Approach to Ix Acid-Base Disorders

Question 1

what is the first step in diagnostically working up a metabolic acidosis pt?

Answer 1

determine if there is an anion gap or not

AG = NA - (Cl+HCO3)

Question 2

what is 2nd step in diagnostically working up a metabolic acidosis pt?

Answer 2

assess if respiratory compensation is appropriate using Winter’s formula

Question 3

what does winter’s formula calculate?

Answer 3

the range of expected pCO2 if a pt doing respiratory compensation

Question 4

what is 3nd step in diagnostically working up a metabolic acidosis pt?

Answer 4

evaluate for additional metabolic disturbances on top of the metabolic acidosis

using the delta gap or delta ratio

Question 5

T/F: respiratory compensation can completely compensate for metabolic acidosis

Answer 5

False! there is only a certain amount of compensation the respiratory system can provide

Question 6

what is the delta gap equation?

Answer 6

delta gap = the difference of actual and normal anion gap (delta AG) - the difference of normal bicarb and actual bicarb (delta bicarb)

Question 7

what blood work do you need to order to be able to get an anion gap?

Answer 7

1. VBG/ABG - gets bicarb
2. electrolytes - get Na, Cl