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单词 chs
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CHS


CHS

(Cylinder Head Sector) An earlier method of addressing a hard disk by referencing all three physical elements of the drive. It was superseded by logical block addressing (see LBA).

CHS


CHS

Abbreviation for:
calvarial hyperostotic syndrome
Canadian Hematology Society
Canada Health Survey
Cardiovascular Health Study
cavernous haemangioma
Center for Health Statistics
central hypoventilation syndrome
Chediak-Higashi syndrome
Child Health Surveillance, see there (Medspeak-UK)
Chinese Health Study
chlorinated hydrocarbons
chronic hyperplastic sinusitis
community health sciences
community health services (Medspeak-UK)
community health study
compression hip screw
controlled haemorrhagic shock
Coronary Heart Study

CHS

Cardiology Any of a number of clinical trials 1. Cardiovascular Health Study.2. Charleston Heart Study.3. Community Health Study.4. Congenital Heart Surgeons Society Study.5. Coronary Heart Study.

Pseudocholinesterase and Dibucaine Number

Synonym/acronym: CHS, PCHE, AcCHS.

Common use

To assess for pseudocholinesterase deficiency to assist in diagnosing a congenital deficiency. Special attention must be given to results for preoperative patients because positive results indicate risk for apnea with use of succinylcholine as an anesthetic agent.

Specimen

Plasma (1 mL) collected in a lavender-top (EDTA) tube. Serum (1 mL) collected in a red-top tube is also acceptable.

Normal findings

(Method: Spectrophotometry, kinetic)
TestConventional Units
Pseudocholinesterase
 Males3,334–7,031 IU/L
 Females2,504–6,297 IU/L
Dibucaine NumberFraction (%) of Activity Inhibited
Normal homozygote79%–84%
Heterozygote55%–70%
Abnormal homozygote16%–28%

Description

There are two types of cholinesterase: acetylcholinesterase (AChE), or “true cholinesterase” which is found in red blood cells, lung, and brain (nerve) tissue (see monograph titled “Red Blood Cell Cholinesterase”); and pseudocholinesterase, which is found mainly in the plasma, liver, and heart. Pseudocholinesterase is a nonspecific enzyme that hydrolyzes acetylcholine and noncholine esters. Carbamate and organophosphate insecticides (e.g., parathion, malathion) inhibit its activity.

Patients with inherited pseudocholinesterase deficiency are at risk during anesthesia if succinylcholine is administered as an anesthetic. Succinylcholine, a short-acting muscle relaxant, is a reversible inhibitor of acetylcholinesterase and is hydrolyzed by cholinesterase. Succinylcholine-sensitive patients may be unable to metabolize the anesthetic quickly, resulting in prolonged or unrecoverable apnea. Abnormal genotypes of pseudocholinesterase are detected using the dibucaine and fluoride inhibition tests because, in normal individuals, these chemicals inhibit pseudocholinesterase activity. The prevalence of succinylcholine sensitivity is 1 in 2,000 to 4,000 homozygote and 1 in 500 heterozygote patients. There are more than 15 identified phenotypes; A, AS, S1, S2, F, AF, and FS are associated with prolonged apnea following the use of succinylcholine. Widespread preoperative screening is not routinely performed.

This procedure is contraindicated for

    N/A

Indications

  • Assist in the evaluation of liver function
  • Screen for abnormal genotypes of pseudocholinesterase in patients with a family history of succinylcholine sensitivity who are about to undergo anesthesia using succinylcholine

Potential diagnosis

Increased in

  • Increased levels are observed in a number of conditions without specific cause.

  • Diabetes
  • Hyperthyroidism
  • Nephrotic syndrome
  • Obesity

Decreased in

    The enzyme is produced in the liver, and any condition affecting liver function may result in decreased production of circulating enzyme.

    Acute infection Anemia (severe) Carcinomatosis Cirrhosis Congenital deficiency Hepatic carcinoma Hepatocellular disease Infectious hepatitis Insecticide exposure (organic phosphate exposure decreases enzyme activity) Malnutrition (possibly related to decreased availability of transport proteins; condition associated with decreased enzyme activity) Muscular dystrophy Myocardial infarction Plasmapheresis (iatrogenic cause) Succinylcholine hypersensitivity (this chemical is a trigger in susceptible individuals) Tuberculosis (chronic infection is known to decrease enzyme activity) Uremia (pathological condition known to decrease enzyme activity)

Critical findings

  • A positive result indicates that the patient is at risk for prolonged or unrecoverable apnea related to the inability to metabolize succinylcholine. Note and immediately report to the health-care provider (HCP) any critically increased values and related symptoms.

