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Discussion

Under most circumstances, clinicians rely on the serum bicarbonate concentration to evaluate the anion gap and the metabolic component of an acid-base disturbance. This case illustrates how a mixed metabolic acid-base disorder could be evaluated without knowledge of the serum bicarbonate level by using Delta Gap (DG) equation. In patients with known anion gap metabolic acidosis, the value of serum bicarbonate (HCO 3-) in the DG equation cancels, thus requiring only two serum values (Na+ and Cl-) to assess concomitant metabolic acid-base disturbances.