Date

Time
CASE Normal
[Na+] (mmol/L) 139.0
[K+] (mmol/L) 4.2
Total [Ca2+] (mmol/L) 2.2
[Mg2+] (mmol/L) 0.7
[Cl-] (mmol/L) 109.0
[Lactate-] (mmol/L) 0.7
[Sulphate2-] (mmol/L) 0.8
[Albumin] (g/L) 46
[Total Protein] (g/L) 79
[Phosphate-] (mmol/L) 1.0
[Uric acid] / [Urate-] (mmol/L) 0.3
Altitude (metres) 24
Altitude (feet)
Blood gas
Sample Type (Arterial or Venous) Arterial
Temperature (C) 37
Temperature (F)
pH 7.400
PCO2 (kPa) 5.3
PCO2 (mmHg)
[HCO3-] (mmol/L)
Base XS (mmol/L) 0
Oxygen Therapy (%) 21
Sample PO2 (kPa) 13.3
Sample PO2 (mmHg)
 [Hb] (g/L) 140
[Urea] 5.0
[Creatinine] 0.08
[Glucose] 4.2
[Troponin I] 0.00

The minimum data required for quantitative analysis is Na, K, Cl, pH and PCO2
The more information given to the calculator, the more accurate will be its resu
It is recommended you get a complete set of test results on admission of the p
and thereafter the completeness of the tests required depends on the clinical si
N.B. NOT IONIZED OR CORRECTED!

N.B. NOT UREA!

Central venous

7.360
6

5.3
Na, K, Cl, pH and PCO2
accurate will be its results
on admission of the patient,
pends on the clinical situation.
 35 mEq/L (0)
Case Normal
Date Strong Ion Ionic Strength (mEq/L)
Time Na +139
K +4.2

Altitude 24 metres
SID Ca
Mg
+6.6 (2.2 mmol/L)
+2.1 (0.7 mmol/L)
Barometric Pressure 101 kPa (N=35) Cl -109
Temperature 37C Lactate -0.7 Phosphate SI
Protein SI -4.1
Phosphate SI -1 (Hb 140 g/L)
Sulphate -2.3 (0.8 mmol/L (Urea 5 mmol/L)
(Creatinine 0.08 mmol/L) Total Protein
QUANTITATIVE (Glucose 4.2 mmol/L)
ACID-BASE (Troponin I 0 g/L) Uric Acid / Urate

ANALYSIS
Albumin 46 g/L A-a gradient*
N.B. Numbers in brackets Globulin 33 g/L
represent the bias in acidity in
Total Protein 79 g/L
nmol/L due to deviation of the
Central venous independent factor from its Phosphate 1 mmol/L
Acidity 44 nmol/L normal value, with the other two Uric Acid / Urate 0.3 mmol/L
PO2 5.3 kPa PCO2 factors and calculated net
unmeasured ions fixed.
Atot
(N=5.3) (N=17)
5.3 kPa (0) 17 mmol/L (0)
Measured Acidity (N arterial = 38-42)
pH 7.40 40 nmol/L
PCO2 5.3 kPa Predicted acidity assuming no unmeasured ions
HCO3- 23 mEq/L 40 nmol/L Please send bug reports/
O2 THERAPY 21% Net Unmeasured Ions (NUI) feature requests to
Sample PO2 13 kPa (Arterial 0 mEq/L peterlloyd@orcon.net.nz

-a gradient | Qs/Qt * 0.3 kPa | 1 %

Base XS | Anion Gap 0 | 11 mmol/L
*Assuming respiratory quotient =
0.8
REPORT
NORMAL ACIDITY. NORMAL PCO2. DEVIATION FROM
5.3 kPa BIASES ACIDITY BY 0 nmol/L. NORMAL
MEASURED SID. DEVIATION FROM 35 mEq/L BIASES
ACIDITY BY 0 nmol/L. NORMAL MEASURED Atot.
DEVIATION FROM 17 mmol/L BIASES ACIDITY BY 0
nmol/L. NORMAL NUI

