ACID BASE ANALYSIS by Nick Mark MD ONE onepagericu.

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What’s the
primary >7.4
disturbance? alkalemia Airflow obstruction
1. pH • COPD, asthma
Acute or chronic? "Drive
acidemia • Medications
<7.4
What is the chronicity? • Central
What’s the respiratory Look at metabolic compensation !CO2 production
pCO2? ! acidosis Acute: 10 Δ pCO2 # 0.08 Δ pH
! drive
Chronic: 10 Δ pCO2 # 0.03 Δ pH
2. pCO2 • Hypoxemia
" • Pain/anxiety
respiratory • Hepatic enceph
• Pregnancy
alkalosis • Salicylates
“BLVD PLACE”
B - Bartter's
L – Laxative
metabolic V – Vomitting
alkalosis D - Diarrhea/diuretics
P - Post-hypercapnea
! Is the anion gap increased? L - Licorice
What’s the AG = [Na] + ([Cl] + [HCO3]) A - Alkali ingestion
bicarb? Expected AG = 2.5 x Albumin C - Contraction alkalosis
E - Endocrine
3. HCO3- If AG > expected AG, there is an
(Conn’s or Cushing’s)
anion gap present

" non anion gap “RAGES”

R – RTA
metabolic acidosis A – Ammonia
metabolic Acetazolamide
Is there HyperAlimentation
acidosis
compensation? G – GI losses
If there is a metabolic acidosis or alkalosis present E – Endocrine
is there appropriate respiratory compensation? S – Saline
Use one of two rules of find out: “GOLDMARKeT”
1. Expected pCO2 = 1.5 x [HCO3] + 8 ± 2 (Winter’s) anion gap G – Glycols
2. Expected pCO2 = last two digits of pH metabolic acidosis O – Oxoproline
If the measured pCO2 does not match the expected L – Lactic acid
value, there is also a respiratory derangement. D – Lactic acid
M – Methanol
A – Aspirin
Does the change in AG account for the change in HCO3?
R – Renal fail, Rhabdo
Used to determine if there is another derangement. Ke – Ketones
superimposed
T – Toluene
Does ΔHCO3 ≈ ΔAG? !ΔΔ >1.5 metabolic alkalosis
4. ΔAG NO
ΔHCO3
v1.1 (10/2020)

YES "ΔΔ < 0.8 superimposed Salicylate poisoning

NAGMA DKA w/ dehydration
No other derangement