The frequency and severity of metabolic acidosis related to topiramate

Objective We planned a cross-sectional analysis to determine the frequency and severity of metabolic acidosis in patients taking topiramate while awaiting craniotomy. Methods Eighty patients (18 – 65 years) taking topiramate to control seizures while awaiting elective craniotomy were enrolled. Any signs of metabolic acidosis or topiramate-related side effects were investigated. Blood chemistry levels and arterial blood gases, including lactate, were obtained. The severity of metabolic acidosis was defined according to base excess levels as mild or moderate. Results Blood gas analysis showed that 71% ( n = 57) of patients had metabolic acidosis. The frequency of moderate metabolic acidosis was 56% ( n = 45), while that of mild metabolic acidosis was 15% ( n = 12). A high respiratory rate was reported in only 10% of moderately acidotic patients. Conclusions In patients receiving topiramate, baseline blood gas analysis should be performed preoperatively to determine the presence and severity of metabolic acidosis.

Download Full-text

Comparison of Blood Gas Analysis between Benchtop and Handheld Device

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v27i1.1610 ◽

2020 ◽

Vol 27 (1) ◽

Author(s):

Phey Liana ◽

Iza Netiasa Haris ◽

Yan Effendi Hasyim

Keyword(s):

Clinical Decision Making ◽

Blood Gas Analysis ◽

Gas Analysis ◽

P Value ◽

Strong Positive Correlation ◽

Blood Gas ◽

Cross Sectional ◽

Handheld Device ◽

Arterial Blood ◽

Significant Difference

The use of blood gas analysis is to determine the Acid-base status required to treat patients with emergency conditionssuch as metabolic disorders and respiratory diseases. Benchtop device is commonly used in hospitals to analyze blood gas;however, handheld devices are recently more often used in emergency settings due to its quick and simple process. Thisstudy was performed to compare blood gas analysis results between the i-STAT handheld device and the Nova pHox Ultrabenchtop device that were currently being used in the central laboratory. This cross-sectional study was conducted by using42 arterial blood patients that were measured with i-STAT handheld device dan Nova pHox Ultra benchtop device. The pH,pCO2, and pO2 parameters were then evaluated. The data were analyzed using Spearman's correlation test, Mann-Whitneytest, and Bland-Altman plots. This study showed a very strong positive correlation for all parameters. Mann-Whitneycomparison test showed that there was no significant difference between the result of the two devices (p-value > 0.05). Allparameters showed that 95% of plots were within the acceptable limit. There was no clinical significance on the mean biasesof blood gas results between both devices. The i-STAT and Nova pHox Ultra devices showed a good agreement for bloodgas measurement. Therefore, both devices can be used interchangeably with minimal effect on clinical decision-making.

Download Full-text

Perbandingan Nilai PETCO2 dan PACO2 pada Pasien dengan Pemasangan Ventilasi Mekanik

Jurnal Keperawatan Padjadjaran ◽

10.24198/jkp.v4i1.134 ◽

1970 ◽

Vol 4 (1) ◽

Author(s):

Baskoro Soetioputro ◽

F. Sri Susilaningsih ◽

Titin Mulyati

Keyword(s):

Mechanical Ventilation ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Regulation Of Respiration ◽

