Acid-base problems

5 simplified steps to solving any Acid-base problem.

1. Look at pH to identify primary disorder... acidosis or alkalasis?  Note, if pH is neutral, look at clinical presentation if you need to suspect mixed disorder
2. Is the primary problem respiratory or metabolic? (respiratory changes pCO2 while metabolic changes HCO3)
3. Calculate the anion gap (AG).  If increased, patient has "gap" metabolic acidosis present.
4. Calculate the delta anion gap. DAG = AG calculated - AG normal (12).
5. Add DAG to HCO3

• if normal, no other metabolic problems present
• if <20 then hyperchloremic, metabolic acidosis is also present
• if >26 then metabolic alkalosis is present

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