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Use of the AG/HCO₃^– Ratio in the Diagnosis of Mixed Acid-Base Disorders

Department of Medicine, Yale University School of Medicine, New Haven, Connecticut

Correspondence: Dr. Asghar Rastegar, 1072 LMP, P.O. Box 2080-30, New Haven, CT 06520-8039. Phone: 203-737-2078; Fax: 203-785-6954; E-mail: asghar.rastegar{at}yale.edu

When a strong acid is added to plasma, one expects a quantitative relationship between excess anion gap (AG) and bicarbonate deficit (HCO₃^–) with the AG/HCO₃^– ratio close to unity. If true, then this ratio could be used to diagnose mixed acid-base disorders in patients with metabolic acidosis. Although the mean ratio in selected patients is close to unity, this ratio also has a wide range, making its use in individual patients problematic. The ratio should therefore be used cautiously in making a diagnosis of mixed acid-base disorders.

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673