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Venous pH (venous + ph)
Selected AbstractsThe case for venous rather than arterial blood gases in diabetic ketoacidosisEMERGENCY MEDICINE AUSTRALASIA, Issue 1 2006Anne-Maree Kelly Abstract Objectives:, For patients with diabetic ketoacidosis (DKA), arterial blood gas (BG) sampling for measurement of pH and bicarbonate has been considered an essential part of initial evaluation and monitoring of progress. There is growing evidence that venous values can be clinically acceptable alternatives to arterial measurements. This article summarizes the recent evidence regarding the validity of venous BG sampling in DKA. Methods:, Medline search for the years 1995 to present, hand search of reference lists, search of on-line evidence-based medicine sites. Results:, In patients with DKA the weighted average difference between arterial and venous pH was 0.02 pH units (95% limits of agreement ,0.009 to +0.021 pH units) and between arterial and venous bicarbonate was ,1.88 mEq/L. Conclusions:, There is reasonable evidence that venous and arterial pH have sufficient agreement as to be clinically interchangeable in patients with DKA who are haemodynamically stable and without respiratory failure. There is some evidence that venous and arterial bicarbonate also agree closely in DKA but this requires confirmation. [source] The workload of riding-school horses during jumpingEQUINE VETERINARY JOURNAL, Issue S36 2006M. M. SLOET Van OLDRUITENBORGH-OOSTERBAAN Summary Reasons for performing the study: As there are no reports on the real workload of horses that jump fences, this study was undertaken in riding-school horses. Objective: To compare the workload of horses jumping a course of fences with that of horses cantering over the same course at the same average speed without jumping fences. The workload variables included heart rate (HR), packed cell volume (PCV), acid-base balance (venous pH, pCO2, HCO3,) and blood lactate (LA), glucose, total protein and electrolyte concentrations. Methods: Eight healthy riding-school horses performed test A (a course of approximately 700 m with 12 jumps from 0.8-1.0 m high at an average speed of approximately 350 m/min) and test B (same course at the same speed, but without the rails) in a crossover study with at least 4 h between the 2 tests. Before each test the horses were fitted with a heart rate meter (Polar Electro)1. Blood samples were taken from the jugular vein at rest prior to the test, after warm-up before starting the course, immediately after the course and after recovery. All samples were analysed immediately. Results: The mean ± s.d maximal HR (beats/min) during the course (184 ± 17 and 156 ± 21, respectively) and the mean HR after recovery (75 ± 6 and 63 ± 7, respectively) were significantly higher in test A compared to test B (P=0.001 and P=0.007 respectively). The mean LA concentrations after the course and after recovery (mmol/1) were significantly higher in test A (3.6 ± 2.7 and 1.0 ± 0.9, respectively) compared to test B (0.9 ± 0.5 and 0.3 ± 0.1, respectively), (P=0.016 and P = 0.048 respectively). The mean PCV (1/1) after the course and after recovery was also significantly different between tests A (0.48 ± 0.04 and 0.39 ± 0.03, respectively) and B (0.42 ± 0.04 and 0.36 ± 0.03, respectively) (P<0.01). The mean pH and the mean HCO3, (mmol/1) after the course were significantly lower in test A (7.40 ± 0.04 and 28.9 ± 1.4, respectively) compared to test B (7.45 ± 0.03 and 30.4 ± 2.3, respectively) (P<0.05). Conclusions: This study indicates that in riding-school horses jumping fences, even at a low level competition, provokes a significant workload compared to cantering the same distance and speed without fences. Potential relevance: This study makes it clear that the extra workload of jumping fences should be taken into account in the training programmes of jumping horses. Further research with more experienced horses jumping higher fences will reveal the workload for top-level jumping horses. [source] Dexmedetomidine during coronary artery bypass grafting surgery: is it neuroprotective?ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 8 2007A preliminary study Background:, In the present study, we aimed to determine whether during coronary artery bypass grafting (CABG) surgery, dexmedetomidine has protective effects against cerebral ischemic injury. Method:, Twenty-four patients, aged 50,70 years, undergoing CABG surgery were randomized into two groups of 12 patients each: those receiving dexmedetomidine (group D) and those not receiving it (group C). As basal blood samples from arterial and jugular bulb catheters were drawn, dexmedetomidine (1 ,g/kg bolus and infusion at a rate of 0.7 ,g/kg/h) was administered to patients in group D. Arterial and jugular venous blood gas analyses, serum S-100B protein (S-100B), neuron-specific enolase (NSE) and lactate measurements were performed after induction, 10 min after the initiation of cardiopulmonary bypass (CPB), 1 min after declamping, at the end of CPB, at the end of the operation and 24 h after surgery. Mann,Whitney U - and Wilcoxon's tests were used for statistical analyses. Results:, No significant between-group differences were found regarding arterial and jugular venous pH, PO2, PCO2 and O2 saturations. S-100B, NSE and lactate levels were also similar between groups D and C. During the post-operative period, there were no clinically overt neurological complications in any patient. Conclusion:, Cerebral ischemia marker (S-100B, NSE, lactate) patterns were as expected during CPB; however, there were no differences between the groups, which led us to believe that during CABG surgery dexmedetomidine has no neuroprotective effects. Future studies with larger populations are recommended to further establish the effects of this drug. [source] Outcome of Dogs with Diabetic Ketoacidosis: 127 Dogs (1993,2003)JOURNAL OF VETERINARY INTERNAL MEDICINE, Issue 3 2006Daniel Z. Hume The aim of this study was to retrospectively describe the outcome of 127 dogs with naturally occurring diabetic ketoacidosis (DKA) and to examine the association between outcome of canine DKA and clinical and clinicopathologic findings. Eighty-two (65%) dogs were diagnosed with DKA at the time of initial diagnosis of diabetes mellitus (DM). Eighty-seven dogs (69%) had one or more concurrent disorders diagnosed at the time of hospitalization. Commonly identified concurrent conditions included acute pancreatitis (52, 41%), urinary tract infection (21, 20%), and hyperadrenocorticism (19, 15%). Dogs with coexisting hyperadrenocorticism were less likely to be discharged from the hospital (P= .029). Of 121 treated dogs, 89 dogs (70%) survived to be discharged from the hospital, with a median hospitalization of 6 days. Nonsurvivors had lower ionized calcium concentration (P <.001), lower hematocrit (P= .036), lower venous pH (P= .0058), and larger base deficit (P= .0066) than did survivors. Time from admission to initiation of subcutaneous insulin therapy was correlated with lower serum potassium concentration (P= .0056), lower serum phosphorus concentration (P= .0043), abnormally high white blood cell count (P= .0060), large base deficit (P= .0015), and low venous pH (P <.001). Multivariate analysis showed that base deficit was associated with outcome (P <.021). For each unit increase in the base deficit, there was a 9% greater likelihood of discharge from the hospital. In conclusion, the majority of dogs with DKA were not previously diagnosed with DM. Concurrent conditions and electrolyte abnormalities are common in DKA and are associated with length of hospitalization. Survival was correlated to degree of anemia, hypocalcemia, and acidosis. [source] Continuous non-invasive end-tidal CO2 monitoring in pediatric inpatients with diabetic ketoacidosisPEDIATRIC DIABETES, Issue 4 2006Michael SD Agus Introduction:, Pediatric inpatients with diabetic ketoacidosis (DKA) are routinely subjected to frequent blood draws in order to closely monitor degree of acidosis and response to therapy. The typical level of acidosis monitoring is less than ideal, however, because of the high cost and invasiveness of frequent blood labs. Previous studies have validated end-tidal carbon dioxide (EtCO2) monitoring in the emergency department (ED) for varying periods of time. We extend these findings to the inpatient portion of the hospitalization during which the majority of blood tests are sent. Methods:, All patients admitted to an intermediate care unit in (InCU) a large children's hospital were fitted with an appropriately sized oral/nasal cannula capable of sensing