Here’s Dr. Freedman with today’s Morning Report!
Delta Force
An approach to the possibly complicated metabolic acidosis
1st What’s primary?
- Compensation is alright, but its never enough
- Ph?
- What’s the respiratory system doing?
2nd Gapped or non-gapped?
- Normal AG?
- Gapped
- MUDPILES
- But what are they really?
- Left Total Knee Replacement
- Lactate
- Toxins (-OHs), Salicylates
- Ketones
- Renal
- Left Total Knee Replacement
- Non-Gapped
- ABCD
- Addisons
- Bicarb loss (GI or renal)
- Chloride Excess (iatrogenic)
- Drugs ( carbonic anhydrase)
- HARDUP
- Hyperalimentation
- Addisons
- Renal
- Diarrhea
- Uretorocolonic fistula
- Pancreatic Fistula
- ABCD
3rd How’s my AG respiratory compensation?
- Winter’s
- 1.5(HCO3) +8 +/-2 = pCO2
- Quick and dirty
- Last 2 digits of pH ~ pC02
4th Delta-Delta
- I’ve got one; do I have two?
- Change in AG / Change in HCO3
- (AG – 12) / (24 – HCO3)
Delta ratio | Assessment Guidelines |
< 0.4 |
Hyperchloremic normal anion gap acidosis |
< 1 |
High AG & normal AG acidosis |
1 to 2 |
Pure Anion Gap Acidosis |
> 2 |
High AG acidosis and a concurrent metabolic alkalosis or a pre-existing compensated respiratory acidosis |
Reference:
- http://fitsweb.uchc.edu/student/selectives/TimurGraham/Delta_Ratio.html
- http://lifeinthefastlane.com/metabolic-muddle-003/
The views expressed on this blog are the author's own and do not reflect the views of their employer. Please read our full disclaimer here. Any references to clinical cases refer to patients treated at a virtual hospital, Janus General Hospital.
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Jay Khadpe MD
Editor in Chief of "The Original Kings of County"
Assistant Professor of Emergency Medicine
Assistant Residency Director
SUNY Downstate / Kings County Hospital
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