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Background: Metabolic acidosis is an important abnormality in ill and injured dogs and cats., Objectives: To describe the incidence, nature, and etiology of metabolic acidosis in dogs and cats that had arterial or venous blood gases measured for any reason at a university teaching hospital., Animals: Dogs and cats at the Veterinary Medical Teaching Hospital., Methods: Acid base parameters and electrolyte and lactate concentrations in dogs and cats measured during a 13-month period were retrospectively retrieved from a computer database. Metabolic acidosis was defined as a standardized base excess (SBE) in dogs of <-4 mmol/L and in cats <-5 mmol/L., Results: A total of 1,805 dogs and cats were included; of these, 887 (49%) were classified as having a metabolic acidosis (753 dogs and 134 cats). Primary metabolic acidosis was the most common disorder in dogs, whereas mixed acid base disorder of metabolic acidosis and respiratory acidosis was most common in cats. Hyperchloremic metabolic acidosis was more common than a high anion gap (AG) metabolic acidosis; 25% of dogs and 34% of cats could not be classified as having either a hyperchloremic metabolic acidosis or a high AG metabolic acidosis., Conclusions and Clinical Importance: Metabolic acidosis was found commonly in this patient population and was associated with a wide variety of disease processes. Mixed acid base disorders occur frequently and routine categorization of metabolic acidosis based on the presence of high AG or hyperchloremia may be misleading in a large proportion of cases., (Copyright © 2012 by the American College of Veterinary Internal Medicine.)

Objectives: Diagnosing diabetic ketoacidosis (DKA) has traditionally required a venous blood gas (VBG) to obtain serum pH and a serum chemistry panel to obtain electrolyte values. Because newer blood gas analyzers have the ability to report electrolyte values and glucose in addition to pH, this diagnostic process could theoretically be condensed. However, neither the diagnostic accuracy of the VBG for DKA nor the agreement between the VBG electrolytes and the serum chemistry electrolytes, including sodium, chloride, and bicarbonate, has been evaluated in the context of acute hyperglycemia. The purpose of this study was to assess the accuracy of VBG electrolytes for diagnosing DKA using serum chemistry electrolytes measures as the criterion standard and to describe the correlation between VBG and serum chemistry electrolytes in a sample of hyperglycemic patients seen in the emergency department (ED)., Methods: The authors prospectively identified a convenience sample of ED patients with serum blood glucose ≥ 250 mg/dL and examined their paired VBG and serum chemistry electrolytes. The diagnosis of DKA was made by using American Diabetes Association (ADA) criteria including serum glucose ≥ 250 mg/dL, serum anion gap > 10 mEq/L, bicarbonate ≤ 18 mEq/L, serum pH ≤ 7.30, and presence of ketosis. Serum chemistry electrolyte values were considered to be the criterion standard. Diagnostic test characteristics of VBG electrolytes including sensitivity and specificity were compared against this standard. In addition, correlation coefficients for individual electrolytes and anion gap between VBG and chemistry electrolytes were calculated., Results: Paired VBG and serum chemistry panels were available for 342 patients, of whom 46 (13.5%) had DKA. The sensitivity and specificity of the VBG electrolytes for diagnosing DKA was 97.8% (95% confidence interval [CI] = 88.5% to 99.9%) and 100% (95% CI = 98.8% to 100%), respectively. One case of DKA was missed by the VBG. Correlation coefficients between VBG and serum chemistry were 0.90, 0.73, 0.94, and 0.81 for sodium, chloride, bicarbonate, and anion gap, respectively., Conclusions: The VBG electrolytes were 97.8% sensitive and 100% specific for the diagnosis of DKA in hyperglycemic patients. These preliminary findings support the use of VBG electrolytes in lieu of VBG along with serum chemistry analysis to rule in or rule out DKA., (© 2011 by the Society for Academic Emergency Medicine.)

Blood gas analyzers serve a critical role in providing information that reflects patient homeostasis. This study was undertaken to evaluate the accuracy, reliability, consistency, and bias of the Radiometer ABL-70 point of care blood gas analyzer. Thirty samples were gathered for analysis of pH, pCO2, pO2, sodium, potassium, sodium bicarbonate, and base excess. Twenty-nine samples were gathered for hematocrit, 31 for ionized calcium, and 33 for venous pO2 and saturations. The data were compared with the Gem-Premier point of care analyzer and the hospital blood gas machine and electrolyte analyzer. There was statistical significance between the pH, pCO2, sodium, potassium, calcium, hematocrit, and venous pO2 and saturations when comparing the ABL-70 with the Gem-Premier. When comparing the ABL-70 with the Corning 278/270 blood gas machine/Co-Ox, the AVL-9180, and the Dimension XL, there was statistical significance seen between the pH, pCO2, pO2, sodium, calcium, hematocrit, and base excess. Although this statistical significance was observed between the ABL-70 and the other analyzers, the significance was not of clinical importance. The ABL-70 demonstrated acceptable accuracy, reliability, consistency, and bias.

An eastern Pacific gray whale (Eschrichtius robustus) stranded off Pelican Point, Tomales Bay, California, USA, was examined for physiological parameters, prey, parasites and associated pathology. The whale was emaciated, and hematological examination revealed an elevation in hematocrit, serum sodium, potassium, electrolyte values and hypoglycemia. Parasites recovered included 5 species, 1 ectoparasite (Cyamus scammoni), and 4 helminths (Anisakis simplex, Ogmogaster antarcticus, Ogmogaster pentalineatus, Bolbosoma balanae) with the latter causing multifocal transmural abscesses. Histological examination indicated severe acute lung congestion, minimal, multifocal, lymphocytic, interstitial myocarditis, and mild hepatocellular and Kupffer cell hemosiderosis. The prey taxa present in the stomach indicated the whale was feeding on hard bottom communities prior to death.

We evaluated the usefulness of commonly ordered routine admission laboratory tests in 301 patients admitted consecutively to the internal medicine wards of a university teaching hospital. Using a consensus analysis approach, three Department of Medicine faculty members reviewed the charts of admitted patients to determine the impact of the test results on patient care. The evaluated tests were the urinalysis, hematocrit, white blood cell count, platelet count, six-factor automated multiple analysis (serum sodium, potassium, chloride, bicarbonate, glucose, and blood urea nitrogen), prothrombin time, partial thromboplastin time, chest x-ray, and electrocardiogram. Forty-five percent of the 3,684 tests were ordered for patients without recognizable medical indications. Twelve percent of these routine tests were abnormal, 5% led to additional laboratory testing, but only 0.5% led to change in the treatment of patients. We conclude that the impact of routine admission laboratory testing on patient care is very small and that there is little justification for ordering tests solely because of hospital admission.