Imran, Though "we nephrologists use it all the ti...

2009-09-08T08:32:25.058-04:00

Imran,

Though "we nephrologists use it all the time" that doesn't mean that it is an evidence based practice or that it makes a difference in the clinical care of your patients. I appreciate your explanation of the concept I don't see anything in your explanation that assures me that it accurately predicts additional acid base disorders more than 44% of the time.

Dr. Topf: Appreciate your remarks about an old co...

2009-09-06T16:02:43.675-04:00

Dr. Topf:

Appreciate your remarks about an old controversary in nephrology.I wonder what do you make of the information listed below. I can ssure you, despite all your reservation about Delta gap, We nephrologist use ait all the time
Delta Gap corrected bicarb 0.7/10 rule
Delta Gap = AG -8 ( 8 is a normal AG)
Corrected Bicarb = Bicarb + delta gap ( Bicarb + Delta gap ( AG-Normal gap) coexisting disorders if < or > than between 24 - 26 ).
24-26 roughly = no other d/o
<24-26 = hyperchloremic acidosis or chronic resp alkalosis
>24-26 = metabolic alkalosis or chronic resp acidosis
Add delta gap back to CO2 = corrected bicarb ( Delta AG + CO2 from Chem-7)

if corrected bicarb = 24-26 then no other disturbance
if corrected bicarb < 24-26 then non-anion gap acidosis is superimposed (or chronic resp alkalosis)
if corrected bicarb >24-26 then met alkalosis is superimposed (or chronic resp acidosis)
if <8 = Non Anion Gap metabolic acidosis

2)-Chloride-Bicarbonate corection==7/10 Rule.

7/10 rule : Multiply Na excess by 0.7 and add to chloride ( Sodium above 140 X 0.7= )
1)-if hypochloremic = metabolic alkalosis or chronic resp acidosis ( Less than 100)
if hyperchloremic = metabolic acidosis or chronic resp alkalosis ( Greater than 100)

Comments on Precious Bodily Fluids: Delta anion gap. Not as good as we think it is.

Imran, Though "we nephrologists use it all the ti...

Dr. Topf: Appreciate your remarks about an old co...