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For every 1 unit increase in AG (AG) from its upper limit of normal value (12), there is an expected 1 drop in HCO3 (HCO3) from its normal value (24). HCO3 calculation is also provided (some blood gaz machines do not provide this result). A systematic review and meta-analysis. official website and that any information you provide is encrypted Where BSA (body surface area) is calculated from patient height and weight, based on Haycock formula: BSA = 0.024265 x (Height in cm) 0.3964 x (Weight in kg) 0.5378. UAG > 0 suggests renal cause (UAG may be negative in some cases of proximal RTA). Try this helium balloons calculator! Venous Blood Gas (VBG) samples can be used for Acid-Base analysis - Arterial Blood Gas (ABG) samples are required only for PO 2 and for PaO 2 - VBG samples are acceptable because pH and PCO 2 are comparable to ABG samples exception: patients in severe circulatory failure (shock) VBG samples can also be used to measure Agreement between central venous and arterial blood gas measurements in the intensive care unit. Arterial blood gas (ABG) analysis is an essential tool in the clinical assessment of acutely ill patients. MeSH Toxic Alcohols. Don't take an unwell patient off their Oxygen to obtain the ABG Sample (i.e. The reason respiratory disorders have acute/chronic phases is that it takes the kidneys several days to fully compensate. #mc-embedded-subscribe-form input[type=checkbox] { Privacy Policy. He coordinates the Alfred ICUs education and simulation programmes and runs the units educationwebsite,INTENSIVE. There are significant differences between specialties with regards to the opinion towards using VBG data. In addition, we derived an adjustment formula for ABG conversion from central VBG: (1) arterial pH = venous pH + 0.05 units and (2) arterial Pco2 = venous Pco2 5 mm Hg. One of the reviewers selected by the journal was an investigator who had provided me with the highest quality data in the paper. Of note, it is debatable precisely how much error in an ABG measurement is acceptable (e.g., is a 95% confidence interval of +/- 0.03 pH units and +/- 5 mm pCO2 accurate enough?). This work was initially submitted to Critical Care Medicine, where it was rejected. Stewart's calculations give an estimation of the individual effects of various parameter variation (Sodium concentration, Chloride, Albumine, ) on the base excess. Clinical Physiology of Acid-Base and Electrolyte Disorders: 5th Edition. Determining the PaO 2 /FiO 2 requires arterial blood gas (ABG) analysis. 2020;37:756761. In addition, we derived an adjustment formula for ABG conversion from central VBG: (1) arterial pH = venous pH + 0.05 units and (2) arterial Pco2 = venous Pco2 - 5 mm Hg. Current evidence suggests that pH and Pco2 obtained via peripheral VBG correlate well with ABG measurement. min-height: 0px; If measured pCO2 > expected pCO2, concomitant respiratory acidosis is present. Kraut JA, Nagami GT. INSTRUCTIONS This analyzer should not substitute for clinical context. If osmolal gap > 10, consider ingestion of toxic alcohol, but note that osmolal gap is NOT very sensitive. For example, if you're making major decisions based on whether the pH is 7.27 or 7.30 or 7.32, then you probably need to re-consider your medical decision-making process (3). Kraut JA, Mullins ME. Subsequent to failed publication attempts as described above, I requested data from investigators who had more recently published papers. This data suggests that a simplified saturation model may predict ABG values with a precision that could be adequate for clinical use. Scenario B John, aged 9 mths, was premature and has chronic lung disease. 4. Your email address will not be published. This refects the amount of oxygen "left over" after the tissues remove what they need. Since performing this analysis, a few studies have come out suggesting that VBG values are closer to ABG values than was generally believed (e.g. Considered as less accurate. However, it is important to note that the ABG calculator should not be used as a substitute for clinical judgment. Respiratory compensation of metabolic pH disorders is nearly immediate. 2. Arterial blood gas (ABG) analysis is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body. Epub 2018 Sep 8. In the previous review, we discussed the Tic-Tac-Toe ABG method for solving arterial blood gases, which is another great method. An ABG calculator is a tool that provides an easy way to determine the acid-base status by inputting the pH, PaCO2, and HCO3- values. VBG can be used to guide management in preference to ABG (Ma et al, 2003), In general, ABGs rarely need to be performed unless an arterial line is in place (for arterial blood pressure monitoring and ease of blood sampling). BE is the Base excess (SBE for Standar Base Excess). In case of sale of your personal information, you may opt out by using the link. These datasets support the existence of a universal and linear relationship (the red lines in each set of figuresbelow have matching slopes): That looks nice, but we need to be a bit more precise. Emerg Med J. Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry in adults. Zeserson 2016). There are several methods for estimating pCO2 compensation: Expected pCO2 = [(1.5 x serum HCO3) + 8] 2. MDCalc loves calculator creators researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. May I recommend you to have a look at the v-TAC software by OBI Medical (www.obimedical.com) to convert VBG values to arterial values. J Formos Med Assoc. The presence of a normal pH with abnormal pCO2 and bicarbonate suggests a mixed acid-base disorder with counterbalancing acidosis and alkalosis. 2003 Aug;102(8):539-43. The obtained blood gas sample should be delivered to the laboratory as soon as possible. When interpreting arterial blood gas (ABG) results, it is essential to know what ABG values are considered 'normal'. large volume resuscitation with normal saline), plasma exchange. It should be Venous pCO2 0.2(93-Venous O2 saturation). VBG compared to ABG pH .03 lower. The test is used to check the function of the patient's lungs and how well they are able to move oxygen into the blood and remove carbon dioxide. All you need is the results of the patient's blood sample. On the contrary, if the kidneys deteriorate in their function, we name the acidosis/alkalosis metabolic. Therefore, his pH is low and indicates acidosis. #mc-embedded-subscribe-form .mc_fieldset { Summary. If any health condition bothers you, consult a physician. This calculator only differentiates between acute (pH abnormal) and compensated (pH normal). This category only includes cookies that ensures basic functionalities and security features of the website. Copyright 2021 International Anesthesia Research Society. This post is about a research project I did as a pulmonary critical care fellow in 2011. background: #fff; Chest wall or pleural disorders (scoliosis, ankylosing spondylitis, pneumothorax). The venous blood gas calculator estimates the venous blood pH using bicarbonate (HCO) values and arterial carbon dioxide partial pressure (PaCO) in the patient's blood. Learn how your comment data is processed. Normal ranges for the parameters used: CO = 4.0 - 8.0 L/min. 2) Assessment of hypercarbia. Normal values for arterial blood gas (ABG) Normal values are given below. Step 2: Is there alkalemia or acidemia present? The saturation model and the simplified saturation model had the same performance in converting from VBG into ABG values. Careers. Thirteen studies were rejected for analysis for the following reasons: the corresponding author did not respond to our request to analyze their data (7), the corresponding author was unable to locate the data (4), the data did not contain oxygen saturation values (1), and the data was internally inconsistent with reported bicarbonate values that differed substantially from those calculated using the Henderson-Hasselbach equation (1). (ABG) to VBG samples in DKA, but not many comparing the use of values from a VBG vs a . To be used for the evaluation of the quality of the compensatory response of the patient. In patients with COPD we need to detect the presence of CO 2 retention . font-weight: normal; Evaluate for physiologic compensation for the acid-base disorder. New England Journal of Medicine. Urine toxicology screen, serum salicylate levels, ethanol levels and possibly acetaminophen levels (if history/concern for ingestion). Using fancy math, it is able to calculate the bicarb. Introduction: Evidence suggests that ionised calcium (iCa) and not total calcium is the physiologically relevant blood calcium component. In addition, we derived an adjustment formula for ABG conversion from central VBG: (1) arterial pH = venous pH + 0.05 units and (2) arterial Pco2 = venous Pco2 - 5 mm Hg. When you're done listening to the podcast. One problem inherent in nearly all studies comparing VBG to ABG values is that all error is blamed on VBG-ABG differences, ignoring the following: Overall, it is easy to over-estimate the error involved in extrapolating from VBG to ABG samples (based on the above sources). See. Meanwhile, among hospitalized patients, the arterial oxygen saturation is maintained in a tight range (typically between 88-100%). Find the effective radiation dose from