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A 86 year old female presented with sudden onset breathlessness since morning along with chest pain. O/E RR- 45Bpm, BP-120/70mmHg, Chest : B/L crepitation. ABG :pH :7.114, PCO2 : 15.7, HCO3- :4.8mEq/L, Lactate : 12.9mmol, Na+ : 135 mEq/l, Cl- : 111 mEq/l, K+ : 6.6 mEq/L

• Step 1 : Acidosis (pH<7.114)

• Step 2 :Metabolic Acidosis (HCO3- <24)

• Step 3 : Anion gap = 135 – (111 +4.8) = 19.2

• Step 4 :

  • Expected PCO2 = [ (1.5* 4.8)+8] +/- 2 = 13.2 – 17.2 mmHg

  • So its a compensated metabolic acidosis.

• Step 5 :

  • Gap- Gap Acidosis = (19.2– 12)/ (24-4.8) =0.375

• Answer : The ABG shows Primary compensated WAGA (Lactic Acidosis) along with concomitant non gap acidosis.

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