RESUMO
INTRODUCTION: We evaluated the effects of pre-analytical care on total carbon dioxide (tCO2 ) in hemodialysis patients, as calculated by blood gas analysis (ctCO2 ) or measured by an enzymatic assay (mtCO2 ). METHODS: Blood samples were collected via vascular access before dialysis sessions. For blood gas analysis, eight aliquots were collected, refrigerated or non-refrigerated, and analyzed at 0, 4, 8, and 24 h after collection. A blood sample was then collected for the enzymatic method and distributed into 14 aliquots. Half of the aliquots were refrigerated. The samples analyzed at time point 0 were centrifuged immediately. The remaining aliquots of both the refrigerated and non-refrigerated clusters were centrifuged before storage. Samples were analyzed at 4, 8, and 24 h post-collection. FINDINGS: By blood gas analysis, no significant change was found in bicarbonate values over time, either in the non-refrigerated or refrigerated samples. ctCO2 values during the experiment showed a minor but statistically significant increase of questionable clinical relevance in both non-refrigerated and refrigerated aliquots. In the enzymatic assay, the reduction in mtCO2 levels during the experiment was negligible. The median absolute reductions at the end of the experiment were 1.77, 1.21, 1.04, and 1.12 mmol/L for the non-centrifuged/non-refrigerated, centrifuged/non-refrigerated, non-centrifuged/refrigerated, and centrifuged/refrigerated aliquots, respectively. DISCUSSION: Our results suggest that measured or calculated tCO2 levels of capped and cooled samples are adequate for analyzing the acid-base status of hemodialysis patients, even when such determination is not performed immediately after collection.
Assuntos
Acidose , Diálise Renal , Humanos , Dióxido de Carbono , Gasometria/métodos , BicarbonatosRESUMO
Twelve steers were used to compare the blood gas and acid-base status. The animals were randomly divided in three equal groups according to the following diets: 1- adequate, for gaining 600g/head/d ; 2- protein and energy levels to meet the maintenence; 3- protein and energy 20% below the maintenance levels. One hundred thirty-two arterial blood (caudal auricular artery) or venous blood (jugular vein) were continuously sampled for 11 fortnights. At the end of the experiment steers from groups 2 and principally 3 presented a moderate level of metabolic acidosis. Higher pH and pO2 levels were found in arterial blood; conversely, higher level of bicarbonate, TCO2, BE and pO2 levels were found in the venous blood. High correlation was found in the pH (r = 0.81), bicarbonate and TCO2 (r = 0.94) between venous and arterial blood; median correlation but significant in the pCO2 (r = 0.56) and lack of correlation in the pO2 (r = -0.06). The higher the pCO2, the higher the bicarbonate (r = 0.54) and TCO2 (r = 0.56) concentration. In spite of the small differences of pH, bicarbonate, TCO2 and even pCO2 between venous and arterial blood the values of arterial blood can be predicted adequately from the venous blood either in healthy steers or steers with moderate metabolic acidosis. When respiratory changes are concerned arterial blood must be collected for evaluating pO2. It was easier to sample venous blood than arterial blood.
