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Topic: Anion gap

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  Anion gap - Wikipedia, the free encyclopedia
The anion gap is used to aid in the differential diagnosis of metabolic acidosis.
Anion gap = ([Na ]) - ([Cl ]) (we can also say : Anion gap= ([Na ]) - ([Cl ]) and its normal value ranges between 8 and 16 mEq/L plasma)
A low anion gap is relatively rare but may occur from the presence of abnormal positively charged proteins, as in multiple myeloma
en.wikipedia.org /wiki/Anion_gap   (159 words)

 MedFriendly.com: Anion gap   (Site not responding. Last check: 2007-10-12)
Anion gap (pronounced an-eye-on gap) is a measurement of the anions in the arterial blood (besides chloride and bicarbonate anions).
The anion gap measurement is taken from the blood serum or blood plasma.
The main anions in the blood (besides chloride and bicarbonate) are phosphate (a type of salt), organic acids (types of acids), sulfate (usually a combination of a metal with a type of acid called sulfuric acid), and proteins in the blood plasma.
www.medfriendly.com /aniongap.html   (1364 words)

 Should the actual or the corrected serum sodium be used to calculate the anion gap in diabetic ketoacidosis?
The anion gap (the serum sodium concentration minus the sum of the serum chloride and bicarbonate concentrations) is useful in estimating the concentration of other anions not usually measured—notably, ketones such as beta-hydroxybutyrate and acetoacetate.
Since all of the components of the anion gap calculation are concentrated or diluted to the same extent, the anion gap is minimally altered—too little to interfere with proper interpretation of the acid-base status.
The accompanying anion (in this case beta-hydroxybutyrate) is retained in the plasma and is an "unmeasured" anion.
www.clevelandclinicmeded.com /ccjm/august2001/beck.htm   (968 words)

 s000328a - Ethylene Glycol - Osmolal Gap
The diagnosis is dependent: upon high anion-gap metabolic acidosis, and an osmolal gap between the calculated and the measured osmolality.: Normal anion gap has been reported in some cases of concomitant methanol and ethanol ingestion, where the high: serum levels of ethanol inhibited the metabolism of methanol by alcohol dehydrogenase.
An osmolal gap above 25 mosm/kg, in a patient with an increased anion gap acidosis, is a strong: indicator of methanol or ethylene glycol intoxication.
Increased osmolal gap was present on admission in all patients, whereas: increased anion gap was present in all except one.
www.emory.edu /WHSCL/grady/amreport/litsrch99/s000328a.html   (2247 words)

 Postgraduate Medicine: A stepwise approach to acid-base disorders
The anion gap should be calculated in all cases of suspected acid-base disorder because it may identify metabolic acidosis even when pH is normal or alkalemic.
However, the anion gap does have limitations, and the distinction between high-anion-gap and non-anion gap metabolic acidosis is not always clear (4).
The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis.
www.postgradmed.com /issues/2000/03_00/fall.htm   (3123 words)

 blood gases, anion gap, delta gap, bicarbonate gap, serum electrolytes, arterial blood gases, pulmonary physiology, ...
All excess anions in the blood are buffered by bicarbonate, and this is why an elevated AG usually indicates a state of metabolic acidosis (Emmett 1977; Gabow 1980; Narins 1980; Gabow 1985; Oster 1988).
Yes: his anion gap is 165 - (32 + 112) = 21 mEq/L. Despite the fact that CO is elevated (reflecting a metabolic alkalosis from dehydration), there is also a slight metabolic acidosis; the acidosis is from lactic acidosis, a result of the hypotension and poor organ perfusion.
It is called bicarbonate gap because the bicarbonate moiety is what is buffered by organic anions; however, the serum CO is used in the calculation because that is what the chemistry lab measures and what the anion gap is based on (as discussed earlier).
www.lakesidepress.com /pulmonary/ABG/bicarbgap.98.htm   (2483 words)

 THE MERCK MANUAL OF GERIATRICS, Ch. 59, Disorders of Acid-Base Metabolism
The serum anion gap, which may help identify the cause of metabolic acidosis (see Table 59-1), is determined as follows: Serum sodium - (serum chloride + total CO The urine anion gap is calculated as follows: (urine sodium + urine potassium) - urine chloride <= 0.
A non-anion gap metabolic acidosis (NAGMA) is due to a failure of bicarbonate homeostasis and is characterized by a compensatory retention of the other main body anions, which results in hyperchloremia.
Acidosis with an increased anion gap (such as occurs with lactic acidosis, diabetic ketoacidosis, salicylate toxicity, toxic alcohol ingestion, and renal failure) is more common.
www.merck.com /mrkshared/mmg/sec8/ch59/ch59b.jsp   (471 words)