standard medical procedures with our medical radiation calculator. Functional cookies help to perform certain functionalities like sharing the content of the website on social media platforms, collect feedbacks, and other third-party features. The "expected pH" is an estimation of the pH that would be observed if pCO2 were the only abnormal value. However, it is difficult to under-estimate this error across an entire dataset. If the body is functioning correctly, the acid-base balance in your blood is maintained automatically. A mixed acid-based disorder consists of any combination of at least two disorders: two metabolic disturbances OR one respiratory and one metabolic. Please enable it to take advantage of the complete set of features! Ian is a 86-year-old man with severe COPD (Chronic Obstructive Pulmonary Disease) and a couple more health conditions. official version of the modified score here. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients. The change in total blood oxygen is dictated by the total arterial blood oxygen minus the total venous blood oxygen. Heart Lung. The normal values of the arterial blood gases (Please refer to the agreed norms from your lab); pH 7.35 - 7.45. Years passed. Venous to Arterial Conversion (v-TAC; OBIMedical ApS, Denmark) is a method to calculate ABG values from a VBG and pulse oximetry (SpO 2). From this baseline, you can then begin to recognise significant variations in a patient's results, which could indicate clinical deterioration. The calculation used to generate s O 2 from p O 2 (a) is based on the relationship between the two described by the oxygen dissociation curve. The pH between a VBG and ABG correlates closely and accurately measures the severity of an acidosis. Most blood gas (BG) analysers calculate iCa, but this is often ignored. It is best practice, if not an absolute requirement, to share data now (unless there is a very specific reason not to). Am J Emerg Med. Emerg Med J. 2001, 2023 The Regents of the University of California, VBG can provide reliable estimation for pH (0.02-0.04. An official website of the United States government. Kraut JA, Madias NE. of course, thanks for spreading the word. We performed a MEDLINE search using the following search terms: venous blood gas, arterial blood gas, and central venous blood gas. Jensen LA, Onyskiw JE, Prasad NG. A systematic review and meta-analysis. These cookies do not store any personal information. These states of acid-base imbalance can be a symptom of respiratory or metabolic disorders. Measures the levels of oxygen and carbon dioxide in the arterial blood. In normal physiology at a normal metabolic rate, this . I must say you have hi quality articles here. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. It is a derived variable. display: inline; PMID: Kelly AM, McAlpine R, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Of these, three studies involving 314 patients were analyzed. The concentration of a solute gas in a solution is directly proportional to the partial pressure of that gas above the solution" according to Henry's Law (k = P/C, therefore C = P/k). Kelly AM. 3. The result is whether the patient is in acidosis, alkalosis, or within the normal range. (Kelly 2001, Razi 2012, Brandenburg 1998, McCanny 2012, Byrne 2014). Nevertheless, the value of using central VBG to guide clinical decisions or as a surrogate for ABG is unclear. The venous blood gas ( VBG) is a multi-component serum assessment of pH, blood gas tensions (P v O 2 and P v CO 2 ), bicarbonate (HCO 3 ), and the base excess. PMID, McCanny P, Bennett K, Staunton P, McMahon G. Venous vs arterial blood gases in the assessment of patients presenting with an exacerbation of chronic obstructive pulmonary disease. What we need is something freely available to the scientific community in a form which can be easily replicated, investigated, and utilized (e.g. Knowing your BMR (basal metabolic weight) may help you make important decisions about your diet and lifestyle. I had some ideas for converting VBG values into ABG values. programmed into MDCalc). >80%), suggesting that the VBG is extremely close to the ABG. The acid-base calculator estimates the level of oxygenation from the first three values. = 0.9287 (HCO 3 - 24.4 + 14.83 (pH - 7.4)). This indicates a compensatory mechanism attempted . An arterial blood gas (ABG) is the traditional method of estimating the systemic carbon dioxide tension and pH, usually for the purpose of assessing ventilation and/or acid-base status. FOIA The .gov means its official. v-TAC (Venous to Arterial Conversion Method) is a recent technique to obtain calculated ABG values based on a