2b:null 2c:["$","title",null,{"children":"ABG Analysis | Erik Neves | Observable"}] 31:T3473,function analysis({ pH = 0, pCO2 = 0, hco3 = 0, na = 0, cl = 0, albumin = 4, timing = "acute" }) { let rational = []; let summary = []; if (!(pH && pCO2 && hco3)) { console.log("error"); summaryPoint(""); println(""); return { summary: summary, rational: rational }; } const PH_NORMAL = 7.4; const PH_NORMAL_DELTA = 0.01; // Acceptable deviation from normal const PCO2_NORMAL = 40; const PCO2_NORMAL_DELTA = 2; const HCO3_NORMAL = 24; const HCO3_NORMAL_DELTA = 2; const ANION_GAP_NORMAL = 12; const ANION_GAP_NORMAL_DELTA = 2; const DELTA_DELTA_GAP_NORMAL_DELTA = 6; const ALBUMIN_NORMAL = 4.0; const ANION_GAP_ALBUMIN_CORRECTION = 2.5; const EXPECTED_DELTA_PH_PER_PCO2_ACUTE = -0.008; const EXPECTED_DELTA_PH_PER_PCO2_CHRONIC = -0.004; const EXPECTED_DELTA_HCO3_PER_PCO2_ACIDOSIS_ACUTE = 0.1; const EXPECTED_DELTA_HCO3_PER_PCO2_ACIDOSIS_CHRONIC = 0.4; const EXPECTED_DELTA_HCO3_PER_PCO2_ALKALOSIS_ACUTE = 0.2; const EXPECTED_DELTA_HCO3_PER_PCO2_ALKALOSIS_CHRONIC = 0.4; const EXPECTED_PCO2_HCO3_COMPENSATION_DIFF = 15; const FLOATING_POINT_ROUNDING_ERROR = 0.0001; function doAnalysis() { if ( Math.abs(pH - PH_NORMAL) - PH_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { summaryPoint("Sem distúrbios"); println( `1. pH within normal range of expected (${roundTo(PH_NORMAL, 2)}):` ); println(" - No primary acid-base disorder, or a mixed disorder"); // analyzeAnionGapAcidosis(); } else if (pH < PH_NORMAL) { println( `1. Acidemia when pH (${roundTo(pH, 2)}) less than expected (${roundTo( PH_NORMAL, 2 )} ± ${PH_NORMAL_DELTA})` ); if (pCO2 > PCO2_NORMAL) { analyzeRespiratoryAcidosis(); } else { analyzeMetabolicAcidosis(); } } else { // ( pH > PH_NORMAL ) println( `1. Alkalemia when pH (${roundTo( pH, 2 )}) greater than expected (${roundTo( PH_NORMAL, 2 )} ± ${PH_NORMAL_DELTA})` ); if (pCO2 < PCO2_NORMAL) { analyzeRespiratoryAlkalosis(); } else { analyzeMetabolicAlkalosis(); } } } ////////////////////////// // RESPIRATORY ACIDOSIS // ////////////////////////// function analyzeRespiratoryAcidosis() { println( `1. **Respiratory Acidosis** when pCO₂ (${roundTo( pCO2, 1 )}) > expected (${roundTo(PCO2_NORMAL, 1)})` ); let isAcute = timing === "aguda"; let pHexpected = PH_NORMAL; let expectedHCO3 = HCO3_NORMAL; if (isAcute) { summaryPoint("Acidose Respiratória, Aguda"); println("1. **Acute respiratory acidosis** ⇒"); println( ` - Expect metabolic compensation when pH (${roundTo( EXPECTED_DELTA_PH_PER_PCO2_ACUTE * 10, 2 )}) per +10 pCO₂` ); println( ` - Expect metabolic compensation when HCO₃⁻ (+${roundTo( EXPECTED_DELTA_HCO3_PER_PCO2_ACIDOSIS_ACUTE * 10, 0 )}) per +10 pCO₂` ); pHexpected += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_PH_PER_PCO2_ACUTE; expectedHCO3 += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_HCO3_PER_PCO2_ACIDOSIS_ACUTE; } else { // chronic summaryPoint("Acidose Respiratória, Crônica"); println("1. **Chronic respiratory acidosis** ⇒"); println( ` - Expect metabolic compensation when pH (${roundTo( EXPECTED_DELTA_PH_PER_PCO2_CHRONIC * 10, 2 )}) per +10 pCO₂` ); println( ` - Expect metabolic compensation when HCO3 (+${roundTo( EXPECTED_DELTA_HCO3_PER_PCO2_ACIDOSIS_CHRONIC * 10, 0 )}) per +10 pCO₂` ); pHexpected += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_PH_PER_PCO2_CHRONIC; expectedHCO3 += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_HCO3_PER_PCO2_ACIDOSIS_CHRONIC; } println( `1. Expected pH (${roundTo(pHexpected, 2)} ± ${roundTo( PH_NORMAL_DELTA, 2 )}), actual pH (${roundTo(pH, 2)}) ⇒` ); println( `1. Expected