CONTENTSdiagnosis of metabolic acidosis/alkalosis:evaluating compensation:metabolic vs. respiratory pH disorders
ABG/VBG isn't needed to evaluate metabolic pH disorders
basic properties of the anion gap
you don't need to correct for albumin
causes of an elevated anion gap
performance of anion gap in detecting lactic acidosis
causes of a reduced anion gap
1. determination of the anion gap to evaluate for anion gap metabolic acidosis (AGMA)
2. if the anion gap is normal, just look at the bicarbonate
3. if the anion gap is elevated, determine the “delta delta”
An ABG/VBG will provide information about respiratory pH abnormalities. Although this is traditionally considered a mandatory component of pH analysis, the amount of useful information provided by this analysis is unclear. Blood gas analysis can answer essentially two questions:
#1) is there adequate respiratory compensation?
#2) is there a primary respiratory disorder?
so, what does the blood gas analysis really add to a clinically relevant analysis of pH?
types of information from pH analysis
Generally, the most critical aspect of pH analysis is to identify unexpected diagnoses (#1). The precise severity of the disorder is less important. As long as we have correctly identified the underlying diagnosis and we are treating it appropriately, the exact pH numbers are often relatively unimportant.
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