High anion gap metabolic acidosis critical pathways

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Approach

metabolic acidosis critical pathways
Anion gap High Normal Low
Delta-delta (ΔΔ) value Greater than 2 Between 1 and 2 Less than 1

Definition

  • Delta-Delta value is used to determine whether there is an additional metabolic acid-base disturbance or not.
  • Delta-Delta (ΔΔ) = Delta anion gap (ΔAG) / Delta bicarbonate (ΔHCO3)
    • Delta anion gap (ΔAG) = Calculated anion gap - Expected anion gap
      • Calculated anion gap = [Na+] - [Cl-] - [HCO3-]
      • Expected anion gap = 2.5 x serum albumin level
    • Delta bicarbonate (ΔHCO3) = 24 - serum bicarbonate level

References

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