High anion gap metabolic acidosis critical pathways

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Approach

Metabolic acidosis physician extender algorithm

Elevated anion gap?

Yes

No

Delta-delta (ΔΔ) value

Equal to 1

Greater than 1

Less than 1

Definition

• Delta-Delta value is used to determine whether there is an additional metabolic acid-base disturbance or not.
• Delta-Delta (ΔΔ) = Delta anion gap (ΔAG) / Delta bicarbonate (ΔHCO3)
  • Delta anion gap (ΔAG) = Calculated anion gap - Expected anion gap
    • Calculated anion gap = [Na+] - [Cl-] - [HCO3-]
    • Expected anion gap = 2.5 x serum albumin level
  • Delta bicarbonate (ΔHCO3) = 24 - serum bicarbonate level

References

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