{"id":19047,"date":"2020-08-19T05:21:47","date_gmt":"2020-08-18T21:21:47","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19047"},"modified":"2020-08-21T08:20:13","modified_gmt":"2020-08-21T00:20:13","slug":"deranged-physiology%e6%96%87%e7%ab%a0%ef%bc%9a%e9%97%b4%e9%9a%99%e5%b7%ae%e4%b8%8e%e6%af%94%e5%80%bc%e5%b7%ae%e7%9a%84%e4%bc%98%e7%82%b9%e4%b8%8e%e7%bc%ba%e7%82%b9","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19047","title":{"rendered":"[Deranged Physiology\u6587\u7ae0]\uff1a\u95f4\u9699\u5dee\u4e0e\u6bd4\u503c\u5dee\u7684\u4f18\u70b9\u4e0e\u7f3a\u70b9"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">The delta gap and delta ratio, advantages and disadvantages<\/h1>\n\n\n\n<p>The delta ratio (or the equivalent delta gap) are diagnostic and analytical tools used to determine the contribution from extra anions to the acidaemia of any given&nbsp;acidosis. A&nbsp;<a href=\"https:\/\/derangedphysiology.com\/main\/node\/1997\">much more detailed overview of the delta ratio<\/a>&nbsp;is available in a dedicated chapter from the&nbsp;<a href=\"https:\/\/derangedphysiology.com\/main\/node\/78\">Acid-Base Disturbances<\/a>&nbsp;series. Even though the calculation of a delta ratio is expected in every ABG interpretation question, the college has never asked any questions regarding its validity, or its limitations as a diagnostic instrument.<\/p>\n\n\n\n<p>Calculation of the delta ratio is performed using the following equation:<\/p>\n\n\n\n<p><strong>Delta ratio= (change in anion gap) \/ (change in bicarbonate)<\/strong><\/p>\n\n\n\n<p>Applied to metabolic acidosis to determine the contribution to acidosis from the unmeasured anions, the delta ratio suggests the following distinctions:<\/p>\n\n\n\n<ul><li>Less than 0.4 = pure normal anion gap acidosis<\/li><li>0.4-0.8 = mixed high and normal anion gap acidosis<\/li><li>0.8-2.0 = pure high anion gap acidosis<\/li><li>More than 2.0= high anion gap acidosis&nbsp;<em>and<\/em>&nbsp;a pre-existing metabolic alkalosis<\/li><\/ul>\n\n\n\n<p><strong>Advantages:<\/strong><\/p>\n\n\n\n<ul><li>Easy to calculate<\/li><li>Stoichiometric method of acid-base assessment<\/li><li>Quantifies the relationship between normal and high anion gap metabolic acidosis<\/li><li>Assesses the contribution of chloride to acidosis<ul><li>thus, informs the use of sodium bicarbonate<\/li><\/ul><\/li><\/ul>\n\n\n\n<p><strong>Disadvantages:<\/strong><\/p>\n\n\n\n<ul><li>Assumes all buffering is by bicarbonate (it is not)<\/li><li>Assumes all buffering is extracellular (it is not)<\/li><li>Possible measurement error of all electrolytes used to calculate the anion gap<\/li><li>The \"normal\" values against which change is measured may not be applicable<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>The delta gap and delta ratio, advantages and disadvant [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[13,14],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19047"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19047"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19047\/revisions"}],"predecessor-version":[{"id":19048,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19047\/revisions\/19048"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19047"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19047"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19047"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}