Lab Case 87 – Interpretation

70 year old female with shortness of breath and confusion

  1. Triple acid base disorder

High anion gap metabolic acidosis (19)

delta ratio 0.42 = mixed high and normal anion gap

compensation: expected CO2  18.5, actual = 30 – partially compensated or additional respiratory acidosis

additional:

elevated potassium

elevated chloride

2. HAGMA – renal failure –  high potassium, other causes-fluid overload, intracranial lesion

DKA, toxins, sepsis less likely – normal lactae, glucose, ketones not given

NAGMA – Normal Saline administration – elevated chloride

Elevated CO2 – altered mental state

3.  

Delta Ratio
ValueInterpretationCause
<0.4Pure NAGMADiarrhoea
0.4-0.8Mixed HAGMA and NAGMASepsis with excess Normal Saline administration
1-2Pure HAGMADKA
>2Pure metabolic alkalosis or compensated respiratory acidosisVentilated patient

 

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