Sweat Chloride
| PATIENT INFO |
| Patient Name: |
| Medical Record #: |
| BD: / / Sex: F M |
| PHYSICIAN INFO |
| Physician Name : |
| Address: |
| Ph: ( ) - Fax: ( ) - |
| Additional Report to: |
| Ph: ( ) - Fax: ( ) - |
| TESTS REQUESTED | |
| Test Name: | ICD9 Code: (required) |
| 1. Sweat Chloride | |
| 2. | |
| 3. | |
| 4. | |
| 5. | |
| 6. | |
| SPECIMEN INFO |
| Collection Date & Time: |
| Collected By: |
| Hospital: |
Test ID :
SWEAT
Test Workstation :
MCHM
Specimen Type:
Sweat
Tube Type:
Sweat container
Collection Volume:
0.03 mL sweat by iontophoresis
Cause for Rejection:
Insufficient sample for testing
Storage:
Ambient
Availability:
Mon-Fri
Methodology:
Pilocarpine Iontophoresis assayed by Elitech Group Wescor Chlorochek
Special Instructions:
See information under Iontophoresis" for collection instructions. Lab will order this test if a sufficient amount of sweat is collected."
For Outpatients, test should only be drawn in outpatient locations within the Hospital at the Akron campus.
Lab/Phone:
330-543-8417
TAT:
Next business day.
Additional Info:
The Cystic Fibrosis Foundation Reference intervals for chloride:
< or = 29 mEq/L, CF unlikely
30-59 mEq/L, Intermediate
> or = 60 mEq/L, Indicative of CF
A result of >30 mEq/L is considered abnormal and should prompt further investigation.
NOTE: Sweat chloride values less than 30 mEq/L have been documented in genetically proven CF patients. Clinical correlation is necessary.
< or = 29 mEq/L, CF unlikely
30-59 mEq/L, Intermediate
> or = 60 mEq/L, Indicative of CF
A result of >30 mEq/L is considered abnormal and should prompt further investigation.
NOTE: Sweat chloride values less than 30 mEq/L have been documented in genetically proven CF patients. Clinical correlation is necessary.
CPT Code:
82438
Synonyms:
Cystic Fibrosis Sweat Test; Pilocarpine Ionto
