CLINICAL CASE 10, ANSWER AND SUMMARY

Fun with numbers.. Na 140 mmol/L K 4.0 mmol/L Cl 110 mmol/L pH 7.0 pCO2 35 mmHg pO2 75 mmHg HCO3 8 mmol/L. What is the disorder?

In this case, we see that the ph is 7.0 suggesting acidosis as a primary disorder and HCO3 is 8 as well suggesting a metabolic acidemia.  

1. Calculate AG= 22

So there is an anion gap metabolic acidosis

2. Then lets do the Winter's formula

which is 3/2 * bicarb +8 +-2 = PC02. In this case, 3/2 *8= 12+ 8= 20. So the PCO2 expected should be 20 but here its 35.  Hmm. so there is more PCO2 production when it should be suggesting a superimposed

Resp acidosis.

3. A delta delta should be performed to make sure there isn't a third disorder.  Change in your AG is 22-12= 10. So your bicarbonate should be 24(normal) -10= 14. But your bicarbonate here is 8, more lower than expected suggesting another significant non gap acidosis.

So this patient has a severe acidosis--> AG+ non gap + respiratory acidosis.