Clinical Utility of Blood Gas Testing Job Aid

Clinical Utility of Blood Gas Put this information at your fingertips with our ABG Guide app. Visit www.siemens.com/pocresources or scan the QR code. RAPIDLab® 1200 System Parameter Normal Elevated Decreased Clinical Significance Underlying Causes Generalized CNS Depression • Respiratory Acidosis • Drowsiness/Lethargy • Increased PCO2 pH 7.35 – 7.45 < 7.35 = Acidosis/Acidemia • Decreased Force Cardiac Contractions • Metabolic Acidosis – • Decreased Response Catecholamines • Decreased cHCO3 • Coma/Death Generalized CNS Stimulation • Respiratory Alkalosis • Irritability • Decreased PCO2 pH 7.35 – 7.45 > 7.45 = Alkalosis/Alkalemia • Tetany • Metabolic Alkalosis – • Arrhythmias • Increased cHCO3 • Convulsions – Death • Variable Neurologic Symptoms • COPD +/– Oxygen Excess • Pulmonary Dyspnea/Distress • Depressant Overdose • Increased Cerebral Perfusion • Extreme V/Q Imbalance Respiratory Acidosis 35 – 45 mmHg • Increased Adrenergic Response • Neurologic Disease PCO > 45 mmHg (6.0 kPa) PCO2 4.7 – 6.0 kPa 2 • Flushed/Warm/Diaphoretic • Neuromuscular Disease (pH < 7.35) • Hypotension/Arrhythmia when severe • Extreme Work of Breathing • Medium- to high-volume testing • Insufficient Mech Ventilation • Patient test results in ~60 seconds • Excessive CO Production • Microsample, bubble, and clot detection 2 • True QC lockout • Pulmonary Discomfort/Dyspnea • Hypoxemia • Paresthesia/Tingling/Numbness • Excessive Mech Ventilation Respiratory Alkalosis 35 – 45 mmHg • Dizziness • Restrictive Lung Disease PCO < 35 mmHg (4.7 kPa) PCO2 4.7 – 6.0 kPa 2 • Increased Adrenergic Response • Neurologic Disorders (pH > 7.45) ® • Palpitations/Arrhythmias • Shock RAPIDPoint 500 System • GI Nausea/Vomiting • Decreased Myocardial Contractility • Toxins/Poisons • Decreased Cardiac Output • Renal Failure Metabolic Acidosis – • Decreased Blood Pressure • Lactic Acidosis – 22 – 26 mmol/L cHCO < 22 mmol/L HCO3 3 • Hyperkalemia • Ketoacidosis (pH < 7.35) • RTA/Renal Base Excretion • Intestinal Base Loss • CNS Abnormalities • Hypokalemia • Neuromuscular Irritability/Tetany • Loop/Thiazide Diuretics Acid-Base Balance – Arterial Blood Values Metabolic Alkalosis • Depressed Myocardial Contractility • Vomiting – 22 – 26 mmol/L cHCO – > 26 mmol/L • Arrhythmias • NG Drainage HCO3 3 (pH > 7.45) • Convulsions • Bicarbonate Therapy • High-Dose Steroids • Extracellular Fluid Deficit – – BE(B) –2 to +2 mmol/L > +2 mmol/L < –2 mmol/L See increased/decreased cHCO3 See increased/decreased cHCO3 – – • Medium- to high-volume testing BE(ECF) –2 to +2 mmol/L > +2 mmol/L < –2 mmol/L See increased/decreased cHCO3 See increased/decreased cHCO3 • Maintenance-free cartridge technology • Intuitive touchscreen user interface • Weakness/Fatigue Intracellular Fluid (ICF) Deficit • Onboard instructional videos and Hypernatremia • CNS Symptoms • Insufficient Water Intake + 135 – 145 mmol/L no-maintenance CO-ox Na Na+ > 145 mmol/L • Tetany/Convulsions • Excessive Water Loss • Febrile/Oliguria • Hyperosmolar Solutions • CNS Symptoms Intracellular Fluid (ICF) Excess ® Hyponatremia • Twitching/Convulsions • Excessive Water Intake RAPIDLab 348EX System + 135 – 145 mmol/L Na Na+ < 135 mmol/L • Central Edema • Renal Disease/ADH • CHF • See Metabolic Acidosis • Metabolic Acidosis Hyperchloremia – 95 – 105 mmol/L • See Hypernatremia • Parenteral Intake CI Cl– > 105 mmol/L • Hypernatremia • See Metabolic Alkalosis • Metabolic Alkalosis Hypochloremia – 95 – 105 mmol/L • See Hyponatremia • Hyponatremia CI Cl– < 95 mmol/L • Hypertonicity • Muscle Weakness • Renal/Adrenal Disease Hyperkalemia • Flaccid Paralysis/Paresthesia • Iatrogenic Administration + 3.5 – 5.0 mmol/L K K+ > 5.0 mmol/L • ECG Abnormalities • Cell Destruction/Hemolysis • Arrhythmia/Cardiac Arrest • Acidosis Electrolytes • Muscle Weakness/Fatigue • Diuretics/Steroids Hypokalemia • Paralysis • Renal Loss + 3.5 – 5.0 mmol/L K K+ < 3.5 mmol/L • ECG Abnormalities • GI Loss • Arrhythmia/Cardiac Arrest • Alkalosis • Low- to medium-volume testing • Small sample size with microsample mode • Hypotonicity • Hyperparathyroidism • Color touchscreen user interface Hypercalcemia • Polyuria/Kidney Stones • Excessive Calcium Ingestion • Bar-code scanner data entry ++ 1.1 – 1.4 mmol/L Ca Ca++ > 3.0 mmol/L • GI Symptoms • Excessive Vitamin D • CNS Depression • Neuromuscular Irritability • Hypoparathyroidism Hypocalcemia • Spasms/Tetany/Convulsions • Decreased Calcium Ingestion ® ++ 1.1 – 1.4 mmol/L RAPIDComm System Ca Ca++ < 1.1 mmol/L • Weak Cardiac Contraction • Inadequate Vitamin D • Bleeding/Coagulopathy • Alkalosis • Oxygen Toxicity • Excessive Oxygen Therapy 80 – 100 mmHg Hyperoxemia • Coronary Vasoconstriction • Hyperventilation PO2 10.7 – 13.3 kPa PO > 100 mmHg (13.3 kPa) 2 • Microatelectasis Hypoxemia • Sympathetic Stimulation • Hypoventilation 80 – 100 mmHg • Mild 60 – 79 mmHg (8.0 – 10.5 kPa) • Increased Cardiac Output • Absolute Shunting PO2 10.7 – 13.3 kPa • Moderate 45 – 59 mmHg (6.0 – 7.9 kPa) • CNS Abnormalities • V/Q Mismatch • Severe < 45 mmHg (6.0 kPa) • Decreased Cardiac Output (severe) • Diffusion Defect SO2 97 – 98% Hyperoxemia SO2 > 98% See Hyperoxemia above See Hyperoxemia above SO2 97 – 98% Hypoxemia SO2 < 90% See Hypoxemia above See Hypoxemia above • Hypoxemia FO2Hb 94 – 98% Hypoxemia FO2Hb < 90% See Hypoxemia above • Carboxyhemoglobinemia • Methemoglobinemia • Real-time remote monitoring and control • Potential Tissue Hypoxia • Smoke Inhalation • Facilitates regulatory compliance and Carboxyhemoglobinemia 0 – 1.5% • CO Exposure inspection readiness FCOHb FCOHb > 1.5% • Smoking • Easily manage operator authorization and recertification • Seamless integration with your LIS • Potential Tissue Hypoxia • Nitrate/Nitrite Exposure Methemoglobinemia 0 – 1.5% • Nitric Oxide FMetHb FMetHb > 1.5% • Topical Anesthetics Oxygenation – Arterial RAPIDLyte® Arterial Syringes and Capillaries FHHb 2 – 3% Increased Desaturated Hb • Potential Tissue Hypoxia See Hypoxemia above • Increased Blood Oxygen Capacity • Primary Pathology Polycythemia 12 – 15 g/dL* • Increased