Blood Gas ◽

Altman Plot ◽

Cross Sectional ◽

Bland Altman Plot ◽

Consecutive Sampling ◽

Arterial Blood

Pasien dengan ventilasi mekanik perlu dilakukan pemantauan CO2 karena berperan penting pada regulasi pernapasan dan keseimbangan asam-basa tubuh. Pemantauan CO2 dapat dilakukan dengan mengukur PaCO2 melalui analisis gas darah arteri. Pengukuran PaCO2 tidak dapat dilakukan secara kontinu sehingga perlu sering dilakukan pengambilan darah arteri yang dapat menimbulkan komplikasi. Pengukuran PETCO2 dapat memantau CO2 secara kontinu dan non invasif. PETCO2 adalah tekanan parsial CO2 ekspirasi yang diukur pada saat akhir volume tidal pernapasan. Penelitian ini bertujuan membandingkan nilai PETCO2 dan PaCO2 pada pasien dengan ventilasi mekanik di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Rancangan penelitian yang digunakan adalah prospective cross sectional. Pemilihan sampel dilakukan secara consecutive sampling. Penelitian dilakukan terhadap 21 pasien yang menggunakan ventilasi mekanik di ruang GICU RSUP Dr. Hasan Sadikin Bandung. Data PETCO2 dicatat pada saat perawat mengambil sampel darah arteri untuk pemeriksaan analisis gas darah. Didapatkan 122 pasang data nilai PETCO2 dan PaCO2. Data yang diperoleh dianalisis dengan Bland-Altman plot. Hasil penelitian nilai PETCO2 berada pada rentang 14-67 mmHg dan nilai PaCO2 berada pada rentang 17-77 mmHg. Bias nilai PETCO2 dan PaCO2 adalah -4,6475 mmHg lebih rendah daripada estimasi nilai bias ±5 mmHg sehingga bisa diterima secara klinik. Presisi nilai PETCO2 adalah 12,7969 mmHg (limit of agreement= 1,7509; -11,0460) lebih tinggi daripada estimasi nilai presisi ±5 mmHg sehingga tidak bisa diterima secara klinik. Kesimpulan dari penelitian ini adalah pengukuran PETCO2 tidak dapat menggantikan pengukuran PaCO2, tetapi pengukuran PETCO2 dapat digunakan untuk memperkirakan nilai PaCO2 pasien dengan ventilasi mekanik.Kata kunci: PETCO2, PaCO2, ventilasi mekanik. Comparison of PETCO2 and PACO2 Values in Patients with Mechanical VentilationAbstractPatients with mechanical ventilation need to be monitored for the CO2 value because it has an important role in regulation of respiration and body acid-base equilibrium. Monitoring of CO2 can be done by measuring PaCO2 through arterial blood gas analysis. Measurement of PaCO2 could not be done continuously so that the arterial blood are needed to be taken quite often which could cause complication. The measurement of PETCO2 can monitor the CO2 continuously and non-invasively. PETCO2 is partial pressure of CO2 expiration that is measured at the end of respiration tidal volume. This study aimed to compare the PETCO2 value and PaCO2 in patients with mechanical ventilation in GICU Dr. Hasan Sadikin Hospital. The research design was prospective cross-sectional using consecutive sampling method. The total sample was 21 patients who used mechanical ventilator in GICU Dr. Hasan Sadikin Hospital Bandung. The PETCO2 data were recorded when the patients’ arterial blood sample were taken for blood gas analysis test. The total of 122 pair date of PETCO2 and PaCO2 values were recorded. The data were analyzed using Bland-Altman plot. The results showed that the PETCO2 value ranged from 14 – 67 mmHg and the PaCO2 values ranged from 17 – 77 mmHg. The deviation of PETCO2 and PaCo2 was -4.6475 mmHg, which is lower than the estimation of ± 5 mmHg deviation, therefore the PETCO2 measurement can be accepted clinically. The precision of PETCO2 was 12.7969 mmHg (limit of agreement = 1.7509; -11.0460) which is higher than the estimation of precision value of ±5 mmHg, therefore it cannot be accepted clinically. In conclusion, the PETCO2 measurement could not replace the PaCO2 measurement, however, PETCO2 measurement can be used to predict the value of PaCO2 for patients with mechanical ventilation.Keywords: Mechanical ventilation, PETCO2, PaCO2.

