scholarly journals Agreement between Arterial and Capillary pH, pCO2, and Lactate in Patients in the Emergency Department

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Vincent Collot ◽  
Stefano Malinverni ◽  
Jabir Haltout ◽  
Eric Schweitzer ◽  
Pierre Mols ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Sensitivity And Specificity ◽  
Blood Gas Analysis ◽  
Primary Objective ◽  
Gas Analysis ◽  
Mean Difference ◽  
Plot Analysis ◽  
High Concordance ◽  
Secondary Objective ◽  
The Difference

Background. Blood gas analysis (BGA) is a frequent painful procedure in emergency departments. The primary objective of the study was a quantitative analysis to assess the mean difference and 95% confidence interval of the difference between capillary and arterial BGA for pH, pCO2, and lactate. Secondary objective was to measure the sensitivity and specificity of capillary samples to detect altered pH, hypercarbia, and lactic acidosis. Adults admitted to the ED were screened for inclusion. We studied the agreement between the two methods for pH, pCO2, and lactate with Bland-Altman bias plot analysis and receiver operating characteristic curves. Results. One hundred ninety-seven paired analyses were included. Mean difference for pH between arterial and capillary BGA was 0.0095, and 95% limits of agreement (LOA) were −0.048 to 0.067. For pCO2, mean difference was −0.3 mmHg, and 95% LOA were −8.5 to 7.9 mmHg. Lactate mean difference was −0.93 mmol/L, and 95% LOA were −2.7 to 0.8 mmol/L. At a threshold of 7.34, capillary pH had 98% sensitivity and 97% specificity to detect acidemia; at 45.9 mmHg, capillary pCO2 had 89% sensitivity and 96% specificity to detect hypercarbia. At a threshold of 3.5 mmol/L, capillary lactate had 66% sensitivity to detect lactic acidosis. Conclusion. Capillary BGA cannot replace arterial BGA despite high concordance between the two methods for pH and pCO2 and moderate concordance for lactate. Capillary measures had good accuracy when used as a screening tool to detect altered pH and hypercarbia but insufficient sensitivity and specificity when screening for lactic acidosis.

scholarly journals Agreement between arterial and capillary pH, pCO2 and lactate in patients in the emergency department

2020 ◽  
Author(s):  
V. Collot ◽  
S. Malinverni ◽  
E. Schweitzer ◽  
J. Haltout ◽  
P. Mols ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Sensitivity And Specificity ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Mean Difference ◽  
Blood Gas ◽  
Limits Of Agreement ◽  
Study Objective ◽  
Arterial Blood Gas ◽  
Arterial Blood

AbstractStudy objectiveThe primary objective of the study was a quantitative analysis to assess the mean difference and 95% confidence interval of the difference between capillary and arterial blood gas analyses for pH, pCO2 and lactate. Secondary objective was to measure the sensitivity and specificity of capillary samples to detect altered pH, hypercarbia and lactic acidosis.MethodsAdults admitted to the ED for whom the treating physician deemed necessary an arterial blood gas analysis (BGA) were screened for inclusion. Simultaneous arterial and capillary samples were drawn for BGA. Agreement between the two methods for pH, pCO2 and lactate were studied with Bland-Altman bias plot analysis. Sensitivity, specificity, positive and negative predictive value as well as AUC were calculated for the ability of capillary samples to detect pH values outside normal ranges, hypercarbia and hyperlactatemia.Results197 paired analyses were included in the study. Mean difference for pH, between arterial and capillary BGA was 0.0095, 95% limits of agreement were -0.048 to 0.067. For pCO2, mean difference was -0.3 mmHg, 95% limits of agreement were -8.5 to 7.9 mmHg. Lactate mean difference was -0.93 mmol/L, 95% limits of agreement were -2.7 to 0.8 mmol/L. At a threshold of 7.34 for capillary pH had 98% sensitivity and 97% specificity to detect acidemia; at 45.9 mmHg capillary pCO2 had 89% sensitivity and 96% specificity to detect hypercarbia. Finally at a threshold of 3.5 mmol/L capillary lactate had 66% sensitivity to detect lactic acidosis.ConclusionCapillary measures of pH, pCO2 and lactate can’t replace arterial measurements although there is high concordance between the two methods for pH and pCO2 and moderate concordance for lactate. Capillary blood gas analysis had good accuracy when used as a screening tool to detect altered pH and hypercarbia but insufficient sensitivity and specificity when screening for lactic acidosis.

