The acute care testing handbook is a practical guide to critical parameters in acute care testing such as pO2, lactate and troponin.
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This practical handbook provides you with each parameter’s physiological role and pathophysiology, reference intervals and the most likely causes of abnormalities.
More than 20 parameters are presented:
Blood gases
pH - Potential of hydrogen
The degree of acidity or alkalinity of any liquid (including blood) is a function of its hydrogen ion concentration [H+], and pH is simply a way of expressing hydrogen ion activity. The relationship between pH and hydrogen ion concentration is described thus [1]:
pH = -log aH+
Low pH is associated with acidosis and high pH with alkalosis.
The pH parameter is available in these products:
pCO2 – Partial pressure of carbon dioxide
Carbon dioxide (CO2) is an acidic gas; the amount of CO2 in blood is largely controlled by the rate and depth of breathing or ventilation. pCO2 is the partial pressure of CO2 in blood. It is a measure of the pressure exerted by that small portion (~5 %) of total CO2 that remains in the gaseous state, dissolved in the blood plasma [2]. pCO2 is the respiratory component of acid-base balance and reflects the adequacy of pulmonary ventilation. The severity of ventilator failure as well as the chronicity can be judged by the accompanying changes in acid-base status.
The pCO2 parameter is available in these products:
pO2 – Partial pressure of oxygen
The amount of oxygen in blood is controlled by many variables, e.g. ventilation/perfusion. pO2 is the partial pressure of oxygen in a gas phase in equilibrium with the blood. pO2 only reflects a small fraction (1 – 2 %) of total oxygen in blood that is dissolved in blood plasma [3]. The remaining 98 – 99 % of oxygen present in blood is bound to the hemoglobin in the erythrocytes. pO2 primarily reflects the oxygen uptake in the lungs.
The pO2 parameter is available in these products:
Electrolytes
cNa+ – Sodium
Sodium (Na+) is the dominant cation in the extracellular fluid, where it has a 14-fold higher concentration (∼140 mmol/L) than in the intracellular fluid (∼10 mmol/L). Na+ is a major contributor of the osmolality of the extracellular fluid and its main function is largely in controlling and regulating water balance, and maintaining blood pressure. Na+ is also important for transmitting nerve impulses and activating muscle concretion.
The cNa+ parameter is available in these products:
cK+ – Potassium
Potassium (K+) is the major cation in the intracellular fluid, where it has a 25 - 37-fold higher concentration (∼150 mmol/L in tissue cells, ∼105 mmol/L in erythrocytes) than in the extracellular fluid (∼4 mmol/L) [4, 5]. K+ has several vital functions in the body, e.g. regulation of neuromuscular excitability, regulation of heart rhythm, regulation of intracellular and extracellular volume and acid-base status.
The cK+ parameter is available in these products:
cCa2+ – Calsium
The calcium ion (Ca2+) is one of the most prevalent cations in the body, where approximately 1 % is present in the extracellular fluid of blood. Ca2+ plays a vital role for bone mineralization and many cellular processes, e.g. contractility of the heart and the skeletal musculature, neuromuscular transmission, hormone secretion and action in various enzymatic reactions such as, e.g. blood coagulation.
The cCa2+ parameter is available in these products:
cCl- – Chloride
Chloride (Cl-) is the major anion in the extracellular fluid and one of the most important anions in blood. The main function of Cl- is to maintain osmotic pressure, fluid balance, muscular activity, ionic neutrality in plasma, and help elucidate the cause of acid-base disturbances.
The cCl- parameter is available in these products:
Metabolites
cGlu – Glucose
Glucose, the most abundant carbohydrate in human metabolism, serves as the major intracellular energy source (see lactate). Glucose is derived principally from dietary carbohydrate, but it is also produced – primarily in the liver and kidneys – via the anabolic process of gluconeogenesis, and from the breakdown of glycogen (glycogenolysis). This endogenously produced glucose helps keep blood glucose concentration within normal limits, when dietary-derived glucose is not available, e.g. between meals or during periods of starvation.
The cGlu parameter is available in these products:
cLac – Lactate
Lactate, the anion that results from dissociation of lactic acid, is an intracellular metabolite of glucose. It is produced by skeletal muscle cells, red blood cells (erythrocytes), the brain, and other tissues during anaerobic energy production (glycolysis). Lactate is formed in the intracellular fluid from pyruvate; the reaction is catalyzed by the enzyme lactate dehydrogenase (LDH) [6].
The cLac parameter is available in these products:
cCrea – Creatinine
Creatinine is an endogenous waste product of muscle metabolism, derived from creatine, a molecule of major importance for energy production within muscle cells. Creatinine is removed from the body in urine and its concentration in blood reflects glomerular filtration and thereby kidney function.
