Total CO2 measurements in horses: where to draw the line

Abstract

Racehorses given a slurry of sodium bicarbonate (known colloquially as a ‘milkshake’) before a race have elevated concentrations of carbon dioxide in their blood. Racing administrators have reacted to this attempt to enhance the performance of the animal by setting limits to ‘total carbon dioxide’ (TCO2, the sum of carbon dioxide, carbonic acid, carbonate and bicarbonate) in prerace samples of plasma. The threshold limit for TCO2 in the rules of racing is an amount concentration of 36.0 mmol/L, with further action ensuing if the reported concentration is greater than an action limit that is calculated from the knowledge of the measurement uncertainty. At present in Australia, the action limit is 37.0 mmol/L, which is based on a combined standard measurement uncertainty of 0.22 mmol/L. From data obtained in a 1997 study in 515 normal racehorses, we have established the distribution (as a probability density function, PDF) of TCO2. This is combined with data from Australian laboratories of 126 horses that were tested following a positive screen, out of which 78 were confirmed positive. We employ the maximum entropy method to establish the PDFs and then apply Bayes Theorem to answer the question ‘given the measured TCO2 concentration what is the probability that a horse has been administered bicarbonate’? The distributions are not normal, which precludes simple approaches that calculate standard deviations from the data. For an action level of 37.0 mmol/L, there is a chance of only 1 in 2 020 000 that a nondoped horse will be judged to be doped, which implies this present threshold is unlikely to lead to conviction of an innocent trainer.