The effects of a history of seizures during pregnancy on umbilical arterial blood gas values in pregnant women with epilepsy

Mr. A is 24 years of age with a history of schizophrenia (Slide 1). He has been living with his parents and has been ill for a few years. Police saw him on the street in a state of crisis and brought him to the emergency room (ER). He was very anxious and his delusions of being in great physical danger had worsened. He reported a history of asthma, but it was noted that his asthma occurred a long time ago and was inactive; however, due to his anxiety, his smoking had increased to where it was continuous. At the time he was brought to the ER, Mr. A was triaged to psychiatry and became agitated in the waiting area; hence, security was called. He was about to be restrained and given an intramuscular dose (IM) of lorazepam, but the psychiatrist noted that he was having trouble breathing and stopped the IM before it was given. The psychiatrist noticed that Mr. A was wheezing, had a rapid respiratory rate of 25/minute, was tachycardic, and sweating. His pulse oximeter measurement was 90% saturated, which is considered low.Mr. A was re-interviewed and reported that he previously had asthma. His parents were contacted and agreed that he had active asthma, had stopped his psychiatric treatment several months ago, and, more recently, stopped his asthma medications when his prescriptions were not refilled ∼1 week prior to this episode. An emergency arterial blood gas showed a pH of acidosis at 7.27; a Po2 of 60 (normal is 80); and a Pco2 of 48 (normal is 40). The Pco2 was of particular concern because if he was retaining CO2, respiratory failure was imminent.

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Hypercalcemia due to milk alkali syndrome: An emerging cause of hypercalcemia: A case report and review of literature

Case Reports in Internal Medicine ◽

10.5430/crim.v5n2p31 ◽

2018 ◽

Vol 5 (2) ◽

pp. 31

Author(s):

Yadav Pandey ◽

Krishna Prasad Joshi ◽

Priya Priyambada ◽

Anmol Chaudhary

Keyword(s):

Calcium Carbonate ◽

Blood Gas ◽

Review Of Literature ◽

Over The Counter ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Extensive Evaluation ◽

Severe Hypercalcemia ◽

Laboratory Results ◽

History Of

Introduction: Hypercalcemia is relatively common in clinical practice. Primary hyperparathyroidism and malignancy accounts for more than 90 percent of all cases of hypercalcemia. Milk alkali syndrome which is hypercalcemia classically caused by ingestion of large amount of calcium and absorbable alkali which was once virtually disappeared as a cause of hypercalcemia has emerged as a third leading cause of hypercalcemia. We present a case of hypercalcemia secondary to ingestion of calcium carbonate tablets resulting in milk alkali syndrome.Case presentation: Patient is a 45-year-old female with history of gastroesophageal reflux disease came to the emergency department with complaints of dizziness, constipation, fatigue and confusion for 3 weeks. She was hypotensive to 83/53 mmHg at arrival. Significant laboratory results were - Potassium of 2.2 mmol/L (3.5-5.1 mmol/L), chloride 73 mmol/L (98-107 mmol/L), Bicarbonate 50 mmol/L (22-29 mmol/L), Blood urea 22 mg/dl (9.8-20.1 mg/dl), Cr 1.4 mg/dl (0.5-1.0 mg/dl), total calcium of 16.6 mg/dl (9-11 mg/dl), ionized calcium 2.02 mmol/L (1.15-1.33 mmol/L), PTH was low to 8.9 pg/ml (10-65 pg/ml). Arterial blood gas showed metabolic alkalosis. Extensive evaluation to find the cause of hypercalcemia was negative. Detailed history after initial stabilization, revealed that she had been taking 10 tablets of calcium carbonate tablets per day and 1 glass of milk daily for reflux symptoms for the last eight weeks. Based on the history and after ruling out all the other serious causes, diagnosis of milk alkali syndrome was made and patient was discharged with proton pump inhibitor with advice to avoid calcium carbonate. Her hypercalcemia responded well to fluid resuscitation.Conclusions: Milk alkali syndrome once a rare cause of hypercalcemia has emerged as a third leading cause of hypercalcemia in completely different scenario. It is important to evaluate the patient with proper history including the use of over the counter calcium supplements to determine the etiology of hypercalcemia. Our case highlights the importance of proper history taking in the evaluation of hypercalcemia and that not all the cause of severe hypercalcemia is secondary to malignancy.

