Approaching a phenomenal contradiction in acid-base physiology

Area of Science:

• Clinical Chemistry
• Physiology
• Critical Care Medicine

Background:

• Interpreting acid-base disturbances requires understanding various physiological and physicochemical approaches.
• Arterial blood gas (ABG) analysis is crucial for diagnosing metabolic disorders.

Purpose of the Study:

• To analyze discrepancies in interpreting an ABG report for a patient with severe lactic acidosis.
• To compare standard base excess, physiological, and physicochemical methods for acid-base disturbance interpretation.

Main Methods:

• Cross-examination of ABG results from a severe lactic acidosis case.
• Application of standard base excess, physiological, and physicochemical interpretation approaches.
• Discussion of underlying pathophysiology and causes of observed contradictions.

Main Results:

• A patient with severe lactic acidosis presented with a normal anion gap (even post-albumin correction).
• The results showed a slightly increased strong ion gap and a moderately decreased standard base excess.
• Contradictory findings emerged when applying different interpretation methods to the ABG data.

Conclusions:

• Real-life case analysis offers practical insights into acid-base disturbance investigation methods.
• Emphasizes commonalities and differences between standard, physiological, and physicochemical interpretation approaches.
• Highlights the need for a comprehensive understanding of various methods for accurate ABG interpretation.