The ‘Great Trans-Atlantic Acid-Base Debate: Current Status in the age of Artificial Intelligence

Pages: 63-70
Prof Aamir Ijaz

MBBS, FCPS, FRCP(Edin), MCPS-HPE

Prof of Chemical Pathology

NUST School of Health Sciences Islamabad, PAKISTAN

Ex-President Pakistan Society of Chemical Pathologists (PSCP)

Country Rep APFCB Member Education Committee APFCB

Member Education Committee APFCB

Abstract

Blood gas analysis (BGA) is one of the most common investigations carried out in critically ill patients. All the results mentioned in the print-out from the BGA equipment are not measured directly but some are calculated using formulae devised by great scientists like Henderson and Hasselbalch. Similarly, in 1950s, interpretation rules were suggested by a group of scientists from Boston Massachusetts US. These rules were based on two BGA parameters i.e. partial pressure of arterial Carbon Dioxide (PaCO2) and concentration of bicarbonate [HCO3].These rules were, however, criticized on the plea that some ‘extra luggage’ has been added on a cognitively over-loaded plethora of symbols appearing ‘Latin’ to a novice. In Copenhagen (Denmark), on other side of the Atlantic Ocean, some parameters were proposed for quantitative assessment of metabolic acid-base abnormalities. These include Standard Bicarbonate (stHCO3), Base Excess (BE) and Standard Base (SBE). These parameters were severely criticized by Boston Group mainly on the ground that these parameters are derived ‘in vitro’ and not valid for ‘in vivo’. Such debates are quite desirable and must continue by the new generations of scientists to find a solution based on Artificial Intelligence, so that the machines should not only give the data (plethora of symbols) but also exact diagnosis of acid-base disorders, stoichiometric analysis and the amount of acid or base required to be given to the patient.