HCO₃⁻ (${roundTo(expectedHCO3, 1)}), actual HCO₃ (${roundTo( hco3, 1 )}) ⇒` ); if ( Math.abs(pHexpected - pH) - PH_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { summaryPoint("Apropriadamente Compensada por Alcalose Metabólica"); println(" - Appropriately **compensated respiratory acidosis**"); } else if (pH < pHexpected) { summaryPoint("Acidose Metabólica Secundária"); println(" - **Secondary metabolic acidosis**"); analyzeAnionGapAcidosis(); } // ( pH > pHexpected ) else { summaryPoint("Alcalose Metabólica Secundária"); println(" - **Secondary metabolic alkalosis**"); } } /////////////////////////// // RESPIRATORY ALKALOSIS // /////////////////////////// function analyzeRespiratoryAlkalosis() { println( `1. **Respiratory Alkalosis** when pCO2 (${roundTo( pCO2, 1 )}) < expected (${roundTo(PCO2_NORMAL, 1)})` ); let isAcute = timing === "aguda"; let pHexpected = PH_NORMAL; let expectedHCO3 = HCO3_NORMAL; if (isAcute) { summaryPoint("Alcalose Respiratória, Aguda"); println("1. **Acute respiratory alkalosis** ⇒"); println( ` - Expect metabolic compensation when pH (${roundTo( EXPECTED_DELTA_PH_PER_PCO2_ACUTE * 10, 2 )}) per +10 pCO₂` ); println( ` - Expect metabolic compensation when HCO₃⁻ (-${roundTo( EXPECTED_DELTA_HCO3_PER_PCO2_ALKALOSIS_ACUTE * 10, 0 )}) per -10 pCO₂` ); pHexpected += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_PH_PER_PCO2_ACUTE; expectedHCO3 += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_HCO3_PER_PCO2_ALKALOSIS_ACUTE; } else { summaryPoint("Alcalose Respiratória, Crônica"); println("1. **Chronic respiratory alkalosis** ⇒"); println( ` - Expect metabolic compensation when pH (${roundTo( EXPECTED_DELTA_PH_PER_PCO2_CHRONIC * 10, 2 )}) per +10 pCO₂` ); println( ` - Expect metabolic compensation when HCO₃⁻ (-${roundTo( EXPECTED_DELTA_HCO3_PER_PCO2_ALKALOSIS_CHRONIC * 10, 0 )}) per -10 pCO₂` ); pHexpected += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_PH_PER_PCO2_CHRONIC; expectedHCO3 += (pCO2 - PCO2_NORMAL) * EXPECTED_DELTA_HCO3_PER_PCO2_ALKALOSIS_CHRONIC; } println( `Expected pH (${roundTo( pHexpected, 2 )} ± ${PH_NORMAL_DELTA}), actual pH (${roundTo(pH, 2)} ⇒` ); println( `Expected HCO₃⁻ (${roundTo(expectedHCO3, 1)}), actual HCO₃⁻ (${roundTo( hco3, 1 )}) ⇒` ); if ( Math.abs(pHexpected - pH) - PH_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { summaryPoint("Apropriadamente Compensada por Acidose Metabólica"); println(" - Appropriately **compensated respiratory alkalosis**"); } else if (pH < pHexpected) { summaryPoint("Acidose Metabólica Secundária"); println(" - **Secondary metabolic acidosis**"); analyzeAnionGapAcidosis(); } // ( pH > pHexpected ) else { summaryPoint("Alcalose Metabólica Secundária"); println(" - **Secondary metabolic alkalosis**"); } } //////////////////////// // METABOLIC ACIDOSIS // //////////////////////// function analyzeMetabolicAcidosis() { summaryPoint("Acidose Metabólica"); println( `1. **Metabolic Acidosis** when pCO2 (${roundTo( pCO2, 1 )}) < expected (${roundTo(PCO2_NORMAL, 1)})` ); // println( // ` - Expect respiratory compensation when pCO₂ = HCO₃⁻ + ${EXPECTED_PCO2_HCO3_COMPENSATION_DIFF}` // ); // let pCO2expected = hco3 + EXPECTED_PCO2_HCO3_COMPENSATION_DIFF; println( ` - Expect respiratory compensation when pCO₂ = (1.5 × HCO₃⁻) + 8` ); let pCO2expected = 1.5 * hco3 + 8; println( ` - Expected pCO2 (${roundTo(pCO2expected, 1)} ± ${roundTo( PCO2_NORMAL_DELTA, 1 )}), actual pCO2 (${roundTo(pCO2, 1)}) ⇒` ); if ( Math.abs(pCO2expected - pCO2) - PCO2_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { summaryPoint("Apropriadamente Compensada