Acid-base cases

<br>

![:scale_c 66%](images/title.png)

# .black[Acid-base cases]

### FY / CMT Teaching July 2023 | Robert Hunter

???

Still to do:

- get PaO2 for case 4 (but will be in paper notes)  
- get Ur / Cr / eGFR for case 5
- update all equns to match ABG manual - and why the discrepancy?

### LOs:

- cases (mixed disorders)

- physiological approach

---

# Overview

- **Case 1:** 40M with SOB after recent ITU admission (&#129299; &#129299;)

- **Case 2:** 82M with confusion and diarrhoea (&#129299;)

- **Case 3:** 59M with new lymphoma (&#129299;)

- **Case 4:** 36F with pancreatitis (&#129299; &#129299; &#129299;)

- **Case 5:** 59M with confusion (&#129299; &#129299;)

[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)

.RWH_footnote_right[.RWH_footer_style[slides at: https://www.kidneyfish.net/talks/]]

---

# Case 1

**40M attending with SOB.**  SaO2 60% on home monitor.

Recent ITU admission for Covid and MOF; CRRT, ECMO.  
PMHx recurrent peptic ulceration; Roux-en-Y gastrectomy.

Drowsy, pin-point pupils.  Given high-flow O2 and naloxone.

**Rx:**  
- pregabalin (stated 6 days prior)  
- apixaban  
- zopiclone

**Ix:**  
- Ur 3.2  
- Cr 79  
- Na 143   
- K 2.6

???

4 months on ITU.

Also OTC Neurofen Plus.

---

# Case 1

<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> venous </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.3 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 81 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.08 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 10.6 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 23.6 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 16.7 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> -9.7 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 146 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 2.6 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Cl </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 111 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> lactate </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.7 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 1

<table style="width:50%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> venous </th>
   <th style="text-align:right;"> arterial </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 0.21 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 7.3 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 15.4 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 81 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 98 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 7.08 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 7.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 10.6 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 10 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 23.6 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 23.3 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 16.7 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 17.7 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> -9.7 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> -8.8 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 146 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 143 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 2.6 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 2.6 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Cl </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 111 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 113 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> lactate </td>
   <td style="text-align:right;width: 15em; background-color: lightblue !important;"> 0.7 </td>
   <td style="text-align:right;width: 15em; background-color: pink !important;"> 0.3 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 2

**82M in A&E with confusion (symptomatic hypoglycaemia).**

2 weeks cough, nausea, diarrhoea.  
Empirical trimethoprim for cloudy urine.  
Not passed urine for three days.

**PMHx:** T2DM, pulmonary oedema, trimethoprim-associated AKI (2 yrs ago).

**Rx:** insulin, metformin, lisinopril, furosemide, clopidogrel

**o/e:** ABP 110/60; JVP +4; no oedema; anuric.

**Ix:**

- urea 43, Cr 660 (baseline 145), K 7.5 mM  
- new RBBB on ECG

???

Lactate 9
Contrast CT > no ischaemic bowel.

After 2 hrs HD and supportive care (so 10 hrs total)  lactate 9 mM; pH 7.2 > started on CVVH > full renal recovery.

---

# Case 2

<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 3.4 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 34 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.15 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 5.4 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 14.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 11.9 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> -16.4 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 134 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 6.8 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Cl </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 101 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 2

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 3

**59M with recent diagnosis of lymphoma.**

Presented with vomiting.

---

# Case 3

<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 12.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 95 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.59 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 8 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 57.5 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 59.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 30.8 </td>
  </tr>
</tbody>
</table>
<br>
<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 121 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 2.1 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 3

<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 12.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 95 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.59 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 8 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 57.5 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 59.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 30.8 </td>
  </tr>
</tbody>
</table>
<br>
<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 121 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 2.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Cl </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 54 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 4

**36F with abnormal blood gas (from surgical SHO).**

Inpatient for 4 months; pancreatitis with chronic collections; recurrent sepsis; acute-on-chronic renal failure (IgAN).

<br>

**Rx:**

- metronidazole, meropenem, vancomycin, gentamicin IV  
- fluconazole PO
- enoxaparin SC  
- amlodipine, atenolol, folic acid, omprazole, lactulose, selenium, domperidone, ramipril, furosemide, paracetamol  
- NaHCO3 2g qds  
- TPN

---

# Case 4

**36F with abnormal blood gas (from surgical SHO).**

Inpatient for 4 months; pancreatitis with chronic collections; recurrent sepsis; acute-on-chronic renal failure (IgAN).

<br>

**Ix:**

- Cr 147 (eGFR 35)  
- Na 139  
- K 4.3  
- TCO2 15

???

2g qds NaHCO3 = 8g = 100 mmol
TPN has 80 mmol acetate = 80 mmol HCO3

---

# Case 4

<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 10.4 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 96 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.51 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 2.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 12.6 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 18.2 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> -7.9 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 139 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 4.3 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Cl </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 97 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> lactate </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 1.5 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

# Case 5

**59M with confusion.**

Cough and reduced oral intake for one week.

**PMHx:** urinary diversion surgery after childhood RTA; colostomy for IBD; peptic ulcer; previous AKIs; previous metabolic acidosis

**Rx:** paracetamol and iron supplements

Cool, volume deplete.  ABP 140/80; SaO2 96%; hypothermic.

???

Sotos syndrome

---

# Case 5

<table style="width:33%; margin-left: auto; margin-right: auto;">
 <thead>
  <tr>
   <th style="text-align:left;"> test </th>
   <th style="text-align:right;"> result </th>
  </tr>
 </thead>
<tbody>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> FiO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 0.21 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 4.7 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> SaO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 66 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pH </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 7.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> pCO2 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 3.8 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> aHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 8.8 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> stdHCO3 </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 10.1 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> BE </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> -20.9 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Na </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 148 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> K </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 2.4 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> Cl </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 125 </td>
  </tr>
  <tr>
   <td style="text-align:left;width: 10em; font-weight: bold;color: white !important;background-color: darkgrey !important;"> lactate </td>
   <td style="text-align:right;width: 20em; background-color: white !important;"> 1.2 </td>
  </tr>
</tbody>
</table>

.RWH_footnote_right[.RWH_footer_style[[Acid-base plot app](https://kidneyfish.shinyapps.io/davenport_plot)
]]

---

#  Take-home messages

- you tell me!

<br>

- plot for mixed disorders

- chloride (to classify metabolic alkalosis AND acidosis)

- corrected AG, deltas in metabolic acidosis

<br>

- https://kidneyfish.shinyapps.io/davenport_plot/

.RWH_footnote_right[.RWH_footer_style[slides at: https://www.kidneyfish.net/talks/; @renalrob]]

---

![:scale_c 75%](images/Davenport.png)