 Anion gap definition - Medical Dictionary definitions of popular medical terms
Anion gap: A measurement of the interval between the sum of "routinely measured" cations minus the sum of the "routinely measured" anions in the blood.
The anion gap = (Na+ + K+) - (Cl- + HCO3-) where Na- is sodium, K+ is potassium, Cl- is chloride, and HCO3- is bicarbonate.
A high anion gap indicated metabolic acidosis, the increased acidity of the blood due to metabolic processes.
www.medterms.com /script/main/art.asp?articlekey=20154   (223 words)

 CHEST: Anion gap in turpentine-induced pleural effusions: correlation with pH and protein level   (Site not responding. Last check: 2007-10-12)
The anion gap is also convenient and inexpensive to measure, and less subject to artifact than the pH measurement.
We found the anion gap correlated with pH, the glucose, protein, and lactate dehydrogenase levels, pleural-fluid/plasma protein and lactate dehydrogenase ratios, and WBC count (all p<0.001).
These results suggest the anion gap may be useful in the clinical evaluation of pleural effusions and could potentially replace the pH measurement.
www.findarticles.com /p/articles/mi_m0984/is_n2_v109/ai_18022396   (328 words)

 Mayo Clinic Proceedings
Anion gap metabolic acidosis, non–anion gap metabolic acidosis, and respiratory acidosis
In the setting of an anion gap metabolic acidosis, the next step should be calculation of the excess anion gap (the difference between the patient’s calculated anion gap and the normal anion gap), which assists in identifying an underlying non–anion gap metabolic acidosis or metabolic alkalosis.
The urine anion gap is useful for determining the cause of a normal anion gap metabolic acidosis.
www.mayoclinicproceedings.com /inside.asp?AID=361&UID=   (2345 words)

 NEJM -- The use of the urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis
We evaluated the use of the urinary anion gap (sodium plus potassium minus chloride) in assessing hyperchloremic metabolic acidosis in 38 patients with altered distal urinary acidification and in 8 patients with diarrhea.
In contrast, the anion gap was positive in all patients with altered urinary acidification, who were classified as having classic renal tubular acidosis (23 +/- 4.1 mmol per liter, 11 patients), hyperkalemic distal renal tubular acidosis (30 +/- 4.2, 12 patients), or selective aldosterone deficiency (39 +/- 4.2, 15 patients).
We conclude that the use of the urinary anion gap, as a rough index of urinary ammonium, may be helpful in the initial evaluation of hyperchloremic metabolic acidosis.
content.nejm.org /cgi/content/short/318/10/594   (431 words)

 Anion Gap
The Anion Gap is an approximate measurement of ions, that is molecules with a charge, either negative or positive.
The electrical potential between the inside of the cell and the outside of the cell is basis for nearly all transactions that occur with in the cell.
The Anion Gap is decreased by free radical pathology due to overproduction of alkaloids.
www.drkaslow.com /html/anion_gap.html   (533 words)

 3.2 The Anion Gap
The term anion gap (AG) represents the concentration of all the unmeasured anions in the plasma.
The acid anions (eg lactate, acetoacetate, sulphate) produced during a metabolic acidosis are not measured as part of the usual laboratory biochemical profile.
Albumin is the major unmeasured anion and contributes almost the whole of the value of the anion gap.
www.anaesthesiamcq.com /AcidBaseBook/ab3_2.php   (581 words)

 arterial blood gases, anion gap, delta gap, bicarbonate gap, serum electrolytes, arterial blood gases, pulmonary ...
Anion gap = Na - (Cl + CO2) = 153 - (100 + 23) = 30 mEq/L. Since normal anion gap is about 12 (+ or - 4) mEq/L, an AG of 30 indicates a definite anion gap metabolic acidosis.
The 'delta gap' or 'bicarbonate gap' is the difference between the change in anion gap and the change in serum CO2.
The bicarbonate gap is the difference between the change in anion gap and the change in serum CO2.
www.lakesidepress.com /pulmonary/ABG/ABG-Quiz.htm   (3135 words)

 Ingestion of ethylene glycol or methanol may result in life-threatening metabolic acidosis, renal failure, blindness, ...
It is simply important to recognize that the osmol gap, which occurs from the parent alcohol, and the anion gap, which is generated from the accumulation of acid metabolites, peak at two extremes during the time course of poisoning.
Early after toxic alcohol poisoning, an elevated osmol gap and no acidosis are expected (Figure 2, point A); in patients arriving late after ingestion, a large anion gap acidosis and no significant osmol gap are expected (Figure 2, point B) because the parent alcohol has metabolized to the acid metabolites.
An anion gap acidosis in the presence of an elevated osmol gap is only evident during the time interval between A and B in Figure 2 after some of the parent alcohol has metabolized to toxic acids.
www.uic.edu /com/er/toxikon/Mountain2jan.htm   (454 words)

