Mixed acid-base disorders are commonly encountered in clinical practice. They are frequently missed by healthcare professionals. On occasion, this has implications for patient management with lost opportunities for therapeutic intervention. In this course, we explain the significance of the ‘derived values’ (base excess and standard bicarbonate) reported on the arterial blood gas (ABG). In case studies, we show you how these values can help us detect the presence of mixed acid-base disturbances on the ABG and facilitate the diagnosis of unsuspected pathologies. We explain the limitations of the derived values. We demonstrate the application of the so-called ‘bedside rules’ in the detection of mixed acid-base disturbances on the ABG. We explain the role of ‘Winter’s formula’ in the assessment of the adequacy of respiratory compensation in metabolic acidosis and illustrate the clinical application of this formula. We show you how to apply and interpret the ‘delta ratio’ in cases of metabolic acidosis and illustrate how this value allows us distinguish between two major categories of causes of metabolic acidosis. We explain the nomenclature used on the ABG readout.
Planner and Author: Dr John Seery MB PhD
Planner: Dr Karen Strahan PhD (University of Cambridge), Head of Editorial
Planner: Tommy O'Sullivan, CME Manager
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Brandis K. The Great Trans-Atlantic Acid-Base Debate.
Yartsev A. Assessment of Compensation: Boston and Copenhagen Methods.
Rastegar A. Use of the ΔAG/ΔHCO3− Ratio in the Diagnosis of Mixed Acid-base Disorders. J Am Soc Nephrol 2007;18(9):2429-31.
Brandis K. Acid-Base Physiology. 9.6 Clinical Examples
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