Download Full-text

Comparison of oxygen saturation measured by pulse oximetry and arterial blood gas analysis in neonates

Paediatrica Indonesiana ◽

10.14238/pi43.6.2003.211-5 ◽

2016 ◽

Vol 43 (6) ◽

pp. 211

Author(s):

Srie Yanda ◽

Munar Lubis ◽

Yoyoh Yusroh

Keyword(s):

Oxygen Saturation ◽

Pulse Oximetry ◽

Heart Defects ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Oxygenation ◽

Blood Gas ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Arterial Blood

Background Arterial blood gas is usually beneficial to discern thenature of gas exchange disturbances, the effectiveness of com-pensation, and is required for adequate management. AlthoughPaO 2 is the standard measurement of blood oxygenation, oxygensaturation measured by pulse oximetry (SapO 2 ) is now a custom-ary noninvasive assessment of blood oxygenation in newborn in-fants.Objective To compare oxygen saturation measured by pulse oxi-metry (SapO 2 ) and arterial blood gas (SaO 2 ), its correlation withother variables, and to predict arterial partial pressure of oxygen(PaO 2 ) based on SapO 2 values.Methods A cross sectional study was conducted on all neonatesadmitted to Pediatric Intensive Care Unit (PICU) during February2001 to May 2002. Neonates were excluded if they had impairedperipheral perfusion and/or congenital heart defects. Paired t-testwas used to compare SapO 2 with SaO 2 . Correlation between twoquantitative data was performed using Pearson’s correlation. Re-gression analysis was used to predict PaO 2 based on SapO 2 val-ues.Results Thirty neonates were included in this study. The differ-ence between SaO 2 and SapO 2 was significant . There were sig-nificant positive correlations between heart rate /pulse rate andTCO 2 , HCO 3 ; respiratory rate and TCO 2 , HCO 3 , base excess (BE);core temperature and HCO 3 , BE; surface temperature and pH,TCO 2, HCO 3, BE; SapO 2 and pH, PaO 2 ; and significant negativecorrelation between SapO 2 and PaCO 2 ; the correlations were weak.The linear regression equation to predict PaO 2 based on SapO 2values was PaO 2 = -79.828 + 1.912 SapO 2 .Conclusion Pulse oximetry could not be used in place of arterialblood gas analysis available for clinical purpose

Download Full-text

Can venous blood gas be a reliable substitute for arterial blood gases in modern clinical practice?

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20193252 ◽

2019 ◽

Vol 6 (4) ◽

pp. 1016

Author(s):

Sabiha Naz ◽

Kiran Chugh ◽

Isha Malik

Keyword(s):

Venous Blood ◽

Blood Gases ◽

Blood Gas Analysis ◽

Gas Analysis ◽

P Value ◽

Emergency Setting ◽

Blood Gas ◽

Arterial Blood Gases ◽

Arterial Blood ◽

Venous Blood Gas

Background: It is clearly mentioned in the medicine books that blood gas analysis from arterial puncture is the gold standard. But in the past few years it is commonly seen that clinicians have started trusting on venous blood gas analysis as well as started advising VBG (Venous blood gas) in the initial diagnosis of critical patients in emergency setting. Keeping this fact in mind, we designed a study to determine whether VBG could be a better replacement of ABG (Arterial blood gases) in the emergency where diverse pathological conditions are encountered.Methods: This prospective cross-sectional study comprised of 50 patients of 20-60 yrs age with a variety of diagnoses admitted in the emergency department. 50 paired samples (ABG+VBG) were obtained from them under strict aseptic precautions after obtaining their verbal consent. With a minimum delay of less than 2 min blood gas analysis was performed on blood gas analyzer. Parameters (pH, PCO2, PO2, HCO3, Base Excess and O2 saturation) from ABG and VBG were recorded and compared using Student’s Unpaired ‘t’ test.Results: pH and HCO3 showed statistical significant (p value <0.05) differences between ABG and VBG, while BE showed statistical non-significant (p value >0.05) difference between them. Contrary to this, PCO2, PO2 and O2 saturation from ABG and VBG showed statistical highly significant (p value <0.0001) differences.Conclusions: VBG should not be interchangeably considered in place of ABG with regard to pH, HCO3, PCO2, PO2 and O2 saturation in conditions where actual oxygenation status of patient is required (e.g.; hypovolemic shock, respiratory disorders, mechanically ventilated patients, etc.)