NB Some ions exhibit markedly non-ideal behaviour when in dilute solution (as the concentration increases this non-ideal behaviour disappears).
Ionic strength must be used instead of concentration for calcium, magnesium, sulphate and monohydrogen phosphate. The ionic strength is
3mEq/mmol for these four ions, (not 2mEq/mmol). The monovalent ions have an ionic strength of +1 or -1 mEq per mmol.
NB2 Factors outside their normal range are colour coded according to the direction in which they are biasing the acidity- red for more acidic, yellow
for less acidic. Because urea, creatinine, PO2 and Qs/Qt do not directly influence acidity but abnormalities in these factors usually are associated with
acidosis and acidaemia, when abnormal they are printed in red italics.
 Cations Anions
Na 139.0 0.0
K, Ca, Mg 12.9 0.0
Unmeasured Cations 0.3 0.0
Chloride 0 109.0
Lactate 0 0.7
Prot, Phos, Sulph SI 0 7.4
Prot, Phos, Urate WAA 0 11.9
Bicarbonate 0 23.3
Unmeasured Anions 0 0.0
152.2 152.2

Gamblegram
160

140

120
Ionic Strength (mEq/L)

Unmeasured Anions
100
Bicarbonate
Prot, Phos, Urate WAA
80 Prot, Phos, Sulph SI
Lactate
60 Chloride
Unmeasured Cations
K, Ca, Mg
40
Na

20

0
Cations Anions
Measured aH+ (nmol/L) Predicted Acidity Average Absolute Difference Average Rel. diff.
30 28 29 -2 29 -5.41%
35 36 36 1 36 3.17%
57 60 59 3 59 5.34%
23 24 23 1 23 2.99%
36 38 37 2 37 5.27%
58 61 60 4 60 5.99%
36 35 36 -1 36 -2.65%
39 37 38 -2 38 -5.90%
41 42 42 2 42 3.71%
22 17 20 -5 20 -24.17%
34 29 32 -6 32 -18.15%
46 40 43 -6 43 -14.68%
30 28 29 -2 29 -5.41%
30 28 29 -2 29 -5.41%
64 60 62 -4 62 -6.05%
35 33 34 -2 34 -5.39%
48 49 48 0 48 0.65%
62 64 63 1 63 2.35%
22 24 23 2 23 9.55%
38 41 40 3 40 7.15%
57 58 57 1 57 1.00%
24 21 23 -3 23 -11.68%
34 32 33 -2 33 -6.86%
48 48 48 0 48 -1.01%
22 18 20 -4 20 -20.52%
32 28 30 -4 30 -14.18%
46 40 43 -5 43 -12.77%
22 18 20 -4 20 -18.22%
33 29 31 -4 31 -13.69%
47 41 44 -5 44 -12.14%
50 48 49 -3 49 -5.20%
70 68 69 -2 69 -2.64%
94 91 93 -3 93 -3.56%
36 35 36 -1 36 -1.57%
53 54 53 0 53 0.89%
75 77 76 2 76 2.48%
28 25 27 -3 27 -11.58%
43 40 41 -3 41 -8.23%
64 57 60 -6 60 -10.50%
27 25 26 -2 26 -7.26%
39 37 38 -3 38 -7.01%
56 52 54 -4 54 -7.17%
33 31 32 -1 32 -3.28%
47 46 46 -1 46 -2.52%
66 64 65 -3 65 -4.09%
28 25 27 -3 27 -11.93%
42 37 39 -5 39 -12.23%
60 53 57 -7 57 -12.13%
20 19 20 -1 20 -6.60%
38 35 37 -3 37 -7.64%
57 53 55 -4 55 -6.71%
23 22 22 -1 22 -4.46%
35 33 34 -2 34 -4.58%
48 47 48 -1 48 -2.11%
20 18 19 -2 19 -10.98%
30 28 29 -2 29 -6.95%
42 40 41 -3 41 -6.15%
16 15 16 -1 16 -5.11%
26 24 25 -1 25 -5.98%
36 35 36 -2 36 -4.48%
47 45 46 -2 46 -4.45%
70 66 68 -3 68 -5.04%
95 87 91 -8 91 -8.63%
38 40 39 2 39 4.96%
56 59 58 3 58 5.60%
79 85 82 6 82 7.44%
27 25 26 -2 26 -8.57%
40 39 39 -1 39 -1.91%
62 58 60 -3 60 -5.61%
22 19 20 -3 20 -14.24%
33 29 31 -4 31 -13.36%
50 46 48 -4 48 -8.59%
Mean -1.8 Mean -5.40%
SD 2.7 SD 6.92%

