You’re still working in the ICU. You get 2 patients back to back, comatose. Little history. Vented.
Patient 1: 22yo female. Found down at home. We don’t know her PMH or meds.
![](https://pbs.twimg.com/media/D5gMEF5XoAEOWIm.jpg)
What do you think she has? Say your opinion in the comments!
Great work everyone. Here’s our approach to ABG’s, in four easy steps.
Step 1: What is the -emia?
![](https://pbs.twimg.com/media/D5q-ObSXsAEtIiE.jpg)
Note that Patient #1 has elevated glucose. Her corrected sodium would be in the neighborhood of 145.
Use the native, uncorrected sodium in the gap calculation!
![](https://pbs.twimg.com/media/D5q-PcrXsAcT7-n.jpg)
Step 3: the delta delta.
This helps you see if there is an additional metabolic disorder ongoing, if you already have a high anion gap acidosis going on.
![](https://pbs.twimg.com/media/D5q-P0tWwAICWOC.jpg)
Step 4: Winters formula.
Lastly, check for respiratory compensation. Winters formula is great for acidoses.
Formulas exist for alkalosis, and for respiratory disorders, but those compensations are less reliable to calculate.
![](https://pbs.twimg.com/media/D5q-QxVWwAAkYh3.jpg)
We hop you enjoyed this week’s #PhysioQuizzo! Oddly, we’ve coincided again with @CPSolvers. Go check out their podcast on a metabolic acidosis case!
And see you next week for another riveting #TwitterReport!