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i-STAT® 1 Cartridge Test Menu Hematology CG4+ CG8+ G Crea E3+ 6+ CHEM8+ EC8+ ACT Celite® cTnl Hematocrit (Hct) Hemoglobin (Hgb) Chemistry Blood Urea Nitrogen (BUN) Creatinine Ionized Calcium (iCa) Electrolytes Glucose (Glu) Chloride (Cl) Sodium (Na) Potassium (K) pH Acid Base PCO2 HCO3 TCO2 i-STAT® ACID – BASE UTILIZATION GUIDE Anion Gap Blood Gas Base Excess PO2 sO2 Specialty Lactate ACT Celite Cardiac Troponin I (cTnl) 800.822.2947 www.abaxis.com/veterinary [email protected] Abaxis, Inc. Worldwide Headquarters 3240 Whipple Road Union City, CA 94587 Tel 800 822 2947 Fax 510 441 6150 BETTER + BETTER. 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 i-STAT Utilization Guide.indd 1-2 887-0200 Rev. C www.abaxis.com BETTER + BETTER 10/25/13 9:28 AM VetScan i-STAT Acid-Base | Utilization Guide 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) Cardiothoracic 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 Examples: Acute/Chronic Insufficiency/Failure, Urinary Obstruction The 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 Renal Disease The American Association of Feline Practitioners (AAFP) recommends routine monitoring and correction of acid-base disorders in chronic renal patients 1 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) + Other Common Presentations Causing Acid-Base Derangement: • Addison’s disease • Toxicities: ethylene glycol, lily, acetaminophen • Large Animal: Grain overload Uroperitoneum Neonatal monitoring Field lactate monitoring 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 Common Presentations of Acid-Base Disorders pH 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. Upper Gastrointestinal Lower Gastrointestinal Diabetes Mellitus 887-0200 Rev. C i-STAT Utilization Guide.indd 3-4 Examples: Vomiting, GI Obstruction, GDV, Pancreatitis Evaluate 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 Acidemia Normal HCO3Low HCO3Low HCO3High HCO3High pCO2 Normal pCO2 Low pCO2 High pCO2 Normal Metabolic Acidosis Compensated Metabolic Acidosis Compensated Metabolic Alkalosis Metabolic Alkalosis pCO2 High HCO3Normal Respiratory Acidosis Pulmonary Disease Hypoventilation Anesthesia/Narcotic (Low HC03- and high pCO2) Mixed Acidosis Alkalemia Chronic Vomiting GI Obstruction Anion Gap High Normal Organic Acid Accumulation HCO3Loss Renal Failure Lactic Acidosis Ketoacidosis Ethyene Glycol Toxicity Early Renal Disease Diarrhea Medications pCO2 Low (High HC03- and low pCO2) Mixed Alkalosis HCO3Normal Respiratory Alkalosis Hyperventilation Severe Anemia Congestive Heart Failure Pneumonia Pain/Anxiety 10/25/13 9:28 AM
