Occurs in:
For example in a patient with diabetic ketoacidosis secondary to infection and vomiting:
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A patient with ongoing ketoacidosis who has compensated to the extent that the bicarbonate is only 6.5 is unlikely to have fully restored their pH to normal levels. This is a falsely reassuring picture and the clinical condition should be considered, or the patient could be undertreated. Therefore if the patient is also vomiting, consider direct loss of [H+].