ACID BASE

Question 1

DOCUMENTATION

Answer 1

STEPWISE APPROACH
Assess the pH
Determine if primarily respiratory or metabolic
Determine compensation
In setting of metabolic acidosis:
-Calculate AG
-Calculate Delta Delta

ANION GAP
[Na]-[Cl]-[HC03]
Normal <12

DELTA DELTA
Delta Anion Gap = Anion Gap - 10 = elevated anion gap

Delta BiCarb = 24 - Bicarb

DELTA RATIOS
Delta HC03 < Delta AG ~ AGMA + NAGMA

Delta HC03 = Delta AG ~ Uncomplicated AGMA

Delta HC03 > Delta AG ~ AGMA + Metabolic Alkalosis

Question 2

DDx AGMA

Answer 2

Methanol
Uremia
Diabetes (ketones)
Paraaldehyde
Isoniazid, Iron
Lactic Acid
Ethylene Glycol
Salicylates