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Benzocaine-Adultered Street Cocaine in Association with Methemoglobinemia

Clinical Chemistry ◽

10.1093/clinchem/38.4.596 ◽

1992 ◽

Vol 38 (4) ◽

pp. 596-597 ◽

Cited By ~ 29

Author(s):

C D McKinney ◽

K F Postiglione ◽

D A Herold

Keyword(s):

Spectral Analysis ◽

Cocaine Abuse ◽

Clinical Effects ◽

Blood Gas ◽

Mass Spectral Analysis ◽

Arterial Blood Gas ◽

Mass Spectral ◽

Arterial Blood ◽

History Of ◽

Clonic Seizures

Abstract A 27-year-old man with a history of cocaine abuse ingested a large quantity of street cocaine in an apparent suicide attempt. Shortly thereafter, he developed tonic-clonic seizures and became cyanotic. An arterial blood gas sample, collected in the emergency department, appeared chocolate-brown and showed pO2 279 mmHg, pCO2 53 mmHg, and pH 7.15. Hemoglobin spectral analysis revealed significant methemoglobinemia (37%). Subsequent gas-chromatographic and mass-spectral analysis of urine confirmed the presence of cocaine (106 mg/L), benzoylecgonine (94 mg/L), and other metabolites. Further testing revealed the presence of benzocaine, a compound known to produce methemoglobinemia. A powder submitted as the "cutting" substance was shown to be benzocaine. When confronted with a possible cocaine overdose (particularly by ingestion), the physician should consider the possible clinical effects of adulterants, especially local anesthetics such as benzocaine.

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Atrial fibrillation associated with carbon monoxide poisoning

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2019.14 ◽

2019 ◽

pp. 203-206

Author(s):

Mevlut Demir ◽

◽

Muslum Sahin ◽

Ahmet Korkmaz ◽

◽

...

Keyword(s):

Atrial Fibrillation ◽

Carbon Monoxide ◽

Sinus Rhythm ◽

Partial Pressure ◽

Motor Vehicle ◽

Carbon Monoxide Poisoning ◽

Venous Blood ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood

Carbon monoxide intoxication occurs usually via inhalation of carbon monoxide that is emitted as a result of a fire, furnace, space heater, generator, motor vehicle. A 37-year-old male patient was admitted to the emergency department at about 5:00 a.m., with complaints of nausea, vomiting and headache. He was accompanied by his wife and children. His venous blood gas measures were: pH was 7.29, partial pressure of carbon dioxide (pCO2) was 42 mmHg, partial pressure of oxygen (pO2) was 28 mmHg, carboxyhemoglobin (COHb) was 12.7% (reference interval: 0.5%-2.5%) and oxygen saturation was 52.4%. Electrocardiogram (ECG) examination showed that the patient was not in sinus rhythm but had atrial fibrillation. After three hours the laboratory examination was repeated: Troponin was 1.2 pg/ml and in the arterial blood gas COHb was 3%. The examination of the findings on the monitor showed that the sinus rhythm was re-established. The repeated ECG examination confirmed the conversion to the sinus rhythm. He was monitored with the normobaric oxygen administration.

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d-Cystine di(m)ethyl ester reverses the deleterious effects of morphine on ventilation and arterial blood gas chemistry while promoting antinociception

Scientific Reports ◽

10.1038/s41598-021-89455-2 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Benjamin Gaston ◽

Santhosh M. Baby ◽

Walter J. May ◽

Alex P. Young ◽

Alan Grossfield ◽

...

Keyword(s):

Gas Exchange ◽

Intracellular Signaling ◽

Dimethyl Ester ◽

Diethyl Ester ◽

Blood Gas ◽

Negative Effects ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Gas Chemistry ◽

Ventilatory Drive

AbstractWe have identified thiolesters that reverse the negative effects of opioids on breathing without compromising antinociception. Here we report the effects of d-cystine diethyl ester (d-cystine diEE) or d-cystine dimethyl ester (d-cystine diME) on morphine-induced changes in ventilation, arterial-blood gas chemistry, A-a gradient (index of gas-exchange in the lungs) and antinociception in freely moving rats. Injection of morphine (10 mg/kg, IV) elicited negative effects on breathing (e.g., depression of tidal volume, minute ventilation, peak inspiratory flow, and inspiratory drive). Subsequent injection of d-cystine diEE (500 μmol/kg, IV) elicited an immediate and sustained reversal of these effects of morphine. Injection of morphine (10 mg/kg, IV) also elicited pronounced decreases in arterial blood pH, pO2 and sO2 accompanied by pronounced increases in pCO2 (all indicative of a decrease in ventilatory drive) and A-a gradient (mismatch in ventilation-perfusion in the lungs). These effects of morphine were reversed in an immediate and sustained fashion by d-cystine diME (500 μmol/kg, IV). Finally, the duration of morphine (5 and 10 mg/kg, IV) antinociception was augmented by d-cystine diEE. d-cystine diEE and d-cystine diME may be clinically useful agents that can effectively reverse the negative effects of morphine on breathing and gas-exchange in the lungs while promoting antinociception. Our study suggests that the d-cystine thiolesters are able to differentially modulate the intracellular signaling cascades that mediate morphine-induced ventilatory depression as opposed to those that mediate morphine-induced antinociception and sedation.