por Alcalose Respiratória"); println(" - Appropriately **compensated metabolic acidosis**"); } else if (pCO2 < pCO2expected) { summaryPoint("Alcalose Respiratória Secundária"); println(" - **Secondary respiratory alkalosis**"); } // ( pCO2 > pCO2expected ) else { summaryPoint("Acidose Respiratória Secundária"); println(" - **Secondary respiratory acidosis**"); } analyzeAnionGapAcidosis(); } ///////////////////////// // METABOLIC ALKALOSIS // ///////////////////////// function analyzeMetabolicAlkalosis() { summaryPoint("Alcalose Metabólica"); println( `1. **Metabolic Alkalosis** when pCO₂ (${roundTo( pCO2, 1 )}) > expected (${roundTo(PCO2_NORMAL, 1)})` ); // println( // ` - Expect respiratory compensation when pCO₂ = HCO₃⁻ + ${EXPECTED_PCO2_HCO3_COMPENSATION_DIFF}` // ); // let pCO2expected = hco3 + EXPECTED_PCO2_HCO3_COMPENSATION_DIFF; println( ` - Expect respiratory compensation when pCO₂ = (1.5 × HCO₃⁻) + 8` ); let pCO2expected = 1.5 * hco3 + 8; println( ` - Expected pCO₂ (${roundTo( pCO2expected, 1 )} ± ${PCO2_NORMAL_DELTA}), actual pCO₂ (${roundTo(pCO2, 1)}) ⇒` ); if ( Math.abs(pCO2expected - pCO2) - PCO2_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { summaryPoint("Apropriadamente Compensada por Acidose Respiratória"); println(" - Appropriately **compensated metabolic alkalosis**"); } else if (pCO2 < pCO2expected) { summaryPoint("Alcalose Respiratória Secundária"); println(" - **Secondary respiratory alkalosis**"); } // ( pCO2 > pCO2expected ) else { summaryPoint("Acidose Respiratória Secundária"); println(" - **Secondary respiratory acidosis**"); } } /////////////// // ANION GAP // /////////////// function analyzeAnionGapAcidosis() { if (!(na && cl)) return; let anionGap = na - cl - hco3; println( `1. Anion Gap = Na⁺ - Cl⁻ - HCO₃⁻ = ${na} - ${cl} - ${hco3} = ${roundTo( anionGap, 1 )}` ); if (albumin < ALBUMIN_NORMAL) { anionGap = anionGap + ANION_GAP_ALBUMIN_CORRECTION * (ALBUMIN_NORMAL - albumin); println( ` - Hypo-albuminemia (lack of natural serum anion): ${roundTo( albumin, 1 )}` ); println( ` - Corrected AG = AG + ${ANION_GAP_ALBUMIN_CORRECTION} × (${ALBUMIN_NORMAL} - ${roundTo( albumin, 1 )}) = ${roundTo(anionGap, 1)}` ); } println( ` - Expected (${ANION_GAP_NORMAL} ± ${ANION_GAP_NORMAL_DELTA}) vs. actual (${roundTo( anionGap, 1 )})` ); if ( Math.abs(anionGap - ANION_GAP_NORMAL) - ANION_GAP_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { summaryPoint("Acidose Metabólica com _Anion Gap_ Normal"); println(" - **Non-gap metabolic acidosis**"); } else if (anionGap > ANION_GAP_NORMAL) { summaryPoint("Acidose Metabólica com _Anion Gap_ Elevado"); println(" - **Anion gap metabolic acidosis**"); analyzeDeltaDeltaGap(anionGap); } // ( anionGap < ANION_GAP_NORMAL ) else { println( "1. ???Gap is too small. Probably additional metabolic alkalosis???" ); } } ///////////////////// // DELTA DELTA GAP // ///////////////////// function analyzeDeltaDeltaGap(anionGap) { println("1. Delta-delta gap check"); println(" - Expect delta HCO₃⁻ -1 for every +1 delta anion gap"); let deltaAnionGap = anionGap - ANION_GAP_NORMAL; let expectedHCO3 = HCO3_NORMAL - deltaAnionGap; println( ` - Delta Anion Gap (${roundTo( anionGap, 1 )} - ${ANION_GAP_NORMAL}) = ${roundTo(deltaAnionGap, 1)}` ); println( ` - Expected HCO₃⁻ (${HCO3_NORMAL} - ${roundTo( deltaAnionGap, 1 )}) = (${roundTo( expectedHCO3, 1 )} ± ${DELTA_DELTA_GAP_NORMAL_DELTA}) vs. actual (${hco3})` ); if ( Math.abs(hco3 - expectedHCO3) - DELTA_DELTA_GAP_NORMAL_DELTA <= FLOATING_POINT_ROUNDING_ERROR ) { println(" - **Pure anion gap metabolic acidosis**"); } else if (hco3 < expectedHCO3) { summaryPoint("Acidose Metabólica com _Anion Gap_ Normal Adicional"); println(" - **Additional non-gap metabolic acidosis**"); } // ( hco3 > expectedHCO3 ) else { summaryPoint("Alcalose Metabólica Adicional"); println(" - **Additional metabolic alkalosis**"); } } function println(txt) { rational.push(txt); } function summaryPoint(txt) { summary.push(txt); } doAnalysis(); return { summary: summary, rational: rational }; }32:T88d,causes = { let c = { acidresp: `- Airway Obstruction - Foreign body, aspiration - OSA (obstructive sleep apnea) - Laryngo- or broncho-spasm - Neuromuscular - Myasthenia gravis - Hypokalemic periodic paralysis - Guillain-Barre - Botulism, Tetanus - Hypo-kalemia, hypo-phosphatemia - Cervical spine injury - Morbid obesity - Polio, MS, ALS - Central - Drugs (opiates, sedatives) - Oxygen treatment in acute hypercapnia - Brain trauma or stroke - Pulmonary - Pulmonary edema - Asthma - Pneumonia - ARDS - COPD - Pulmonary Fibrosis - Mechanical Ventilation`, alcresp: `- Hypoxia - High altitude - CHF - Pulmonary Embolism - Lung Disease - Pulmonary fibrosis - Pulmonary edema - Pneumonia - Drugs - Progesterone - Nicotine - Stimulation of Respiratory Drive - Psychogenic - Neurologic (pontine tumor) - Sepsis - Pregnancy - Mechanical ventilation`, alcmet: `- Alkaline Input - Bicarbonate Infusion - Hemodialysis - Calcium Carbonate - Parenteral Nutrition - Proton Loss - GI Loss (vomiting, NG suction) - Renal loss - Diuretics - Mineralocorticoids`, acidmet: `**Anion Gap** - MUDPILES - Methanol - Uremia - Diabetic Ketoacidosis (check serum ketones) - Propylene Glycol (in BZD drips) or Paraldehydes - Isoniazid - Lactic Acidosis (check serum lactate) - Ethylene Glycol (anti-freeze) - Salycylates - GOLDMARK - Glycols (ethylene or propylene) - Oxoporin (reflects fatty liver damage from glutathione consumption, e.g. acetaminophen toxicity) - L-Lactate - D-Lactate (bacterial form) - Methanol - Aspirin (salycylate) - Renal Failure (BUN uremia) - Ketoacidosis **Sem Gap** - GI Loss - Diarrhea / Laxatives - Fistula, (pancreatic, biliary) - Uretero-intestinal diversion (ileal conduit) - Renal Loss - Renal Tubular Acidosis (Type 1 Distal or Type 2 Proximal) - Renal Failure - Hyper-kalemia - Exogenous Acid - HCl - Amino Acids - FUSED CARS - Fistula (pancreatic, biliary) - Uretero-gastric conduit - Saline admin (dilutional acidosis) - Endocrine (hyper-PTH) - Diarrhea - Carbonic anhydrase inhibitor (acetazolamide) - Ammonium chloride - Renal tubular acidosis - Spironolactone` }; return c; }33:[] 2f:{"id":"d6c50bb31271a915","slug":"abg-analysis","title":"ABG Analysis","thumbnail":"00b8fed7eb4fc726db00fd45cb1440ff2b83fd17c0218a10f3f587d80c85ff6c","access_level":"public","create_time":"$D2022-12-07T19:08:32.093Z","update_time":"$D2023-01-01T02:22:07.648Z","view_time":null,"first_public_time":"$D2022-12-11T18:18:40.764Z","fork":false,"stars":0,"starred":false,"owner":{"type":"team","id":"6ba4c593548fd948","login":"erikneves","name":"Erik Neves","avatar_url":"https://avatars-next.observableusercontent.com/a1fcf6301c655eb7b1281f700a033112e5d96d414e802d7ec0a0f86da4db1385","tier":"starter_2024"},"version":422,"publish_version":null,"role":null,"authored":false,"authors":[{"type":"individual","id":"f1ca5b1759d5aa61","login":"erikneves","name":"Erik Neves","avatar_url":"https://avatars-next.observableusercontent.com/a1fcf6301c655eb7b1281f700a033112e5d96d414e802d7ec0a0f86da4db1385","tier":null}],"members":[{"type":"individual","id":"f1ca5b1759d5aa61","login":"erikneves","name":"Erik