PEDIATRICS Vol. 87 No. 5 May 1991, pp. 631-635
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Release of Benzalkonium Chloride From a Heparin-Bonded Umbilical Catheter With Resultant Factitious Hypernatremia and Hyperkalemia

Mark S. Gaylord MD1, Patricia A. Pittman MT1, John Bartness PhD1, Albert A. Tuinman PhD1, and Vichien Lorch MD1

1 From the Departments of Pediatrics and Chemistry, University of Tennessee Medical Center, Knoxville

Elevated serum sodium and potassium levels were recently observed when sampled through a heparin-bonded umbilical catheter and measured with certain ion-selective electrodes. The cationic surfactant, benzalkonium chloride (BZC), is known to falsely elevate those cations in serum. Inasmuch as most heparin-bonded umbilical catheters use BZC during the bonding process, an in vitro study was performed to estimate the quantity of BZC released and the duration of sodium and potassium elevations during pooled sera infusion. Three heparin-bonded umbilical catheters and 3 silastic umbilical catheters were first flushed with 0.3 mL of normal saline and then perfused with pooled sera (sodium, 142 mEq/L; potassium, 4.6 mEq/L) at 2.5 µL/h. Effluent samples were collected from 0 to 8 hours and analyzed by ion-selective electrodes. Elevated serum sodium concentrations from 160 to ge250 mEq/L and potassium concentrations from 6.0 to ge9.6 mEq/L were observed. The BZC concentration in the catheter effluent was measured by mass spectrometry, with peak values of 10 µg/mL detected by this method. When varying concentrations of BZC (1 to 100 µg/mL) were added directly to pooled serum, a dose-dependent increase in serum sodium was observed. These data demonstrate that BZC released from heparin-bonded umbilical catheters elevates serum electrolyte values measured with some ion-selective electrodes. The observed increase in sodium and potassium concentrations may lead to clinical errors in management. Benzalkonium chloride is associated with myriad of clinical symptomatology. Whether this amount of BZC is toxic in the small premature neonate is presently unknown.

Key Words: umbilical arterial catheters • benzalkonium chloride • heparin bonding

Submitted on November 3, 1989
Accepted on July 2, 1990




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