Modification of the alkaline picrate assay for creatinine to prevent spuriously elevated values by keto acids.

Acetoacetate and pyruvate, sometimes present in patients' serum in abnormal amounts, interfere, like other keto acids, with the determination by some usual procedures of creatinine. Acetoacetate can be responsible for overestimation of "creatinine" in the order of 400 mumol/l in sera of ketotic diabetics, fasting subjects and other patients with ketosis. The pseudocreatinine reaction of acetoacetate increases with increasing concentration of NaOH and picrate. Pyruvate causes falsely elevated values, especially at high picrate concentrations. The effect of acetoacetate at 25 degrees C has ceased 90 sec after the start of the reaction. We propose a continuous flow method with relatively low concentrations of NaOH and picrate, and a kinetic method at 25 degrees C with a measuring time of between 90 and 270 sec after mixing sample and reagents. In this way the interference by acetoacetate and pyruvate is eliminated or reduced. We found excellent correlation between the proposed method for a centrifugal analyzer and a manual reference method, based on the adsorption of creatinine to fuller's earth.