The cCrea parameter is available in these products:
cUrea – Urea
Urea (molecular formula CO(NH2)2) is the principal nitrogenous waste product of protein catabolism, which is eliminated from the body in urine. It is the most abundant organic component of urine.
The cUrea parameter is available in this product:
Oximetry
ctHb – Total hemoglobin
The concentration of total hemoglobin (ctHb) in blood includes oxyhemoglobin (cO2Hb), deoxyhemoglobin (cHHb), as well as the dysfunctional hemoglobin species that are incapable of binding oxygen:
carboxyhemoglobin (cCOHb) (see COHb), methemoglobin (cMetHb) (see MetHb) and sulfhemoglobin (cSulfHb).
Thus:
ctHb = cO2Hb + cHHb + cCOHb + cMetHb + cSulfHb
The rare sulfHb is not included in the reported c tHb in most oximeters.
The ctHb parameter is available in these products:
MetHb – Methemoglobin
FMetHb is the fraction of total hemoglobin (ctHb) that is present as methemoglobin (MetHb). By convention the fraction is expressed as a percentage (%) [1].
In most medical text boxes MetHb(a) is referred to as simply methemoglobin (MetHb).
The MetHb parameter is available in these products:
COHb – carboxyhemoglobin
FMetHb is the fraction of total hemoglobin (ctHb) that is present as methemoglobin (MetHb). By convention the fraction is expressed as a percentage (%) [1].
In the range of 0 – 60 % COHb in arterial (COHb(a)) and venous blood (COHb(v)) is similar, i.e. either venous or arterial blood may be analyzed [7]. In most medical texts FCOHb(a) is referred to as simply COHb.
The COHb parameter is available in these products:
sO2 – Oxygen saturation
Oxygen saturation (sO2) is the ratio of oxyhemoglobin concentration to concentration of functional hemoglobin (i.e. oxyhemoglobin (O2Hb) and deoxyhemoglobin (HHb) capable of carrying oxygen [1].
The sO2 reflects utilization of the currently available oxygen transport capacity.
In arterial blood 98 – 99 % of oxygen is transported in erythrocytes bound to hemoglobin. The remaining 1–2 % of the oxygen transported in blood is dissolved in the blood plasma – this is the portion reported as partial pressure of oxygen (pO2) [8].
The sO2 parameter is available in these products:
FO2Hb – Fraction of oxyhemoglobin
Fraction of oxyhemoglobin in total hemoglobin in blood.
The FO2Hb parameter is available in these products:
FHHb – Fraction of deoxyhemoglobin
Fraction of deoxyhemoglobin in total hemoglobin in blood.
The FHHb parameter is available in these products:
FHbF – Fraction of fetal hemoglobin
Fraction of fetal hemoglobin in total hemoglobin in blood.
The FHbF parameter is available in these products:
ctBil – Bilirubin
Bilirubin is the yellow breakdown product of the degradation of the heme group of hemoglobin. It is transported in blood from its site of production – the reticuloendothelial system – to the liver, where it is biotransformed before excretion in bile. Jaundice, the pathological yellow discoloration of skin, is due to abnormal accumulation of bilirubin in the tissues, and is always associated with elevated blood concentration of bilirubin (hyperbilirubinemia).
The ctBil parameter is available in these products:
Hematocrit
Hct – Hematocrit
Hematocrit, the ratio between the volume of erythrocytes and the volume of whole blood.
The Hct parameter is available in these products:
References
CLSI. Blood gas and pH analysis and related measurements; Approved Guidelines. CLSI document CA46-A2, 29, 8. Clinical and Laboratory Standards Institute, 940 West Valley Road, Suite 1400, Wayne, Pennsylvania 19087-1898 USA, 2009.
Higgins C. Parameters that reflect the carbon dioxide content of blood. www.acutecaretesting.org Oct 2008.
Wettstein R, Wilkins R. Interpretation of blood gases. In: Clinical assessment in respiratory care, 6th ed. St. Louis: Mosby, 2010.
Burtis CA, Ashwood ER, Bruns DE. Tietz textbook of clinical chemistry and molecular diagnostics. 5th ed. St. Louis: Saunders Elsevier, 2012.
Engquist A. Fluids/Electrolytes/Nutrition. 1st ed. Copenhagen: Munksgaard, 1985.
Robergs RA, Ghiasvand F, Parker D. Biochemistry of exercise-induced metabolic acidosis. Am J Physiol Regul Integr Comp Physiol 2004; 287: R502-16.
Lopez DM, Weingarten-Arams JS, Singer LP, Conway EE Jr. Relationship between arterial, mixed venous and internal jugular carboxyhemoglobin concentrations at low, medium and high concentrations in a piglet model of carbon monoxide toxicity. Crit Care Med 2000; 28: 1998-2001.
Higgins C. Why measure blood gases? A three-part introduction for the novice. Part 1. www.acutecaretesting.org Jan 2012.
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