scholarly journals The Effectiveness Of High Levels Of Knowledge Regarding Hiv/Aids In Reducing Discriminatory Attitudes And Behaviour Towards Hiv-Infected People

2006 ◽  
Vol 4 (1) ◽  
Author(s):  
M. Pirie ◽  
W. J. Coetsee
Keyword(s):  
Sample Size ◽  
Primary Objective ◽  
Large Sample Size ◽  
Infected People ◽  
Eta Squared ◽  
Secondary Objective ◽  
Level Of Knowledge ◽  
The Difference ◽  
F Statistics ◽  
Hiv Aids

The primary objective of this study was to assess whether there is a relationship between increasing levels of knowledge about HIV/AIDS and perceptions of discriminatory attitudes and behaviour towards people with HIV/AIDS. Employees (3662) from a large accounting firm were exposed to a survey and a response rate of 41% or 1532 was received. The secondary objective of the study was to determine whether there were any statistically significant differences in the mean difference of knowledge scores of groups created in terms of the different biographical variables. ANOVA’S (to determine the significance of differences between the means), t-tests (two groups only) and F-statistics were used for the analysis. Given the large sample size an F-test is not conclusive and the effect of the difference in sample size needs to be taken into account. For this reason it was also necessary to look at the Partial Eta Squared. Results indicate that respondents are generally knowledgeable about the prevention and transmission of HIV/AIDS and that respondents’ level of knowledge correlates negatively with discriminatory practices.

scholarly journals Lactic Acidosis in Prostate Cancer: Consider the Warburg Effect

2017 ◽  
Vol 10 (3) ◽  
pp. 1085-1091 ◽  
Author(s):  
Johannes C. van der Mijn ◽  
Mathijs J. Kuiper ◽  
Carl E.H. Siegert ◽  
Annabeth E. Wassenaar ◽  
Carel J.M. van Noesel ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Lactic Acidosis ◽  
Warburg Effect ◽  
Blood Gas Analysis ◽  
Tp53 Gene ◽  
Gas Analysis ◽  
Metabolic Reprogramming ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Warburg Effect

Lactic acidosis is a commonly observed clinical condition that is associated with a poor prognosis, especially in malignancies. We describe a case of an 81-year-old patient who presented with symptoms of tachypnea and general discomfort. Arterial blood gas analysis showed a high anion gap acidosis with a lactate level of 9.5 mmol/L with respiratory compensation. CT scanning showed no signs of pulmonary embolism or other causes of impaired tissue oxygenation. Despite treatment with sodium bicarbonate, the patient developed an adrenalin-resistant cardiac arrest, most likely caused by the acidosis. Autopsy revealed Gleason score 5 + 5 metastatic prostate cancer as the most probable cause of the lactic acidosis. Next-generation sequencing indicated a nonsense mutation in the TP53 gene (887delA) and an activating mutation in the PIK3CA gene (1634A>G) as candidate molecular drivers. This case demonstrates the prevalence and clinical relevance of metabolic reprogramming, frequently referred to as “the Warburg effect,” in patients with prostate cancer.

scholarly journals Experimental Investigation of the Viscosity Parameters Ranges—Case Study of Engine Oils in the Selected Viscosity Grade

Energies ◽  
2020 ◽  
Vol 13 (12) ◽  
pp. 3152 ◽  
Author(s):  
Artur Wolak ◽  
Grzegorz Zając ◽  
Kamil Fijorek ◽  
Piotr Janocha ◽  
Arkadiusz Matwijczuk
Keyword(s):  
Energy Efficient ◽  
Kinematic Viscosity ◽  
Primary Objective ◽  
Laboratory Measurements ◽  
Mahalanobis Distances ◽  
Engine Oils ◽  
Secondary Objective ◽  
Viscosity Grade ◽  
The Difference

