The best way to tackle acid base problems?

[amestramgram]

Hi, I am still struggling with clinical acid base problems (i.e. does the patient have a combined disorder, appropriate compensation) - I can always distinguish single disorders, but I have gotten every single question wrong in all of medical school (I am supposed to be almost done 4th year) when they refer to mixed disorders or they ask me if the compensation is appropriate. So, I have the following questions:

1. Am I required to memorize all 16 (or however many there are) versions of Winter's formula? Does it take such a superhuman feat just to tackle the compensation of one acid base problem? Is there no shortcut to memorizing all the different versions of Winter's fomula (i.e. the formula for metabolic alkalosis is different than the one for metabolic acidosis)

2. What does the delta-delta calculation have to do with anything? I was first taught to look at the pH, look at the HCO3, look at the CO2, and then you can tell if the patient is acidotic or alkalotic. This method appears to fail me every single time.

3. Whenever someone teaches me their way of solving acid base problems, I forget everything I previously learned about acid base and it 's like I have never learned how to tackle this type of question in my whole life. Can someone tell me which method will work every time?

Thank you for your help.

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[An0MalY]

http://www.ncbi.nlm.nih.gov/m/pubmed/15069420/

 

[Phlame217]

I recommend you pick up Rapid Review Path by Dr. Goljan. He is amazing with acid base disorders.

I'd explain my reasoning, but its screwed a lot of people up before so I'll forego it with you but seriously, rapid review path. Hit the fluid and hemodynamics (chapter 4 page 54 of the revised 3rd edition).