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Clinical Chemistry and Laboratory Medicine (CCLM)

Published in Association with the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM)

Editor-in-Chief: Plebani, Mario

Ed. by Gillery, Philippe / Lackner, Karl J. / Lippi, Giuseppe / Melichar, Bohuslav / Payne, Deborah A. / Schlattmann, Peter / Tate, Jillian R.

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The Accuracy of Calculated Base Excess in Blood

Werner Lang / Rolf Zander

Citation Information: Clinical Chemistry and Laboratory Medicine. Volume 40, Issue 4, Pages 404–410, ISSN (Print) 1434-6621, DOI: https://doi.org/10.1515/CCLM.2002.065, June 2005

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Most equations used for calculation of the base excess (BE, mmol/l) in human blood are based on the fundamental equation derived by Siggaard-Andersen and called the Van Slyke equation: BE = Z . [{cHCO3-(P)–c 7.4 HCO3-(P)} + β. (pH–7.4)]. In simple approximation, where Z is a constant which depends only on total hemoglobin concentration (cHb, g/dl) in blood, three equations were tested: the ones proposed by Siggaard-Andersen (SA), the National Committee for Clinical Laboratory Standards (NCCLS) or Zander (ZA). They differ only slightly in the solubility factor for carbon dioxide αCO2, mmol/l.mmHg) and in the apparent pK (pK'), but more significantly in the plasma bicarbonate concentration at reference pH (c> 7.4HCO3-(P), mmol/l) and in Β, the slope of the CO2-buffer line (mmol/l) for whole blood. Furthermore, the approximation was improved either by variation in Z (r c), or in the apparent pK (pK') with changing pH. Thus, from a total of seven equations and from a reference set for pH, pCO2 and BE taken from the literature (n=148), the base excess was calculated. Over the whole range of base excess (−30 to +30 mmol/l) and pCO2(12 to 96 mmHg), mean accuracy ΔBE, mmol/l) was greatest in the simple equation according to Zander and decreased in the following order: ±0.86 (ZA); ±0.94 (ZA, r c); ±0.96 (SA, r c); ±1.03 (NCCLS, r c); ±1.40 (NCCLS); ±1.48 (SA); and ±1.50 (pK').

For all clinical purposes, the Van Slyke equation according to Zander is the best choice and can be recommended in the following form: BE = (1−0.0143 . cHb) . [{0.0304 . pCO2. 10ph−6.1−24.26} + (9.5+1.63 . cHb) . (pH −7.4)] −0.2 . cHb . (1−sO2), where the last term is a correction for oxygen saturation (sO2). Hence, base excess can be obtained with high accuracy (<1 mmol/l) from the measured quantities of pH, pCO2, cHb, and sO2 in used.

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