delta-delta

速算法：delta gap

• (Δ/Δ = ΔAG/ΔHCO3) to assess if there is an additional metabolic

acid-base disturbance; ΔAG = (calculated AG – expected AG), ΔHCO3 = (24 – HCO3) Δ/Δ = 1–2 → pure AG metabolic acidosis Δ/Δ <1 → AG metabolic acidosis and simultaneous non-AG acidosis Δ/Δ >2 → AG metabolic acidosis and simultaneous metabolic alkalosis For pure lactic acidosis Δ/Δ 1.6 b/c of slow lactate clearance

🦎 贊曰

• HCO3 身為防守方(buffer system)，應該會有五成到十成的戰損率
• 也就是說：增加 10 的 A/G，HCO3 應該會少 5 到 10 a.k.a delta delta 1 to 2 — 如果不到五成，沒有預期的少、表示得到了增援 — 即得到了多的鹼，即代謝鹼中毒 Δ/Δ > 2 a.k.a 1/0.4>2 — 如果損失超過 100%，表示有逃兵 — 即有另一個 non-A/G 代謝酸=流失鹼 a.k.a. Δ/Δ<1

Δ/Δ = HCO3 的失敗率，這樣記才不會記反

• Ketoacidosis:
  • [ΔAG-ΔHCO3]
  • Na-Cl - 24
• Lactic acidosis:
  • [Δ0.6 AG- Δ(HCO3)]

If the result is -5 to 5 mmol/liter for either of the above: only high anion- gap metabolic acidosis ＞ 5 mmol/liter: high anion-gap metabolic acidosis as well as metabolic alka- losis ←5 mmol/liter: high anion-gap metabolic acidosis as well as normal anion-gap acidosis