ACID-BASE ANALYSIS-STEP 3
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1. If the AG is elevated, calculate the expected bicarbonate using 25 - change in AG. If the AG is not elevated, the expected bicarbonate is 25.
2. Essentially, what you're doing in this step is reducing the bicarbonate by 1 for every 1 acidic anion that the bicarbonate neutralizes.
3. If the measured bicarbonate is less than what is expected, a Normal Anion Gap Metabolic Acidosis (NAGMA) is present.
4. If the measured bicarbonate is more than what is expected, a metabolic alkalosis is present.
5. NAGMA or a metabolic alkalosis can coexist with a HAGMA.
Reference(s)
Gale, M., Grantham, H., Morley, P. and Parr, M. (2016). Advanced Life Support Level 1: 3rd Australian Edition. Australian Resuscitation Council. American College Of Surgeons. Committee On Trauma (2012). ATLS : student course manual. Chicago, Ill.: American College Of Surgeons.
