Respiratory failure laboratory findings: Difference between revisions
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==Overview== | ==Overview== | ||
Laboratory findings consistent with the diagnosis of respiratory failure include abnormal bicarbonate, oxygen, phosphate, and magnesium levels. | Laboratory findings consistent with the diagnosis of respiratory failure include abnormal [[bicarbonate]], [[oxygen]], [[phosphate]], and [[magnesium]] levels. | ||
==Laboratory Findings== | ==Tests of Oxygenation== | ||
*Laboratory findings consistent with the diagnosis of respiratory failure include: | ;PaO<sub>2</sub>/FiO2 ratio (PF ratio) | ||
**Arterial blood gases | :<math>{P/F\ ratio} = \left (\frac{PaO_2}{Fi0_2}\right) \times 100</math> | ||
***Bicarbonate may be elevated to more than 45mmHg, and oxygen levels below 60mmHg | * Normal is 500 | ||
* ARDS is < 200 | |||
This measure is easier to calculate. Comparative studies suggest it correlates better with pulmonary shunts than does the A-a gradient.<ref name="pmid6409506">{{cite journal |author=Covelli HD, Nessan VJ, Tuttle WK |title=Oxygen derived variables in acute respiratory failure |journal=Crit. Care Med. |volume=11 |issue=8 |pages=646–9 |year=1983 |pmid=6409506 |doi=}}</ref><ref name="pmid14769743">{{cite journal |author=El-Khatib MF, Jamaleddine GW |title=A new oxygenation index for reflecting intrapulmonary shunting in patients undergoing open-heart surgery |journal=Chest |volume=125 |issue=2 |pages=592–6 |year=2004 |pmid=14769743 |doi=}}</ref><ref name="pmid3191742">{{cite journal |author=Cane RD, Shapiro BA, Templin R, Walther K |title=Unreliability of oxygen tension-based indices in reflecting intrapulmonary shunting in critically ill patients |journal=Crit. Care Med. |volume=16 |issue=12 |pages=1243–5 |year=1988 |pmid=3191742 |doi=}}</ref> | |||
;Alveolar-arterial oxygen (A-a) gradient (alveolar-arterial oxygen difference - AVO<sub>2</sub>D) | |||
:<math>\mbox{A-a gradient} = {PAO_2}\ -\ {PaO_2}</math> | |||
:<math>{PAO_2} = {Fi0_2} *\left ({760 - 47}\right) \ -\ \frac{PaCO_2}{0.8}</math> | |||
* Normal is < 10 mm Hg | |||
The A-a gradient is harder to calculate, but accounts for changes in respiration as measured by the [[partial pressure]] of carbon dioxide. However, this calculation relies on the respiratory quotient being constant in the prediction of alveolar CO<sub>2</sub> When compared to the PF ratio, the A-a gradient is found to correlate less well with pulmonary shunting.<ref name="pmid6409506">{{cite journal |author=Covelli HD, Nessan VJ, Tuttle WK |title=Oxygen derived variables in acute respiratory failure |journal=Crit. Care Med. |volume=11 |issue=8 |pages=646–9 |year=1983 |pmid=6409506 |doi=}}</ref><ref name="pmid14769743">{{cite journal |author=El-Khatib MF, Jamaleddine GW |title=A new oxygenation index for reflecting intrapulmonary shunting in patients undergoing open-heart surgery |journal=Chest |volume=125 |issue=2 |pages=592–6 |year=2004 |pmid=14769743 |doi=}}</ref><ref name="pmid3191742">{{cite journal |author=Cane RD, Shapiro BA, Templin R, Walther K |title=Unreliability of oxygen tension-based indices in reflecting intrapulmonary shunting in critically ill patients |journal=Crit. Care Med. |volume=16 |issue=12 |pages=1243–5 |year=1988 |pmid=3191742 |doi=}}</ref> | |||
Among outpatients with possible pulmonary embolism, the A-a gradient may be a better test.<ref name="pmid8304364">{{cite journal |author=McFarlane MJ, Imperiale TF |title=Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism |journal=Am. J. Med. |volume=96 |issue=1 |pages=57–62 |year=1994 |pmid=8304364 |doi=}}</ref> | |||
An online calculator for the A-a gradient is at http://www.mdcalc.com/aagrad. | |||
==Other Laboratory Findings== | |||
*Laboratory findings consistent with the diagnosis of respiratory failure include:<ref name="pmid28507176">{{cite journal |vauthors=O'Driscoll BR, Howard LS, Earis J, Mak V |title=BTS guideline for oxygen use in adults in healthcare and emergency settings |journal=Thorax |volume=72 |issue=Suppl 1 |pages=ii1–ii90 |date=June 2017 |pmid=28507176 |doi=10.1136/thoraxjnl-2016-209729 |url=}}</ref><ref name="pmid15219010">{{cite journal |vauthors=Celli BR, MacNee W |title=Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper |journal=Eur. Respir. J. |volume=23 |issue=6 |pages=932–46 |date=June 2004 |pmid=15219010 |doi= |url=}}</ref> | |||
