Bicarbonate

They donate hydrogen ions, dropping her blood pH dangerously below the normal range of 7.35.

Her bicarbonate, HCO3, which is the body's natural alkaline buffer system, gets entirely consumed and used up trying to fight and neutralize this massive acid load, so her bicarbonate levels drop far below the normal 22.

So she is acidic, she is full of sugar, and she is full of ketones.

The triage logic outlines three major sequential goals of therapy for Patty.

How do you know when you've won? When is the DKA technically resolved? The triage goal's state resolution is indicated by a pH of 7.38 and an HCO3 of 24.

Those are perfectly normal, beautiful numbers.

A pH of 7.38 means the acidic ketones have been cleared, and an HCO3 of 24 means her body's bicarbonate buffer system has successfully replenished itself.

The chemical fire is out.

Yes, technically they're not, but practically they are.

And it's basically the presence of bicarbonate in English, Hüttel-Ging-Carbonat, HCO3 in German.

And that will... affect the acidity perception of your coffee so the level of carbon and hardness is going to be how acidic your coffee tastes basically all else

being equal so low would be lower acidity

So for instance, 10 milligrams per liter of magnesium would be 41.2, so let's call it 40, just remember, for parts per million.

So if you want to calculate the hardness of your waters, they're basically the three things you want to pay attention to.

For carbonate hardness, all that matters is the bicarb, the HCO3.

that has a specific grade of 0.85 you can call that one if you want to be lazy and if you're on vacation you're looking for a bottle of water to use for coffee find something that has hydrogen carbonate bicarb um around like 30 to 50 ish that's that range milligrams per liter yeah um that's going to be fine and then calcium magnesium don't matter that much but if you want to know them um you times calcium by 2.5 and magnesium by 4.12, if you want to be precise, and add those together to get the general hardness.

It's sodium minus the sum of chloride and bicarbonate.

So Ag, I'll put the formula right here.

Ag equals Na minus, in parentheses, Cl plus HCO3.

You'll commonly see it written as Na minus Cl minus HCO3, same thing.

But what does that number mean? A high anion gap generally tells you that there are additional unmeasured anions present.

Think about conditions like lactic acidosis, DKA, and renal failure, and certain toxic ingestions.

It's unbelievable.

Anyway, so the point is, to answer Liam's question, like, trees have carbon in them, and this carbon is in several forms, and there's a very complex carbon cycle on Earth where you have carbon in the atmosphere, and then trees can take that carbon in, right, to build themselves up, and trees are about 50% carbon, often stored in cellulose, but then they die, and then those trees return that carbon to the soil, and it can get washed out into the oceans, where the carbon is mostly in the form of, like, HCO3 and CO3.

And sometimes marine organisms can take that carbon in and make calcium carbonate, and if enough of that builds up, then you can get, like, limestone.

So sometimes this carbon cycle can take, like, 10 or 100 million years before the limestone on the bottom of the ocean gets, like, subducted by tectonic activity back into magma, melted, and then, like, burped up back into the atmosphere by volcanoes.

You have a patient in the ICU.

Their arterial blood gas shows a pH of seven point zero, a PCO2 of thirty-five millimeters of mercury, and a bicarbonate, or HCO3, of ten milliequivalents per liter.

Okay.

The low bicarb tells us they have a metabolic acidosis, but we need to know if their lungs are compensating properly.