Acid-Base Disorders - Algorithmic Approach
Step-Wise ...
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Acid-Base Disorders - Algorithmic Approach

Step-Wise Approach:

1. Is there acidemia (pH < 7.36) or alkalemia (pH > 7.44)?

2. Is primary d/o metabolic (parallels pH ∆) or respiratory (opposite pH ∆)?

3. Is pt compensating? (respiratory takes min-hrs, renal 3-5 days)

4. Is there an anion gap? Regardless of pH or HCO3

     AG = Na – (Cl + HCO3) = unmeasured anions – unmeasured cations

     Correct AG for albumin: AG = 2.5 x (4 – Albumin)

     Negative AG: ↑↑Na, lipids (interfere w/ chloride), bromide intoxication

5. If there is ↑ AG, calculate “delta-delta” and Osm gap

     ∆/∆ = ∆ AG /∆ HCO3 = AG – (albumin x 2.5) / (24 – HCO3)

6. Consider Osm gap = 2x (Na + K) + Urea/2.8 + glucose/18 – serum Osm



#AcidBase #Disorders #Algorithm #diagnosis #differential #acidosis #alkalosis #metabolic #Respiratory 
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