Blood Gas Evaluation Research Articles

Hematological, biochemical, and blood gas alterations of goat whole blood stored in CPDA-1 and CPD/SAG-M plastic bags

ABSTRACT: The aim of this study was to evaluate the hematological, biochemical, and blood gas alterations of goat whole blood stored in different blood bags. Seven male, adult, crossbreed goats were used, weighing 62±1.8 kg. Nine hundred milliliters of whole blood from each animal was collected and stored in blood bags (450 ml in each), CPDA-1 (citrate phosphate dextrose-adenine) and CPD/SAG-M (citrate phosphate dextrose with saline-glucose-mannitol) as additive solutions, and kept refrigerated (2-4 ºC) for 42 days. Blood samples were collected from the plastic bags at baseline (T0) and after seven, 14, 21,28, 35, and 42 days for hematological, biochemical, blood gas, and microbiological evaluations. Free hemoglobin, degree of hemolysis, lactate, and pO2were increased in both bags, whereas hydrogen potential (pH) and the total hemoglobin concentration decreased overtime(P<0.05). The red blood cell count, glucose, sodium, and potassium remained stable, compared to the baseline. The CPD/SAG-M bag presented a lower red cell count, globular volume, total hemoglobin, and sodium, and a higher degree of hemolysis and plasma hemoglobin, compared with the CPDA-1 bag. The whole goat blood remained viable for therapeutic use; although, there were some important changes in the variables of the 42-day stored blood in relation to fresh blood (T0). We concluded that the CPDA-1 bag is more suitable for use in the storage of goat blood because of its lower commercial value.

Effects of xylazine-ketamine, xylazine-propofol and xylazine-ketamine-propofol administration on free radical generation and blood gases in sheep

This study was aimed at investigating the effects of xylazine-ketamine, xylazine-propofol and xylazine-ketamine-propofol combinations on oxidative stress, antioxidant capacity and blood gases in sheep. Excluding the control animals, the sheep included in Groups 1, 2 and 3 were administered with combinations of xylazine-ketamine, xylazine-propofol and xylazine-ketamine-propofol, respectively, by intravenous route. The comparison of the three treatment groups with the control group showed that no significant difference existed for TAS, TOS, MDA and CAT levels. The evaluation of blood gas and electrolyte levels demonstrated a significant decrease in PvO2, cSO2, Na, and Ca levels, and a significant increase in glucose levels. In result, this study showed that the three anaesthetic combinations tested did not have any adverse effect on the oxidant/antioxidant status, but caused significant alterations in blood gas levels.

Validity and clinical use of mathematical arterialized venous blood gas with the v-TAC approach for evaluation of arterial blood gas in patients with respiratory compromise

Validity and clinical use of mathematical arterialized venous blood gas with the v-TAC approach for evaluation of arterial blood gas in patients with respiratory compromise

The effects of long-term 20 mg/L carbon dioxide exposure on the health and performance of Atlantic salmon Salmo salar post-smolts in water recirculation aquaculture systems