Download Full-text

Arterialised Capillary Blood Gases in Accident and Emergency Department Patients - a Reliable Alternative to Arterial Sampling?

McGill Journal of Medicine ◽

10.26443/mjm.v7i2.788 ◽

2020 ◽

Vol 7 (2) ◽

Author(s):

Faheem Shakur ◽

Suzanne Mason

Keyword(s):

Blood Gases ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Capillary Blood ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

Significant Difference ◽

Emergency Department Patients

OBJECTIVES: Many patients with respiratory complaints who present to the Accident & Emergency (A & E) department have an arterial blood gas analysis performed at some point. It is our belief that there is no difference between arterial and capillary blood gas values in patients presenting to the A & E department. It is also anticipated that body temperature and blood pressure may play a part, so these will also be reported and associations will be investigated. METHODS: Patients who require arterial blood gas analysis at any stage during their stay in the A & E department at the Northern General hospital of Sheffield are eligible for inclusion in the study. In total there were 32 patients. PROCEDURE:Transvasin cream was applied to the ear lobe to improve local blood flow by dilating the capillaries. When ten minutes have elapsed after the application of the Transvasin cream, a capillary sample is taken from the ear lobe by the researchers. CONCLUSION: From the t-tests conducted, no significant difference was seen between the arterial and capillary blood gas samples for the parameters pO2 and O2 saturation. However, for pCO2, pH and [HCO3] there were significant differences observed. This result seems to disagree with the findings of most other studies that have so far shown stronger correlations generally for pH, pCO2 and bicarbonate, than for oxygen measuring parameters.

Download Full-text

Blood Gas Analysis in Neonatal Tetanus

Paediatrica Indonesiana ◽

10.14238/pi34.1-2.1994.44-7 ◽

2018 ◽

Vol 34 (1-2) ◽

pp. 44-7

Author(s):

Taslim S. Soetomenggolo ◽

Dwi Putro Widodo ◽

Jimmy Passat ◽

Sofyan Ismael

Keyword(s):

Metabolic Acidosis ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Neonatal Tetanus ◽

Common Finding ◽

Blood Gas ◽

Acid Base Balance ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Significant Difference

We reviewed the results of arterial blood gas analysis in 127 patients with neonatal tetanus on admission, and in 52 of such patients on the day before they died. All patients were hospitalized at the Department of Child Health, Cipto Mangunkusumo Hospital, Jakarta. On admission, most patients showed uncompensated metabolic acidosis. The mortality of patients wjth pH ofless than 7 was 100%. There was no significant difference between the mortality of patients with pH 7.35-7.45 and those with pH of less than 7.35. Analysis of acid-base balance indicated that ventilatory fw1ure was the most common finding in 52 patients who subsequently died. We recommend using intravenous fluid containing a combination of 5% dextrose and sodium bicarbonate with 4 : 1 (vol/vol) ratio from the fust day of hospitalization to reduce the possibility of the development of ongoing metabolic acidosis in patients with neonatal tetanus. Maintaining adequate ventilation is mandatory ln such patients.

Download Full-text

Arterial Blood Gas Analysis and the Outcome of Treatment in Tricyclic Antidepressants Poisoned Patients with Benzodiazepine Coingestion

Anesthesiology Research and Practice ◽

10.1155/2015/232401 ◽

2015 ◽

Vol 2015 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Ahmad Yaraghi ◽

Nastaran Eizadi-Mood ◽

Maryam Katani ◽

Shadi Farsaei ◽

Mahrang Hedaiaty ◽

...