**[[Arterial blood gas|Arterial blood gases]] | |||
***[[Bicarbonate]] may be elevated to more than 45mmHg, and oxygen levels below 60mmHg | |||
**Electrolyte studies | **Electrolyte studies | ||
***Low phosphate and low magnesium | ***Low [[phosphate]] and low [[magnesium]] | ||
**Toxicology screen for detection of: | **[[Toxicology screen]] for detection of: | ||
***Opiates | ***[[Opiate|Opiates]] | ||
***Benzodiazepines | ***[[Benzodiazepine|Benzodiazepines]] | ||
***Tricyclic antidepressants | ***[[Tricyclic antidepressant|Tricyclic antidepressants]] | ||
***Barbiturates | ***[[Barbiturate|Barbiturates]] | ||
**Complete blood count | **[[Complete blood count]] | ||
***Chronic hypoxemia may be associated with polycythemia | ***[[Hypoxemia|Chronic hypoxemia]] may be associated with [[polycythemia]] | ||
***Eosinophilia may be associated with eosinophilic myalgia | ***[[Eosinophilia]] may be associated with eosinophilic myalgia | ||
**Thyroid function tests | **[[Thyroid function tests]] | ||
***An elevated TSH and decreased T4 indicates hypothyroidism | ***An elevated [[Thyroid-stimulating hormone|TSH]] and decreased [[T4]] indicates [[hypothyroidism]] | ||
**Creatine phosphokinase may be elevated and may indicate: | **[[Creatine phosphokinase]] may be elevated and may indicate: | ||
***Infectious or autoimmune polymyositis | ***Infectious or autoimmune [[polymyositis]] | ||
***Hypothyroidism | ***[[Hypothyroidism]] | ||
***Rhabdomyolysis secondary to colchicine or chloroquine toxicity | ***[[Rhabdomyolysis]] secondary to [[colchicine]] or [[chloroquine]] toxicity | ||
***Procainamide myopathy | ***[[Procainamide]] [[myopathy]] | ||
**Cardiac enzymes | |||
***To detect mysocardial infarction | |||
**Kidney and liver function tests | |||
***May be a cause of respiratory failure or may help to anticipate complications | |||
==References== | ==References== | ||
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{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
[[Category:Surgery]] | [[Category:Surgery]] | ||
[[Category:Up-To-Date]] | [[Category:Up-To-Date]] | ||
[[Category:Medicine]] | [[Category:Medicine]] | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Pulmonology]] | |||
[[Category:Anesthesiology]] | |||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Laboratory findings consistent with the diagnosis of respiratory failure include abnormal bicarbonate, oxygen, phosphate, and magnesium levels.
Tests of Oxygenation
- PaO2/FiO2 ratio (PF ratio)
- <math>{P/F\ ratio} = \left (\frac{PaO_2}{Fi0_2}\right) \times 100</math>
- Normal is 500
- ARDS is < 200
This measure is easier to calculate. Comparative studies suggest it correlates better with pulmonary shunts than does the A-a gradient.[1][2][3]
- Alveolar-arterial oxygen (A-a) gradient (alveolar-arterial oxygen difference - AVO2D)
- <math>\mbox{A-a gradient} = {PAO_2}\ -\ {PaO_2}</math>
- <math>{PAO_2} = {Fi0_2} *\left ({760 - 47}\right) \ -\ \frac{PaCO_2}{0.8}</math>
- Normal is < 10 mm Hg
The A-a gradient is harder to calculate, but accounts for changes in respiration as measured by the partial pressure of carbon dioxide. However, this calculation relies on the respiratory quotient being constant in the prediction of alveolar CO2 When compared to the PF ratio, the A-a gradient is found to correlate less well with pulmonary shunting.[1][2][3]
Among outpatients with possible pulmonary embolism, the A-a gradient may be a better test.[4]
An online calculator for the A-a gradient is at http://www.mdcalc.com/aagrad.
Other Laboratory Findings
- Laboratory findings consistent with the diagnosis of respiratory failure include:[5][6]
- Arterial blood gases
- Bicarbonate may be elevated to more than 45mmHg, and oxygen levels below 60mmHg
- Electrolyte studies
- Toxicology screen for detection of:
- Complete blood count
- Chronic hypoxemia may be associated with polycythemia
- Eosinophilia may be associated with eosinophilic myalgia
- Thyroid function tests
- An elevated TSH and decreased T4 indicates hypothyroidism
- Creatine phosphokinase may be elevated and may indicate:
- Infectious or autoimmune polymyositis
- Hypothyroidism
- Rhabdomyolysis secondary to colchicine or chloroquine toxicity
- Procainamide myopathy
- Cardiac enzymes
- To detect mysocardial infarction
- Kidney and liver function tests
- May be a cause of respiratory failure or may help to anticipate complications
- Arterial blood gases
References
- ↑ 1.0 1.1 Covelli HD, Nessan VJ, Tuttle WK (1983). "Oxygen derived variables in acute respiratory failure". Crit. Care Med. 11 (8): 646–9. PMID 6409506.
- ↑ 2.0 2.1 El-Khatib MF, Jamaleddine GW (2004). "A new oxygenation index for reflecting intrapulmonary shunting in patients undergoing open-heart surgery". Chest. 125 (2): 592–6. PMID 14769743.
- ↑ 3.0 3.1 Cane RD, Shapiro BA, Templin R, Walther K (1988). "Unreliability of oxygen tension-based indices in reflecting intrapulmonary shunting in critically ill patients". Crit. Care Med. 16 (12): 1243–5. PMID 3191742.
- ↑ McFarlane MJ, Imperiale TF (1994). "Use of the alveolar-arterial oxygen gradient in the diagnosis of pulmonary embolism". Am. J. Med. 96 (1): 57–62. PMID 8304364.
- ↑ O'Driscoll BR, Howard LS, Earis J, Mak V (June 2017). "BTS guideline for oxygen use in adults in healthcare and emergency settings". Thorax. 72 (Suppl 1): ii1–ii90. doi:10.1136/thoraxjnl-2016-209729. PMID 28507176.
- ↑ Celli BR, MacNee W (June 2004). "Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper". Eur. Respir. J. 23 (6): 932–46. PMID 15219010.