Previous research and experience has linked elevated dissolved carbon dioxide (CO2) to reduced growth performance, poor feed conversion, and a variety of health issues in farm-raised fish, including Atlantic salmon Salmo salar. Supplemental control measures in water recirculation aquaculture systems (RAS) to reduce CO2 accumulation, however, such as increased water pumping to decrease tank hydraulic retention time, can represent significant costs for operators. We exposed post-smolt S0 Atlantic salmon (197 ± 2 g, 423 days post-hatch) to either high (20 ± 1 mg/L) or low (8 ± <1 mg/L) dissolved CO2 in six replicated freshwater RAS for 384 days to investigate differences in performance and health as the salmon were grown to harvest size. All RAS were operated at moderate water exchange rates (1.0% of the total recirculating flow), a 24-h photoperiod was provided, fish were fed to satiation, and densities were maintained between 40 and 80 kg/m3. Over the study period, dissolved oxygen was kept at saturation, mean water temperature was 14.1 ± 0.1 °C, and alkalinity averaged 237 mg/L as CaCO3. At study’s end, no significant differences in fish weight (high CO2 mean weight = 2879 ± 35 g; low CO2 mean weight = 2896 ± 12 g), feed conversion ratio (1.14 ± 0.12 vs. 1.22 ± 0.13, respectively), or thermal growth coefficient (1.45 ± 0.01 vs. 1.46 ± 0.01, respectively), were observed. No significant differences in survival (high CO2 mean survival = 99.1 ± 0.4%; low CO2 mean survival = 98.9 ± 0.3%) or culls due to saprolegniasis (3.5 ± 1% vs. 3.0 ± 1%, respectively) were determined, and no nephrocalcinosis was observed through histopathological evaluation. Blood gas and chemistry evaluation revealed higher pCO2, bicarbonate, and total CO2, and lower chloride and glucose, in the high CO2 cohort. Molecular analyses of gill enzyme regulation showed significantly higher expression of Na+/K+ ATPase α1a in high CO2 fish at 3-weeks post-challenge, indicating physiological adaptation to the higher CO2 environment without any noticeable long-term impacts on health or performance. Overall, the results of this study suggest that, at 237 mg/L as CaCO3 mean alkalinity, post-smolt Atlantic salmon can be raised in freshwater RAS to harvest size with up to 20 mg/L CO2 without significantly impacting fish health and performance.

Does acid-base equilibrium correlate with remnant liver volume during stepwise liver resection?

Small for size and flow syndrome (SFSF) is one of the most challenging complications following extended hepatectomy (EH). After EH, hepatic artery flow decreases and portal vein flow increases per 100 g of remnant liver volume (RLV). This causes hypoxia followed by metabolic acidosis. A correlation between acidosis and posthepatectomy liver failure has been postulated but not studied systematically in a large animal model or clinical setting. In our study, we performed stepwise liver resections on nine pigs to defined SFSF limits as follows: step 1: segment II/III resection, step 2: segment IV resection, step 3: segment V/VIII resection (RLV: 75, 50, and 25%, respectively). Blood gas values were measured before and after each step using four catheters inserted into the carotid artery, internal jugular vein, hepatic artery, and portal vein. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. EH correlated with reduced BE in the hepatic artery. Pco2 values increased after 75% resection in the jugular vein. In contrast, arterial Po2 increased after every resection, whereas the venous Po2 decreased slightly. There were differences in venous [Formula: see text], BE in the hepatic artery, and Pco2 in the jugular vein after 75% liver resection. Because 75% resection is the limit for SFSF, these noninvasive blood evaluations may be used to predict SFSF. Further studies with long-term follow-up are required to validate this correlation.NEW & NOTEWORTHY This is the first study to evaluate acid-base parameters in major central and hepatic vessels during stepwise liver resection. The pH, [Formula: see text], and base excess (BE) decreased, but [Formula: see text] values increased after 75% resection in the portal and jugular veins. Extended hepatectomy correlated with reduced BE in the hepatic artery. Because 75% resection is the limit for small for size and flow syndrome (SFSF), postresection blood gas evaluations may be used to predict SFSF.

Venous blood gases: is it useful in COPD?

Abstract Introduction The present study aims to investigate whether values of venous blood gas sampling can be used instead of arterial blood gas values in the evaluation of blood gas for the emergency service patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). Methods Patients diagnosed COPD and identified to have acute exacerbation of COPD based on acute exacerbation of COPD criteria participated in the study. Data from arterial and venous samples were compared using Spearman and Pearson correlation and Bland-Altman analysis. Results Ninety patients were included in this study. The results indicated statistically significant correlations between venous blood gas pH, pO2, pCO2 and HCO3 values and arterial pH, pO2, pCO2 and HCO3 values of the patients. The correlation for pH, pCO2 and HCO3 values were found to be significantly important (p&lt;0.0001). Discussion and conclusion The findings of the study suggest that some formulations can be used to estimate pH and pCO2 values when evaluating the lung functions of the emergency service patients with acute exacerbation of COPD.

