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Large differences between the concentrations of serum total carbon dioxide (TCO 2 ) and blood gas bicarbonate (HCO 3  - ) were observed in two consecutive simultaneously drawn sets of samples of serum and arterial blood gases in a patient who presented with severe carbon dioxide retention and profound acidemia. These differences could not be explained by the effect of the high partial pressure of carbon dioxide on TCO 2 , by variations in the dissociation constant of the carbonic acid/bicarbonate system or by faults caused by the algorithms of the blood gas apparatus that calculate HCO 3  - . A recalculation using the Henderson-Hasselbach equation revealed arterial blood gas HCO 3  -  values close to the corresponding serum TCO 2  values and clarified the diagnosis of the acid-base disorder, which had been placed in doubt by the large differences between the reported TCO 2  and HCO 3  -  values. Human error in the calculation of HCO 3  -  was identified as the source of these differences. Recalculation of blood gas HCO 3  -  should be the first step in identifying the source of large differences between serum TCO 2  and blood gas HCO 3  - .

Discrepancy between Measured Serum Total Carbon Dioxide Content and Bicarbonate Concentration Calculated from Arterial Blood Gases