Anion Gap Delta Delta Gradient Multicalc

 
Input
 
Na  
Cl  
HCO3  
Baseline Gap  

 
Results
 
 
Anion Gap  
Delta Gap  
Delta HCO3  
Delta Delta Gradient  
 
Decimal Precision  
 

 

 
A simple high anion gap metabolic acidosis produces a Delta Delta Gradient around 0.
 
A Delta Delta Gradient significantly greater than 0 usually indicates either:
  • A mixed high anion gap metabolic acidosis plus a primary metabolic alkalosis.
  • A mixed high anion gap metabolic acidosis plus a chronic respiratory acidosis.
  • A non-acidotic high anion gap state (such as with excess penicillin administration.)

 
A Delta Delta Gradient significantly less than 0 may result from:
  • A mixed high anion gap metabolic acidosis plus a normal anion gap metabolic acidosis.
  • A mixture of high anion gap metabolic acidosis plus chronic respiratory alkalosis plus hyperchloremia acidosis.
  • A high anion gap acidosis with a prexisting low anion gap state (such as hypoalbuminemia, para-proteinemia, etc ...)

 
Equations used
 
AnionGap = Na - (Cl + HCO3)
DeltaGap = AnionGap - BaselineGap
DeltaHCO3 = 25 - HCO3
DeltaDeltaGradient = DeltaGap - DeltaHCO3

 

 
References
  1. Wrenn K. The delta (delta) gap: an approach to mixed acid-base disorders. Ann Emerg Med. 1990 Nov;19(11):1310-3. PubMed ID: 2240729 PubMed Logo
  2. Breyer JA. Acid base course material. 6th National Critical Care Medicine Review Course.

 

 
 
Legal Notices and Disclaimer

 
All information contained in and produced by the EBMcalc system is provided for educational purposes only. This information should not be used for the diagnosis or treatment of any health problem or disease. THIS INFORMATION IS NOT INTENDED TO REPLACE CLINICAL JUDGMENT OR GUIDE INDIVIDUAL PATIENT CARE IN ANY MANNER. Click here for full notice and disclaimer.
 
EBMcalc is Copyright © 1998-2020 Foundation Internet Services    [Build 261279 v20.3]