CORRECTED ELECTROLYTES EXPECTED pCO2 (In primary metabolic disturbance) ie is there a co-existing respiratory problem besides compensation?

IN METABOLIC ACIDOSIS: Expected pCO2 = (1.5 x HCO3) + 8 (+/-2)

if < than expected, then RESP ALKALOSIS exists if > than expected, then RESP ACIDOSIS exists IN METABOLIC ALKALOSIS Expected pCO2 = (0.9 x HCO3) + 9 (+/-2)

if < than expected, then RESP ALKALOSIS exists if > than expected, then RESP ACIDOSIS exists Alternative Method for Expected pCO2 In primary met acidosis, pCO2 should = last 2 digits of pH between ph 7.4-7.1 In primary met alkalosis, pCO2 should = last 2 digits of pH between ph 7.4-7.6 EXPECTED/CORRECTED BICARB In Respiratory Acidosis Acute: HCO3 1 (from 24) per 10 in pCO2 (Max 30) Chronic: HCO3 4 (from 24) per 10 in pCO2 (Max 36) Observed > Expected: = Concurrent Metabolic Alkalosis Observed < Expected: = Concurrent Metabolic Acidosis CHECK ANION GAP!!! Observed = Expected: = Adequate compensation Respiratory Alkalosis Acute: HCO3 2 (from 24) per 10 in pCO2 (Min18) Chronic: HCO3 5 (from 24) per 10 in pCO2 (Min12) Observed > Expected: = Concurrent Metabolic Alkalosis Observed < Expected: = Concurrent Metabolic Acidosis CHECK ANION GAP!!! Observed = Expected: = Adequate compensation CORRECTED SODIUM (pseudo-hyponatremia) For each 3mmol/L increase in glucose adjust Na+ upwards by 1 mmol/L Corrected Na+ = (Na+) + GLUCOSE 3 Also artificially lowered by mannitol, sorbitol, glycerol Osmotically active substances draw water into ECF and increase the sodium free space

CORRECTED POTASSIUM Each 0.10 in pH (from 7.4) = K+ by 0.5 Each 0.02 in pH (from 7.4) = K+ by 0.1 Method 1: Can add this number to observed K+ Eg If pH 7.10, K+ 5.3 pH has from 7.4 7.1 = 0.3 (= 3 x 0.1) So expect K+ to by 3 x 0.5 = 1.5 So Expected K+ for this level of pH = 5.3 + 1.5 = 6.8 This means: Observed K+ < Expected K+ = Whole body K+ deficient = Will need K+ replacement as acidosis resolves OR: The better way Method 2: Can subtract this number from observed K+ pH has from 7.4 7.1 = 0.3 (= 3 x 0.1) So expect K+ to by 3 x 0.5 = 1.5 So Expected K+ = 5.3 1.5 = 3.8 = This is the level you can expect K+ to drop to as acidosis resolves ie theyll become potassium deplete & need replacement PROBABLY BETTER TO DO IT THIS WAY Easier & quicker to write in VAQ: Note: Given pH anticipate K+ to to (x) (K+ 0.5 per 0.1 in pH) Quicker & you dont need to write sums/explanation CORRECTED CALCIUM Add 0.10 to Ca2+ for every 5 albumin is below 40 Add 0.02 to Ca2+ for every 1 albumin is below 40