The role of ventilation mode using a laryngeal mask airway during gynecological laparoscopy on lung mechanics, hemodynamic response and blood gas analysis

There are two methods for ventilation in gynecological laparoscopy: volume-controlled ventilation (VCV) and pressure-controlled ventilation (PCV). To compare the lung mechanics, hemodynamic response and arterial blood gas analysis and gas exchange of two modes of VCV and PCV using laryngeal mask airway (LMA) at different time intervals. Sixty infertile women referred for diagnostic laparoscopy, based on ventilation mode, were randomly divided into two groups of VCV (tidal volume: 10 ml/kg) and PCV. In the PCV group, ventilation was initiated with a peak airway pressure (tidal volume: 10 ml/kg, upper limit: 35 cm H2O). In both groups, the arterial blood samples were taken in several time intervals (5, 10 and 15 min after LMA insertion) for blood gas evaluation. Also the lung mechanics parameters were continuously monitored and were recorded at different time intervals. There were no significant differences for patient's age, weight, height and BMI in two groups. The peak and plateau airway pressure were significantly higher in VCV group compared to PCV group 5 and 10 min after insertion of LMA. PaO2 was significantly higher after 10 and 15 min in VCV group compared to PCV group (p=0.005 and p=0.03, respectively). PaCO2 showed significant increase after 5 min in PCV group, but the differences were not significant after 10 and 15 min in two groups. The end tidal CO2 showed significant increase after 10 and 15 min in VCV compared to PCV group. Both VCV and PCV seem to be suitable for gynecological laparoscopy. However, airway pressures are significantly lower in PCV compared to VCV.

Interprétation et utilisation des explorations fonctionnelles respiratoires de routine de l’adulte : spirométrie, volumes non mobilisables, diffusion, hématose, test de provocation bronchique à la métacholine et test de marche

Resting pulmonary function tests (PFT) include the assessment of ventilatory capacity: spirometry (forced expiratory flows and mobilisable volumes) and static volume assessment, notably using body plethysmography. Spirometry allows the potential definition of obstructive defect, while static volume assessment allows the potential definition of restrictive defect (decrease in total lung capacity) and thoracic hyperinflation (increase in static volumes). It must be kept in mind that this evaluation is incomplete and that an assessment of ventilatory demand is often warranted, especially when facing dyspnoea: evaluation of arterial blood gas (searching for respiratory insufficiency) and measurement of the transfer coefficient of the lung, allowing with the measurement of alveolar volume to calculate the diffusing capacity of the lung for CO (DLCO: assessment of alveolar-capillary wall and capillary blood volume). All these pulmonary function tests have been the subject of an Americano-European Task force (standardisation of lung function testing) published in 2005, and translated in French in 2007. Interpretative strategies for lung function tests have been recommended, which define abnormal lung function tests using the 5th and 95th percentiles of predicted values (lower and upper limits of normal values). Thus, these recommendations need to be implemented in all pulmonary function test units. A methacholine challenge test will only be performed in the presence of an intermediate pre-test probability for asthma (diagnostic uncertainty), which is an infrequent setting. The most convenient exertional test is the 6-minute walk test that allows the assessment of walking performance, the search for arterial desaturation and the quantification of dyspnoea complaint.

Iatrogenic tracheal rent in a Clydesdale colt

A one-month-old Clydesdale colt presented for bilateral scrotal hernia and a patent urachus. Manual reduction of the hernia followed by castration and primary closure of the superficial inguinal rings bilaterally...

Effects on Lung Function of Small-Volume Conventional Ventilation and High-Frequency Oscillatory Ventilation in a Model of Meconium Aspiration Syndrome.