  • Notify the anesthesiologist if the test result is positive and surgery is scheduled.

Interfering factors

  • Drugs and substances that may decrease pseudocholinesterase levels include ambenonium, bambuterol, barbiturates, chlorpromazine, cyclophosphamide, echothiophate, edrophonium, esmolol, estrogens, fluorides, glucocorticoids, hexafluorenium, ibuprofen, iodipamide, iopanoic acid, isoflurophate, metoclopramide, monoamine oxidase inhibitors, neostigmine, pancuronium, parathion, phenelzine, physostigmine, procainamide, pyridostigmine, oral contraceptives, and tetrahydroaminacrine.
  • Drugs that may increase pseudocholinesterase levels include carbamazepine, phenytoin, and valproic acid.
  • Plasmapheresis decreases pseudocholinesterase levels.
  • Pregnancy decreases pseudocholinesterase levels by about 30%.
  • Improper anticoagulant; fluoride interferes with the measurement and causes a falsely decreased value.

Nursing Implications and Procedure

Pretest

  • Positively identify the patient using at least two unique identifiers before providing care, treatment, or services.
  • Patient Teaching: Inform the patient this test can assist in evaluating for enzyme deficiency.
  • Obtain a history of the patient’s complaints, including a list of known allergens, especially allergies or sensitivities to latex. Particularly important to report is exposure to pesticides causing symptoms including blurred vision, muscle weakness, nausea, vomiting, headaches, pulmonary edema, salivation, sweating, or convulsions.
  • Obtain a history of the patient’s hepatobiliary and musculoskeletal systems, symptoms, and results of previously performed laboratory tests and diagnostic and surgical procedures.
  • Obtain a list of the patient’s current medications, including herbs, nutritional supplements, and nutraceuticals (see Effects of Natural Products on Laboratory Values).
  • Review the procedure with the patient. Inform the patient that specimen collection takes approximately 5 to 10 min. Address concerns about pain and explain that there may be some discomfort during the venipuncture.
  • Sensitivity to social and cultural issues, as well as concern for modesty, is important in providing psychological support before, during, and after the procedure.
  • Note that there are no food, fluid, or medication restrictions unless by medical direction.

Intratest

  • Potential complications: N/A
  • Avoid the use of equipment containing latex if the patient has a history of allergic reaction to latex.
  • Instruct the patient to cooperate fully and to follow directions. Direct the patient to breathe normally and to avoid unnecessary movement.
  • Observe standard precautions, and follow the general guidelines in Patient Preparation and Specimen Collection. Positively identify the patient, and label the appropriate specimen container with the corresponding patient demographics, initials of the person collecting the specimen, date, and time of collection. Perform a venipuncture.
  • Remove the needle and apply direct pressure with dry gauze to stop bleeding. Observe/assess venipuncture site for bleeding or hematoma formation and secure gauze with adhesive bandage.
  • Promptly transport the specimen to the laboratory for processing and analysis.

Post-Test

  • Inform the patient that a report of the results will be made available to the requesting health-care provider (HCP), who will discuss the results with the patient.
  • The patient with decreased values should be observed for signs of fluid volume excess related to compromised regulatory mechanisms, decreased cardiac output related to decreased myocardial contractility or arrhythmias, and pain related to inflammation or ischemia.
  • Social and Cultural Considerations Recognize anxiety related to test results, and be supportive of impaired activity related to weakness and fear of shortened life expectancy. Discuss the implications of abnormal test results on the patient’s lifestyle. Provide teaching and information regarding the clinical implications of the test results, as appropriate. Educate the patient regarding access to genetic counseling services and screening tests for other family members. Educate the patient regarding the use of a medic-alert bracelet to notify health-care workers of increased risk from exposure to medications that may lower pseudocholinesterase activity.
  • Reinforce information given by the patient’s HCP regarding further testing, treatment, or referral to another HCP. Answer any questions or address any concerns voiced by the patient or family.
  • Depending on the results of this procedure, additional testing may be performed to evaluate or monitor progression of the disease process and determine the need for a change in therapy. Evaluate test results in relation to the patient’s symptoms and other tests performed.

Related Monographs

  • Related tests include ALT, AST, and red blood cell cholinesterase.
  • Refer to the Hepatobiliary and Musculoskeletal systems tables at the end of the book for related tests by body system.