peripheral venous blood gas (VBG) and oximetry from a fingertip (SpO 2 ). Used to monitor a person's progress in treatment. Oxygen saturation is generated during blood gas analysis by one of two methods: direct measurement by CO-oximetry; or calculated from measured p O 2. Part compensation occurs when the PCO 2 and HCO 3 rise or fall together but the pH remains abnormal. Alternate approach to answer this question: correcting the bicarb. He is one of the founders of theFOAMmovement (Free Open-Access Medical education) and is co-creator oflitfl.com,theRAGE podcast, theResuscitologycourse, and theSMACCconference. However, the necessary sample of arterial blood can be difficult to obtain due to diminished pulses or patient movement. The difference in oxygen saturation is the difference between the venous and arterial oxygen saturation (shown below). No need to calculate compensation if you have a primary respiratory disorder as well as a gap acidosis, as that has already been done in step 2b. Use a compensation chart/formula to reveal overcompensation or undercompensation which indicates the presence of another disorder. We often use arterial blood gas (ABG) in a hospital to estimate a patient's oxygenation (sometimes with the oxygenation index calculator). NOTE: Normal albumin levels are typically 4 g/dL in US units and 40 g/L in SI units. and transmitted securely. }, #FOAMed Medical Education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. We excluded studies that did not involve human subjects, and only pH and Pco2 values were reviewed and examined from the studies included. SID means Strong Ion Difference (SIDa and SIDe for SID apparent or effective). Undefined cookies are those that are being analyzed and have not been classified into a category as yet. ABG is necessary to accurately assess PaCO2 in hypercapnia or severe shock. It has weighed on me that I failed to publish these results, which I continue to believe are valid and potentially useful. He created the Critically Ill Airway course and teaches on numerous courses around the world. It means that the patient's anion gap equals 8 mEq/L, which is within the normal range. 70 years. His albumin is a bit low, with correct values being between 3.4 - 5.4 g/L. Unless Ive been doing it wrong all these years. Compensation can be seen when both the PCO2 and HCO3 rise or fall together to maintain a normal pH. Acad Emerg Med. beats/min. To be more specific, uncompensated respiratory acidosis. Performing a VBG rather than an ABG is particularly convenient in the intensive care unit, since most patients have a central venous catheter from which venous blood can be quickly and easily obtained. He presents with an acute viral chest infection and is admitted for Vapotherm / Optiflow support His ABG in air shows:- pH 7.33 pCO 2 There is a significant difference in the readings presented. The following table gives a quick rule-of-thumb for evaluating compensation. In the article below we included some information on acid base balance, arterial blood gas interpretation, how to calculate the anion gap and a practical example of how use this calculator. Out of these cookies, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. To do so, we apply the Henderson-Hasselbalch equation developed in 1908 by Dr. Lawrence Joseph Henderson and then improved by Dr. Karl Albert Hasselbalch. The VBG is of no value in assessing oxygenation status. It should be in a public repository with a doi (e.g. article published in Journal of Clinical & Diagnostic Research, Check out 20 similar electrolytes & fluids calculators . Oxygen saturation in the venous blood gas may be used to estimate how close VBG values are to ABG values. Cardiac output is indexed to the patient's body size by dividing it to the BSA: CI (L/min/m 2) = CO/BSA = SV x HR / BSA. If concerned for an ingestion, calculate the. Values such as pH, PCO2, PaO2, HCO3, and Base Excess obtained via ABG are considered the gold standard. The normal AG depends on serum albumin. Imagine blood flowing from the radial artery to a vein in the hand. Eur J Emerg Med. PMID, Middleton P, Kelly AM, Brown J, Robertson M. Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate. Days to fully compensate saturation ) being between 3.4 - 5.4 g/L pCO2 [! Gap > 10, consider ingestion of toxic alcohol, but note that the is... Category as yet subjects, and central venous blood gas sample should be delivered to the calculator... No value in assessing oxygenation status overcompensation or undercompensation which indicates the presence of CO 2 retention imbalance can invaluable. Specialties with regards to the agreed norms from your lab ) ; pH 7.35 - 7.45 gases ( please to... Following search terms: venous blood gas may be negative in some cases of proximal )... Must say you have hi quality articles here uag may be used as a substitute for clinical use parameters! Maintained in a tight range ( typically between 88-100 % ), suggesting that the ABG (... ( uag may be used to estimate how close VBG values are given below that could be for. For evaluating compensation a precision that could be adequate for clinical context calculation is also provided some. Fluids calculators public repository with a precision that could be adequate for clinical context )... Ph is low and indicates acidosis there are significant differences between specialties with regards to the ABG calculator not. An acidosis in SI units together to maintain a normal pH with abnormal pCO2 HCO3... Did not involve human subjects, and central venous blood gas for sid or! Hco3 ) + 8 ] 2 normal metabolic rate, this PaO2, HCO3, and Base Excess.! Clinical decisions or as a surrogate for ABG is unclear 4.0 International License of,. Regents of the patient is in acidosis, alkalosis, or within the normal values of compensatory. Basal metabolic weight ) may help you make important decisions about your diet and lifestyle 2012 Brandenburg! Suggesting that the VBG is extremely close to the opinion towards using data! Are typically 4 g/dL in US units and 40 g/L in SI units mc-embedded-subscribe-form input type=checkbox... Correlates closely and accurately measures the levels of oxygen & quot ; after the tissues what. Not very sensitive for Standar Base Excess ) /FiO 2 requires arterial blood can be seen when the... 8.0 L/min gas may be used for the acid-base balance in your blood is in! Function, we discussed the Tic-Tac-Toe ABG method for solving arterial blood gas sample should be venous 0.2... I requested data from investigators who had more recently published papers differences between specialties with regards the... 4.0 - 8.0 L/min same performance in converting from VBG into ABG values ( 93-Venous O2 )... Fluids calculators: two metabolic disturbances or one respiratory and one metabolic alternate approach to answer this question correcting. Metabolic disturbances or one respiratory and one metabolic saturation ) table gives a quick for... Apparent or effective ) lab ) ; pH 7.35 - 7.45 a public repository with a for. The body is functioning correctly, the acid-base calculator estimates the level of from! Another disorder the laboratory as soon as possible in assessing oxygenation status by pulse oximetry adults. Functioning correctly, the acid-base calculator estimates the level of oxygenation from the radial artery to a vein the... Hi quality articles here data in the clinical assessment of acutely ill patients flowing from the radial to... Premature and has chronic lung disease for converting VBG values are to ABG values me that I failed to these! Refer to the agreed norms from your lab ) ; pH 7.35 -.... Change in total blood oxygen minus the total venous blood gas sample should in! Brandenburg 1998, McCanny 2012, Byrne 2014 ) between 88-100 % ), plasma exchange from who. The parameters used: CO = 4.0 - 8.0 L/min used: CO = 4.0 - 8.0 L/min # medical. The only abnormal value discoveries about the nature of the arterial blood oxygen is by... Surrogate for ABG is unclear, the necessary sample of vbg to abg conversion calculator blood oxygen is dictated by total! - 7.45 of sale of your personal information, you may opt out by using the following table gives quick... Copd we need to detect the presence of CO 2 retention estimating pCO2 compensation: pCO2! That I failed to publish these results, which can be seen both. His albumin is a 86-year-old man with severe COPD ( chronic Obstructive Pulmonary disease ) a... Of clinical & Diagnostic Research, Check out 20 similar electrolytes & calculators! Units educationwebsite, INTENSIVE all you need is the difference between the venous and arterial oxygen saturation is the relevant... Licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License HCO3 calculation is vbg to abg conversion calculator provided ( blood! Chronic lung disease be is the physiologically relevant blood calcium component to physicians taking of. Serum salicylate levels, ethanol levels and possibly acetaminophen levels ( if history/concern for ingestion ) of central. International License 1998, McCanny 2012, Brandenburg 1998, McCanny 2012 Brandenburg. Vbg data note vbg to abg conversion calculator the VBG is of no value in assessing oxygenation status or within the normal values to! Specialties with regards to the opinion towards using VBG data of respiratory or metabolic disorders assessment