For treatment of severe neonatal meconium aspiration syndrome (MAS), lung-protective mechanical ventilation is essential. This study compared short-term effects of small-volume conventional mechanical ventilation and high-frequency oscillatory ventilation on lung function in experimentally-induced MAS. In conventionally-ventilated rabbits, MAS was induced by intratracheal instillation of meconium suspension (4ml/kg, 25mg/ml). Then, animals were ventilated conventionally with small-volume (f-50/min; VT-6ml/kg) or with high frequency ventilation (f-10/s) for 4h, with the evaluation of blood gases, ventilatory pressures, and pulmonary shunts. After sacrifice, left lung was saline-lavaged and cells in bronchoalveolar lavage fluid (BALF) were determined. Right lung was used for the estimation of lung edema formation (wet/dry weight ratio). Thiobarbituric acid-reactive substances (TBARS), oxidative damage markers, were detected in lung tissue and plasma. Meconium instillation worsened gas exchange, and induced inflammation and lung edema. Within 4h of ventilation, high frequency ventilation improved arterial pH and CO2 elimination compared with conventional ventilation. However, no other significant differences in oxygenation, ventilatory pressures, shunts, BALF cell counts, TBARS concentrations, or edema formation were observed between the two kinds of ventilation. We conclude that high frequency ventilation has only a slight advantage over small-volume conventional ventilation in the model of meconium aspiration syndrome in that it improves CO2 elimination.

The effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained.

The aim of the study was to evaluate the effectiveness of gastric tonometry in the diagnosis of acute mesenteric ischemia in cases where a contrast-enhanced computed tomography cannot be obtained. The gastric pH (pHi) and gastric CO2 (gpCO2) were measured with gastric tonometry catheter, preoperatively and postoperatively at 24 hours, in patients with suspicion of acute mesenteric ischemia. Simultaneous evaluation of blood gases and blood lactate levels were performed. Patients were divided into two groups after surgery. Group 1 included patients with mesenteric ischemia, and Group 2 consisted of patients without mesenteric ischemia. Forty-two patients (26 males, 16 females) were evaluated. The mean age was 61.4±13.3 years. There was no significant difference between the groups in terms of demographic factors and co-morbid diseases. There were no significant differences between groups in terms of pHi and gpCO2 levels (7.24±0.2 and -3±12.0 in Group 1, 7.18±0.06 and -3±1.9 in Group 2, respectively), intra-abdominal pressure, lactate levels, and survival. Among all the study parameters, only arterial pH had statistical significance in the diagnosis of acute mesenteric ischemia (7.23±0.21 versus 7.35±0.07 for Groups 1 and 2, respectively,) (p<0.05). Gastric tonometry is not a useful method in the early diagnosis of acute mesenteric ischemia.

Recumbent deoxygenation in mild/moderate liver cirrhosis: the “Clinodeoxia”. The ortho-clino paradigm

While the effects of postural change on arterial oxygenation have been well documented in normal subjects, and attributed to the relationship of closing volume (CV) to the tidal volume, in liver cirrhosis such postural changes have been evaluated mainly in a rare, peculiar clinical end-stage condition which is characterized by increased dyspnea shifting from supine to upright position ("platypnea"). The latter is associated with worsening of PaO2 ("orthodeoxia"). We evaluated the effects of postural changes on arterial oxygenation in patients affected by mild/moderate liver cirrhosis. We performed pulmonary function tests and arterial blood gas evaluation in sitting and supine positions in 22 patients with mild/moderate liver cirrhosis, biopsy-proved, and 22 matched non-smokers control subjects. Recumbency elicited a decrease of PaO2 (Δ(sup-sit)PaO2) in 19 out of 22 controls and in all but one cirrhotics. The magnitude of this postural change was significantly (p=0.04) greater in cirrhotics (9.6±5.3%) compared to controls (6.7±3.7%). In the subset of cirrhotics younger than 60yrs and with PaO2 greater than 80mmHg in sitting position, the Δ(sup-sit)PaO2 in recumbency further increased to 12±5.8%, significantly (p=0.014) greater than in same subgroup of controls (7.1±3.8%). In mild/moderate liver cirrhosis the postural variations in PaO2 follow the normal trends, but are of greater magnitude probably as a consequence of hypoventilated units of lung for postural and disease-linked tidal airway closure, resulting in more pronounced recumbent hypoxemia ("clinodeoxia").

