ACID-BASE ANALYSIS-STEP 3

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SUMMARY

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.