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do you think the tolerance of the delta gap is too narrow? say for example, using delta AG of 12 and delta bicarb of 14, you get delta gap of -2 which suggest combined nagma and hagma, but with same value the delta ratio is 0.85, which suggest hagma
Great observation. I need to get an answer to that. What will I consider in a case like this where the classification is different when using the two delta calculations?
Very astute observation. Two possible thoughts to this question: 1) If we are purely considering this for test questions, they shouldn’t give you a question where these two answers differ. They almost definitely will make it firmly fall into a single category by both methods. 2) In real life clinical medicine when applying this to patients, it’s important to remember that these equations aren’t “absolutes”. The evidence behind their derivations isn’t robust or perfect. They should be thought of as a guide to revealing concomitant acid/base disorders but a borderline result does not rule out the concomitant acid/base disturbance in the clinical arena. All of these equations have standard deviations and degrees of error where things can fall outside the designated values if that makes sense?
So... Delta Gap is an easier to do and remember method. Delta Delta ratio is a bit complicated, but may be more detailed info. Thanks! (I would go for Delta gap).
Thank you so much for this wonderful explanation, but if was calculating the Delta gap and there was only HAGMA, then it should be zero, right? I mean instead of 1 or 2 ?
Thanks for checking out the video and for the kind words! Given the fraction, HAGMA alone would be about 1, with the formal range being 1-2. For it to be zero, the denominator would have to be 0 (since it’s a fraction), which would mean the HCO3 would have to be normal. Since there is an acidosis the HCO3 won’t be normal. Does that make sense?
@@WhiteboardMedicine no, it doesn't make sense for two reasons: 1. The question was about Delta Gap, which is calculated by subtraction, but the answer was about Delta Ratio. 2. Even in the Delta Ratio, for the value to be zero the numerator (not the denominator) has to be zero. I mean, mathematicaly, we cannot divide a number to zero (7/0, for example). So, in case of the Delta Ratio, I think HAGMA will never be zero, because the numerator (Delta AG) will never be zero either, given the fact that for Delta AG to be zero there must be a normal AG. And when we have a normal AG we don't calculate the Delta.
I've seen 3 or 4 ways to interpret these numbers. Ninja nerd says 0-1 Delta means pure HAGMA, but here you say mixed. There seems to be no consensus on how to interpret the actual values. Med students beware.
Sexy content, bro. I was postponing this for way too long. Btw, if you just add the value of normal anion gap(8-12, I presume) at the beginning, this video would be complete.
Thanks for checking out the video!
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I am studying for my boards and i'm so thankful i found this video. I have been so confused on this topic since medical school
We love to hear that! So glad it was helpful. Good luck on boards and let us know if there are any other topics you'd like us to cover!
Wonderful and concise, this video makes me look cooler on the wards now lol
Love to hear that! Nothing better than dropping some acid/base knowledge
do you think the tolerance of the delta gap is too narrow? say for example, using delta AG of 12 and delta bicarb of 14, you get delta gap of -2 which suggest combined nagma and hagma, but with same value the delta ratio is 0.85, which suggest hagma
Great observation. I need to get an answer to that.
What will I consider in a case like this where the classification is different when using the two delta calculations?
Very astute observation. Two possible thoughts to this question:
1) If we are purely considering this for test questions, they shouldn’t give you a question where these two answers differ. They almost definitely will make it firmly fall into a single category by both methods.
2) In real life clinical medicine when applying this to patients, it’s important to remember that these equations aren’t “absolutes”. The evidence behind their derivations isn’t robust or perfect. They should be thought of as a guide to revealing concomitant acid/base disorders but a borderline result does not rule out the concomitant acid/base disturbance in the clinical arena. All of these equations have standard deviations and degrees of error where things can fall outside the designated values if that makes sense?
Thanks for the reply :)
So... Delta Gap is an easier to do and remember method.
Delta Delta ratio is a bit complicated, but may be more detailed info.
Thanks! (I would go for Delta gap).
Thanks for checking out the video! Glad to hear a method stuck!
So clear thank you
Love to hear that! Thanks for checking out the video and for commenting! Let us know if there are any other topics you’d like us to cover!
Legendary ❤
You’re too kind! Glad to hear it was helpful!
Thank you so much for this wonderful explanation, but if was calculating the Delta gap and there was only HAGMA, then it should be zero, right? I mean instead of 1 or 2 ?
Thanks for checking out the video and for the kind words! Given the fraction, HAGMA alone would be about 1, with the formal range being 1-2. For it to be zero, the denominator would have to be 0 (since it’s a fraction), which would mean the HCO3 would have to be normal. Since there is an acidosis the HCO3 won’t be normal. Does that make sense?
@@WhiteboardMedicine ok, that's clear. Thank you so much for your answer and your informative videos.
@@WhiteboardMedicine no, it doesn't make sense for two reasons:
1. The question was about Delta Gap, which is calculated by subtraction, but the answer was about Delta Ratio.
2. Even in the Delta Ratio, for the value to be zero the numerator (not the denominator) has to be zero. I mean, mathematicaly, we cannot divide a number to zero (7/0, for example).
So, in case of the Delta Ratio, I think HAGMA will never be zero, because the numerator (Delta AG) will never be zero either, given the fact that for Delta AG to be zero there must be a normal AG. And when we have a normal AG we don't calculate the Delta.
Doing a favor to all med students
Thank you very much
Always our pleasure! Goodness knows we have been there!
Let us know if there are any topics in particular you want covered!
I've seen 3 or 4 ways to interpret these numbers. Ninja nerd says 0-1 Delta means pure HAGMA, but here you say mixed. There seems to be no consensus on how to interpret the actual values. Med students beware.
Oh Dear, I shall be swimming out of my depth again, but thank you very much & I shall try not to drown.
I think you will thrive!
Sexy content, bro. I was postponing this for way too long.
Btw, if you just add the value of normal anion gap(8-12, I presume) at the beginning, this video would be complete.