker in the future.

    Matched MeSH terms: Laboratories
  8. Fulltext Simultaneous optimization of nanocrystalline SnO2 thin film deposition using multiple linear regressions
    Ebrahimiasl S, Zakaria A
    Sensors (Basel), 2014;14(2):2549-60.
    PMID: 24509767 DOI: 10.3390/s140202549
    A nanocrystalline SnO2 thin film was synthesized by a chemical bath method. The parameters affecting the energy band gap and surface morphology of the deposited SnO2 thin film were optimized using a semi-empirical method. Four parameters, including deposition time, pH, bath temperature and tin chloride (SnCl2·2H2O) concentration were optimized by a factorial method. The factorial used a Taguchi OA (TOA) design method to estimate certain interactions and obtain the actual responses. Statistical evidences in analysis of variance including high F-value (4,112.2 and 20.27), very low P-value (<0.012 and 0.0478), non-significant lack of fit, the determination coefficient (R2 equal to 0.978 and 0.977) and the adequate precision (170.96 and 12.57) validated the suggested model. The optima of the suggested model were verified in the laboratory and results were quite close to the predicted values, indicating that the model successfully simulated the optimum conditions of SnO2 thin film synthesis.
    Matched MeSH terms: Laboratories
  9. Audit of Turnaround Time for a Training Oral Histopathology Laboratory in Malaysia
    Chan SW, Liew LH, Wong GR, Kallarakkal TG, Abraham MT, Ramanathan A, et al.
    Int. J. Surg. Pathol., 2016 Aug;24(5):401-9.
    PMID: 27006298 DOI: 10.1177/1066896916639372
    BACKGROUND: Turnaround time (TAT) is the benchmark to assess the performance of a laboratory, pathologists, and pathology services, but there are few articles on TAT of surgical pathology, particularly in relation to oral or head and neck specimens. This study investigates the TAT for oral histopathology reporting in an academic institution's training laboratory and offers recommendations to achieve better overall quality of diagnostic services.

    METHODS: This study examined data obtained from biopsy request forms for specimens received from the Oro-Maxillofacial Surgery Department of Hospital Tengku Ampuan Rahimah Klang in the Oral Pathology Diagnostic Laboratory of the Faculty of Dentistry, University of Malaya, over a period of 3 years between January 2012 and October 2014.

    RESULTS: TAT for surgical and decalcified specimens were increased significantly compared to biopsies. Additional special handling did not influence TAT, but increased specimen volume resulted in greater TAT. Slide interpretation was the most time-consuming stage during histopathology reporting. Overall, mean TAT was acceptable for most specimens, but the TAT goals were less than satisfactory.