CHS


AcronymDefinition
CHSCentral High School
CHSCenter for Health Statistics
CHSCalifornia Historical Society
CHSCatholic High School (Singapore)
CHSChildren's Home Society
CHSCarmel High School
CHSCanadian Hydrographic Service
CHSCarolinas Healthcare System
CHSCenter for Human Services
CHSCentennial High School (USA)
CHSCanadian Hearing Society
CHSCommunity Health Services
CHSConnecticut Historical Society
CHSColumbia High School (White Salmon, Washington)
CHSCooperative Housing Society (various locations)
CHSCharleston International Airport (Charleston, SC)
CHSCenter for Health Sciences (various locations)
CHSCapitol Hill Seattle (news blog)
CHSCitrus High School (Inverness, FL)
CHSCardiovascular Health Study
CHSCollege of Human Sciences
CHSConant High School (Hoffman Estates, IL)
CHSCounseling and Health Services (various organizations)
CHSCross High School (Cross, SC)
CHSComprehensive Health Services (Cape Canaveral, FL)
CHSCommunity Healthcare System (various locations)
CHSColorado Historical Society
CHSCylinder-Head-Sector (computing)
CHSCalexico High School (Calexico, CA)
CHSCentre d'Histoire Sociale (French: Social History Center)
CHSChicago Historical Society
CHSCentre for Health and Society (Australia)
CHSChaparral High School (Scottsdale, AZ)
CHSCupertino High School (Cupertino, CA)
CHSChabad Hebrew School (Vienna, VA)
CHSConfidential Human Source (US FBI)
CHSCordless Hand Scanner
CHSClayton High School (Clayton, Missouri)
CHSCarthage High School
CHSClifton High School (New Jersey)
CHSCongenital Heart Surgery (cardiology)
CHSConcord High School (USA)
CHSCalgary Humane Society (Canada)
CHSCherry Hill Seminary (South Carolina)
CHSCollege of Humanities and Sciences (various schools)
CHSCity Honors School (New York)
CHSChannel Statistics Module
CHSChange Sign
CHSCylinder Head Sector
CHSChinese Simplified
CHSCalifornia High School (San Ramon, CA)
CHSCherokee High School (Georgia)
CHSChatsworth High School
CHSCapital Harness Systems (Mentor Graphics Corporation)
CHSCaledonia High School (Caledonia, MI, USA)
CHSConnersville High School (Connersville, IN)
CHSCampus Health Service
CHSCommunity Health Specialist (various locations)
CHSCanyon High School (Canyon County, California)
CHSCore Humanitarian Standard on Quality and Accountability (est. 2006)
CHSCentre Hospitalier Spécialisé (French: specialty hospital)
CHSChildren's Health Study (various organizations)
CHSCentre for Human Settlements (Canada)
CHSCherokee Health Systems (Tennessee)
CHSChild Health Surveillance
CHSCharlottesville High School (Charlottesville, Virginia)
CHSConnecticut Humane Society (est. 1881)
CHSCanadian Hemophilia Society (Montreal, Canada)
CHSCarolinas Hospital System (North Carolina and South Carolina)
CHSCathedral High School
CHSCode Hennessy & Simmons (investing; Chicago, IL)
CHSColumbine High School (Littleton, CO, USA)
CHSCommercial High Speed
CHSCannabis Hyperemesis Syndrome
CHSChelmsford High School (Massachusetts, USA)
CHSClovis High School (Clovis, NM)
CHSChediak-Higashi Syndrome
CHSCoronado High School (USA)
CHSCumberland High School (Rhode Island)
CHSChillicothe High School
CHSCommon Hardware/Software
CHSCampbell High School (Litchfield, NH)
CHSComprehensive High School (Hudda, Quetta, Pakistan)
CHSChesterton High School (Indiana)
CHSChandler High School (Arizona)
CHSChristiansburg High School (Virginia)
CHSCombat Health Support (US Army)
CHSCombat Health Support
CHSCornell Hotel Society (Cornell University; Ithaca, NY)
CHSCertified in Homeland Security
CHSCarlsbad High School
CHSCarson High School
CHSComparative-Historical Sociology (various schools)
CHSCircular Hollow Section (used in the steel construction industry)
CHSChristian Home School (various locations)
CHSCheltenham High School
CHSCapital Health System
CHSCabinet for Health Services (Kentucky)
CHSClark High School (Las Vegas, Nevada)
CHSCibola High School (Albuquerque, NM)
CHSChinese High School (Singapore)
CHSCedartown High School (Cedartown, Georgia)
CHSCenter for Human Simulation (University of Colorado)
CHSCalaveras High School (California)
CHSCloud Hosting Solutions (USGS)
CHSCompact Helical System
