A 55-year-old man on ICU with severe sepsis has a base excess of -12 mmol/L. pH is 7.22, HCO3 12 mmol/L, PaCO2 3.0 kPa (appropriate respiratory compen...

Question

A 55-year-old man on ICU with severe sepsis has a base excess of -12 mmol/L. pH is 7.22, HCO3 12 mmol/L, PaCO2 3.0 kPa (appropriate respiratory compensation), lactate 8.5 mmol/L. Anion gap is 28 mmol/L. Corrected anion gap (for albumin of 18 g/L) is 34 mmol/L. What does the delta ratio (delta-delta) tell us about the acid-base disorder?

Accepted Answer

All of B, C, and D are correct

Answer

The delta ratio is irrelevant

Answer

Delta ratio = (change in AG) / (change in HCO3) = (34-12)/(24-12) = 22/12 = 1.83 - a ratio between 1 and 2 suggests a pure elevated anion gap metabolic acidosis without a concurrent non-anion-gap acidosis or metabolic alkalosis

Answer

A delta ratio >2 would suggest a concurrent metabolic alkalosis

Answer

A delta ratio

uk-fficm MCQ (SBA): Delta Ratio - Mixed Acid-Base