    CONCLUSION: A TAT goal appropriate for this laboratory may hence be established based on this study. Collective efforts to improve the TAT for various specimens are essential for better laboratory performance in the future.
    Matched MeSH terms: Laboratories
  10. Formulation variables affecting drug release from xanthan gum matrices at laboratory scale and pilot scale
    Billa N, Yuen KH
    AAPS PharmSciTech, 2000;1(4):E30.
    PMID: 14727895
    The purpose of this research was to study processing variables at the laboratory and pilot scales that can affect hydration rates of xanthan gum matrices containing diclofenac sodium and the rate of drug release. Tablets from the laboratory scale and pilot scale proceedings were made by wet granulation. Swelling indices of xanthan gum formulations prepared with different amounts of water were measured in water under a magnifying lens. Granules were thermally treated in an oven at 60 degrees C, 70 degrees C, and 80 degrees C to study the effects of elevated temperatures on drug release from xanthan gum matrices. Granules from the pilot scale formulations were bulkier compared to their laboratory scale counterparts, resulting in more porous, softer tablets. Drug release was linear from xanthan gum matrices prepared at the laboratory scale and pilot scales; however, release was faster from the pilot scales. Thermal treatment of the granules did not affect the swelling index and rate of drug release from tablets in both the pilot and laboratory scale proceedings. On the other hand, the release from both proceedings was affected by the amount of water used for granulation and the speed of the impeller during granulation. The data suggest that processing variables that affect the degree of wetness during granulation, such as increase in impeller speed and increase in amount of water used for granulation, also may affect the swelling index of xanthan gum matrices and therefore the rate of drug release.
    Matched MeSH terms: Laboratories/standards*
  11. A shelf-stable fluorogenic isothermal amplification assay for the detection of Burkholderia pseudomallei
    Michelle Wong Tzeling J, Yean Yean C
    Analyst, 2016 Feb 21;141(4):1246-9.
    PMID: 26783560 DOI: 10.1039/c5an01741f
    A shelf-stable loop-mediated isothermal amplification (LAMP) reagent for Burkholderia pseudomallei detection is described. The coupling of LAMP reagents with the indirect colorimetric indicator and consequently its lyophilization enable the simple evaluation of results without the need for any advance laboratory instruments. The reagents were found to have a stable shelf life of at least 30 days with well-maintained sensitivity and specificity.
    Matched MeSH terms: Laboratories
  12. The immunology laboratory services in Malaysia
    Yap SF
    Malays J Pathol, 1982 Aug;5:11-3.
    PMID: 7187453
    Matched MeSH terms: Laboratories*
  13. Fulltext Preparation and properties of fish cracker from different freshwater fish species
    Zzaman, W., Yusoff, M.M., Yang, T.A.
    International Food Research Journal, 2017;24(5):1858-1862.
    MyJurnal
    Fish crackers made from freshwater fishes is a new dimension in fish cracker industry. In this study, three species were chosen based on their general preference and acceptability by Malaysian. Together with other ingredients, these crackers were prepared using standard formulation and tested in laboratory for their proximate analysis and physical characteristic analysis includes linear expansion, oil absorption, color measurement and texture. Sensory analysis for overall acceptability was carried out among trained panelist in the school. The results for proximate composition and physical analysis showed that there were significant differences (p
    Matched MeSH terms: Laboratories
  14. Pilot test of a fermentation tank for producing coal methane through anaerobic fermentation
    Daping Xia, Huaiwen Zhang, Xile Liu, Chaoyong Fu, Xianbo Su
    Sains Malaysiana, 2017;46:2083-2089.
    The development and utilization of clean energy has long been a focus of research. In the coal bed methane field, most coal bed biogenic methane experiments are small static sample tests in which the initial conditions are set and the process cannot be batch-fed elements and microbial strains, and the gas cannot be collected in batches. Although significant results have been achieved in the coal-to-biogenic methane conversion in China, findings are restricted to the laboratory scale. No successful commercialization of coal bed biogenic methane production has been achieved yet. This study used a large-capacity fermentation tank (5 L) to conduct biogenic methane experiments. Results were compared to those from the traditional laboratory test. The gas production rate and gas concentration were higher when the 250 mL methane test volume was increased to a 5 L fermentation volume, increasing by 20.9% and 2.3%, respectively. The inhibition effect of the liquid phase products was reduced in the large fermentation tank, and the microbial activity was extended by batch feeding trace elements (iron and nickel) and methane strains and by semi-continuous collection of the gas. However, the gas conversion rate can be increased by retaining the H2 and CO2 in the intermediate gas products in the fermentation tank. The gas production rate was increased from 17.9 to 24.6 mL/g, increasing by 37.4%. The simulation pilot test can lay a foundation for the transition from a coal bed biogenic methane laboratory static small sample test to a dynamic pilot test, optimizing the process parameters to improve the reaction efficiency and move forward to commercialization test.
    Matched MeSH terms: Laboratories
  15. The development of tone discrimination in infancy: Evidence from a cross-linguistic, multi-lab report
    Kalashnikova M, Singh L, Tsui A, Altuntas E, Burnham D, Cannistraci R, et al.
    Dev Sci, 2024 May;27(3):e13459.
    PMID: 37987377 DOI: 10.1111/desc.13459
    We report the findings of a multi-language and multi-lab investigation of young infants' ability to discriminate lexical tones as a function of their native language, age and language experience, as well as of tone properties. Given the high prevalence of lexical tones across human languages, understanding lexical tone acquisition is fundamental for comprehensive theories of language learning. While there are some similarities between the developmental course of lexical tone perception and that of vowels and consonants, findings for lexical tones tend to vary greatly across different laboratories. To reconcile these differences and to assess the developmental trajectory of native and non-native perception of tone contrasts, this study employed a single experimental paradigm with the same two pairs of Cantonese tone contrasts (perceptually similar vs. distinct) across 13 laboratories in Asia-Pacific, Europe and North-America testing 5-, 10- and 17-month-old monolingual (tone, pitch-accent, non-tone) and bilingual (tone/non-tone, non-tone/non-tone) infants. Across the age range and language backgrounds, infants who were not exposed to Cantonese showed robust discrimination of the two non-native lexical tone contrasts. Contrary to this overall finding, the statistical model assessing native discrimination by Cantonese-learning infants failed to yield significant effects. These findings indicate that lexical tone sensitivity is maintained from 5 to 17 months in infants acquiring tone and non-tone languages, challenging the generalisability of the existing theoretical accounts of perceptual narrowing in the first months of life. RESEARCH HIGHLIGHTS: This is a multi-language and multi-lab investigation of young infants' ability to discriminate lexical tones. This study included data from 13 laboratories testing 5-, 10-, and 17-month-old monolingual (tone, pitch-accent, non-tone) and bilingual (tone/non-tone, non-tone/non-tone) infants. Overall, infants discriminated a perceptually similar and a distinct non-native tone contrast, although there was no evidence of a native tone-language advantage in discrimination. These results demonstrate maintenance of tone discrimination throughout development.
    Matched MeSH terms: Laboratories
  16. A hepatitis B serological survey in Sibu, Sarawak January - July 1990
    Hu CH, Ting R, Wong L
    Family Physician, 1991;3:70-73.
    Matched MeSH terms: Laboratories
  17. Fulltext An efficient and robust laboratory workflow and tetrapod database for larger scale environmental DNA studies
    Axtner J, Crampton-Platt A, Hörig LA, Mohamed A, Xu CCY, Yu DW, et al.
    Gigascience, 2019 Apr 01;8(4).
    PMID: 30997489 DOI: 10.1093/gigascience/giz029
    BACKGROUND: The use of environmental DNA for species detection via metabarcoding is growing rapidly. We present a co-designed lab workflow and bioinformatic pipeline to mitigate the 2 most important risks of environmental DNA use: sample contamination and taxonomic misassignment. These risks arise from the need for polymerase chain reaction (PCR) amplification to detect the trace amounts of DNA combined with the necessity of using short target regions due to DNA degradation.

