Cubic Decision Card Component

Arterial pH Step 1

7.28 Normal: 7.35 – 7.45

Acidemia Detected Primary metabolic acidosis suspected when HCO3 < 24 mEq/L

Serum Anion Gap Step 2

20 Normal: 8 – 12 mEq/L

Elevated AG (> 12) MUDPILES / GOLD MARK differential (DKA, Lactic, Uremia, Toxic)

Winters Formula Compensation Step 3

PCO2 Prediction

Expected PaCO2 = 1.5 × [HCO3] + 8 ± 2

Calculated PaCO2 26 ± 2 mmHg

Measured PaCO2 25 mmHg

Compensation Adequate / Pure

Measured PaCO2 > Expected = Concomitant Respiratory Acidosis Measured PaCO2 < Expected = Concomitant Respiratory Alkalosis

Delta-Delta (Δ-Δ) Analysis Step 4 (Final Synthesis)

Triple Acid-Base Screen

Δ-Δ Ratio = (Δ Anion Gap) / (Δ HCO3) = (AG - 12) / (24 - [HCO3])

Δ-Δ = 1.0 to 2.0: Pure High Anion Gap Metabolic Acidosis

Every 1 mEq/L rise in anion gap is matched by a 1 mEq/L fall in serum bicarbonate.

Δ-Δ < 1.0: Concurrent Normal Anion Gap (NAGMA)

Bicarbonate has dropped more than expected (e.g. Diarrhea, Renal Tubular Acidosis, saline resuscitation).

Δ-Δ > 2.0: Concurrent Metabolic Alkalosis or Pre-existing Compensation

Bicarbonate is higher than expected for the degree of anion gap elevation (e.g. Vomiting, Diuretics, COPD retention).

Board Diagnosis: Pure DKA with Adequate Respiratory Compensation Tenderpoints Hub Modular Clinical Architecture

Arterial Blood Gas & Chem-7 Laboratory Panel Structured Lab Panel

Sodium (Na+) 138 mEq/L

Chloride (Cl-) 106 mEq/L

Bicarbonate (HCO3-) 12 mEq/L (Low)

Serum Glucose 340 mg/dL (High)

PaO2 95 mmHg

Standardized Clinical Reference Display Zero Cumulative Layout Shift (CLS)

Acute Acid-Base Diagnostic Decision Matrix