NB A mean bias of -5.4% corresponds to a mean pH error of +0.02

95% CI
Lower -7.1
Upper 3.4
Data from Figge et al, J Lab Clin Med 1991;117:453-67

Performance of Strong Ion Calculator V 7.0

100

90 f(x) = 0.99892069x - 1.7812355791

R = 0.9766455433
Predicted Acidity (nmol/L)

80

70

60

50

40

30

20

10

0
10 20 30 40 50 60 70 80 90 100
A b so lu te d ifferen ce ( p red icted - o b served acid ity) , ( nm o l/ L)

Observed Acidity (nmol/L)

Bland Altman Plot of Absolute Error

100

75

50

25

0
10 20 30 40 50 60 70 80 90 100
-25

-50

-75

-100

Average of observed and predicted acidity (nmol/L)

 -100

A b so lu te d if
Average of observed and predicted acidity (nmol/L)

Bland-Altman Plot of Relative Error

100.00%

80.00%

60.00%
Relative difference (%)

40.00%

20.00%

0.00%
10 20 30 40 50 60 70 80 90 100
-20.00%

-40.00%

-60.00%

-80.00%

-100.00%

Average of observed and predicted acidity (nmol/L)

a mean pH error of +0.02 units

 Albumin MeasAlbumin PrediAverage Absolute Diff Average Rel. diff.
40.926066 34.8805887 38 -6 38 -15.95%
41.3999675 40.0572777 41 -1 41 -3.30%
0 30.1300602 28.3158626 29 -2 29 -6.21%
40.8319386 38.511148 40 -2 40 -5.85%
60.673633 57.7319531 59 -3 59 -4.97%
48.4172368 45.949914 47 -2 47 -5.23%
63.9734835 60.6348743 62 -3 62 -5.36%
104.954243 98.0401699 101 -7 101 -6.81%
15.1705037 14.8174475 15 0 15 -2.35%
19.2309173 18.9698056 19 0 19 -1.37%
31.3328572 31.4170999 31 0 31 0.27%
14.1253754 13.8822363 14 0 14 -1.74%
19.0985326 19.4266952 19 0 19 1.70%
30.6902199 31.9454292 31 1 31 4.01%
35.7272838 31.9648131 34 -4 34 -11.12%
42.1696503 38.2327042 40 -4 40 -9.79%
80.5378441 72.7120773 77 -8 77 -10.21%
11.6144861 11.9480849 12 0 12 2.83%
19.2309173 20.5111027 20 1 20 6.44%
37.7572191 39.8917428 39 2 39 5.50%
17.9473363 16.1474703 17 -2 17 -10.56%
90 100 30.3389118 28.0709822 29 -2 29 -7.77%
60.5340875 56.8543656 59 -4 59 -6.27%
35.8096437 39.3016808 38 3 38 9.30%
59.4292159 64.0962615 62 5 62 7.56%
95.9400632 101.819426 99 6 99 5.95%
21.0862815 18.7922351 20 -2 20 -11.51%
42.7562886 39.0488305 41 -4 41 -9.06%
19.4536008 18.073791 19 -1 19 -7.35%
19.8609492 17.9829319 19 -2 19 -9.93%
23.4422882 22.1101649 23 -1 23 -5.85%
26.7916832 23.7738389 25 -3 25 -11.94%
19.1425593 18.6048891 19 -1 19 -2.85%
30.9029543 30.4238925 31 0 31 -1.56%
39.9024902 39.1299449 40 -1 40 -1.96%
20.7014135 19.6093416 20 -1 20 -5.42%
90 100
33.3426413 32.0169507 33 -1 33 -4.06%
40.7380278 40.8453115 41 0 41 0.26%
28.1190083 28.0985456 28 0 28 -0.07%
44.874539 46.2593726 46 1 46 3.04%
57.5439937 56.6148439 57 -1 57 -1.63%
25.2348077 22.1090103 24 -3 24 -13.20%
41.8793565 36.7902376 39 -5 39 -12.94%
49.3173804 45.8182373 48 -3 48 -7.36%
47.8630092 56.2801215 52 8 52 16.16%
71.7794291 78.1790907 75 6 75 8.54%
98.6279486 102.369459 100 4 100 3.72%
38.3707245 29.8295514 34 -9 34 -25.05%
61.2350392 49.4380188 55 -12 55 -21.32%
 85.5066713 68.595703 77 -17 77 -21.95%
34.673685 33.3414284 34 -1 34 -3.92%
56.7544605 55.2087052 56 -2 56 -2.76%
82.603795 80.0952464 81 -3 81 -3.08%
74.9894209 67.5418317 71 -7 71 -10.45%
107.646521 96.7191669 102 -11 102 -10.69%
141.579378 124.142307 133 -17 133 -13.12%
55.7185749 51.6266804 54 -4 54 -7.62%
88.9201118 80.1595963 85 -9 85 -10.36%
119.124201 106.366252 113 -13 113 -11.32%
22.1819642 22.0867364 22 0 22 -0.43%
31.0455959 30.5438038 31 -1 31 -1.63%
44.9779855 44.5729052 45 0 45 -0.90%
19.6788629 19.5375824 20 0 20 -0.72%
90 100
27.4789415 27.5217576 28 0 28 0.16%
41.1149721 42.5098238 42 1 42 3.34%
 Albumin Data
140

