Definitions and Background

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Type

Criteria

Normal values

Sodium

- 136-140 mEq/L

Chloride

- 96-100 mEq/L

Bicarbonate

- 22-24 mEq/L

Anion gap (AG)

- AG= Serum Na- (Serum Cl + Serum HCO3)

- Low < 8

- Normal ~ 12

- Elevated > 16

Delta gap (D gap)

- Difference between measured AG and normal AG of 12

Acidemia

- Overall acid base status of serum in acidic range

Alkalemia

- Overall acid base status of serum in alkaline range

Acidosis/Alkalosis

- Refers to actual processes (eg, metabolic, respiratory) causing acidemia or alkalemia

- < 7.40 is acidemia

- 7.40 is normal

- > 7.40 is alkalemia

Arterial blood gas (ABG)

- pH/pCO2/PO2

- 7.40/40/100

Types of acid base disorders (Can be acute or chronic)

Metabolic acidosis

- Decreased serum bicarbonate (HCO3)

- Anion gap metabolic acidosis (AGMA)

- - Typically due to addition of an external acid that binds to serum bicarbonate and lowers it

- Non-anion gap metabolic acidosis (NAGMA)

- - Can be due to bicarbonate wasting or acid retention

Metabolic alkalosis

- Defect causing increased serum bicarbonate

Respiratory acidosis

- Defect causing CO2 retention usually due to hypoventilation or impaired gas exchange in lung

Respiratory alkalosis

- Defect causing CO2 loss usually due to hyperventilation

- Possible to have combination of AGMA, NAGMA, anion gap metabolic alkalosis, and either respiratory acidosis or alkalosis

- pH and pCO2 usually go in the same direction for above disorders

Back to Approach to Acid Base Disorders

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Approach to Acid Base Disorders

Definitions and Background

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