You Know You've Gone Peat Mad When

[Blossom]

Is this an end tidal CO2? PaC02 has to come from an artery I believe unless you have a new technology. PAC02 is alveolar C02.

 

[visionofstrength]

Is this an end tidal CO2? PaC02 has to come from an artery I believe unless you have a new technology. PAC02 is alveolar C02.

Yes, it's called end tidal CO2. There is a strong correlation (so I read) between end tidal CO2 and PaCO2, at least in people who have good alveolar perfusion.

 

[Suikerbuik]

Good you've figured it out already. Should have said mmol/l, sorry for the misunderstanding. End-tidal measurements seem great and wayy less invasive. (Not sure if it matters, but I don't get your formula to be honest.)

 

[aquaman]

@vision: I have seen Peat write that transdermal CO2 therapy is very safe. I have not seen anything from him that inhaling supplementary CO2 (beyond bag-breathing) is generally safe and/or advisable. That doesn't mean there isn't a place for it, but I haven't heard it from him. If you can point to such a quote I'd be interested.

I got an answer from RP. I asked whether inhaling CO2 mixed with air from a tank is safe, given that we don't know exactly what concentraiton of CO2 is being inhaled:

If it isn't causing discomfort or heavy breathing it should be o.k. If you have a finger oxygen saturation meter that would be helpful

.

I have since asked whether it would have the same benefits as CO2 produced in the cells by oxidative metabolism. No answer yet.

 

[Such_Saturation]

Finger meters measure hemoglobin saturation, not discerning what it is attached to.

 

[visionofstrength]

@vision: I have seen Peat write that transdermal CO2 therapy is very safe. I have not seen anything from him that inhaling supplementary CO2 (beyond bag-breathing) is generally safe and/or advisable. That doesn't mean there isn't a place for it, but I haven't heard it from him. If you can point to such a quote I'd be interested.

I got an answer from RP. I asked whether inhaling CO2 mixed with air from a tank is safe, given that we don't know exactly what concentraiton of CO2 is being inhaled:

If it isn't causing discomfort or heavy breathing it should be o.k. If you have a finger oxygen saturation meter that would be helpful

.

I have since asked whether it would have the same benefits as CO2 produced in the cells by oxidative metabolism. No answer yet.

I do keep a pulse oximeter on my finger to monitor O2 saturation. When doing breath-holding for two minutes, I've seen O2 saturation go as low as mid 70s (and CO2 level goes as high, I suspect, as 18%). But with my own personal comfort level of inhaling a steady 8-10% CO2 it stays around 92%, which is equivalent to what my O2 saturation is normally when I'm at (or adapting to) a very high elevation (1000m+).

 

[aquaman]

Finger meters measure hemoglobin saturation, not discerning what it is attached to.

Not sure what this means?

 

[visionofstrength]

I have since asked whether it would have the same benefits as CO2 produced in the cells by oxidative metabolism. No answer yet.

Dude! You ask good questions! Glad I don't have to answer that!

 

[pboy]

I have since asked whether it would have the same benefits as CO2 produced in the cells by oxidative metabolism. No answer yet.

Dude! You ask good questions! Glad I don't have to answer that!

indeed aquaman, awesome...appreciated. Looking forward to his response

 

[Such_Saturation]

Finger meters measure hemoglobin saturation, not discerning what it is attached to.

Not sure what this means?

You can have hemoglobin saturated with carbon dioxide and the finger meter will still show 100% because it is saturated.

 

[visionofstrength]

Finger meters measure hemoglobin saturation, not discerning what it is attached to.

Not sure what this means?

You can have hemoglobin saturated with carbon dioxide and the finger meter will still show 100% because it is saturated.

I use something called a "pulse oximeter" and I don't know more about it then what I read in places such as this:
http://www.ccmtutorials.com/rs/oxygen/page17.htm
The claim is that there is an error in the presence of carboxyhemoglobin (COHb), the product of the reaction between hemoglobin and carbon monoxide (CO); and that the error is caused because carboxyhemoglobin absorbs the same spectrum of red light as oxyhemoglobin (660nm).

te interwebz babbles (click here for Wikibabble) that hemoglobin bound to carbon dioxide (CO2), called Carbaminohemoglobin?, is bluish, but I don't have an authoritative source for this.

