Latte-Blood/Gas test results....UPDATE

[carolynandlatte]

I have her results from the blood/gas test (EG7+) only. I should hear back on the u/a and chem panel tomorrow. Problem with these results is that they have no normal ranges listed on them. I do have another set of labs (EC8+) from May/June from the same clinic with some of the same lab values. I thought I would post them for comparison, as some things have changed. Im not sure how significant the changes are OR how important it is to have the other tests in hand to compliment. Keep in mind the 6/09 labs were in ER due to 5 hrs of non stop diahrea and vomiting.

If Jess, or anyone else can see a potential problem so I have a heads up with the specialist calls that would be great. OR, if there are any questions I should be asking...

Test Results (1/11/10), Results (6/09)
pH 7.216, 7.365 (DECREASED-slightly belownormal?)

pCO2 38.3, 32.9 (INCREASE- but still normal range?)

p02 40 , none

HC03 15.5, 18.8 (now below normal? borderline 6/09?)

BEecf -12, -7 (whats this about?)

S02 64%, none

Na+ 145, 152

K+ 4.1, 3.7

TC02 17 , 20 (this is bicarb, right?)

ica5.5, none (what is this?)

HCT 29%, 31%

Hgb 9.9 , 10.5 (if its the same as Hb, via hct)

I believe both were taken VEN (back leg)

A lot of what I have started reading shows this *could* be MA...with the decrease in HC03. But usually there would also be a decrease in pC02. That increased, though it sounds like it may be in normal range. Now, an increase in pC02 could also be respiratory, right? AHHHHH! very confusing. So how about mixed acidosis? Is that the correct term? I have no idea where all the other stuff fits in to the picture either!

Im going to go back and read the original post you helped out with and see if any of that will start to click after seeing her labs.

Thanks for any interpretation or thoughts you have to offer. I wont hold anyone accountable for being wrong! :mrgreen: Most importantly I just want to have somewhat of a good grasp of what all this means so I can ask the right questions and get the best care for Latte.

 

[Larry and Kitties]

Re: Latte-Blood/Gas test results....Jess?

This site provides some info:
http://74.125.93.132/search?q=cache:rZs ... ent=safari
ica is ionized calcium.

 

[Jess & Earl]

Re: Latte-Blood/Gas test results....Jess?

Believe it or not, I don't carry the normals with me ;-) at home, but I will try to wing it w/o causing such confusion.

Weird, now that i hit reply, your formatting makes more sense. Anyway ...

Keep in mind the 6/09 labs were in ER due to 5 hrs of non stop diahrea and vomiting.

Because of this, I think it's important to not so much as compare them, but check the newest against normal levels. Is her body temp listed on the sheet? Some values are influenced by temperature.

Test Results (1/11/10), Results (6/09)
pH 7.216, 7.365 (DECREASED-slightly belownormal?)

Today's blood pH a little below low-normal--acidotic. I *think* that cats can go down to 7.23 and still be normal. Why is it below? We don't know why yet -- is it metabolic or respiratory? Let's look ..

pCO2 38.3, 32.9 (INCREASE- but still normal range?)

This is venous blood, so not as accurate as arterial blood, but we always use venous in cats (arteries are small and cats don't like needles stuck in the top of their feet!) ... Anyway according to my memory, the range for cats is something like 32-33 to 42? No quoting me. So your cat today would be on the acid-er side of normal.

p02 40 , none

I think this is in the normal range. I'm going to ignore the oxygens, though, as this is a venous sample.

HC03 15.5, 18.8 (now below normal? borderline 6/09?)

This is bicarb, and I think the lowest-normal (the most acidic-normal) is around 15.5, so she's WNL range here but barely.

BEecf -12, -7 (whats this about?)

This is base excess of blood (acronyme base excess of extracellular fluid). For carnivores we expect them to be negative for a complicated boring reason. This is abnormally low, indicating a lack of base (alkaline). I honestly don't remember how low this is -- I think it is abnormally low but not terrifyingly. So I can't give a good interpretation for this one.

Na+ 145, 152

K+ 4.1, 3.7

Both WNL limits, I think. Na might be borderline-low, but I wouldn't worry about a single value like this. You should have Na in your recent blood chemistries too, to compare.

TC02 17 , 20 (this is bicarb, right?)

This is not bicarb, it's total CO2 so bicarb plus CO2 free in the blood. It should always be a little higher than bicarb. We dont' care about it now, because we have a bicarb value and that is always more accurate.

ica5.5, none (what is this?)

