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HelpTest Code LABRAMIK Amikacin, Random, Serum
Additional Codes
| Test Name in EPIC | EPIC Test Code | Mnemonic | Mayo Test ID |
|---|---|---|---|
| AMIKACIN, RANDOM, SERUM | LABRAMIK | RAMIK | RAMIK |
Useful For
Monitoring adequacy of blood concentration during amikacin therapy
Method Name
Kinetic Interaction of Microparticles in Solution (KIMS)
Reporting Name
Amikacin, Random, SSpecimen Type
SerumOrdering Guidance
Specimen for a peak level should be collected 30 to 60 minutes after last dose; order PAMIK / Amikacin, Peak, Serum.
Specimen for a trough level should be collected immediately before next scheduled dose; order TAMIK / Amikacin, Trough, Serum.
Specimen Required
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 0.5 mL
Collection Instructions:
1. Serum gel tubes should be centrifuged within 2 hours of collection.
2. Red-top tubes should be centrifuged, and the serum aliquoted into a plastic vial within 2 hours of collection.
Loading Dose Kinetics:
1. Levels after a loading dose should be drawn 1 hour and 12 hours after infusion is complete, keeping in mind that draw times may vary depending on dose schedule planned.
2. Subsequent levels are subject to change based on the results of the 1st level and the patient’s kidney function.
3. The pharmacy will notify lab of any changes in time. Also, a creatinine will be ordered separately if needed.
4. For newborns and/or NICU babies, draw specimens according to the following schedule as ordered per physician:
Q8 Hours: Draw 6 hours after infusion is complete
Q12 Hours: Draw 8 hours after infusion is complete
Q18 Hours: Draw 12 hours after infusion is complete
Q24 Hours: Draw 12 hours after infusion is complete
Specimen Minimum Volume
0.25 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 14 days | |
| Frozen | 28 days | ||
| Ambient | 72 hours |
Reject Due To
| Gross hemolysis | Reject |
Clinical Information
Amikacin is an aminoglycoside used to treat severe blood infections by susceptible strains of gram-negative bacteria. Aminoglycosides induce bacterial death by irreversibly binding bacterial ribosomes to inhibit protein synthesis. Amikacin is minimally absorbed from the gastrointestinal tract, and thus can been used orally to reduce intestinal flora.
Peak serum concentrations are seen 30 minutes after intravenous infusion, or 60 minutes after intramuscular administration. Serum half-lives in patients with normal renal function are generally 2 to 3 hours. Excretion of aminoglycosides is principally renal, and all aminoglycosides may accumulate in the kidney at 50 to 100 times the serum concentration.
Toxicity can present as dizziness, vertigo, or, if severe, ataxia and a Meniere disease-like syndrome. Auditory toxicity may be manifested by simple tinnitus or any degree of hearing loss, which may be temporary or permanent, and can extend to total irreversible deafness. Nephrotoxicity is most frequently manifested by transient proteinuria or azotemia, which may occasionally be severe. Aminoglycosides also are associated with variable degrees of neuromuscular blockade leading to apnea.
Reference Values
Peak: 20.0-35.0 mcg/mL
Toxic peak: >40.0 mcg/mL
Trough: <8.0 mcg/mL
Toxic trough:>10.0 mcg/mL
Interpretation
For conventional (nonpulse) dosing protocols, clinical effects may not be achieved if the peak serum concentration is <20.0 mcg/mL. Toxicity may occur if, for prolonged periods of time, peak serum concentrations are maintained >35.0 mcg/mL, or trough concentrations are maintained at >10.0 mcg/mL.
Cautions
Aminoglycosides are excreted primarily by glomerular filtration, thus, the serum half-life will be prolonged and significant accumulation will occur in patients with impaired renal function.
Method Description
Kinetic interaction of microparticles in solution (KIMS) as measured by changes in light transmission. The assay is a homogeneous immunoassay based on the principle of measuring changes in scattered light or absorbance which result when activated microparticles aggregate. The microparticles are coated with amikacin and rapidly aggregate in the presence of an amikacin antibody solution. When a sample containing amikacin is introduced, the aggregation reaction is partially inhibited, slowing the rate of the aggregation process. Antibody bound to sample drug is no longer available to promote microparticle aggregation, and subsequent particle lattice formation is inhibited. Thus, a classic inhibition curve with respect to amikacin concentration is obtained, with the maximum rate of aggregation at the lowest amikacin concentration. By monitoring the change in scattered light or absorbance, a concentration-dependent curve is obtained.(Package insert: Roche Amikacin reagent, Roche Diagnostic Corp, Indianapolis, IN)
Day(s) Performed
Monday through Sunday
Report Available
Same day/1 daySpecimen Retention Time
1 weekPerforming Laboratory
Mayo Clinic Laboratories in Rochester
Test Classification
This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| RAMIK | Amikacin, Random, S | 35669-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| RAMIK | Amikacin, Random, S | 35669-1 |
CPT Code Information
80150
Forms
If not ordering electronically, complete, print, and send a Therapeutics Test Request (T831) with the specimen.