Answer
(1) Look at the pH: Acidemia vs Alkalemia
(2) What is the primary problem?:
Compare HCO3 vs pCO2
(3) Is there adequate compensation?
met acid = 1:1 (pCO2)
met alk = 1:0.7 (pCO2)
R acid A = 1:10 (pCO2)
R acid C = 3:10 (pCO2)
R alk A = 2:10 (pCO2)
R alk C = 5:10 (pCO2)
(4) a) What is the Anion Gap?
AG = Na – (Cl + HCO3)
--Normal is 12 +/‐ 2 mmol/L
b) Is there an Osmolar Gap?
Osmolar gap = Osm(meas) – Osm(calc)
Osm(calc) = 2Na + Urea + Glucose
--Normal is upto 10 mosm/kg
(5) Is there another metabolic disorder?
Does the Δ AG = Δ HCO3?
Δ AG = Δ HCO3 (only AGMA)
Δ AG < Δ HCO3 (AGMA + met alk)
Δ AG > Δ HCO3 (AGMA + NAGMA)