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The Computing Techniques

Page Index

Introduction:

If you're not interested in mathematics or computer programs, you have probably read too far already!

The section describes the logic utilized to generate the text reports. as well as the development of the necessary equations and iterative subroutines required to convert the raw data into the diagrams on the screen.

Technique for the text Interpretations

• Base Excess (BE)
• Bicarbonate

• Locatation of the Zone
• Magnitude of the 2 components

Diagnostic Zones

This diagram shows the radial zones employed to generate the sentence fragments. Radiating out from the center are the rectangles which determine the choice of adjective to describe the magnitude of the respiratory and metabolic components. Each zone is numbered. The numbers correspond to the radial search used to choose a code which generate the Sentence Fragments.

For the six Classical Zones an extra phrase or sentence is added describing the selected typical zone.

Typical Zones:

• Acute Respiratory Acidosis (7 & 8)
• Chronic Respiratory Acidosis (5)
• Metabolic Alkalosis (3)
• Acute Respiratory Alkalosis (18 & 19)
• Chronic Respiratory Alkalosis (16)
• Metabolic Acidosis (14)

The Rectangles which Determine the Adjectives

The expanding family of rectangles determine the choice of adjectives used to describe the degree of acidosis and alkalosis. Normal; Minimal; Mild; Moderate; Marked; Severe. The corners of these rectangles corresponds to the slope for pH = 7.4.

Objective of the Algorithm.

The intention behind this reporting algorithm was to produce reports with a style and a range of distinctions to which a human being might aspire when writing Acid-Base reports. Each report, or even a small series of reports, should appear to be "human". However, because no random variation is included, there is no pretense that a longer series of reports might be mistaken as actually coming from a human hand.

Computing Strategy.

The computer program conducts a radial search of the diagram to determine which sector (1 - 29) contains the result. The sector corresponds to a stored numerical sequence, each number in which corresponds to a sentence fragment in the final report. Two additional numbers govern the adjectives which describe the magnitude of the respiratory and metabolic components; these numbers are derived from the location either inside or outside the central rectangles ( A - E) and are inserted at the appropriate point in the numerical sequence. A final descriptive phrase is included when the location is characteristic of a chronic or an acute disturbance.

Grogono Equation.

These are the equations used to obtain a first approximations, e.g., to obtain bic from BE and PCO₂.

[H⁺] x (30.17 + BE) = 22.63 x (PCO₂ + 13.33) (Grogono et al, 1976)

bic = (BE + 30.17) / (0.94292 + 12.569 / PCO2)

Siggaard Andersen Equation.

It is a pleasure to thank Dr. Severinghaus for giving me these equations which are used in iterative procedures to obtain successively better approximations

SBE = 0.9287 (bic - 24.4 + 14.83 (pH - 7.4)), which can be simplified to:

BE = 0.9287 * bic + 13.77 * pH - 124.58

bic = BE/0.9287 - 14.83 * pH +134.142

Modified Henderson Equation.

This is the equation used to derive [HCO₃^-] from pH and PCO₂.

[H⁺] x [HCO₃^-] = 24 x PCO₂

Iterative Procedure.

The following Java Code shows how these equations were employed to derive accurate bicarbonate values from PCO₂ and BE:

Algorithm Design.

Respiratory/Metabolic Precedence:

The program gives precedence to the dominant component: respiratory or metabolic. Whether the two components are in opposition or supplement each other - the dominant one is described first in the report. Dominance is determined utilizing the slope of the pH = 7.4 line to compare the metabolic and respiratory components.

Compensatory vs. Additive:

When the components are additive, the wording changes from, e.g., " . . . is a marked metabolic acidosis with a moderate respiratory compensation" to a more appropriate: " . . . has both a marked metabolic acidosis and a moderate respiratory acidosis."

Normal/Close to Normal:

If a patient is normal or close to normal, a human reporter would probably comment on this. The program mimics this: the report is preceded by an introductory phrase.

1. These values are close to normal
2. This patient has normal acid-base values

Describing Magnitude:

When choosing adjectives to rank and compare the metabolic and respiratory components we indicate that, e.g., the respiratory component is dominant with a phrase like :....marked respiratory acidosis compensated by a moderate metabolic ....." The adjectives "marked" or "moderate" do not consistently indicate magnitude; a small number of adjectives are used as it suits us. Such fluidity is harder to program. To allow the computer to have a sufficient "hierarchy" of adjectives, the following adjective sequence was employed:

1. No or Negligible
2. Minimal
3. Mild
4. Moderate
5. Marked
6. Severe

Sentence Structure:

Several alternative sentence "stems" are used to provide variety when constructing sentences in different areas.

