Acid-Base

Base Excess = 0.02786 * pCO2 * 10 (pH - 6.1) + 13.77 * pH - 124.58

 
Kidney International (2009) 76, 1239–1247

Anion gap correction for hypoalbuminemia:  add 2.5 meq/L for every 1g/dL decline in albumin

Venous blood gas agrees with arterial blood gas (pH, bicarbonate, lactate, base excess, and carbon dioxide pressure (Pco2)) within 95% CI:

1. Middleton P, Kelly AM. Brown J, et al: Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate.  Emerg Med J  2006; 23(8):622-4.
2. Malatesha G, Singh NK, Bharija A, et al: Comparison of arterial and venous pH, bicarbonate, Pco2 and Po2 in initial emergency department assessment.  Emerg Med J  2007; 24(8):569-71.
3. Kelly AM: The case for venous rather than arterial blood gases in diabetic ketoacidosis.  Emerg Med Australas  2006; 18:64.

MUDPILES --> KULT

Methanol                   Toxin (formate)
Uremia                      Uremia
DKA                          Ketoacids
Propylene Glycol     Toxin (glycolate)
Isoniazid                   Lactate
Lactate                     Lactate
Ethylene Glycol       Toxin (glycolate, oxalate)
Salicylates               Toxin (salicylate --> lactate + ketoacids)

Ketoacids: acetoacetate, beta-hydroxy butyrate
Uremia: phosphates, sulfates, organic acids
Lactic Acidosis: Cyanide, Carbon Monoxide, Metformin, Didanosine, Stavudine, Strychnine, Emtriva, Rotenone (fish poison), NaAzide (lab workers), APAP (if liver dysfxn), Phosphine (rodenticide), NaMonofluoroacetate (coyote poison‐give etOH as antidote), INH (if patient seizes), Hemlock, Depakote, Hydrogen Sulfide, Nitroprusside (if cyanide toxic), Ricin, Propofol, & Jequerty Bean
Toxic acids: glycolic acid, formic acid, oxalic acid, salicylic acid, citric acid (blood product admin, esp FFP), pyroglytamic acid (oxoproline) from APAP overdose
 
Blood Gas Interpretation:

From LifeInTheFastLane:
  • When you look at a gas either draw this little grid or visualise it with your mind’s eye:

met comp grid 2 Funtabulously Frivolous Friday Five 057

  • For instance, if PaCO2 is 50 mmHg, that’s an increase of 10 mmHg from normal (PaCO2 40 mmHg). Thus in acute metabolic compensation the HCO3 should increase by 1 mmol/L from normal (HCO3 25 mmol/L) to 26 mmol/L, and in chronic compensation it should increase by 4 mmol/L from normal to 29 mmol/L.
  • Using the 4 square grid helps you remember which numbers correspond to what (acute comes before chronic, left before right), and whether they go up (top row) or down (bottom row).
THAM (mL of 0.3 M solution) = body weight (kg) x base deficit (mEq/L) x 1.1
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