The primary objective of the research was to compare the viscosity parameters of the same viscosity grade engine oils, as declared by the manufacturers, to the actual laboratory measurements. The secondary objective was to briefly investigate (1) what kind of information oil manufacturers provide in the product data sheets of the studied oils, and (2) the potential savings resulting from the use of the energy efficient oils. The study material consisted of 42 selected synthetic engine oils that belong to the 5W-30 viscosity grade. Stabinger SVM 3001 viscometer was used to determine kinematic viscosity at −20 °C, 40 °C, 100 °C and 130 °C. The HTHS (high temperature high shear), CCS (cold cranking simulator), FTIR (Fourier-transform infrared spectroscopy) and GC (Gas Chromatography) measurements were also performed for the samples that had the lowest and the highest kinematic viscosity. Large differences (5–25%) between oil producers’ declarations and the results of laboratory tests were found. Although all of the engine oils tested met the 5W-30 grade standards, the high variability of viscosity measurements needs to be reported. The difference between the oil with the highest and the oil with the lowest kinematic viscosity at −20 °C was 11,804 mm2/s. The outlying temperature-related viscosity profiles were recovered using Mahalanobis distances which identified 16 out of 42 analyzed oil samples as atypical.

scholarly journals Wernicke’s Encephalopathy after Pancreaticoduodenectomy: A Case Report

2019 ◽  
Vol 2 (1-3) ◽  
pp. 1-7 ◽  
Author(s):  
Kazuteru Monden ◽  
Hiroshi Sadamori ◽  
Masayoshi Hioki ◽  
Satoshi Ohno ◽  
Mitsue Rikimaru ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Pancreatic Fistula ◽  
Thiamine Deficiency ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Wernicke’S Encephalopathy ◽  
Wernicke's Encephalopathy ◽  
High Dose ◽  
Blood Gas ◽  
Laboratory Test Results

Background: Wernicke’s encephalopathy (WE) is caused by thiamine deficiency and classically appears as changes in mental status, oculomotor manifestations, and gait ataxia. WE is mostly found in patients with chronic alcoholism and malnutrition, and has rarely been reported following pancreaticoduodenectomy. Case Presentation: A 77-year-old woman was admitted to our hospital complaining of loss of appetite and weakness of the lower extremities. No abnormalities were found on blood examination. One year earlier, she had undergone pancreaticoduodenectomy for bile duct cancer, and pancreatic fistula developed as a postoperative complication. On hospital day 8, her level of consciousness deteriorated, and she experienced difficulty bending the lower limbs and walking. Computed tomography and upper gastrointestinal series showed dilatation of the residual stomach and stenosis of the gastrojejunostomy. Laboratory test results were normal except for blood gas analysis, which revealed severe lactic acidosis. A diagnosis of WE was suspected due to lactic acidosis secondary to thiamine deficiency. Definitive diagnosis was confirmed by magnetic resonance imaging of the brain. Intravenous infusion of high-dose thiamine (1,200 mg/day) was commenced, leading to improvement of her neurological condition. Conclusions: Physicians should recognize that pancreaticoduodenectomy, when complicated by gastrojejunostomy stenosis resulting in pancreatic fistula, can lead to WE. In this case, blood gas analysis was helpful in arriving at the correct diagnosis. A high degree of suspicion should be maintained if any of the classical features of WE are observed following pancreaticoduodenectomy.

Design of Reflectance Pulse Oximeter and BPM using the Max30100 Sensor in Early Detection of Hypoxemia in Patients with Cardiovascular Disorders

2021 ◽  
Vol 1 (1) ◽  
pp. 1-6
Author(s):  
Chiu-Hua Huang ◽  
Jia-Wei Guo
Keyword(s):  
Oxygen Saturation ◽  
Pulse Oximeter ◽  
Light Emitting Diode ◽  
Blood Gas Analysis ◽  
Large Error ◽  
Gas Analysis ◽  
Measuring Instruments ◽  
Blood Oxygen Saturation ◽  
Organic Light Emitting Diode ◽  
The Difference