Keyword(s):

Tricyclic Antidepressants ◽

Tertiary Care ◽

Blood Gas Analysis ◽

Gas Analysis ◽

University Hospital ◽

Blood Gas ◽

Cross Sectional ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Ph

Background. Poisoning with tricyclic antidepressants (TCAs) is still a major concern for emergency physicians and intensivists. Concomitant ingestion of other psychoactive drugs especially benzodiazepines with TCAs may make this clinical situation more complex. This study aimed to compare the arterial blood gas (ABG) values and the outcome of treatment in patients with coingestion of TCA and benzodiazepine (TCA + BZD) poisoning and TCA poisoning alone.Methods. In this cross-sectional study which was carried out in a tertiary care university hospital in Iran, clinical and paraclinical characteristics of one hundred forty TCA only or TCA + BZD poisoned patients (aged 18–40 years) were evaluated. ABG analysis was done on admission in both groups. Outcomes were considered as survival with or without complication (e.g., intubation) and the frequency of TCA poisoning complications.Results. Arterial pH was significantly lower in TCA + BZD poisoning group compared with TCA only poisoning group (7.34 ± 0.08 and 7.38 ± 0.08, resp.;P=0.02). However, other complications such as seizure, and the need for the endotracheal intubation were not significantly different. All patients in both groups survived.Conclusions. Concomitant TCA plus BZD poisoning may make the poisoned patients prone to a lower arterial pH level on hospital admission which may potentially increases the risk of cardiovascular complications in TCA poisoning.

Download Full-text

Evaluation of the cardiopulmonary and antinociceptive effects of bupivacaine administered epidurally at the first lumbar vertebra in awake dogs

Arquivo Brasileiro de Medicina Veterinária e Zootecnia ◽

10.1590/1678-4162-8886 ◽

2016 ◽

Vol 68 (6) ◽

pp. 1395-1402

Author(s):

P.E.S. Silva ◽

N. Nunes ◽

A.P. Gering ◽

T.C. Prada ◽

A.P.R. Simões ◽

...

Keyword(s):

Carbon Dioxide ◽

Antinociceptive Effect ◽

Lumbar Vertebra ◽

Blood Gases ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Parametric Data

ABSTRACT The aim of this study was to evaluate the effect of epidural bupivacaine administration at the first lumbar vertebra on cardiopulmonary variables, arterial blood gases and anti-nociception. Sixteen healthy female dogs were randomly assigned into two groups based on bupivacaine dose: G1 group, 1mg kg-1 or G2 group, 2mg kg-1, diluted in the same final volume (1mL4kg-1). Cardiopulmonary variables were measured and arterial blood gas was collected (T0), it was repeated 10 minutes after intravenous administration of butorphanol 0.4mg kg -1 (T1). Anesthesia was induced with intravenous etomidate at 2mg kg-1 and the epidural catheter was introduced and placed at the first lumbar vertebra. Thirty minutes later, bupivacaine was administered epidurally. Cardiopulmonary measurements and arterial blood gas analysis were recorded at 10 minute intervals (T2 to T6). Evaluation of pre surgical anti-nociception was performed at 5 minute intervals for 30 minutes by clamping the hind limbs, anus, vulva, and tail with the dogs awake. Subsequently, ovariohysterectomy was performed and adequacy of surgical anti-nociception was evaluated at 5 time points. Parametric data were analyzed using the F test with a <0.05 significance. After bupivacaine administration, there were differences between groups just for bicarbonate means (HCO3 -) on T6 (P=0.0198), with 18.7±1.3 and 20.4±0.8 for G1 and G2, respectively. After T1, before bupivacaine administration, both groups presented a slightly lower pH, base excess (BE), the end-tidal carbon dioxide tension (PECO2), and partial pressure of carbon dioxide (PaCO2), suggesting mild metabolic acidosis. G2 showed better antinociceptive effect both before and during surgery. It was possible to perform ovariohysterectomy in 87.5% of the G2 bitches and 25% of the G1 bitches. The two doses of bupivacaine evaluated do not cause important alterations in the studied parameters and the dose of 2mg kg-1 results in a better antinociceptive effect.

