High anion gap metabolic acidosis critical pathways

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

Approach

metabolic acidosis critical pathways

Anion gap

High

Normal

Low

Delta-delta (ΔΔ) value

Greater than 2

Between 1 and 2

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