Blood oxygen saturation meter is a tool used to monitor the state of oxygen saturation in the blood and also the patient's heart rate (BPM) and to assist in the physical assessment of the patient without going through blood gas analysis. Oxygen saturation measuring devices usually use the difference in the wavelengths of red and infrared led light that will be captured by the photodiode. The purpose of this research is to make a pulse oximeter equipped with a display of SPO2, BPM values ​​and an additional SP02 signal. The design of this measuring instrument uses the MAX30100 sensor, the minimum system circuit of Arduino ATmega328p and OLED (Organic Light-Emitting Diode). Data from the MAX30100 sensor enters the I2C pin on the minimum Arduino system, then the microcontroller is processed to produce the percentage of SPO2 value, BPM value, and SPO2 signal which is then displayed on the OLED. The test is done by comparing the module with standard measuring instruments which produces the largest % error of 0.81% for Spo2 and 0.87% for BPM. The error presentation is obtained from factor measurements, if there is finger movement it will cause a large error. From the results obtained, the tool is still feasible to use because in the "Guidelines for Testing and Calibrating Medical Devices" Ministry of Health RI 2001, the maximum limit in the pulse oximeter error tolerance is for Spo2 1% and BPM 5%.

scholarly journals Metformin poisoning treated with high dose insulin dextrose therapy: a case series

2019 ◽  
Vol 26 (1) ◽  
pp. 72-78
Author(s):  
Theodore Young ◽  
Joaquim Cevallos ◽  
James Napier ◽  
Juan Martin-Lazaro
Keyword(s):  
Lactic Acidosis ◽  
Case Series ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Independent Effect ◽  
High Dose ◽  
Blood Gas ◽  
Compassionate Use ◽  
Life Threatening ◽  
Dextrose Infusion

Purpose. We describe the compassionate use of high dose insulin dextrose (HID) for life threatening metformin associated lactic acidosis (MALA) in four patients admitted to intensive care. Methods. Patients presenting with refractory lactic acidosis believed to be secondary to metformin poisoning were included. High dose insulin dextrose at 0.5units/kg/hour was infused in 50% dextrose. Frequent blood gas analysis allowed titration of therapy. All patients also received continuous veno-venous haemofiltration. Results. All four patients recovered to normal or near normal lactate and pH between 10 and 24 hours of therapy. Two patients had significant separation in time between initiation of HID and haemofiltration to suggest an independent effect of HID on improving pH and lactate. All patients had at least one episode of hypoglycaemia below 4.0 mmol/L with the lowest glucose in any patient during therapy being 3.0 mmol/L. All episodes were corrected with a dextrose infusion without sequelae. Conclusions. Our study demonstrates that HID therapy appears to be safe in patients with suspected metformin poisoning. It also appears to work to drive down lactate, improve pH and patients’ clinical condition. Further evidence is required to assess the effectiveness of HID therapy in the context of MALA.

scholarly journals Effect of arterial blood bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire screening for obstructive sleep apnea

2021 ◽  
Author(s):  
Chong Pei ◽  
Shuyu Gui
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Sensitivity And Specificity ◽  
Statistical Significance ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Apnea Hypopnea Index ◽  
Berlin Questionnaire ◽  
Arterial Blood ◽  
Obstructive Sleep