    FINDINGS: Our high-throughput workflow minimizes these risks via a 4-step strategy: (i) technical replication with 2 PCR replicates and 2 extraction replicates; (ii) using multi-markers (12S,16S,CytB); (iii) a "twin-tagging," 2-step PCR protocol; and (iv) use of the probabilistic taxonomic assignment method PROTAX, which can account for incomplete reference databases. Because annotation errors in the reference sequences can result in taxonomic misassignment, we supply a protocol for curating sequence datasets. For some taxonomic groups and some markers, curation resulted in >50% of sequences being deleted from public reference databases, owing to (i) limited overlap between our target amplicon and reference sequences, (ii) mislabelling of reference sequences, and (iii) redundancy. Finally, we provide a bioinformatic pipeline to process amplicons and conduct PROTAX assignment and tested it on an invertebrate-derived DNA dataset from 1,532 leeches from Sabah, Malaysia. Twin-tagging allowed us to detect and exclude sequences with non-matching tags. The smallest DNA fragment (16S) amplified most frequently for all samples but was less powerful for discriminating at species rank. Using a stringent and lax acceptance criterion we found 162 (stringent) and 190 (lax) vertebrate detections of 95 (stringent) and 109 (lax) leech samples.

    CONCLUSIONS: Our metabarcoding workflow should help research groups increase the robustness of their results and therefore facilitate wider use of environmental and invertebrate-derived DNA, which is turning into a valuable source of ecological and conservation information on tetrapods.