Blood Viscosity • Secondary to Hypoxemia tHb ctHb > 15 g/dL • COPD • Potential Tissue Hypoxia • Decreased RBC Production tHb 12 – 15 g/dL* Anemia tHb < 12 g/dL • Fatigue/Weakness • Increased RBC Destruction • Blood Loss • Anaerobic Metabolism • Tissue Hypoxia Hyperlactatemia 1.0 – 1.8 mmol/L • Increased Morbidity • Sepsis Lac > 2.0 mmol/L • Increased Mortality • Trauma • Polyuria • Diabetes Mellitus 70 – 110 mg/dL Hyperglycemia • Glycosuria • Stress Glu 3.9 – 6.1 mmol/L Glu > 110 mg/dL (6.1 mmol/L) • Dehydration 70 – 110 mg/dL Hypoglycemia Glu < 70 mg/dL • Weakness • Starvation Glu 3.9 – 6.1 mmol/L (3.9 mmol/L) • Coma • Insulin Excess • Comprehensive choice of sampling devices to meet 0.3 – 1.0 mg/dL (adult) tBil > 2.0 mg/dL (34.2 µmol/L) (adults) • Jaundice (neonates) • Hepatitis/Cirrhosis arterial blood collection needs 5.1 – 17.1 µmol/L (adult) tBil > 8.0 mg/dL (136.8 µmol/L) • Seizures • Drugs/Hemolysis • Special heparin formulation reduces potential for clots General Analytes tBil 0.6 – 7.9 mg/dL (neonates**) (neonates) • Kernicterus • Pathological Syndromes • Fully compatible with all Siemens blood gas systems 10.3 – 135.1 µmol/L (neonates**) • Available in select markets *Gender-specific normals exist. Refer to your Medical Director for normals. *Acceptable* neonatal values are time and birth weight dependent. Order No. A91DX-POC-110789-XC2-4A00 | 11-2012 | All rights reserved | © 2012 Siemens Healthcare Diagnostics Inc. Scan the QR code with your smartphone to download the ABG Guide App. Answers for life. Clinical Utility of Blood Gas Put this information at your fingertips with our ABG Guide app. Visit www.siemens.com/pocresources or scan the QR code. RAPIDLab® 1200 System Parameter Normal Elevated Decreased Clinical Significance Underlying Causes Generalized CNS Depression • Respiratory Acidosis • Drowsiness/Lethargy • Increased PCO2 pH 7.35 – 7.45 < 7.35 = Acidosis/Acidemia • Decreased Force Cardiac Contractions • Metabolic Acidosis – • Decreased Response Catecholamines • Decreased cHCO3 • Coma/Death Generalized CNS Stimulation • Respiratory Alkalosis • Irritability • Decreased PCO2 pH 7.35 – 7.45 > 7.45 = Alkalosis/Alkalemia • Tetany • Metabolic Alkalosis – • Arrhythmias • Increased cHCO3 • Convulsions – Death • Variable Neurologic Symptoms • COPD +/– Oxygen Excess • Pulmonary Dyspnea/Distress • Depressant Overdose • Increased Cerebral Perfusion • Extreme V/Q Imbalance Respiratory Acidosis 35 – 45 mmHg • Increased Adrenergic Response • Neurologic Disease PCO > 45 mmHg (6.0 kPa) PCO2 4.7 – 6.0 kPa 2 • Flushed/Warm/Diaphoretic • Neuromuscular Disease (pH < 7.35) • Hypotension/Arrhythmia when severe • Extreme Work of Breathing • Medium- to high-volume testing • Insufficient Mech Ventilation • Patient test results in ~60 seconds • Excessive CO Production • Microsample, bubble, and clot detection 2 • True QC lockout • Pulmonary Discomfort/Dyspnea • Hypoxemia • Paresthesia/Tingling/Numbness • Excessive Mech Ventilation Respiratory Alkalosis 35 – 45 mmHg • Dizziness • Restrictive