CHSCommunity Health Scholars (Florida)
CHSCertified Histocompatibility Specialist (American Board of Histocompatibility and Immunogenetics)
CHSCatholic Human Services (est. 1972)
CHSCalumet High School (Calumet, Michigan)
CHSCascade High School (Leavenworth, Washington)
CHSCaldwell High School (various cities)
CHSChildren's Health Services
CHSChong Hing Securities (Hong Kong)
CHSCertified Hospitality Supervisor
CHSConway High School (Conway, AR)
CHSConestoga High School (Berwyn, Pennsylvannia)
CHSChino High School (Chino, California)
CHSChugiak High School (Alaska)
CHSCatonsville High School (Baltimore, MD)
CHSCapitol Historical Society (US Capitol Building)
CHSCanterbury High School (Ottawa, Canada)
CHSCapuchino High School (San Bruno, CA)
CHSCommunications High School (New Jersey)
CHSCelebration High School (Celebration, Florida)
CHSCome Home Soon
CHSCheyenne High School (Las Vegas, NV)
CHSCrockett High School (Austin, Texas)
CHSColorado Herpetological Society (est. 1972)
CHSCrestview High School (USA)
CHSCredit Hour System (various schools)
CHSCarteret High School
CHSCreekview High School (Carrollton, TX, US)
CHSCommon Hardware Systems
CHSChesterfield County Historical Society (Chesterfield, VA)
CHSCameron High School (West Virginia)
CHSCanisius High School (Crusaders; Buffalo, NY)
CHSCleburne High School (Cleburne, TX, USA)
CHSCabrini High School
CHSCottonwood High School
CHSCortez High School (Phoenix, AZ )
CHSCerritos High School
CHSClarence High School (Clarence, NY)
CHSCenter for Humanistic Studies
CHSClewiston High School (Clewiston, FL, USA)
CHSCochrane High School (Alberta, Canada)
CHSColdwater High School (Coldwater, Michigan)
CHSCentereach High School (New York)
CHSCreative Home Supplies Limited (UK)
CHSCeres High School (Ceres, CA)
CHSCashmere High School (Cashmere, WA)
CHSCreative Host Services (Virginia)
CHSCohoes High School (Cohoes, NY)
CHSCrookston High School (Minnesota)
CHSChatard High School
CHSChapmanville High School (West Virginia)
CHSCactus High School
CHSCrofton House School
CHSChittenango High School (Chittenango, New York)
CHSCargo Handling System (airline management)
CHSCrossland High School
CHSCloverleaf High School (Lodi, OH)
CHSCharleston, SC, USA - Charleston International Airport (Airport Code)
CHSCathedral Healthcare System (New Jersey)
CHSCampbellsville High School (Kentucky)
CHSChristleton High School
CHSComing Home Studios LLC (Los Angeles, CA)
CHSCarlinville High School
CHSCadillac High School (Michigan)
CHSCalgary Horticultural Society (Canada)
CHSChancellor High School
CHSCokato Historical Society (Cokato, MN)
CHSChatswood High School (Sydney, Australia)
CHSCastle Hot Springs (Arizona)
CHSClarenceville High School (Livonia, MI)
CHSCharging Subsystem
CHSChoudrant High School (Choudrant, LA)
CHSCrofton High School (Crofton, NE)
CHSCounseling for High Skills
CHSCousino High School (Warren, Michigan)
CHSCanadian Hemerocallis Society
CHSClydesdale Horse Society
CHSCaruthersville High School
CHSCardiff High School (various locations)
CHSCommon Hardware Suite
CHSCloudcroft High School (New Mexico)
CHSCarlingford High School (Carlingford, Sydney, Australia)
CHSCyprus High School
CHSComsewogue High School (New York)
CHSCoalgate High School (Coalgate, OK)
CHSCoolant Heat Storage (Toyota Motor Corporation)
CHSCentral Healthy Start
CHSCentre for Housing Studies (India)
CHSCandidate Harmonized Standard
CHSCollimated Hole Structure
CHSCan't Hit Stuff (polite form)
CHSCylinder(s) Head(s) Sector(s)
CHSCheese Head Screw
CHSCoalition for Homeland Security
CHSCalifornia Horticultural Society
CHSCircular Hollow Shape (structural steel connections)
CHSContractor Highgrade Sylvania (electronic tubes made by Sylvania for US Army)
CHSClient Handling System
CHSConventional Hybrid System
CHSCommunications Hub Structure (construction)
CHSCustomer Happiness System (software: BusinessHub)
CHSCommander's Handstation (Bradley turret handstation operated by the commander)
CHSCommonwealth Historians Society (UK)
CHSCarrizozo High School (New Mexico)
CHSConsumer Home Services (General Electric Co.)
CHSCabcalor Hoofcare Specialist
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