Midtown Morning Report: What is the approximation of ABG to VBG?

The Bottom Line: “In this review of 7 studies comparing arterial and central VBG analyses in perioperative and critically ill patients, we found a reasonable correlation between arterial and central VBG values. Our findings suggest that measuring blood gas values from centrally obtained venous blood is a good substitute for estimating arterial pH and Pco2 values in critically ill patients who are hemodynamically stable. Across all studies of hemodynamically stable patients, the mean difference between arterial and central venous pH and Pco2 is 0.03 units and 4–6.5 mm Hg with narrow 95% confidence intervals, respectively.”

Article of Interest: Chest Radiograph Signs Suggestive of Pericardial Disease

Ridley, Lloyd. (2019, Sept.) Chest Radiograph Signs Suggestive of Pericardial Disease. Latest in Cardiology. American College of Cardiology.

Article of Interest: Performing lumbar puncture in patients with coagulopathy.

Parsons AS. Performing lumbar puncture in patients with coagulopathy. NEJM Journal Watch, December 3, 2020.

Comment: “One limitation of this study is that details on the timing and doses of recently used antithrombotic drugs were not available in this database. Nevertheless, these results suggest that risk for spinal hematoma following lumbar puncture is quite low (only 1 in 500) in all patients, without significant excess risk in coagulopathic patients. Diagnostic or therapeutic necessity — not coagulopathy — should drive the decision for urgent lumbar puncture in patients with undiagnosed CNS infections or neurological disease.”

Article of Interest: Propylene glycol poisoning from excess whiskey ingestion: A case of high osmolal gap metabolic acidosis.

Cunningham CA, Ku K, Sue GR. Propylene Glycol Poisoning From Excess Whiskey Ingestion: A Case of High Osmolal Gap Metabolic Acidosis. J Investig Med High Impact Case Rep. 2015 Sep 3;3(3):2324709615603722.

“In this report, we describe a case of high anion gap metabolic acidosis with a significant osmolal gap attributed to the ingestion of liquor containing propylene glycol. Recently, several reports have characterized severe lactic acidosis occurring in the setting of iatrogenic unintentional overdosing of medications that use propylene glycol as a diluent, including lorazepam and diazepam. To date, no studies have explored potential effects of excess propylene glycol in the setting of alcohol intoxication. Our patient endorsed drinking large volumes of cinnamon flavored whiskey, which was likely Fireball Cinnamon Whisky. To our knowledge, this is the first case of propylene glycol toxicity from an intentional ingestion of liquor containing propylene glycol.”

NEJM Journal Watch: Early Paracentesis for Cirrhotic Patients with Ascites: A Missed Opportunity

John P. Haydek, MD and Daniel D. Dressler, MD, MSc, SFHM, FACP reviewing: Rosenblatt R, Tafesh Z, Shen N, et al. Early Paracentesis in High-Risk Hospitalized Patients: Time for a New Quality Indicator. Am J Gastroenterol. 2019 Dec;114(12): 1863-1869.

Paracentesis within 1 day of hospital admission is associated with lower inpatient mortality and fewer readmissions.