i-STAT ACID – BASE UTILIZATION GUIDE 1 Utilization...Acid-Base Analysis Is Vital to Your...
Transcript of i-STAT ACID – BASE UTILIZATION GUIDE 1 Utilization...Acid-Base Analysis Is Vital to Your...
i-STAT® ACID – BASE UTILIZATION GUIDE
Abaxis and VetScan are registered trademarks of Abaxis, Inc. i-STAT is a registered trademark of the Abbott Group of Companies in various jurisdictions. Celite is a registered trademark of Celite Corporation, Santa Barbara, CA, for its diatomaceous products. © Abaxis 2013 887-0200 Rev. C
CG4+
Hematocrit (Hct)
Hemoglobin (Hgb)
Blood Urea Nitrogen (BUN)
Creatinine
Ionized Calcium (iCa)
Glucose (Glu)
Chloride (Cl)
Sodium (Na)
Potassium (K)
pH
HCO3
TCO2
Anion Gap
Base Excess
PCO2
PO2
Lactate
ACT Celite
Cardiac Troponin I (cTnl)
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i-STAT® 1 Cartridge Test Menu
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Acid-Base Analysis Is Vital to Your Diagnostic Protocols
Chemical reactions, especially those occurring in vivo, are dependent on many factors, none more important than optimal pH. Illness, whether acute or chronic, often results in pH abnormalities. Failure to recognize and address these abnormalities may result in:
• Missed diagnoses• Inappropriate treatment• Delayed or poor patient response to therapy• Increased time in hospital • Frequent relapse • Inability to thrive • Patient death
Acid-Base Definitions
• pH: Measurement of the H+ ion concentration in the plasma • pCO2: Partial pressure of the CO2 in the blood; reflects the amount of carbonic acid present • HCO3
-: The amount of the major buffer (bicarbonate) in the blood • Anion Gap: The amount of unmeasured anions in the blood (Na+ + K+)-(Cl- + HCO3
-). Can be helpful in describing the cause of acidosis • Base Excess: The amount of base needed to return the pH to 7.40. Can be helpful in determining the amount of HCO3
- to administer to the acidotic patient • Electrolytes: Na+, K+ Cl-, Ca2+
• TCO2: Total carbon dioxide, the sum of HCO3- and dissolved CO2 (from pCO2)
Common Presentations of Acid-Base Disorders
Patients you see every day present with clinical signs and/or physical examination findings that may initially suggest a conservative treatment approach. When completely investigated, many of these patients have underlying acid-base abnormalities best treated by a more aggressive approach. This includes both acute and chronic conditions.
Examples: Vomiting, GI Obstruction, GDV, PancreatitisEvaluate acid-base and electrolytes as vomiting causes:• Loss of H+ and Cl- (in the form of HCl)• H+ Loss pH Metabolic Alkalosis• Loss of H+ and Cl- can results in hypochloremic alkalosis• Severe disease causes elevated base excess
Examples: Diarrhea, Viral or Bacterial Infections, Severe Parasitism, Calf Scours, Equine Colic Evaluate acid-base and electrolytes as diarrhea causes:• Loss of HCO3
-
• HCO3- Loss pH Metabolic Acidosis
• Anion gap often normal• Base excess may be decreased
Inability to utilize glucose leads to formation of ketones • Ketones pH Metabolic Acidosis• May see high or normal anion gap depending on severity• Base excess may be decreased
Upper Gastrointestinal
Lower Gastrointestinal
Examples: Heart/Lung Disease, Pneumonia, Chylo/hemo/pyothorax, Neoplasia, Pulmonary/Pleural Effusion Reduced ability to uptake O2 leads to alkalosis• Decreased O2 Hyperventilation pCO2 pH Respiratory Alkalosis• Therapy directed at improving O2 exchange and reducing alkalosis• Long-term monitoring to include acid-base analysis (3–5 days for kidneys to compensate)
Examples: Acute/Chronic Insufficiency/Failure, Urinary ObstructionThe kidney plays a major role in regulation of electrolytes and H+ blood levels• Retention of uremic toxins contributes to increased acid levels• Renal disease leads to acidosis through: Electrolyte abnormalities Buildup of toxins HCO3
- loss and/or H+ retention• Therapy directed at correcting electrolytes and acid-base disorders• Acidosis commonly recurs due to reduced renal function
The American Association of Feline Practitioners (AAFP) recommends routine monitoring and correction of acid-base disorders in chronic renal patients1
• Addison’s disease• Toxicities: ethylene glycol, lily, acetaminophen• Large Animal: Grain overload Uroperitoneum Neonatal monitoring Field lactate monitoring
Cardiothoracic
Renal Disease
Other Common Presentations
Causing Acid-Base Derangement:
1 Pittari J, Rodan I, Beekman G, et al. American Association of Feline Practitioners. Senior care guidelines. J Feline Med Surg. 2009;11:763-778.
Acid-Base Diagnostic Chart
Acidemia Normal Alkalemia
(Low HC03- and high pCO2)
Mixed Acidosis
pCO2 High
HCO3-
Normal
Respiratory Acidosis
HCO3-
Low
pCO2 Normal
Metabolic Acidosis
(High HC03- and
low pCO2)
Mixed Alkalosis
HCO3-
High
pCO2 Normal
Metabolic Alkalosis
pCO2 Low
HCO3-
Normal
Respiratory Alkalosis
pH
HCO3-
Low
pCO2 Low
Compensated Metabolic Acidosis
HCO3-
High
pCO2 High
Compensated Metabolic Alkalosis
Renal Failure Lactic Acidosis Ketoacidosis
Ethyene Glycol Toxicity
Pulmonary Disease Hypoventilation
Anesthesia/Narcotic
Early Renal Disease Diarrhea
Medications
Chronic Vomiting GI Obstruction
Hyperventilation Severe Anemia
Congestive Heart Failure Pneumonia
Pain/Anxiety
Anion Gap
High
Organic Acid Accumulation
Normal
HCO3-
Loss
Diabetes Mellitus
VetScan i-STAT Acid-Base | Utilization Guide
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