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Analysis of Arterial Blood Gas Values Based on Storage Time Since Sampling: An Observational Study

Nursing Reports ◽

10.3390/nursrep11030048 ◽

2021 ◽

Vol 11 (3) ◽

pp. 517-521

Author(s):

Alejandro Montero-Salinas ◽

Marta Pérez-Ramos ◽

Fernando Toba-Alonso ◽

Leticia Quintana-DelRío ◽

Jorge Suanzes-Hernández ◽

...

Keyword(s):

Lactic Acid ◽

Observational Study ◽

Partial Pressure ◽

Group Analysis ◽

Initial Time ◽

Blood Gas ◽

Initial Sample ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Prospective Longitudinal

Aim. To evaluate the influence of time on arterial blood gas values after artery puncture is performed. Method. Prospective longitudinal observational study carried out with gasometric samples from 86 patients, taken at different time intervals (0 (T0), 15 (T15), 30 (T30) and 60 (T60) min), from 21 October 2019 to 21 October 2020. The study variables were: partial pressure of carbon dioxide, bicarbonate, hematocrit, hemoglobin, potassium, lactic acid, pH, partial pressure of oxygen, saturation of oxygen, sodium and glucose. Results. The initial sample consisted of a total of 90 patients. Out of all the participants, four were discarded as they did not understand the purpose of the study; therefore, the total number of participants was 86, 51% of whom were men aged 72.59 on average (SD: 16.23). In the intra-group analysis, differences in PCO2, HCO3, hematocrit, Hb, K+ and and lactic acid were observed between the initial time of the test and the 15, 30 and 60 min intervals. In addition, changes in pH, pO2, SO2, Na and glucose were noted 30 min after the initial sample had been taken. Conclusions. The variation in the values, despite being significant, has no clinical relevance. Consequently, the recommendation continues to be the analysis of the GSA at the earliest point to ensure the highest reliability of the data and to provide the patient with the most appropriate treatment based on those results.

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Reference intervals for venous blood gas measurement in adults

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2020-1224 ◽

2020 ◽

Vol 0 (0) ◽

Author(s):

Kirsty L. Ress ◽

Gus Koerbin ◽

Ling Li ◽

Douglas Chesher ◽

Phillip Bwititi ◽

...

Keyword(s):

Partial Pressure ◽

Meta Analysis ◽

Venous Blood ◽

Reference Interval ◽

Reference Intervals ◽

Published Data ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Venous Blood Gas

AbstractObjectivesVenous blood gas (VBG) analysis is becoming a popular alternative to arterial blood gas (ABG) analysis due to reduced risk of complications at phlebotomy and ease of draw. In lack of published data, this study aimed to establish reference intervals (RI) for correct interpretation of VBG results.MethodsOne hundred and 51 adult volunteers (101 females, 50 males 18–70 y), were enrolled after completion of a health questionnaire. Venous blood was drawn into safePICO syringes and analysed on ABL827 blood gas analyser (Radiometer Pacific Pty. Ltd.). A non-parametric approach was used to directly establish the VBG RI which was compared to a calculated VBG RI based on a meta-analysis of differences between ABG and VBGResultsAfter exclusions, 134 results were used to derive VBG RI: pH 7.30–7.43, partial pressure of carbon dioxide (pCO2) 38–58 mmHg, partial pressure of oxygen (pO2) 19–65 mmHg, bicarbonate (HCO3−) 22–30 mmol/L, sodium 135–143 mmol/L, potassium 3.6–4.5 mmol/L, chloride 101–110 mmol/L, ionised calcium 1.14–1.29 mmol/L, lactate 0.4–2.2 mmol/L, base excess (BE) −1.9–4.5 mmol/L, saturated oxygen (sO2) 23–93%, carboxyhaemoglobin 0.4–1.4% and methaemoglobin 0.3–0.9%. The meta-analysis revealed differences between ABG and VBG for pH, HCO3−, pCO2 and pO2 of 0.032, −1.0 mmol/L, −4.2 and 39.9 mmHg, respectively. Using this data along with established ABG RI, calculated VBG RI of pH 7.32–7.42, HCO3− 23 – 27 mmol/L, pCO2 36–49 mmHg (Female), pCO2 39–52 mmHg (Male) and pO2 43–68 mmHg were formulated and compared to the VBG RI of this study.ConclusionsAn adult reference interval has been established to assist interpretation of VBG results.

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