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- Many acid anions remain in the extracellular fluid
- Up to 50% of HCO3- buffered intracellularly and by bones
- Delta-delta gap is the ratio of the change in Anion Gap to the change of bicarbonate
- Lactate poorly filtered and actively reabsorbed
- Delta-delta gap averages 1.6 (1.6:1)
- Ketoacids readily eliminated in urine
- Delta-delta gap averages 1.0 (1:1)
- Toluene → benzoic acid → hippuric acid: actively secreted
- Delta-delta gap averages <1.0 (<1:1)
- Delta-Delta Gap also <1.0 (<1:1) in mixed HAGMA + NAGMA & in D-lactic acidosis
- Delta-Delta Gap >1.6 = Metabolic Alkalosis