Doze novilhos foram utilizados para comparar os resultados hemogasométricos de sangue arterial e venoso. Esses animais foram divididos em três grupos idênticos, recebendo: 1- dieta balanceada, proporcionando ganho de peso de 600g/d; 2- dieta de mantença em proteína e energia e 3- dieta com teores 20% abaixo da mantença. Amostras de sangue arterial (artéria auricular caudal) e venoso (veia jugular) foram colhidas por 11 quinzenas consecutivas, num total de 132 amostras. Ao término do experimento, os animais dos grupos 2 e principalmente 3 apresentaram acidose metabólica moderada. Maiores valores de pH e de pO2 foram constatados no sangue arterial enquanto os teores de bicarbonato, TCO2, BE e pCO2 foram superiores no sangue venoso. Existiram altas correlações entre os valores do sangue arterial e venoso para o pH (r = 0,81), bicarbonato e TCO2 (r = 0,94), sendo esta correlação média, mas significativa, no caso da pCO2 (r = 0,56) e inexistente na pO2 (r= -0,06). Quanto maiores foram os valores de pCO2 maiores foram os teores de bicarbonato (r = 0,54) e TCO2 (r =0,56). Apesar das discrepâncias de pH, das concentrações de bicarbonato, TCO2, e mesmo de pCO2 obtidos no sangue venoso e arterial, é possível estimar, adequadamente, a partir do primeiro esses valores nas amostras arteriais em novilhos normais e com moderado grau de acidose metabólica. Nos casos de alterações respiratórias, amostras de sangue arterial devem ser colhidas para determinação de pO2. A colheita de sangue venoso foi mais facilmente realizada que do sangue arterial.
RESUMO
Twelve steers were used to compare the blood gas and acid-base status. The animals were randomly divided in three equal groups according to the following diets: 1- adequate, for gaining 600g/head/d ; 2- protein and energy levels to meet the maintenence; 3- protein and energy 20% below the maintenance levels. One hundred thirty-two arterial blood (caudal auricular artery) or venous blood (jugular vein) were continuously sampled for 11 fortnights. At the end of the experiment steers from groups 2 and principally 3 presented a moderate level of metabolic acidosis. Higher pH and pO2 levels were found in arterial blood; conversely, higher level of bicarbonate, TCO2, BE and pO2 levels were found in the venous blood. High correlation was found in the pH (r = 0.81), bicarbonate and TCO2 (r = 0.94) between venous and arterial blood; median correlation but significant in the pCO2 (r = 0.56) and lack of correlation in the pO2 (r = -0.06). The higher the pCO2, the higher the bicarbonate (r = 0.54) and TCO2 (r = 0.56) concentration. In spite of the small differences of pH, bicarbonate, TCO2 and even pCO2 between venous and arterial blood the values of arterial blood can be predicted adequately from the venous blood either in healthy steers or steers with moderate metabolic acidosis. When respiratory changes are concerned arterial blood must be collected for evaluating pO2. It was easier to sample venous blood than arterial blood.
Doze novilhos foram utilizados para comparar os resultados hemogasométricos de sangue arterial e venoso. Esses animais foram divididos em três grupos idênticos, recebendo: 1- dieta balanceada, proporcionando ganho de peso de 600g/d; 2- dieta de mantença em proteína e energia e 3- dieta com teores 20% abaixo da mantença. Amostras de sangue arterial (artéria auricular caudal) e venoso (veia jugular) foram colhidas por 11 quinzenas consecutivas, num total de 132 amostras. Ao término do experimento, os animais dos grupos 2 e principalmente 3 apresentaram acidose metabólica moderada. Maiores valores de pH e de pO2 foram constatados no sangue arterial enquanto os teores de bicarbonato, TCO2, BE e pCO2 foram superiores no sangue venoso. Existiram altas correlações entre os valores do sangue arterial e venoso para o pH (r = 0,81), bicarbonato e TCO2 (r = 0,94), sendo esta correlação média, mas significativa, no caso da pCO2 (r = 0,56) e inexistente na pO2 (r= -0,06). Quanto maiores foram os valores de pCO2 maiores foram os teores de bicarbonato (r = 0,54) e TCO2 (r =0,56). Apesar das discrepâncias de pH, das concentrações de bicarbonato, TCO2, e mesmo de pCO2 obtidos no sangue venoso e arterial, é possível estimar, adequadamente, a partir do primeiro esses valores nas amostras arteriais em novilhos normais e com moderado grau de acidose metabólica. Nos casos de alterações respiratórias, amostras de sangue arterial devem ser colhidas para determinação de pO2. A colheita de sangue venoso foi mais facilmente realizada que do sangue arterial.