Lung Disease PCO < 35 mmHg (4.7 kPa) PCO2 4.7 – 6.0 kPa 2 • Increased Adrenergic Response • Neurologic Disorders (pH > 7.45) ® • Palpitations/Arrhythmias • Shock RAPIDPoint 500 System • GI Nausea/Vomiting • Decreased Myocardial Contractility • Toxins/Poisons • Decreased Cardiac Output • Renal Failure Metabolic Acidosis – • Decreased Blood Pressure • Lactic Acidosis – 22 – 26 mmol/L cHCO < 22 mmol/L HCO3 3 • Hyperkalemia • Ketoacidosis (pH < 7.35) • RTA/Renal Base Excretion • Intestinal Base Loss • CNS Abnormalities • Hypokalemia • Neuromuscular Irritability/Tetany • Loop/Thiazide Diuretics Acid-Base Balance – Arterial Blood Values Metabolic Alkalosis • Depressed Myocardial Contractility • Vomiting – 22 – 26 mmol/L cHCO – > 26 mmol/L • Arrhythmias • NG Drainage HCO3 3 (pH > 7.45) • Convulsions • Bicarbonate Therapy • High-Dose Steroids • Extracellular Fluid Deficit – – BE(B) –2 to +2 mmol/L > +2 mmol/L < –2 mmol/L See increased/decreased cHCO3 See increased/decreased cHCO3 – – • Medium- to high-volume testing BE(ECF) –2 to +2 mmol/L > +2 mmol/L < –2 mmol/L See increased/decreased cHCO3 See increased/decreased cHCO3 • Maintenance-free cartridge technology • Intuitive touchscreen user interface • Weakness/Fatigue Intracellular Fluid (ICF) Deficit • Onboard instructional videos and Hypernatremia • CNS Symptoms • Insufficient Water Intake + 135 – 145 mmol/L no-maintenance CO-ox Na Na+ > 145 mmol/L • Tetany/Convulsions • Excessive Water Loss • Febrile/Oliguria • Hyperosmolar Solutions • CNS Symptoms Intracellular Fluid (ICF) Excess ® Hyponatremia • Twitching/Convulsions • Excessive Water Intake RAPIDLab 348EX System + 135 – 145 mmol/L Na Na+ < 135 mmol/L • Central Edema • Renal Disease/ADH • CHF • See Metabolic Acidosis • Metabolic Acidosis Hyperchloremia – 95 – 105 mmol/L • See Hypernatremia • Parenteral Intake CI Cl– > 105 mmol/L • Hypernatremia • See Metabolic Alkalosis • Metabolic Alkalosis Hypochloremia – 95 – 105 mmol/L • See Hyponatremia • Hyponatremia CI Cl– < 95 mmol/L • Hypertonicity • Muscle Weakness • Renal/Adrenal Disease Hyperkalemia • Flaccid Paralysis/Paresthesia • Iatrogenic Administration + 3.5 – 5.0 mmol/L K K+ > 5.0 mmol/L • ECG Abnormalities • Cell Destruction/Hemolysis • Arrhythmia/Cardiac Arrest • Acidosis Electrolytes • Muscle Weakness/Fatigue • Diuretics/Steroids Hypokalemia • Paralysis • Renal Loss + 3.5 – 5.0 mmol/L K K+ < 3.5 mmol/L • ECG Abnormalities • GI Loss • Arrhythmia/Cardiac Arrest • Alkalosis • Low- to medium-volume testing • Small sample size with microsample mode • Hypotonicity • Hyperparathyroidism • Color touchscreen user interface Hypercalcemia • Polyuria/Kidney Stones • Excessive Calcium Ingestion • Bar-code scanner data entry ++ 1.1 – 1.4 mmol/L Ca Ca++ > 3.0 mmol/L • GI Symptoms • Excessive Vitamin D • CNS Depression • Neuromuscular Irritability • Hypoparathyroidism Hypocalcemia • Spasms/Tetany/Convulsions • Decreased Calcium Ingestion ® ++ 1.1 – 1.4 mmol/L RAPIDComm System Ca Ca++ < 1.1 mmol/L • Weak Cardiac Contraction • Inadequate Vitamin D • Bleeding/Coagulopathy • Alkalosis • Oxygen Toxicity • Excessive Oxygen Therapy 80 – 100 mmHg Hyperoxemia • Coronary Vasoconstriction • Hyperventilation PO2 10.7 – 13.3 kPa PO > 100 mmHg (13.3 kPa) 2 • Microatelectasis Hypoxemia • Sympathetic Stimulation • Hypoventilation 80 – 100 mmHg • Mild 60 – 79 mmHg (8.0 – 10.5 kPa) • Increased Cardiac Output • Absolute Shunting PO2 10.7 – 13.3 kPa • Moderate 45 – 59 mmHg (6.0 – 7.9 kPa) • CNS Abnormalities • V/Q Mismatch • Severe < 45 mmHg (6.0 kPa) • Decreased Cardiac Output (severe) • Diffusion Defect SO2 97 – 98% Hyperoxemia SO2 > 98% See Hyperoxemia above See Hyperoxemia above SO2 97 – 98% Hypoxemia SO2 < 90% See Hypoxemia above See Hypoxemia above • Hypoxemia FO2Hb 94 – 98% Hypoxemia FO2Hb < 90% See Hypoxemia above • Carboxyhemoglobinemia • Methemoglobinemia • Real-time remote monitoring and control • Potential Tissue Hypoxia • Smoke Inhalation • Facilitates regulatory compliance and Carboxyhemoglobinemia 0 – 1.5% • CO Exposure inspection readiness FCOHb FCOHb > 1.5% • Smoking • Easily manage operator authorization and recertification • Seamless integration with your LIS • Potential Tissue Hypoxia • Nitrate/Nitrite Exposure Methemoglobinemia 0 – 1.5% • Nitric Oxide FMetHb FMetHb > 1.5% • Topical Anesthetics Oxygenation – Arterial RAPIDLyte® Arterial Syringes and Capillaries FHHb 2 – 3% Increased Desaturated Hb • Potential Tissue Hypoxia See Hypoxemia above • Increased Blood Oxygen Capacity • Primary Pathology Polycythemia 12 – 15 g/dL* • Increased Blood Viscosity • Secondary to Hypoxemia tHb ctHb > 15 g/dL • COPD • Potential Tissue Hypoxia • Decreased RBC Production tHb 12 – 15 g/dL* Anemia tHb < 12 g/dL • Fatigue/Weakness • Increased RBC Destruction • Blood Loss • Anaerobic Metabolism • Tissue Hypoxia Hyperlactatemia 1.0 – 1.8 mmol/L • Increased Morbidity • Sepsis Lac > 2.0 mmol/L • Increased Mortality • Trauma • Polyuria • Diabetes Mellitus 70 – 110 mg/dL Hyperglycemia • Glycosuria • Stress Glu 3.9 – 6.1 mmol/L Glu > 110 mg/dL (6.1 mmol/L) • Dehydration 70 – 110 mg/dL Hypoglycemia Glu < 70 mg/dL • Weakness • Starvation Glu 3.9 – 6.1 mmol/L (3.9 mmol/L) • Coma • Insulin Excess • Comprehensive choice of sampling devices to meet 0.3 – 1.0 mg/dL (adult) tBil > 2.0 mg/dL (34.2 µmol/L) (adults) • Jaundice (neonates) • Hepatitis/Cirrhosis arterial blood collection needs 5.1 – 17.1 µmol/L (adult) tBil > 8.0 mg/dL (136.8 µmol/L) • Seizures • Drugs/Hemolysis • Special heparin formulation reduces potential for clots General Analytes tBil 0.6 – 7.9 mg/dL (neonates**) (neonates) • Kernicterus • Pathological Syndromes • Fully compatible with all Siemens blood gas systems 10.3 – 135.1 µmol/L (neonates**) • Available in select markets *Gender-specific normals exist. Refer to your Medical Director for normals. *Acceptable* neonatal values are time and birth weight dependent. Order No. A91DX-POC-110789-XC2-4A00 | 11-2012 | All rights reserved | © 2012 Siemens Healthcare Diagnostics Inc. Scan the QR code with your smartphone to download the ABG Guide App. Answers for life.