Ionized calcium? But I don't understand the value, it should be 1. something, not 5. something.

HCT 29%, 31%

Hgb 9.9 , 10.5 (if its the same as Hb, via hct)

Disregard the HCT/Hgb on these machines. PCV or CBC/HCT is what to look for. These are always lower on i-Stat machines.

A lot of what I have started reading shows this *could* be MA...with the decrease in HC03. But usually there would also be a decrease in pC02. That increased, though it sounds like it may be in normal range. Now, an increase in pC02 could also be respiratory, right? AHHHHH! very confusing. So how about mixed acidosis? Is that the correct term? I have no idea where all the other stuff fits in to the picture either!

You're doing a good job if your head is spinning ;-) What you are talking about is that you expect to see compensation if there is a primary acidosis of one type or another -- a low PCO2 and HCO3 would be classic. The body compensates one way or another, but it is slower to compensate in terms of the HCO3. Don't worry about that, it's confusing and merely academic as its own point (rather than part of the big picture). I agree that she is leaning towards the acidic side and it looks mixed to me (I don't see a terrific pCO2 compensation), but to be honest with you I would need to crack books and do research and review more of her history to give you a more intelligent answer, and it's kinda late at night for that

So for the overall interpretation, I think you need to talk to someone about it. Will your internist review it for you? Nothing here screams GO TO ER to me, but I think someone needs to be on the case here because you're establishing a baseline for the future. I would speak to someone this week. Perhaps you can fax your internist tomorrow and speak to him at some point.

Hope this helps, or at least allows you to stop googling for the night ;-)

 

[carolynandlatte]

Re: Latte-Blood/Gas test results....Jess?

Weird, now that i hit reply, your formatting makes more sense. Anyway ...

I just HATE typing labs into formats like this...they NEVER end up looking like you actually put A LOT of time into formatting them for easy reading.

Is her body temp listed on the sheet? Some values are influenced by temperature.

The spot where it belongs is blank.

pCO2 38.3, 32.9 (INCREASE- but still normal range?)

This is venous blood, so not as accurate as arterial blood, but we always use venous in cats (arteries are small and cats don't like needles stuck in the top of their feet!) ... Anyway according to my memory, the range for cats is something like 32-33 to 42? No quoting me. So your cat today would be on the acid-er side of normal.

I think what I have been seeing is 32.7-44.7 The link larry added was one I looked at earlier. I think thats where I got these numbers. So I must be looking in the right places (Larry, too! )

HC03 15.5, 18.8 (now below normal? borderline 6/09?)
This is bicarb, and I think the lowest-normal (the most acidic-normal) is around 15.5, so she's WNL range here but barely.

My understanding, depending on the interpretation of her labs, bicarb should be treated when lower than 18 or 16 (cant remember). Ive read this in a zillion places and strangely enough, its all been protocols written by her specialist/internist!

BEecf -12, -7 (whats this about?

This is base excess of blood (acronyme base excess of extracellular fluid). For carnivores we expect them to be negative for a complicated boring reason. This is abnormally low, indicating a lack of base (alkaline). I honestly don't remember how low this is -- I think it is abnormally low but not terrifyingly. So I can't give a good interpretation for this one.

Well, I may have to do ONE more google search, then! :mrgreen:

Na+ 145, 152

K+ 4.1, 3.7

Both WNL limits, I think. Na might be borderline-low, but I wouldn't worry about a single value like this. You should have Na in your recent blood chemistries too, to compare.

Im fine with these. The K+ is a lot lower than recent labs at her regular vet. But different machines, different labs...I think it would be good to know what the normal is according to their machines. That will reveal itself in the chemistry I get back.

ica5.5, none (what is this?)

Ionized calcium? But I don't understand the value, it should be 1. something, not 5. something.

It definately says 5.5mg/dL! Guess I have ONE more thing to google tonight!

but to be honest with you I would need to crack books and do research and review more of her history to give you a more intelligent answer, and it's kinda late at night for that

Ha! No need to do THAT! What you have explained, in a simple manner was very helpful for me tonight. Thank you!!!

And yes, her specialist/internist should be calling tomorrow. If not, they told me to call him on Wed. I have full faith in Dr. Polzin. I just prefer to do my own research and learn everything I can ahead of time BEFORE they try explaining things to me.

and yes, two more things to google...the BEecf and ionized calcium.