f(x) = 0.9152659599x + 1.6963478804

120 R = 0.9753212351
Predicted Acidity (nmol/L)

100

80

60

40

20

0
0 20 40 60 80 100 120 140 160

Observed Acidity (nmol/L)

Absolute difference (predicted - observed acidity) (nmol/L)

Albumin Data. Bland-Altman Plot of Absolute Difference

140
120
100
80
60
40
20
0
0 20 40 60 80 100 120 140
-20
-40
-60
-80
-100
-120
-140
Average of observed and predicted acidity (nmol/L)
 -40

Absolute difference
-60
-80
-100
-120
-140
Average of observed and predicted acidity (nmol/L)

Albumin Data. Bland-Altman Plot of Relative Difference

100.00%

80.00%

60.00%

40.00%
Relative error (%)

20.00%

0.00%
0 20 40 60 80 100 120 140
-20.00%

-40.00%

-60.00%

-80.00%

-100.00%

Average of observed and predicted acidity (nmol/L)

 140 160

te Difference

120 140

/L)
/L)

Difference

120 140

l/L)
Date
Time
CASE Normal
Strong ions
[Na+] (mmol/L) 139.0
[K+] (mmol/L) 4.2
[Ca2+] (mmol/L) 2.2
[Mg2+] (mmol/L) 0.7
[Cl-] (mmol/L) 109.0
[Lactate-] (mmol/L) 0.7
[Sulphate2-] (mmol/L) 0.8
Weak acids
[Albumin] (g/L) 46.0
[Total Protein] (g/L) 79.0
[Phosphate-] (mmol/L) 1.0
[Urate-] (mmol/L) 0.3
Blood gas
pH 7.4 7.4
PCO2 (kPa) 5.3
Constants
K'1 bicarbonate (mol/L) 7.5858E-07
S 0.2303
Ka proteins (mol/L) 8.00E-08
Ka proteins (nmol/L) 80
pKa 7.1
Ka phosphate (nmol/L) 219
Ka urate (nmol/L) 1778
Working (Default) Values
W[Ca2+] (mmol/L) 2.2
W[Mg2+] (mmol/L) 0.7
W[Lactate-] (mmol/L) 0.7
W[Sulphate2-] (mmol/L) 0.75
W[Albumin] (g/L) 46.0
W[Total Protein] (g/L) 79.0
W[Phosphate-] (mmol/L) 1.0
W[Urate-] (mmol/L) 0.3
Scenario - mandatory data
Na measured? 1
K measured? 1
Cl measured 1
pH measured? 1
PCO2 measured? 1
Miminum data? 1
Scenario - weak acid data
[albumin] measured? 1
[T protein] measured? 1
[phosphate] measured? 1
[urate] measured? 1
Full Atot data? 1
Some protein Atot data? 1

