Does it really matter if you have a metabolic acidosis that is high anion gap or not? just goes straight to Winters formula for any form of metabolic acidosis
it basically means correcting for hypoalbuminemia. In case of hypoalbuminemia, there is going to be decreased anion gap as albumin is a negatively charged non calculated ion. To correct for the same, we use the formula for corrected AG i.e. Corr. AG= Ag + 2.5(4.5-x) where x is the measured albumin level in the plasma.
Hi. How can we identify primary disorders if pH is normal? For example, pH is normal, pC02 is low, bicarbonate is low. Is it compensated respiratory alkalosis or compensated metabolic acidosis? Thank you!
It's important to recognize that it's rare to see fully compensated patients with mixed disorders. You will also never see a fully compensated patient (normal pH) on an exam. However, if you do see this on wards, for example, in a patient in DKA who is also exhibiting kussmaul breathing to compensate for the acidosis...you understand the clinical scenario. So history taking and the clinical scenario is what will guide you if the patient is fully compensated. Good luck studying!
When the anion gap you calculated came up as 10, you said the patient does not have an anion gap. I assumed he did and went on to calculate a delta gap and came up with a mixed anion gap and non anion gap metabolic acidosis. With a normal anion gap as 12, what is your cut off for no anion gap?
No, It's correct. The delta gap is simple once you do it a few times. You take the a normal AG, which is 12, then subtract it from the calculated anion gap. The difference you get is the amount of bicarb that will return once you fix the anion gap. You add this number back to the bicarb you have from the BMP. If it's higher than 24 (a normal bicarb level), you have a concomitant metabolic alkalosis, if it's less than 24, you have a metabolic acidosis WITH a non anion gap metabolic acidosis (NAGMA). It will not always be a metabolic alkalosis.
@4:37, I meant to say and write respiratory alkalosis, not respiratory acidosis.
Really nice video! Thank you so much for explaining it so well and making it so simple!
If you only want to learn about serum anion gap, you can start watching from 11:40.
very nice lecture, thanks alot
im learning these in the time of the great virus quarantine because I like to hurt myself
Does it really matter if you have a metabolic acidosis that is high anion gap or not? just goes straight to Winters formula for any form of metabolic acidosis
what do you mean by "correct for albumin when you have it" ?? @ 37:50
it basically means correcting for hypoalbuminemia. In case of hypoalbuminemia, there is going to be decreased anion gap as albumin is a negatively charged non calculated ion.
To correct for the same, we use the formula for corrected AG i.e.
Corr. AG= Ag + 2.5(4.5-x)
where x is the measured albumin level in the plasma.
if you dont know a pts baseline pco2, do you have to basically wait until theres at least a change of 10 in the co2 to do that formula?
Hi. How can we identify primary disorders if pH is normal? For example, pH is normal, pC02 is low, bicarbonate is low. Is it compensated respiratory alkalosis or compensated metabolic acidosis? Thank you!
It's important to recognize that it's rare to see fully compensated patients with mixed disorders. You will also never see a fully compensated patient (normal pH) on an exam. However, if you do see this on wards, for example, in a patient in DKA who is also exhibiting kussmaul breathing to compensate for the acidosis...you understand the clinical scenario. So history taking and the clinical scenario is what will guide you if the patient is fully compensated. Good luck studying!
@@MedMessyNotes Thank you very much!
When the anion gap you calculated came up as 10, you said the patient does not have an anion gap. I assumed he did and went on to calculate a delta gap and came up with a mixed anion gap and non anion gap metabolic acidosis. With a normal anion gap as 12, what is your cut off for no anion gap?
The anion gap has to be greater than 12 to have an anion gap metabolic acidosis. The patient just had a non anion gap metabolic acidosis.
I think theres mistake in delta gap calculation
With your formula all high anion gap metabolic acidosis mixed with metabolic alkalosis
No, It's correct. The delta gap is simple once you do it a few times. You take the a normal AG, which is 12, then subtract it from the calculated anion gap. The difference you get is the amount of bicarb that will return once you fix the anion gap. You add this number back to the bicarb you have from the BMP. If it's higher than 24 (a normal bicarb level), you have a concomitant metabolic alkalosis, if it's less than 24, you have a metabolic acidosis WITH a non anion gap metabolic acidosis (NAGMA). It will not always be a metabolic alkalosis.
@@MedMessyNotes
Very nice
Thanks