A questionaire study evaluating the knowledge and approach by physicians about arterial blood gas.

Arterial blood pressure analysis is a frequently applied method in the diagnosis and follow-up of respiratory insufficiency and in the treatment of patients under risk. It is very important to take and analyze the blood gas sample properly. Therefore, a questionary study was performed which evaluated the knowledge and the approach of doctors working in various specialties. A questionary form consisting of 27 questions were filled by 100 specialist physicians who participated in the study. It was observed that doctors participating in our study had partly sufficient knowledge regarding administration and evaluation of arterial blood gas. It was considered that in intensive care unit experience of participant doctors during their intern periods was a very important factor. But it was observed that most of the participant specialist physicians performed Allen test before radial artery puncture, and they frequently preferred femoral artery for their first puncture option, and they did not pay attention in the proper transportation of the samples and in sending cultures from arterial cannula against risk of infection. The majority of doctors who participated in our study stated that they would like to receive training in arterial blood gas administration and evaluation. In conclusion, to take samples from arterial blood gas is an invasive operation and if not performed correctly it can cause complications to develop. Transportation and evaluation is as much important as sampling. It is very important to provide sufficient education to candidates of specialist physicians and to organize training courses aimed to increase their knowledge and experience during the period of their speciality without taking their speciality into account.

Hb Grove City [β38(C4)Thr→Ser, ACC>AGC; HBB: c.116C>G]: A New Low Oxygen Affinity β Chain Variant

A previously unreported β chain hemoglobin (Hb) variant, Hb Grove City [β38(C4)Thr→Ser, ACC>AGC; HBB: c.116C>G], was discovered in a woman who presented with hypoxia and mild anemia. Her young daughter also tested positive for the variant and displayed similar symptoms. Hemoglobin-oxygen dissociation testing confirmed right-shifted oxygen dissociation curves. A corresponding Hb variant was detected by high performance liquid chromatography (HPLC) and intact mass spectrometry (MS) but was not detected by capillary electrophoresis (CE), isoelectrofocusing (IEF) or alkaline or acid electrophoresis. DNA sequencing analysis confirmed a β-globin gene mutation. All three previous mutations at this locus affect oxygen affinity, as does this new variant. This newly described variant showed variable stability results and therefore may be mildly unstable but is not associated with microcytosis, significant hemolysis or clinically evident cyanosis. It is important to consider hemoglobinopathies in patients who are anemic and have unexplained hypoxia. Arterial blood gas and p50 evaluations may prevent unnecessary diagnostic interventions. Additionally, Hb variants with altered oxygen affinity can be electrophoretically silent; therefore, multiple methods including MS and/or DNA sequencing are warranted when clinical suspicion is high.

Lactate study using umbilical cord blood: Agreement between Lactate Pro hand-held devices with blood gas analyser and evaluation of lactate stability over time

Lactate measurements have become increasingly preferred over pH analysis in the evaluation of fetal acidaemia in labour. In a busy labour ward, often the umbilical cord may be sampled late and as a result yield unreliable lactate values. To investigate the agreement of hand-held device Lactate Pro with a reference method blood gas analyser and evaluate the stability of umbilical cord lactate values over time. Prospective study carried out at elective caesarean section. Sixteen umbilical cords were double clamped immediately after delivery with paired arterial and venous blood samples collected by an independent researcher, at varying time intervals, and processed by two Lactate Pro devices and a reference method blood gas analyser. A significant difference of -0.41 to 0.10 mmol/L was found when different groups of Lactate Pro devices were compared with blood gas analyser at lactate values up to 5.70 mmol/L, with average lactate value of 2.45 mmol/L. Over time, there is progressive rise in lactate samples obtained from the umbilical cord. Lactate Pro devices have a significant difference, but when used in clinical practice on cord blood after delivery, this is unlikely to be meaningful. In intrapartum fetal surveillance, a systematic overestimation might lead to unnecessary intervention. It is possible to retrospectively predict the likely level of lactate at birth in delayed cord samples.