Scenario (1=both, 2=alb only, 3=tp only, 4=neither) 1

Calculation
Protein Strong Ion Charge 4.1
SID 34.8
Atot 17.1
Measured aH+ (mol/L) 4.0E-08
Measured aH+ (nmol/L) 40
[HCO3-] (mmol/L) 23.3
Protein WAA charge 9.9
Phosphate WAA charge 1.7
Urate WAA charge 0.3
NUI 0.3
SIG (OLD FORMULA) 0.3
Predicted Acidity 40
Bias Calculations
PCO2 bias 0
Measured [SID+] bias 0
Atot bias 0
SID + NUI 35.1
Reports
Acidity Report NORMAL ACIDITY
Specimen type Arterial Central venous
NORMAL MEASURED SID.
DEVIATION FROM 35 mEq/L
BIASES ACIDITY BY 0
SI Ac/Alk Report nmol/L
NORMAL MEASURED Atot.
DEVIATION FROM 17 mmol/L
BIASES ACIDITY BY 0
WA Ac/Alk Report nmol/L
NORMAL PCO2. DEVIATION
FROM 5.3 kPa BIASES
Resp Ac/Alk Report ACIDITY BY 0 nmol/L
NUI Report NORMAL NUI
Altitude (metres) 24 24
Barometric pressure (kPa) 101.0 101
PiO2 19.9
PAO2 (alveolar) 13.6
Sample PO2 13.3 5.3
PaO2 13.3
A-a gradient 0.3
O2 THERAPY (percent) 21
Anion Gap 10.9
Sample PO2 formatted 13.0 5.3
A-a gradient formatted 0.3
ccO2 189.0
caO2 188.7
cvO2 139.0 138.6
c(c-a)O2 difference 0.3
c(c-mixed venous) O2 difference 50.0 50.5
Qs/Qt (exact, both art and mixed venous samples taken) 0.6326
Qs/Qt (noninvasive, percent) 1
Qs/Qt (estimated invasive) 7
Siggaard-Andersen et al's HbO2 dissociation curve Siggaard-Andersen et al, Clinical Chemistry 1984;30(10):1646-51
y0 1.875
x0 alveolar 1.948
n0 alveolar 2.871
h alveolar 3.502
k 0.534
a alveolar 0.002
b alveolar 0.000
x alveolar 2.609
y alveolar 3.725
S alveolar = end-capillary Hb saturation 97.645
n0 arterial 2.870
h arterial 3.502
a arterial 0.002
b arterial 0.000
x0 arterial 1.948
x arterial 2.588
y arterial 3.668
S arterial 97.512
c(c-mixed venous)O2 corrected 47.7
Temperature specified and arterial specimen 1
Temperature C 37.0
[Hb] 140.0
Solubility coefficient O2 (temp corrected) 0.23000000
Qs/Qt (corrected for mean and bias in c(a-v) O2 diff) 0.7
T = 35
ccO2 190.1
caO2 188.7
cvO2 139.0
c(c-a)O2 difference 1.4
c(c-mixed venous) O2 difference 51.1
Qs/Qt (noninvasive, percent) 3
Qs/Qt (estimated invasive) 9
Severinghaus' HbO2 dissociation curve
y0 1.875
x0 alveolar 1.838
n0 alveolar 2.871
h alveolar 3.502
k 0.534
a alveolar 0.002
b alveolar -0.110
x alveolar 2.609
y alveolar 4.013
S alveolar = end-capillary Hb saturation 98.225
n0 arterial 2.870
h arterial 3.502
a arterial 0.002
b arterial 0.000
x0 arterial 1.948
x arterial 2.588
y arterial 3.668
S arterial 97.512
c(c-mixed venous)O2 corrected 48.1
Temperature = 35 35.0
[Hb] 140.0
Solubility coefficient O2 (temp corrected) 0.23644000
Qs/Qt (corrected for mean and bias in c(a-v) O2 diff) 3.0
Qs/Qt (exact, both art and mixed venous samples taken) T=35 2.7581
T=37
ccO2 189.0
caO2 188.7
cvO2 139.0
c(c-a)O2 difference 0.3
c(c-mixed venous) O2 difference 50.0