Thoughts?

 

[Such_Saturation]

Finger meters measure hemoglobin saturation, not discerning what it is attached to.

Not sure what this means?

You can have hemoglobin saturated with carbon dioxide and the finger meter will still show 100% because it is saturated.

I use something called a "pulse oximeter" and I don't know more about it then what I read in places such as this:
http://www.ccmtutorials.com/rs/oxygen/page17.htm
The claim is that there is an error in the presence of carboxyhemoglobin (COHb), the product of the reaction between hemoglobin and carbon monoxide (CO); and that the error is caused because carboxyhemoglobin absorbs the same spectrum of red light as oxyhemoglobin (660nm).

te interwebz babbles (click here for Wikibabble) that hemoglobin bound to carbon dioxide (CO2), called Carbaminohemoglobin?, is bluish, but I don't have an authoritative source for this.

Thoughts?

Good point. I wonder what kind of information the newer oximeters can give.

 

[visionofstrength]

To get a PaC02 reading would require an arterial blood gas draw which would also give a pH, Pa02, HC03 and base excess. I merely had a venous draw and the unit of measurement was in MMOL/L.

B, not sure if you saw this, but did they give you a pH in the test results for the venous draw, to go with your HCO3 results? I understand that they don't do arterial gas, but I think I have seen pH in some venous blood tests.

 

[Blossom]

To get a PaC02 reading would require an arterial blood gas draw which would also give a pH, Pa02, HC03 and base excess. I merely had a venous draw and the unit of measurement was in MMOL/L.

B, not sure if you saw this, but did they give you a pH in the test results for the venous draw, to go with your HCO3 results? I understand that they don't do arterial gas, but I think I have seen pH in some venous blood tests.

Oh, I'm sure we are talking about different tests. I had a CBC and CMP (I said BMP above but it was actually a CMP). Anyway this is a venous/serum test different than a Blood Gas (either arterial or venous) so that is why the numbers are in different units of measurement. Mmol/l or mEq/l rather than mmHg. If I had had a Blood Gas then my result of 29 would have indeed been low but for the test I had 29 was actually a little high according to the labs reference range. That's why I think it is always good to know the actual test one has had done or the conclusions drawn can be incorrect. The test I had actually measures total venous CO2 in the form of bicarbonate (@95%). I know one could get more specific if they wish but for me that was part of other blood work and simply gave me a rough idea of how things have changed. I hope that resolves any possible confusion about the number for CO2 that I posted. Thanks

 

[visionofstrength]

To get a PaC02 reading would require an arterial blood gas draw which would also give a pH, Pa02, HC03 and base excess. I merely had a venous draw and the unit of measurement was in MMOL/L.

B, not sure if you saw this, but did they give you a pH in the test results for the venous draw, to go with your HCO3 results? I understand that they don't do arterial gas, but I think I have seen pH in some venous blood tests.

Oh, I'm sure we are talking about different tests. I had a CBC and CMP (I said BMP above but it was actually a CMP). Anyway this is a venous/serum test different than a Blood Gas (either arterial or venous) so that is why the numbers are in different units of measurement. Mmol/l or mEq/l rather than mmHg. If I had had a Blood Gas then my result of 29 would have indeed been low but for the test I had 29 was actually a little high according to the labs reference range. That's why I think it is always good to know the actual test one has had done or the conclusions drawn can be incorrect. The test I had actually measures total venous CO2 in the form of bicarbonate (@95%). I know one could get more specific if they wish but for me that was part of other blood work and simply gave me a rough idea of how things have changed. I hope that resolves any possible confusion about the number for CO2 that I posted. Thanks

Right, understood now about the units issue.

But here's a different question: I'm just asking about pH now. If it's listed on the results, it might say a result like 7.4 or thereabouts?

In the venous blood draws I've seen (only two!) they did list the pH as a separate result, but I wondered if they did for yours? The journal articles I've seen also sugest that pH is measured in a venous blood draw, at least sometimes.
(For example, http://www.clinicalcorrelations.org/?p=5608)

 

[Blossom]

No pH, I just checked. All blood gas tests include pH though.