Thanks again SOOOO much! I will let you know what Dr. P says tomorrow. And when I get a hard copy of other labs in my hand, I will post those too.

have a great night jess!

Hope this helps, or at least allows you to stop googling for the night ;-)[/quote]

 

[carolynandlatte]

Re: Latte-Blood/Gas test results....Jess?

This is why it may have been important to do the full chem panel...because one number cant offer a diagnosis...you need to look at a lot of things together. Since she has a 5.5 ionized calcium, she could be borderline hypercalcemic (her calcium has almost always been on the high end...calcifacations in kidneys).

Ionized Calcium

http://www.vin.com/VINDBPub/SearchPB/Proceedings/PR05000/PR00123.htm
When a serum sample is submitted to the laboratory, typically it is the total serum calcium concentration that is reported. Total calcium includes ionized calcium, complexed calcium, and protein-bound calcium. In most laboratories, hypercalcemia is documented when serum total calcium concentration is > 11.0 mg/dL in cats. The exact value when hypercalcemia exists must be determined for each laboratory. Serum total calcium and serum ionized calcium values are lower in cats than in dogs. In our laboratory, hypercalcemia in cats is defined when the total serum calcium is greater than 10.1 mg/dL and the ionized calcium concentration is greater than 5.5 mg/dL.

In clinically normal animals, serum ionized calcium is typically proportional to the level of serum total calcium (ionized calcium is usually 50–60% of total calcium). However, in diseased animals, serum ionized calcium is NOT proportional to total serum calcium, and cannot be predicted from total serum calcium. Ionized calcium is often much lower than predicted in patients with renal failure, regardless of their serum total calcium level (low, normal, or high). Patients with hypoalbuminemia and “corrected” serum total calcium values may still have decreased levels of ionized calcium. Patients with moderate to severe metabolic acidosis undergo increases in their ionized calcium fraction due to shifting of calcium from protein-bound stores of calcium. For these reasons, measurement of serum ionized calcium concentration is recommended in all patients with renal failure or hypercalcemia. Since ionized serum calcium concentration is affected by exposure to oxygen and pH, serum samples should be collected and handled anaerobically before analysis. Serum ionized calcium concentration does not change in samples stored up to 72 hr at room temperature or at 4° C, when samples are collected and stored anaerobically. When delay in measurement of serum samples is necessary (as in sending samples to an outside laboratory), anaerobic collection with cold storage up to 72 hr will result in the most accurate assessment of serum ionized calcium.

BEecf...<-4 indicates MA
http://www.vetlearn.com/ME2/Audiences/d ... EEBCF5480A

Dang! frain brazzled!
:roll:

 

[Jess & Earl]

Re: Latte-Blood/Gas test results....Jess?

This is why it may have been important to do the full chem panel...because one number cant offer a diagnosis...you need to look at a lot of things together. Since she has a 5.5 ionized calcium, she could be borderline hypercalcemic (her calcium has almost always been on the high end...calcifacations in kidneys).

BEecf...<-4 indicates MA
http://www.vetlearn.com/ME2/Audiences/d ... EEBCF5480A

Dang! frain brazzled!
:roll:

I must be thinking of something different. . . 5.5 would be impossible on the i-Stat as I remember it. I'll look at it tomorrow.

I wouldn't jump on that BEecf yet, as a sole number it is of dubious value. It is based on an equation, and the equation is different for different machines and can be put off by certain things (a lot of criticalists think it can get wonked by dehydration, etc.). I also read that at Penn they found that some "normal" cats had a BE of up to (down to?) -10 -- the stricter carnivore an animal is, the lower the BE may be. But I agree I think that is in the acidosis range, I just wouldn't take it and run with it. The bigger pic is more important.

Dunno what I am thinking of with the iCa. That bugs me a little, I'll check tomorrow.

Did you start this thread in this forum or did you get bumped? I wonder why, Latte is the diabetic.

 

[WCF and Meowzi]

Re: Latte-Blood/Gas test results....Jess?

ica5.5, none (what is this?)

Ionized calcium? But I don't understand the value, it should be 1. something, not 5. something.