    Matched MeSH terms: Laboratories
  18. Fulltext Evaluation of the performance of a micromethod for measuring urinary iodine by using six sigma quality metrics
    Hussain H, Khalid NM, Selamat R, Wan Nazaimoon WM
    Ann Lab Med, 2013 Sep;33(5):319-25.
    PMID: 24003421 DOI: 10.3343/alm.2013.33.5.319
    BACKGROUND: The urinary iodine micromethod (UIMM) is a modification of the conventional method and its performance needs evaluation.
    METHODS: UIMM performance was evaluated using the method validation and 2008 Iodine Deficiency Disorders survey data obtained from four urinary iodine (UI) laboratories. Method acceptability tests and Sigma quality metrics were determined using total allowable errors (TEas) set by two external quality assurance (EQA) providers.
    RESULTS: UIMM obeyed various method acceptability test criteria with some discrepancies at low concentrations. Method validation data calculated against the UI Quality Program (TUIQP) TEas showed that the Sigma metrics were at 2.75, 1.80, and 3.80 for 51±15.50 µg/L, 108±32.40 µg/L, and 149±38.60 µg/L UI, respectively. External quality control (EQC) data showed that the performance of the laboratories was within Sigma metrics of 0.85-1.12, 1.57-4.36, and 1.46-4.98 at 46.91±7.05 µg/L, 135.14±13.53 µg/L, and 238.58±17.90 µg/L, respectively. No laboratory showed a calculated total error (TEcalc)
    Matched MeSH terms: Laboratories/standards
  19. Fulltext Haemoglobin A1c: comparing performance of two point of care devices with laboratory analyser
    Wan Mohd Zin RM, Ahmad Kamil ZI, Tuan Soh TR, Embong M, Wan Mohamud WN
    BMC Res Notes, 2013 Dec 18;6:540.
    PMID: 24344903 DOI: 10.1186/1756-0500-6-540
    BACKGROUND: Measurement of HbA1c has been widely used for long-term monitoring and management of diabetes control. There is increasing use of point-of-care (POC) devices for measuring HbA1c where quicker results would allow immediate clinical management decisions to be made. Therefore, it is important to evaluate and compare the performance of such devices to the reference laboratory method.

    FINDINGS: A total of 274 venous blood was collected from normal healthy adults during the community screening programmes. The performance of POC devices, Afinion and Quo-test were compared to central laboratory HPLC method; Adams A1c HA 8160. Both POC devices showed good correlation to HA 8160 with r = 0.94 (p < 0.001) and r = 0.95 (p < 0.001) for Afinion and Quo-test respectively. The means difference were statistically higher between POC and HA 8160 with 0.23% (95% CI 0.19-0.26, p < 0.001) and 0.29% (95% CI 0.24-0.34, p < 0.001) for Afinion and Quo-test respectively.

    CONCLUSIONS: Both POC devices could be considered in health clinics for diabetes management but not to be used for the diagnostic purposes.

    Matched MeSH terms: Laboratories/standards
  20. Fulltext Intractable normal anion gap metabolic acidosis in a patient with diabetic ketoacidosis
    Huan, Nai Chien, Wan Awatif Wan Mohd Zohdi
    Borneo Journal of Medical Sciences, 2020;14(2):37-40.
    MyJurnal
    High anion gap metabolic acidosis (HAGMA) is a hallmark of Diabetic Ketoacidosis (DKA). Occasionally, a Normal Anion Gap Metabolic Acidosis (NAGMA) can be seen, especially during the treatment phase. In this case report, a 55-year-old lady with diabetes mellitus who presented with a 2-day history of fever, lethargy and multiple episodes of vomiting and diarrhoea. Initial laboratory investigations revealed: capillary blood glucose as 27 mmol/L, urine ketone as 3+, blood ketone as 3.5 mmol/L, serum bicarbonate as 14 mmol/L, and serum chloride as 95 mmol/L. She was treated with intravenous normal saline fluid resuscitation and constant rate insulin infusion which was fortunately accompanied by stabilization of blood glucose and normalization of blood ketone to 0.2 mmol/L. However, despite normalization of her anion gap (25 to 14), she remained unwell with acidotic breathing due to refractory hyperchloraemic NAGMA with bicarbonate at 11 mol/L and chloride of 112 mmol/L. It was then decided to administer 100 mL of 8.4% Sodium Bicarbonate solution. The next day, she was no longer tachypneic as her bicarbonate and carbon dioxide improved to 21 mmol/L and 32 mmHg respectively. The presence of NAGMA in DKA should prompt clinicians to conduct a thorough search for possible underlying causes, such as gastrointestinal fluid loss, sepsis and chloride load from aggressive fluid resuscitation with normal saline. Sodium bicarbonate should only be considered in intractable cases to correct a NAGMA and not routinely used in the treatment of DKA.
    Matched MeSH terms: Laboratories
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