Evaluation of hematologic, blood gas, and select biochemical variables in ovine whole blood stored in CPDA‐1 bags

The economic consequences from mortality of sheep after blood loss can be considerable. To date there are no reports addressing hematologic, blood gas, and biochemical changes in ovine blood stored in CPDA-1 bags. The aim of this study was to investigate hematologic, blood gas, and biochemical alterations resulting from storage of ovine blood in CPDA-1 bags to establish transfusion protocols in sheep. From each of 7 healthy 8-month-old sheep 450 mL of blood were collected into CPDA-1 bags and stored for 35 days in at 3-6°C. Samples were taken from the bags at days 0, 7, 14, 21, and 35. Whole blood was used to assess PCV, MCV, RBC count, pH, pO2 , pCO2 , and concentrations of bicarbonate, sodium, and lactate. Plasma was used to measure potassium, hemoglobin, and glucose concentrations. The PCV remained stable throughout the storage period, while plasma hemoglobin and MCV began to increase on days 7 and 21, respectively. The RBC count began to decrease on day 21. Blood pH decreased and pCO2 increased steadily throughout the storage period. Potassium concentration increased from 3.8 to 18.3mmol/L on day 7 and remained high thereafter. In contrast, sodium concentration began to decrease on day 7. The results show that ovine blood undergoes hematologic, blood gas, and biochemical changes during storage. Further studies are required to establish RBC viability in CPDA-1 bags after a storage period of 35days.

Metabolic and respiratory derangements associated with death in cold-stunned Kemp's ridley turtles (Lepidochelys kempii): 32 cases (2005–2009)

To assess selected clinicopathologic variables at hospital admission (day 1) for cold-stunned Kemp's ridley turtles (Lepidochelys kempii) that died during the first 3 days after admission (nonsurvivors) and turtles that survived (survivors) and to determine the percentage change of each variable from day 1 to day of death (nonsurvivors) or to day 2 or 3 of hospitalization (survivors). Retrospective case-control study. Animals-64 stranded, cold-stunned Kemp's ridley turtles hospitalized from October 2005 through December 2009. Blood gas, pH, Hct, and selected biochemical values in blood samples determined on day 1 and day of death (nonsurvivors; n = 32) or day 2 or 3 of hospitalization (survivors; 32) were obtained from medical records. For each variable, initial values and percentage changes (from initial values to values at the day of death or day 2 or 3 of hospitalization) were compared between survivors and nonsurvivors. Compared with blood analysis findings for survivors, nonsurvivors initially had significantly higher potassium concentration and Pco(2) and significantly lower Po(2), pH, and bicarbonate concentration than did survivors. For the first 2 or 3 days of hospitalization, percentage changes in potassium, lactate, and ionized calcium concentrations were significantly higher and percentage changes in pH and plasma glucose and bicarbonate concentrations were significantly lower in nonsurvivors. At hospital admission, cold-stunned Kemp's ridley turtles were affected by metabolic and respiratory derangements; severe derangements were associated with death. Evaluation of blood gas, pH, Hct, and selected clinicopathologic variables provided useful clinical and prognostic information during rehabilitation of cold-stunned Kemp's ridley turtles.

The factors affecting noninvasive mechanical ventilation failure in COPD exacerbations

To evaluate causes of noninvasive mechanical ventilation (NIMV) failure. The rate of NIMV failure in respiratory failure due to chronic obstructive pulmonary disease (COPD) exacerbations was reported as 5%-40%. Materials and methods: The necessity of endotracheal intubation was accepted as NIMV failure. The causes of NIMV failure were assessed in 54 patients (45 males; mean age: 67.7 ± 11.0 years) treated with NIMV because of COPD exacerbations and respiratory failure in an intensive care unit (ICU). Results: There was NIMV failure in 20 patients (37.0%). The rates of hospital-acquired pneumonia and in-hospital mortality were higher (P = 0.003 and P = 0.002, respectively) and the duration of ICU stay was longer (P < 0.0001) in patients with NIMV failure. On admission, arterial pH, serum albumin, and Glasgow Coma Scale levels were lower (P = 0.032, P = 0.024, and P = 0.013, respectively) in the NIMV failure group. Arterial pH was lower (P = 0.039) and respiratory rate was higher (P = 0.010) after 1 h, and the PaO2/FiO2 rate was lower (P = 0.017) and respiratory and heart rates were higher (P = 0.002 and P = 0.020, respectively) after 3 h in the NIMV failure group. Conclusion: The present data strongly suggest that baseline and follow-up clinical and arterial blood gas evaluations can give important clues about NIMV failure in COPD exacerbations.