It definately says 5.5mg/dL! Guess I have ONE more thing to google tonight!

mg/dL? I just looked at Meowzi's iCa from MSU, and it's in mmol/L, ref range 1.00-1.40. (I'm not smart enough to know what the different units mean LOL)

 

[WCF and Meowzi]

Re: Latte-Blood/Gas test results....Jess?

ooooh lightbulb went off. so i went to the conversion site and plugged it in. if this was total calcium, 5.5 mg/dL converts to 1.37 mmol/L. dont know if the conversion factor for total calcium is the same for ionized calcium, though?

 

[carolynandlatte]

Re: Latte-Blood/Gas test results....Jess?

Did you start this thread in this forum or did you get bumped?

I put the thread here, because I didnt think it was diabetes related. I thought this was for 'other' health problems. Is it in the right spot? I should put a link on the other thread for this one...in case anyone was following it.

I wonder why, Latte is the diabetic.

Long story short - dex shot, followed by pred...the alternative, at the point we were at, was pts. STopped pred, but Restarted after VERY bad reaction to leukeran...again, it was that or pts.

Short story Long - metacam induced ARF three years ago. now only one semi functioning kidney. Stopped eating for almost all of 2008, so I syringe fed (couldnt afford tube). Finally pulled money together for an u/s 1yr ago and it showed pancreatitis, and either ibd or lymphoma. No biopsy done. Held off on pred as long as possible (slight fear of strong meds and how she might react...for obvious reasons ;-) ). ER visit last May/June from diarrhea and vomiting...started pred. UTI 3 months into the pred (and my request for BG test) revealed the diabetes.

There should be a link in my signature to her profile with more details, if you ever find yourself interested.

Despite all her quarks and challenges, she acts amazingly well. You would not think she is sick when you look at her. THAT is the only reason I have kept this going (tx's) as long as I have...its VERY apparent she still has some work to do here (like drive me crazy with her sugar levels :lol: )

did not hear back from specialist today. Will call tomorrow and follow up. Guess no news is good (or better) news! If it was urgent or really bad, Im sure he would have called.

 

[carolynandlatte]

Re: Latte-Blood/Gas test results....Jess?

ooooh lightbulb went off. so i went to the conversion site and plugged it in. if this was total calcium, 5.5 mg/dL converts to 1.37 mmol/L. dont know if the conversion factor for total calcium is the same for ionized calcium, though?

That makes sense if they measured in different units.
Guess we will find out soon enough!
Thanks for checking that out!!!!

 

[carolynandlatte]

Test Result - Update

Well, i wish I could give you a long list of values to read over. Unfortunately I can only give you a very brief summary after a short conversation with Dr. P over the phone. Getting more specifics and clarity will likely require a follow up appt. This cannot happen until he is out of research and back in clinic later in the month.

So....She is definately acidic, though not as severe as original labs from regular vet lent to believe. her bicarb was 15. He recommended tx if I wanted to slow progression of her kidney disease and reduce any symptoms. pH is not terribly low, but not normal and lower than desired. Neither are consistent with whatever her renal values showed (he didnt tell me those). he also did not specify between respiratory or metabolic. Im assuming he thinks its metabolic or he would have said otherwise. I am to start her on a potassium/sodium(?) liquid medicine. He warned me she may not be compliant because it does not taste good. She should be checked in 2-3 weeks to make sure potassium and sodium do not increase too much. Quite often she is the opposite of most cats, with a higher potassium...so I do worry a bit about this. Its also typical for her to be on the higher end of sodium. this however, is with the labs done at regular vet. I think its measured lower the last few times we have done labs at the U.

No ketones. No infection. Urine was representative of a diabetic cat.

He mentioned Enzyme 4 being extremely elevated, which is related to the pancreas. He said it is very unusual to see such high numbers in a cat. He also said there should be other testing done (for the pancreas) before getting too excited about the number. We did have an u/s done there last year, in which they said her pancreas was inflammed and likely had pancreatitis. I did no further bloodwork because the results would not change the way I was currently treating her (fluids, pepcid, ondansetron, etc).

Because the phone conversation was limited in time, i think it would be best to set an appt with him armed with questions. He deals with hundreds of cats, if not thousands each year. Getting an appt with him is never easy, so we have not seen him more than probably 3 times. I didnt get the sense he had the full picture of latte's issues in front of him as we spoke. Seeing him in person will help capture his attention, as it usually does. we always get a lot from our visits. I can get the labwork at that time as well. Before that he is only sending the abnormal results via snail mail. arg!

So that is all I know. I have tons of questions for him. Will set up the appt tomorrow.
Hopefully she will accept the liquid medicine.