Qs/Qt (noninvasive, percent) 1
Qs/Qt (estimated invasive) 7
Severinghaus' HbO2 dissociation curve
y0 1.875
x0 alveolar 1.948
n0 alveolar 2.871
h alveolar 3.502
k 0.534
a alveolar 0.002
b alveolar 0.000
x alveolar 2.609
y alveolar 3.725
S alveolar = end-capillary Hb saturation 97.645
n0 arterial 2.870
h arterial 3.502
a arterial 0.002
b arterial 0.000
x0 arterial 1.948
x arterial 2.588
y arterial 3.668
S arterial 97.510
c(c-mixed venous)O2 corrected 47.7
Temperature = 37 37.0
[Hb] 140.0
Solubility coefficient O2 (temp corrected) 0.23000000
Qs/Qt (corrected for mean and bias in c(a-v) O2 diff) 0.7
Qs/Qt (exact, both art and mixed venous samples taken) T=37 0.6326
T=39
ccO2 187.5
caO2 188.7
cvO2 139.0
c(c-a)O2 difference -1.3
c(c-mixed venous) O2 difference 48.4
Qs/Qt (noninvasive, percent) -3
Qs/Qt (estimated invasive) 4
Severinghaus' HbO2 dissociation curve
y0 1.875
x0 2.058
n0 alveolar 2.871
h alveolar 3.502
k 0.534
a alveolar 0.002
b alveolar 0.110
x alveolar 2.609
y alveolar 3.429
S alveolar = end-capillary Hb saturation 96.861
n0 arterial 2.870
h arterial 3.502
a arterial 0.002
b arterial 0.000
x0 arterial 1.948
x arterial 2.588
y arterial 3.668
S arterial 97.512
c(c-mixed venous)O2 corrected 47.2
Temperature = 39 39.0
[Hb] 140.0
Solubility coefficient O2 (temp corrected) 0.22356000
Qs/Qt (corrected for mean and bias in c(a-v) O2 diff) -2.7
Qs/Qt (exact, both art and mixed venous samples taken) T=39 -2.5810
T=41
ccO2 185.4
caO2 188.7
cvO2 139.0
c(c-a)O2 difference -3.4
c(c-mixed venous) O2 difference 46.3
Qs/Qt (noninvasive, percent) -7
Qs/Qt (estimated invasive) -1
Severinghaus' HbO2 dissociation curve
y0 1.875
x0 2.168
n0 alveolar 2.871
h alveolar 3.502
k 0.534
a alveolar 0.002
b alveolar 0.220
x alveolar 2.609
y alveolar 3.127
S alveolar = end-capillary Hb saturation 95.801
n0 arterial 2.870
h arterial 3.502
a arterial 0.002
b arterial 0.000
x0 arterial 1.948
x arterial 2.588
y arterial 3.668
S arterial 97.512
c(c-mixed venous)O2 corrected 46.6
Temperature = 41 41.0
[Hb] 140.0
Solubility coefficient O2 (temp corrected) 0.21712000
Qs/Qt (corrected for mean and bias in c(a-v) O2 diff) -7.2
Qs/Qt (exact, both art and mixed/central venous samples taken) T=41 -7.1983
Mixed venous oxygen content calculation
Siggaard-Andersen et al's HbO2 dissociation curve Central venous
y0 1.875
x0 mixed venous 1.9891020762
n0 mixed venous 3.0227150555
h mixed venous 3.5431020762
k 0.534
a mixed venous 0.0431020762
b mixed venous 0
x mixed venous 1.6677068206
y mixed venous 0.9514205156
S mixed venous 72.140076539
IF ART + MIXED OR CENTRAL VENOUS THEN TRUE, ELSE ESTIMAT 1.0
Shunt at patient's temperature 0.6
Shunt @ 35 2.8
Shunt @ 37 0.6
Shunt @ 39 -2.6
Shunt @ 41 -7.2
Temperature specified 1.0