Test Overview
Test Methodology

Piccolo Express- spectrophotometry

Test Usage

Performed at authorized locations by point of care operators. Includes: Sodium, Potassium, Chloride, CO2, Calcium, Glucose, Creatinine, BUN.

Calcium- parathyroid, bone and chronic renal diseases; tetany

Chloride- dehydration, prolonged diarrhea and vomiting, renal tubular disease, hyperparathyroidism, burns, salt-losing renal diseases, overhydration and thiazide therapy

Creatinine- monitoring of renal disease

Glucose- carbohydrate disorders, including adult and juvenile diabetes mellitus and hypo glycemia.

Potassium- renal glomerular or tubular disease, adrenocortical insufficiency, diabetic keto acidosis, excessive intravenous potassium therapy, sepsis, para-hypothyroidism, in vitro hemolysis, hyperaldosteronism, malnutrition, hyper insulinism, metabolic alkalosis, and gastrointestinal loss

Sodium- dehydration, diabetes insipidus, loss of hypotonic gastro intestinal fluids, salt poisoning, selective depression of sense of thirst, skin losses, burns, sweating, hyperaldosteronism, CNS disorders, dilutional, deletional and delusional hyponatremia and syndrome of inappropriate ADH secretion

Total Carbon Dioxide- primary metabolic alkalosis and acidosis and primary respiratory alkalosis and acidosis

Blood urea nitrogen- renal and metabolic disorders

Reference Range *

Analyte reference ranges are available in the Piccolo test procedure located on the POC website: https://www.pathology.med.umich.edu/point-of-care.

* Reference ranges may change over time. Please refer to the original patient report when evaluating results.

Test Limitations

•Extremely elevated amylase levels (9000 U/L) will have a significant effect, >10 % increase, on a chloride result. The concentration of amylase is not evaluated by the Piccolo system for each specimen.
•The potassium assay in the Piccolo system is a coupled pyruvate kinase (PK)/ lactate dehydrogenase assay. Therefore, in cases of extreme muscle trauma or highly elevated levels of creatine kinase (CK), the Piccolo may recover a falsely elevated potassium (K+) value. In such cases, unexpected high potassium recoveries need to be confirmed utilizing a different methodology.
•Samples with hematocrits in excess of 62-65% packed red cell volume (a volume fraction of 0.62 - 0.65) may give inaccurate results. Samples with high hematocrits may be reported as hemolyzed.
•Hemolysis may cause erroneously high results in potassium assays. This problem may go undetected when analyzing whole blood * release of potassium from as few 0.5% of the erythrocytes can increase the potassium serum level by 0.5 mmol/L). In addition, even un-hemolyzed specimens that are not promptly processed may have increased potassium levels due to intracellular potassium leakage.

Test Details
Analytic Time

12 minutes

Soft Order Code
MiChart Code
Basic Panel, POC (Piccolo)
Point of Care
Point of Care
Specimen Requirements
Collection Instructions

Collect in lithium heparin tube.

Special Handling

Whole blood sample must be run within 60 minutes of collection.

Normal Volume
3 mL whole blood
Minimum Volume
100 µL whole blood
Rejection Criteria
•Specimens collected in any other anticoagulant other than lithium heparin.
•Clotted specimens.
• Specimens grossly hemolyzed and/or lipemic.
Additional Information

For more test specific information, please refer to the test procedure found on the Michigan Medicine POC website: https://www.pathology.med.umich.edu/point-of-care

CPT Code
Glucose (2339-0), blood urea nitrogen (6299-2), calcium (49765-1), creatinine (38483-4), sodium (2947-0), potassium (6298-4), chloride (2069-3), CO2 (2021-4)