#141: Monitoring Magnesium to Guide Magnesium Therapy for Heart Surgery
(T. Shirey, Ph.D., J. Anesth, Vol. 18, 5/04)

For many years it has been recognized that magnesium levels play an important role in morbidity associated with heart surgery. However, considerable confusion exists in the literature whether Mg should be administered to these patients and, if so, how much and when. This article reviews methods to evaluate Mg status in patients, causes and consequences of abnormal Mg levels perioperatively, outcome improvements and risks with Mg supplementation, and guidelines for administering Mg therapy.

#136: Caring for the Critically Ill
(T. Shirey, Ph.D., Advance/Lab, Vol. 12, No. 9, 9/03)

With technology available to produce a core critical care profile from <200µL of whole blood in less than 2 minutes, real-time therapy is becoming a reality for the most compromised patients where critical care profiling and point-of-care strategies are used.

#124: Speaking Out on Point-of-Care (POC) Testing and POC Connectivity
(J. DuBois, Ph.D., MEEN Cardiology-Critical Care Tech, Vol. 41, No. 5, 9-10/01)

As hospitals are moving toward greater use of point-of-care devices, the need for rapid data transfer from these analyzers to and from the laboratory has heightened to the point where direct electronic connectivity methods are essential.

#117: Case Study: Point of Care Testing Getting to the Heart of the Matter
(E. Szelag, MHM, BS, MT(ASCP) and H. Polishook, Advance for the Lab, Vol. 10, No 6, 6/01)

As emphasis on point-of-care testing expands at major US hospitals, POC Coordinators have taken on greater responsibilities, including implementation of multiple testing apparatus and multiple testing locations, expanded menus, regulatory compliance, training and competency, quality control, and data capture. Along with the increase in remote testing has been a significant increase in the tests ordered by the physician. In order to keep pace with these trends, the POC Coordinator must have the appropriate instrumentation and management tools at his or her disposal.

This case study describes how Holmes Regional Medical Center instituted a comprehensive point-of-care testing program to respond to the increased demands of their new Open Heart Institute.

#115: Multicenter study of whole blood creatinine, total carbon dioxide content, and chemistry profiling for laboratory and point-of-care testing in critical care in the United States
(G. Kost, M.D. Ph.D. et al, Univ. of CA, Davis, Crit Care Med 2000, Vol. 28, No 7, 7/00)

Multicenter sites compared whole blood measurements with a transportable analyzer (Nova 16, Nova Biomedical) to assess its potential for point-of-care testing versus plasma measurements from the same specimens with local reference instruments.

#113: Measuring ionized magnesium in complex physiological solutions
(H. Polishook, Nova Biomedical, Am Clin Lab, Vol. 19, No 11, 11-12/00)

Magnesium is the fourth most abundant cation in the human body, and the second most common intracellular cation after potassium. A co-factor for more than 325 cellular enzymes, magnesium can play a pivotal role in such functions as control of neuronal activity, cardiac excitability, neuromuscular transmission, vasomotor tone, and blood pressure.

The purpose of this article is to discuss why measurement of ionized magnesium (iMg) can provide a more clinically significant result than total magnesium (TMg), and to support the use of an ion-selective electrode based instrument to achieve the most accurate test profile.

#102: Importance and Interpretation of Ionized Magnesium (iMg) Activity in Acutely and Chronically Ill Patients
(T. Shirey, Ph.D., Nova Biomedical, 2/00)

Abnormal blood magnesium (Mg) activity can have profound effects in either acutely or chronically ill patients, and it is the physiologically active fraction of total magnesium (TMg). Ionized magnesium does not always correlate to TMg and is often an easier assay and better physiological indicator of the clinical need for magnesium supplementation.

This review examines several physiologic systems relying on Mg activity; how whole blood plasma iMg serves as a relevant indicator of Mg status; what factors affect iMg activity; and why detection and real time management of Mg abnormalities can provide better patient outcomes in a variety of acute and chronic clinical settings. Cites 550 specific references.

#101: Maximizing POCT with Innovative Data Management
(I. Kampa, Ph.D., The Valley Hospital, Ridgewood, NJ, Advance for the Lab, Vol. 9, No 2, 2/00)

Clinical laboratories are under constant pressure to provide testing at or near critically ill patients in order to provide the shortest possible turnaround times.

This article describes how The Valley Hospital established a point-of-care testing program without increasing laboratory staffing and without the typically high cost of POC devices and reagents.

#100: A Cost Effective High Performance Approach to Critical Care Testing
(Lab Med, Vol. 30, No 9, 9/99)

#60: Critical Care Profile Testing for Informed Treatment of Severely Ill Patients
(T. Shirey, Ph.D. 9/95)

#59: Understanding Blood Lactate Analysis
(J. Kruse, M.D., J Resp Care Pract, 8-9/95)

#55: Magnesium in Cardiovascular Biology
(B.M. Altura and B.T. Altura, Sci Am, 5-6/95)

#53: Deficiency in Serum Ionized Magnesium But Not Total Magnesium in Patients With Migraines. Possible Role of iCa2+/iMg2+ Ratio
(A. Mauskop et al, Headache, Vol. 33, No 3, 3/93)

#41: Point-of-Care Testing – Meeting Regulatory Guidelines with Nonlaboratory Personnel
(N. St. John and R. Reed, 1994)

#39: The Use and Clinical Importance of a Substrate-Specific Electrode for Rapid Determination of Blood Lactate Concentrations
(Auden et al, JAMA, Vol. 272, No 21, 12/7/94)

#36: Unique Magnesium-Sensitive Ion Electrodes
(B.M. Altura and A. Lewenstam, The Scandanavian J Clin and Lab Investigation, Vol. 54, Suppl 217, 1994)

#35: Ionized Magnesium: A New Assay
(T. Shirey, Ph.D., Clin Chem News, Vol. 19, No 5, 5/93)

#32: A Clinical Review of Ionized Calcium. A Better Indicator than Total Calcium
(J. Toffaletti, Ph.D., 1992)

#29: Bedside Diagnostic Blood Testing, Its Accuracy, Rapidity, and Utility in Blood Conservation
(M. Salem, M.D, et al, JAMA, Vol. 266, No 3, 7/17/91)

#27: Hypomagnesemia is Common Following Cardiac Surgery
(L. Aglio et al, J Cardiothorac and Vasc Anesth, Vol. 5, No 3, 6/91)

Biotechnology References

#130: Fed-Batch Process for Mab Production
(A. Frison and K. Memmert, GEN, Vol. 22, No. 11, 6/1/02)

The authors describe a cost-effective fed-batch process for large-scale production of monoclonal antibodies (Mabs) incorporating the BioProfile 200 Chemistry Analyzer to monitor the full range of analytes available on the system.

#106: Rapid Monitoring of Mammalian Cell Culture
(H. Polishook, GEN, 3/00)

While the biotechnology industry generally utilizes fundamental scientific principles in its day-to-day operations, cell culture is frequently approached as more art than science. In cell culture, there is often a lack of adequate on- or off-line data to correlate with culture performance or product quality.
This article focuses on mammalian cell culture and the key biochemical parameters that should be monitored, including introduction of an advanced instrument (BioProfile Chemistry Analyzer, Nova Biomedical) that allows rapid, real-time monitoring of these parameters.

#89: An Improved Method for Rapid Monitoring of Cell Culture and Fermentation Processes
(C. Quern, ABL, 12/98)