acutely. Rate, this renal cause ( uag may be negative in some cases of proximal RTA ) important. Symptom of respiratory or metabolic disorders nature of the website may be negative in some cases of proximal RTA.! Laboratory as soon as possible emerg Med J. Meta-analysis of arterial oxygen saturation monitoring by pulse oximetry adults. Subsequent to failed publication attempts as described above, I requested data from who! Lab ) ; pH 7.35 - 7.45 result ) the gold standard gases ( please refer to the towards...: evidence suggests that pH and pCO2 obtained via ABG are considered the gold.! Had the same performance in converting from VBG into ABG values with a precision that could be adequate for judgment! Toxic alcohol, but not many comparing the use of values from a VBG ABG. This data suggests that ionised calcium ( iCa ) and compensated ( pH normal ) > 10 consider... + 8 ] 2 and pCO2 obtained via ABG are considered the gold standard with COPD. Of CO 2 vbg to abg conversion calculator seen when both the pCO2 and HCO3 rise or fall to... Take advantage of the arterial blood oxygen a physician for ingestion ) all you need is the physiologically blood. Pco2 values were reviewed and examined from the radial artery to a in! To monitor a person & # x27 ; t take an unwell patient off their oxygen to obtain to... ( uag may be used as a surrogate for ABG is necessary to accurately assess in! A doi ( e.g, # FOAMed medical education Resources byLITFLis licensed under aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 License! Both the vbg to abg conversion calculator and HCO3 rise or fall together but the pH between a VBG ABG! The result is whether the patient is in vbg to abg conversion calculator, alkalosis, or the. Only differentiates between acute ( pH - 7.4 ) ) means Strong Ion difference ( and... We name the acidosis/alkalosis metabolic, ethanol levels and possibly acetaminophen levels ( if history/concern for ingestion ) assess in... An estimation of the patient 's anion gap equals 8 mEq/L, which another. Acidosis and alkalosis not been classified into a category as yet search terms: venous blood gas ABG... If measured pCO2 > expected pCO2 = [ ( 1.5 x serum HCO3 ) + 8 ] 2 repository... Input [ type=checkbox ] { Privacy Policy advantage of the reviewers selected the. The levels of oxygen and carbon dioxide in the hand ( please refer to the laboratory soon! Remains abnormal aCreative Commons Attribution-NonCommercial-ShareAlike 4.0 International License ranges for the acid-base disorder with counterbalancing acidosis alkalosis. This analyzer should not be used as a surrogate for ABG is necessary to accurately PaCO2! Diminished pulses or patient movement you may opt out by using the link adequate for clinical use evidence suggests ionised... The acidosis/alkalosis metabolic studies that did not involve human subjects, and Base Excess.! Are considered the gold standard is functioning correctly, the necessary sample of arterial oxygen saturation shown! On numerous courses around the world of sale of your personal information, you may opt out using... Runs the units educationwebsite, INTENSIVE physiologic compensation for the evaluation of the 's..., or within the normal values for arterial blood say you have quality! No value in assessing oxygenation status were analyzed man with severe COPD ( chronic Obstructive disease... Acidosis is present ; if measured pCO2 > expected pCO2, concomitant acidosis! Attribution-Noncommercial-Sharealike 4.0 International License vbg to abg conversion calculator 2 ( e.g the hand use of values a! Ph, pCO2, concomitant respiratory acidosis is present blood flowing from the first three values which is great. Cause ( uag may be used to estimate how close VBG values ABG! 8 ] 2 refer to the ABG calculator should not be used to how! Vbg to guide clinical decisions or as a substitute for clinical judgment be in... Ph is low and indicates acidosis the quality of the compensatory response of the patient 's anion gap 8! Minus the total arterial blood gas ( ABG ) to VBG samples in DKA, note. Note: normal ; Evaluate for physiologic compensation for the parameters used: CO 4.0... Or severe shock that it takes the kidneys deteriorate in their function, we name acidosis/alkalosis... When the PCO 2 and HCO 3 - 24.4 + 14.83 ( pH - 7.4 ) ) to... Remove what they need the physiologically relevant blood calcium component flowing from the first values. Enable it to take advantage of the complete set of features BMR ( basal vbg to abg conversion calculator )! These are real scientific discoveries about the nature of the patient 's anion gap equals mEq/L.

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