Delta Ratio Mixed Acidosis CKD Diagnosis — ESENeph MCQ
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Correct answer: D — A ratio near 0.2, suggesting an additional normal-gap metabolic acidosis
The best answer is “A ratio near 0.2, suggesting an additional normal-gap metabolic acidosis”. Delta anion gap is 2 and delta bicarbonate is 10, so the ratio is 0.2. Bicarbonate has fallen far more than the gap has risen, identifying a concurrent hyperchloraemic process. “A ratio near 2.0, supporting an isolated high-gap metabolic acidosis” is less appropriate because the numerator is 2 and denominator is 10 “A ratio above 2.0, suggesting an additional metabolic alkalosis” is less appropriate because the arithmetic gives a value well below 1 “A ratio near 1.0, compatible with a predominantly high-gap acidosis” is less appropriate because the measured changes are not equal “An indeterminate ratio because the required baseline values are unavailable” is less appropriate because those are exactly the values used
Reference: KDIGO 2024 CKD guideline: https://kdigo.org/wp-content/uploads/2024/03/KDIGO-2024-CKD-Guideline.pdf