EtCO2. Laboratory studies were obtained according to hospital clinical practice guidelines. In a retrospective analysis, EtCO2 values were correlated with serum total CO2 (stCO2), venous pH (vpH), venous pCO2 (vpCO2), and calculated bicarbonate from venous blood gas (vHCO3,). Results:, A total of 78 consecutive episodes of DKA in 72 patients aged 1,21 yr were monitored for 3,38 h with both capnography and laboratory testing, producing 334 comparisons. Initial values were as follows, reported as median (range): stCO2, 11 (4,22) mmol/L; vpH, 7.281 (6.998,7.441); vpCO2, 28.85 (9.3,43.3) mmHg; and vHCO3,, 14 (3,25) mmol/L. EtCO2 was correlated well with stCO2 (r = 0.84, p < 0.001), vHCO3, (r = 0.84, p < 0.001), and vpCO2 (r = 0.79, p < 0.001). Conclusions:, These data support the findings of previous studies limited to ED populations and suggest that non-invasive EtCO2 monitoring is a valuable and reliable tool to continuously follow acidosis in the setting of the acutely ill pediatric patient with DKA. Continuous EtCO2 monitoring offers the practitioner an early warning system for unexpected changes in acidosis that augments the utility of intermittent blood gas determinations. [source] Deterioration in cord blood gas status during the second stage of labour is more rapid in the second twin than in the first twinBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 6 2004Tak-Yeung Leung Objective To compare in twin pregnancy the rate of deterioration in umbilical blood gas status during the second stage of labour, and to investigate whether the duration of the first twin's delivery has any effect on the blood gas status of the second twin. Design A retrospective study. Setting Department of Obstetrics and Gynaecology in a university teaching hospital. Population Twin pregnancies with both of the twins delivered by normal cephalic vaginal mode, at or beyond 34 weeks of gestation, over a period of seven years. Twins with any maternal or fetal complications including discordant growth, intrauterine growth restriction, intrauterine death, fetal malformations, fetal distress, pre-eclampsia and diabetes were excluded. Methods The first twins' second stage was defined as from the start of maternal pushing to his/her delivery, while the second twins' second stage started after the delivery of the first twin and ended by his/her delivery. The total duration of the second stage was the sum of the above two intervals. The correlations between the first twins' umbilical cord blood gas parameters and the duration of their own second stage, the second twins' umbilical cord blood gas parameters and the duration of their own second stage, as well as that of the total second stage, were studied. Main outcome measures The changes of umbilical arterial pH of each twin with the duration of the corresponding second stage of labour, and the difference among them. Results A total of 51 cases were reviewed. The median gestation at delivery was 37 weeks. The median duration of first twins' second stage was 10 minutes (range 1,75) while that of the second twins' was 10 minutes (range 3,26). The first twins' second stage was inversely correlated with their arterial pH, venous pH and base excess [BE] (P < 0.01). Both the second twins' second stage and the total second stage were inversely correlated with both of their arterial and venous pH and BE (P < 0.01). However, further multiple regression analysis suggested that the correlation of the total second stage with the second twins' cord blood parameters could be solely explained by their own second stage. The rate of reduction in the second twins' arterial pH was 4.95 × 10,3 per minute, and was significantly faster than that of the first twins', which was 1.55 × 10,3 per minute (P < 0.05). Conclusions During normal vaginal delivery, the umbilical cord blood gas status of both the first and the second twins deteriorated with the duration of their corresponding second stages, but the effects are greater in the latter. Furthermore, the duration of the first twins' second stage does not affect the blood gas status of the second twins'. These observations support the postulation of a diminished uteroplacental exchange function after the delivery of the first twin. Close monitoring and expeditious delivery of the second twins are important. [source] | ||||||||||