Solve acid base disturbances easily

*Use these as your reference normal values. Any thing above or below is abnormal.
Normal values:
pH 7.4
CO2 40
HCO3 24
AG 12

*Use the five golden roles:
1-pH & primary disorder
2-Primary disturbance
3-AG (should always be calculated)
4-Compensation
5-Check Delta gap (Mixed disorders) +/- osmolal gap

*1-Primary disorder:
pH < 7.4 acidemia
pH > 7.4 alkalemia

*2- Primary Disturbance:
Acidosis:
HCO3 < 24 metabolic
pCO2 > 44 respiratory
Alkalosis:
HCO3 > 24 metabolic
pCO2 < 40 respiratory

*3- AG
Calculated Na - Cl + HCO3
Correct for low albumin by: every 10 drop in albumin increase AG by 2.5

*4- compensation:
Metabolic acidosis: (winter's)
Expected pCO2 = 1.5 X HCO3 + 8 (+/- 2)
Metabolic alkalosis:
10 ⬆ HCO3 = 6 ⬆ pCO2
Respiratory acidosis & respiratory alkalosis:
For every change in
Acute: every 10 ⬆ or ⬇ pCO2 change HCO3 by 1-2 (⬆ for ⬆ and ⬇ for ⬇)
Chronic: every 10 ⬆ or ⬇ pCO2 change HCO3 by 4 (⬆ for ⬆ and ⬇ for ⬇)

*5- Delta
Delta gap (delta delta)
Change in HCO3
Change in AG
🔼HCO3 = 🔼AG Pure AG MA
🔼HCO3 > 🔼AG AG MA + non AG MA
🔼HCO3 < 🔼AG Malk + MA