Neves","avatar_url":"https://avatars-next.observableusercontent.com/a1fcf6301c655eb7b1281f700a033112e5d96d414e802d7ec0a0f86da4db1385","tier":null,"role":"editor"}],"comments":[],"custom_thumbnail":false,"trashed":false,"subscribed":null,"forks":0,"collection":null,"type":"notebook","body":{"title":"ABG Analysis","cells":[{"id":0,"value":"# ABG Analysis","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined"},{"id":5,"value":"Baseado no trabalho do [Dr. Jonathan H. Chen](https://github.com/HealthRex/CDSS/blob/master/medinfo/web/tools/AcidBaseAnalysis.htm).","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined"},{"id":29,"value":"viewof abg = Inputs.form({\n ph: Inputs.text({ label: \"pH\", width: 100, value: \"7.40\" }),\n pco2: Inputs.text({ label: \"pCO₂\", width: 100, value: \"40\" }),\n hco3: Inputs.text({ label: \"HCO₃⁻\", width: 100, value: \"24\" }),\n na: Inputs.text({ label: \"Na⁺\", width: 100, value: \"140\" }),\n cl: Inputs.text({ label: \"Cl⁻\", width: 100, value: \"100\" }),\n alb: Inputs.text({ label: \"Albumina\", width: 100, value: \"4.0\" }),\n timing: Inputs.radio([\"aguda\", \"crônica\"], {\n label: \"Evolução\",\n value: \"aguda\"\n })\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":376,"value":"{\n let ph_c =\n 6.1 + Math.log10(parseFloat(abg.hco3) / 0.03 / parseFloat(abg.pco2));\n\n if (Math.abs(ph_c - parseFloat(abg.ph)) >= 0.02) {\n return md`**Valores de pH, pCO₂ e HCO₃⁻ não são compatíveis.** \nVerifique os dados ou colha nova gasometria.`;\n } else {\n return md`Valores de pH, pCO₂ e HCO₃⁻ compatíveis.`;\n }\n}","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":305,"value":"## Distúrbios","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined"},{"id":287,"value":"{\n return md`- ${form.summary.join(\"\\n- \")}`;\n}","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":301,"value":"{\n return md`## Avaliação\n\n${form.rational.join(\"\\n\")}`;\n}","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":358,"value":"## Causas Possíveis","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined"},{"id":357,"value":"{\n let d = form.summary[0];\n if (d == \"Sem distúrbios\") {\n return md``;\n } else if (\n d == \"Acidose Respiratória, Aguda\" ||\n d == \"Acidose Respiratória, Crônica\"\n ) {\n return md`${causes.acidresp}`;\n } else if (\n d == \"Alcalose Respiratória, Aguda\" ||\n d == \"Alcalose Respiratória, Crônica\"\n ) {\n return md`${causes.alcresp}`;\n } else if (d == \"Alcalose Metabólica\") {\n return md`${causes.alcmet}`;\n } else if (d == \"Acidose Metabólica\") {\n return md`${causes.acidmet}`;\n }\n}","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":159,"value":"---\n\n# Apêndice\n\n**Kaufman DA.** _Interpretation of Arterial Blood Gases (ABGs)._ Written for Thoracic.org. [Retrieved 12/07/2022](https://www.thoracic.org/professionals/clinical-resources/critical-care/clinical-education/abgs.php).","pinned":false,"hidden":false,"mode":"md","author":"$undefined","summary":"$undefined"},{"id":154,"value":"import { roundTo } from \"0199a694e2edc141\"","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":54,"value":"$31","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":327,"value":"form = analysis({\n pH: parseFloat(abg.ph),\n pCO2: parseFloat(abg.pco2),\n hco3: parseFloat(abg.hco3),\n na: parseFloat(abg.na),\n cl: parseFloat(abg.cl),\n alb: parseFloat(abg.alb),\n timing: abg.timing\n})","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"},{"id":356,"value":"$32","pinned":false,"hidden":false,"mode":"ojs","author":"$undefined","summary":"$undefined"}],"files":"$W33","stdlib":"1","titling":"auto"}} 30:"$2f:body"