Updated on SoS - Introducing CARIS

Introducing CARMIS - Codes of Antibiotic Responsive Medical Infections associated with Sepsis. In a previous blog I developed the work on SoS codes of Matt Inada-Kim to focus on those codes that are are associated with high mortality infections. Having just completed the first GIRFT deep dive, this concept worked, but was clear it needs development. The first is with the "branding", and we need a new name that more clearly distinguishes this from sepsis, and makes it clear that it is derived from Hospital Episode Statistics. I also felt we needed more categories, to make the reasoning clearer. It is hard to know how to deal with things like aspiration pneumonia and COPD. These have amongst the highest mortalities of any common disease, but it is debatable how much antibiotics contribute to management. Similarly, surgical conditions that are principally managed through intervention (certainly perforation, but also probably cholangitis) muddy the waters. My latest feeling is

Artefactual hyperkalemia - dangerous, expensive. And preventable.

Potassium is part of a renal profile, the most commonly ordered test in pathology.  In N Devon we do just over 100000 primary care tests per year for a population of 160000 Assuming we are similar to others, that would be about 40 million primary care tests per year in the UK. Most potassium in a blood sample sits inside the blood cells, and there is a large concentration gradient across the cell membranes. This is maintained through the the Na/K ATPase, which uses energy to drive sodium out of the cell, in return for potassium entering the cell. Because this is an enzymatic process it is extremely sensitive to environmental conditions. For instance, as temperature rises then the enzyme works faster, pumping more potassium out of the serum into the cell. Conversely, when it is cold the pump doesn't work well and potassium leaks out of the cells. All this means that the level of potassium in the serum can be affected by the conditions in which a non-stabilised sample is kep

Chronic Disease Test Groups

FBC Renal ALT (or LFT if   single   test not available) HbA1C Lipids * Non-fasting TSH Calcium      (or bone if single test not available) B12 + Folate ACR micro albumin Coeliac antibodies Cardiovascular Disease New X X X X Full profile Cardiovascular Disease Annual X X **** Chronic Kidney Disease 3 Annual ** X **** X At risk of CKD Annual X X Dementia New X X Full set of LFTs X X X X Type 1 Diabetes New X X X X Full profile X X X Type 1 Dia