Abstract Background To evaluate the effect of arterial bicarbonate (HCO3−) concentration on the accuracy of STOP-Bang questionnaire (SBQ) screening for obstructive sleep apnea (OSA). Methods A total of 144 patients with suspected OSA were included. Polysomnograms (PSG) and blood gas analysis were performed, and the Epworth Sleepiness Scale (ESS), STOP-Bang questionnaire, and Berlin questionnaire were completed. The correlation between the arterial HCO3− concentration, apnea hypopnea index (AHI), and other related indicators was analyzed. The scoring results of the ESS, SBQ, and Berlin questionnaire were compared with the PSG results, and the sensitivity and specificity were calculated in the form of a four-cell table. The changes in the sensitivity and specificity of OSA screening after SBQ alone and combined with HCO3− concentration were compared, and ROC curves were drawn. Results Arterial HCO3− concentration was positively correlated with AHI (r = 0.537, P < 0.001). The ratio of HCO3− concentration ≥ 24.6 mmol/L in the non-OSA group was significantly lower than that in the OSA group (25.0% VS 80.8%, P < 0.001). The sensitivity of the SBQ was higher than that of the ESS (97.5% VS 81.7%, P < 0.001) and the Berlin questionnaire (97.5% VS 79.2%, P < 0.001). There was no statistical significance in the specificity of the three scales (25%, 37.5%, 37.5%). A combined SBQ score ≥ 3 and HCO3− concentration ≥ 24.6 mmol/L showed increased specificity and decreased sensitivity compared with an SBQ score ≥ 3 alone, with a corresponding AUC of 0.771 (P < 0.01) and 0.613 (P > 0.05), respectively. Conclusion The sensitivity of the SBQ was better than that of the Berlin questionnaire and ESS. After combining arterial blood HCO3− concentration, the SBQ questionnaire increased the specificity of OSA prediction and decreased the sensitivity, which improved the accuracy of screening.

scholarly journals Acid-base balance in sheep with experimentally induced acute ruminal lactic acidosis

2017 ◽  
Vol 69 (3) ◽  
pp. 637-643 ◽  
Author(s):  
A.F. Sabes ◽  
A.M. Girardi ◽  
D. Zangirolami Filho ◽  
G.M. Bueno ◽  
J.A. Oliveira ◽  
...  
Keyword(s):  
Lactic Acidosis ◽  
Base Excess ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Urine Samples ◽  
Acid Base Balance ◽  
Acid Base ◽  
Arterial Blood ◽  
Base Balance ◽  
Experimentally Induced

ABSTRACT This study aimed to investigate the changes in the acid-base balance of sheep with experimentally induced acute ruminal lactic acidosis (ARA). Ten ewes orally received 15 grams of sucrose per kilogram of body mass. Arterial blood samples for blood gas analysis were obtained at the following intervals: before the induction of ARA (control), and 2, 4, 6, 8, 10, 12, 16, 20, 24, 28, 32, 36, 48, 72, 96, 120 and 144 hours after sucrose administration. Urine samples for pH measurement were obtained at the following times: -15 days, -7 days, and immediately before sucrose administration, then at 24, 48, 72, 96, 120 and 144 hours. Thereafter, both blood and urine samples were obtained on the 2nd, 3rd, and 4th following weeks. From 4 hours after the induction, elevation of the pH, bicarbonate and base excess on the arterial blood was observed. After 12 hours, the animals showed a decrease of these parameters, as well as urine acidification, which are symptomatic of metabolic acidosis. Within 28 hours, all parameters were normalized except the base excess, which only returned to normal after 72 hours. Despite the occurrence of acidemia, there was no need for medication and no animals died.

scholarly journals Lactic Acidosis as an Unusual Finding in Undifferentiated Carcinoma

2021 ◽  
pp. 1237-1241
Author(s):  
Adrian Viteri-Noel ◽  
Maria Eugenia Cobo-Reinoso ◽  
Blanca de Felipe-Noguerales ◽  
Luis Manzano
Keyword(s):  
Lactic Acidosis ◽  
Rare Complication ◽  
Abdominal Mass ◽  
Laboratory Data ◽  
Blood Gas Analysis ◽  
The Elderly ◽  
Undifferentiated Carcinoma ◽  
Gas Analysis ◽  
Increased Risk ◽  
Risk Of Malignancy

Lactic acidosis associated with solid neoplasms is a rare complication; its occurrence is poorly described, and it is associated with a poor prognosis. We present the case of an 84-year-old woman who was admitted to the internal medicine department with a diagnosis of urinary tract infection accompanied by a blood gas analysis showing lactic acidosis. During her admission, an abdominal mass was evidenced and finally diagnosed as undifferentiated carcinoma. We wanted to emphasize the importance of correlating clinical and laboratory data at the time of making a diagnostic approach and also highlight other possible explanations of lactic acidosis that should be considered in addition to hypoperfusion due to sepsis, especially in the elderly who are at increased risk of malignancy.

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