Download Full-text

The effect of clamped and unclamped umbilical cord samples on blood gas analysis

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-021-06076-w ◽

2021 ◽

Author(s):

Elisabetta Colciago ◽

Simona Fumagalli ◽

Elena Ciarmoli ◽

Laura Antolini ◽

Antonella Nespoli ◽

...

Keyword(s):

Blood Gas Analysis ◽

Cross Sectional Study ◽

Gas Analysis ◽

Blood Collection ◽

Large Sample Size ◽

Blood Gas ◽

Delayed Cord Clamping ◽

Cross Sectional ◽

High Risk Women ◽

Significant Difference

Abstract Purpose Delayed cord clamping for at least 60 s is recommended to improve neonatal outcomes. The aim of this study is to evaluate whether there are differences in cord BGA between samples collected after double clamping the cord or without clamping the cord, when blood collection occurs within 60 s from birth in both groups. Methods A cross-sectional study was carried out, collecting data from 6884 high-risk women who were divided into two groups based on the method of cord sampling (clamped vs unclamped). Results There were significant decrease in pH and BE values into unclamped group compared with the clamped group. This difference remained significant when considering pathological blood gas analysis parameters, with a higher percentage of pathological pH or BE values in the unclamped group. Conclusion Samples from the unclamped cord alter the acid–base parameters compared to collection from the clamped cord; however, this difference does not appear to be of clinical relevance. Findings could be due to the large sample size, which allowed to achieve a high power and to investigate very small numerical changes between groups, leading to a statistically significant difference in pH and BE between samples even when we could not appreciate any clinical relevant difference of pH or BE between groups. When blood gas analysis is indicated, the priority should be given to the timing of blood collection to allow reliable results, to assess newborns status at birth and intervene when needed.

Download Full-text

Validation of transcutaneous carbon dioxide monitoring using an artificial lung during adult pulsatile cardiopulmonary bypass

The International Journal of Artificial Organs ◽

10.1177/0391398820987855 ◽

2021 ◽

pp. 039139882098785

Author(s):

Lawrence Garrison ◽

Jeffrey B Riley ◽

Steve Wysocki ◽

Jennifer Souai ◽

Hali Julick

Keyword(s):

Carbon Dioxide ◽

Cardiopulmonary Bypass ◽

Gold Standard ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Artificial Lung ◽

Blood Gas ◽

Median Difference ◽

Transcutaneous Carbon Dioxide ◽

Arterial Blood

Measurements of transcutaneous carbon dioxide (tcCO2) have been used in multiple venues, such as during procedures utilizing jet ventilation, hyperbaric oxygen therapy, as well as both the adult and neo-natal ICUs. However, tcCO2 measurements have not been validated under conditions which utilize an artificial lung, such cardiopulmonary bypass (CPB). The purpose of this study was to (1) validate the use of tcCO2 using an artificial lung during CPB and (2) identify a location for the sensor that would optimize estimation of PaCO2 when compared to the gold standard of blood gas analysis. tcCO2 measurements ( N = 185) were collected every 30 min during 54 pulsatile CPB procedures. The agreement/differences between the tcCO2 and the PaCO2 were compared by three sensor locations. Compared to the earlobe or the forehead, the submandibular PtcCO2 values agreed best with the PaCO2 and with a median difference of –.03 mmHg (IQR = 5.4, p < 0.001). The small median difference and acceptable IQR support the validity of the tcCO2 measurement. The multiple linear regression model for predicting the agreement between the submandibular tcCO2 and PaCO2 included the SvO2, the oxygenator gas to blood flow ratio, and the native perfusion index ( R2 = 0.699, df = 1, 60; F = 19.1, p < 0.001). Our experience in utilizing tcCO2 during CPB has demonstrated accuracy in estimating PaCO2 when compared to the gold standard arterial blood gas analysis, even during CO2 flooding of the surgical field.

Download Full-text