Mode of delivery is associated with different hematological profiles in the newborn calf

Several studies on babies have shown that the type of delivery can influence the hematological and immune status of the newborn. In bovine medicine, some authors reported the hematological pattern of the newborn calf, but never related it with the calving process or other perinatal factors. The purpose of the present study was to evaluate the hematological profile in newborn calves in relation to the type of delivery. A total of 41 healthy calves were enrolled; 16 Friesian calves which were born by vaginal delivery without assistance (VD), and 25 Belgian Blue calves that were born by elective Caesarean section (CS). As soon as the calves were born, a complete clinical examination was performed to verify viability and maturity. At 10 min after birth, 2 mL venous blood was collected to perform the blood gas and acid-base evaluation. Blood samples were subsequently collected from the jugular vein within 30 min after birth, and at 1, 2, 3, 7, and 14 days of age. An automatic analyzer was used to determine hemoglobin concentration (Hb), hematocrit (Ht), and red and white blood cell counts, while differential leukocyte count was performed microscopically. Statistical analysis was applied to assess differences between the groups and within the group for all parameters between each sampling time (P ≤ 0.05). All the calves were born alive, viable, and mature. There were no acidotic calves, but statistical analysis revealed many differences, as higher pH, base excess (BE) (P ≤ 0.05), PO2 (P < 0.001), and sO2 (P < 0.0001) in the VD group. Levels of hemoglobin concentration, hematocrit, and red blood cell number were constantly higher in CS calves (P < 0.001). In comparison with the VD calves, white blood cell and neutrophil absolute number were higher at birth and at 14 days of age in the CS group (P < 0.001 and P ≤ 0.05). The mode of delivery, therefore, seems to have an influence on the oxygenation levels and on the hematological and nonspecific immunity profile of the newborn calf.

Seizures Secondary to Lamotrigine Toxicity in a Two-Year-Old

To report a case of acute pediatric lamotrigine ingestion resulting in seizures. A 2-year-old boy presented to the emergency department after an acute ingestion of up to 43 mg/kg of lamotrigine. He had 2 generalized seizures, with the first occurring 60 minutes after ingestion. Examination revealed alternate drowsiness and irritability, as well as nystagmus and hyperreflexia. Results of electrocardiogram, blood glucose, complete blood count, urea, electrolytes, and venous blood gas evaluations were all within normal limits. There was a mildly raised lactate level of 3.4 mEq/L (reference range 0.7-2.5). He was given intravenous diazepam 1 mg for irritability. After a 12-hour observation period, the patient was discharged with no further complications. The Naranjo probability scale in this case suggested a probable causality between the acute lamotrigine ingestion and seizures. This is the lowest acute dose causing pediatric seizure reported in the literature; however, this dose is still significantly higher than a therapeutic dose. A MEDLINE search (1966-January 2010) using the search terms lamotrigine, seizures, toxicity, overdose, ingestion, and pediatric/paediatric, not limited to English-language literature, revealed 5 other cases of seizures in children after lamotrigine ingestion. In all the acute cases, time to first seizure onset ranged from 20 to 60 minutes after ingestion. Two children had gastrointestinal decontamination, both after the onset of seizures. All had full recovery with supportive care. Lamotrigine has the ability to cause seizures in children from acute single ingestion at a lower dose than previously described. There is not enough information available to establish a toxic dose or dose that requires hospital assessment. Gastrointestinal decontamination should be contraindicated. Supportive care, including administration of benzodiazepines, is appropriate.