1. The principal abnormality is a
2. There is both a
3. This patient has both a
4. This patient has a

Characteristic Zones:

The six characteristic zones which are recognized and reported are:

1. Acute Respiratory Acidosis
2. Acute Respiratory Alkalosis
3. Chronic Respiratory Acidosis
4. Chronic Respiratory Alkalosis
5. Metabolic Acidosis
6. Metabolic Alkalosis

Terminal Phrases:

When appropriate, a final phrase is added to the report:

1. which is typical of chronic respiratory disease.
2. which compensate completely for each other.
3. typical of a partially compensated metabolic disturbance.
4. This is typically seen in prolonged hyperventilation.
5. It is characteristic of an acute respiratory disturbance.
6. which may occur in prolonged hyperventilation.

Color Changes for Graph:

For visual interest the diagram changes color "Litmus Paper Style": red in acidosis and blue in alkalosis.

Metabolic Measurement Comparison:

To demonstrate the discrepancy between bicarbonate and Base Excess, both isopleths and numerical values are displayed. Particularly at low PCO₂ levels the change in the bicarbonate value can be seen to deviate from Base Excess.

About the Java Applets

Getting the Java-based pieces of this site to run was challenging and the results were sometimes unexpected. Some of the planned features (mostly color changes) had to be omitted initially because they wrecked the function of the program. As Java stabilized, they were reintroduced. Some of the applets - notably the "pH Playground" - sometimes stall temporarily and fail to respond to the mouse clicks. Any advice or suggestions from Java-experts will be appreciated. Details about how each Applet is used are in the following paragraphs.

Selecting Host for Java Websites:

To avoid problems with Java applications or Java scripts, a good first step is to go to Java Web Hosting to find websites that use Java applets or are entirely JSP based.

Using the Java Applets.

There is only one applet running the diagrams. Each Applet can run in four different modes and, in the "resting condition", will assume a gray background color. The color of the background is supplied by the HTML text. If you plan to use one of the applets, this explanation about the required HTML tags will help you get the best out of it.

A complete call to one of the Graph Applets would look like this

<APPLET CODE = "AcidGrog.class" WIDTH=520 HEIGHT=360>
<PARAM NAME=pH VALUE = "7.25">
<PARAM NAME=PCO2 VALUE = "62">
<PARAM NAME=color VALUE = "FFFF9F">
</APPLET>

Controls for the Graph Applets

Note: All of the following parameters are optional and may be omitted

Dimension

1. HEIGHT is 360
2. WIDTH controls behavior:
   • WIDTH=360 - the Applet works in "Explore" or "Report" modes.
   • WIDTH=520 - the Applet works in "Self-Test" or "Challenge" modes

Patient Data

1. No Data Given in HTML code - the Applet works in "Explore" or "Self-Test" modes
2. Both pH and PCO2 provided - the Applet works in "Report" or "Challenge" modes.
   The Tags to provide the patient data must both be present:
   • <PARAM NAME=pH VALUE = "7.3">
   • <PARAM NAME=PCO2 VALUE = "60" >

Color

1. The Color of the Graph Border may be selected in the Applet:
   • <PARAM NAME=color VALUE = "FFFF9F">
     If absent - default is light gray

Modified Henderson Equation Applet.

Like the Graph Applets, this Applet can run in four different modes. If you plan to use this applet, this explanation about the required HTML tags will help you get the best out of it.

A complete call to the Henderson Applet would look like this

<APPLET CODE ="Henderson.class" width=540 height=360>
<PARAM NAME=pH VALUE = "7.25">
<PARAM NAME=PCO2 VALUE = "62">
<PARAM NAME=color VALUE = "FFFF9F">
</APPLET>

Controls for the Henderson Applet

Dimension

1. HEIGHT is 360
   
2. WIDTH controls behavior:
   • WIDTH=360 - the Applet works in "Explore" or "Report" modes.
   • WIDTH=540 - the Applet works in "Self-Test" or "Challenge" modes

Patient Data

1. No Data Given in HTML code - the Applet works in "Explore" or "Self-Test" modes
2. Both pH and PCO2 provided - the Applet works in "Report" or "Challenge" modes.
   The Tags to provide the patient data must both be present:
   • <PARAM NAME=pH VALUE = "7.3">
   • <PARAM NAME=PCO2 VALUE = "60" >

The pH Playground Applet.

The Applet operates in only one mode. The HTML tag required to call it is:

<applet code="pHcalc.class" width=280 height=210></applet>

Acid-Base Tutorial Alan W. Grogono

Copyright Nov 2009. All Rights Reserved