 

[Blossom]

I do think it's positive that my CO2 is increased especially in light of the fact that I live at only 700 feet above sea level and have been off diamox for several months. My bag breathing has been sporadic at best due to some stressful life circumstances, so all in all I'm pleased with my results.
The pulse oximeters can give a false high reading in a person with carbon MONOXIDE poisoning but otherwise they are a reliable indicator of oxygen saturation. I learned that in school though (for what it's worth) and not from any publication.

 

[visionofstrength]

I do think it's positive that my CO2 is increased especially in light of the fact that I live at only 700 feet above sea level and have been off diamox for several months. My bag breathing has been sporadic at best due to some stressful life circumstances, so all in all I'm pleased with my results.

In your travels as a therapist, have you come across something called metabolic alkalosis?

Basically, as I read about it, the "normal" range of blood pH is between 7.35 and 7.45. When you have a pH at or above 7.45, you could have a condition called metabolic alkalosis, in which your CO2 level is likely to be low, even though your bicarbonate (HCO3) level is high.

I'm working up a separate post on how the formula seems to work. But if, as an example, your blood pH was 7.45, then we would calculate like this:

HCO3 = 29 mEq/L
pH = 7.45
then calculated pCO2 = 42.87

Formula is calculated pCO2 = HCO3 X (10 to the exponent (9 - pH)) / 24

For Peat, it's really the calculated pCO2 that matters. Peat's said he's even willing to accept mild respiratory acidosis (pH < 7.35) if it means you can get your pCO2 up. That's sort of the point of aspirin and diamox, they may induce mild respiratory acidosis, by inhibiting the carbonic anhydrase that converts CO2 (acid) to HCO3 (base).

As a comparison, you mentioned that your bicarbonate (HCO3) was 24 before. But assuming your blood pH was 7.35 before, then the calculated pCO2 would be:

HCO3 = 24 mEq/L
pH = 7.35
then calculated pCO2 = 44.67

In other words, your important measure of pCO2, in theory, could have been higher then, IF your pH was lower then (even though your bicarbonate (HCO3) was lower then).

 

[Blossom]

I do think it's positive that my CO2 is increased especially in light of the fact that I live at only 700 feet above sea level and have been off diamox for several months. My bag breathing has been sporadic at best due to some stressful life circumstances, so all in all I'm pleased with my results.
The pulse oximeters can give a false high reading in a person with carbon MONOXIDE poisoning but otherwise they are a reliable indicator of oxygen saturation. I learned that in school though (for what it's worth) and not from any publication.

In your travels as a therapist, have you come across something called metabolic alkalosis?

Basically, as I read about it, the "normal" range of blood pH is between 7.35 and 7.45. When you have a pH at or above 7.45, you could have a condition called metabolic alkalosis, in which your CO2 level is likely to be low, even though your bicarbonate (HCO3) level is high.

I'm working up a separate post on how the formula seems to work. But if, as an example, your blood pH was 7.45, then we would calculate like this:

HCO3 = 29 mEq/L
pH = 7.45
then calculated pCO2 = 42.87

Formula is calculated pCO2 = HCO3 X (10 to the exponent (9= pH)) / 24

For Peat, it's really the calculated pCO2 that matters. Peat's said he's even willing to accept mild respiratory acidosis (pH < 7.35) if it means you can get your pCO2 up. That's sort of the point of aspirin and diamox, they may induce mild respiratory acidosis, by inhibiting the carbonic anhydrase that converts CO2 (acid) to HCO3 (base).

Yes, there are several different states in the blood gas realm. I did get that same impression from reading Peat about a slight acidosis being positive.There are many ways blood gasses are interpreted in 'medicine' like respiratory acidosis, respiratory alkalosis, metabolic acidosis, metabolic alkalosis, and then there is the consideration of compensated and combined. It really is quite interesting.

 

[aquaman]

Peat's said he's even willing to accept mild respiratory acidosis (pH < 7.35) if it means you can get your pCO2 up.

Where is this from?