 WebHealthCentre.com - Doctor's Calculators
The serum anion gap is the difference between the concentrations of the major cation, sodium and the major anions(Cl + HCO
The anion gap measurement is likely to be most useful in emergency department in cases with ketoacidosis, lactic acidosis or renal failure.
In practice, an increased anion gap is usually due to an accumulation of unmeasured anions.
www.webhealthcentre.com /calculators/doc_gap.asp   (217 words)

 eMedicine - Acidosis, Metabolic : Article by Margaret A Priestley, MD   (Site not responding. Last check: 2007-10-12)
The anion gap indicates the presence or absence of increased levels of unmeasured anions; it is the parameter most frequently used to determine whether metabolic acidosis is the result of accumulation of hydrogen ions or loss of bicarbonate.
Elevated anion gap is due either to overproduction of organic acids or to the kidneys' failure to maintain bicarbonate levels.
Normal anion gap metabolic acidosis is caused by loss of bicarbonate, addition of hydrochloric acid, or renal tubular dysfunction.
www.emedicine.com /PED/topic15.htm   (2853 words)

 Acid Base Disorders in Critical Care MEDSTUDENTS-INTENSIVE CARE
A normal anion gao acidosis occurs when Cl replaces the HCO3 lost in buffering H. An increased anion gap acidosis occurs when the anion replacing the HCO3 is not one that is routinely measured (albumin, phosphate, sulfates, lactate, …).
Anions always equal cations, but if the anion is not Cl then the anion gap calculated from routine chemistries will increase.
Normal anion gap acidosis occures from loss of HCO3 through the kidneys or the gut, or from the addition of an acid with Cl as the accompaining anion.
www.medstudents.com.br /terin/terin5.htm   (2297 words)

 Mind-Sharpeners Directed Learning Modules
However, several anions are not measured routinely, leading to the anion gap.
The anion gap is thus an artifact of measurement, and not a physiologic reality.
Thus there is both an anion gap metabolic acidosis (from dehydration and poor perfusion) and a metabolic alkalosis (from vomiting and loss of stomach acid).
www.erworld.com /mindsharp/mindIII_2.htm   (1375 words)

In certain types of metabolic acidosis, the unmeasured anions are increased concentration, thus resulting in an increased in the anion gap.
The osmolar gap is a measure of molecules in plasma that are osmotically active, but are not measured by standard blood chemistry panels.
If there is profound metabolic acidosis with an elevated anion gap and osmolar gap, and the clinical suspicion exists, a methanol blood level should be determined by the lab.
www.mountain-research.org /teaching/acidbase.htm   (3619 words)

As a result a reduction of albumin can reduce the baseline anion gap so that a hypoalbuminaemic patient may not have a high anion gap even in the presence of a disorder which usually produces an increased anion gap.
Anion gap is reduced by approx 2.5 mEq/L for every 10g/L fall in albumin.
Increase in unmeasured anions in metabolic alkalosis is due principally to increased albumin anions.
www.aic.cuhk.edu.hk /web8/acid_base.htm   (1407 words)

 Mixed acid-base   (Site not responding. Last check: 2007-10-12)
In an uncomplicated high anion gap acidosis, the change in AG is equivalent to the change in bicarbonate.
If the decrease in bicarbonate is less than the increase in anion gap, this indicates that there is a mixed disturbance, with something preventing the bicarbonate from being as low as it should be.
In an uncomplicated normal anion gap acidosis or a metabolic alkalosis, the change in chloride is equivalent to the change in bicarbonate.
www.diaglab.vet.cornell.edu /clinpath/modules/chem/mixedab.htm   (684 words)

 Anion Gap   (Site not responding. Last check: 2007-10-12)
The normal anion gap is 6-22 mEq/L (some omit K+ from the calculation, in which case normal is 2-18 mEq/L).
Example: normal anion gap = (150 + 4) - (115 + 20) = 19.
Increased unmeasured anions (lactate, ketoacids, phosphate, sulfate, hyperalbuminemia, salicylates, uremia)
cvm.msu.edu /courses/vm545/fluid/agap.htm   (94 words)

 anion gap - General Practice Notebook
The anion gap is a method of assessing the contribution of unmeasured anions to acidosis.
The normal range for the anion gap is 8 to 16 mmol/l.
The anion gap provides a measure of the difference between unestimated anions - phosphate, acetate and ketones - and cations.
www.gpnotebook.co.uk /simplepage.cfm?ID=403046401   (859 words)

 Correction of the anion gap for albumin in order to detect occult tissue anions in shock -- Hatherill et al. 87 (6): ...
anion gap (CAG) to detect the presence of occult tissue anions.
Decreased anion gap associated with hypoalbuminemia and polyclonal gammopathy.
Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit.
adc.bmjjournals.com /cgi/content/full/87/6/526   (2855 words)

 Chapter 26. Clinical disorders of acid-base metabolism adn metabolic acidosis
The anion gap is the calculated difference between the measured cations (Na+ and K+) and the measured anions (HCO3- and Cl-).
An increased anion gap metabolic acidosis, indicates the accumulation of unmeasured anions and, therefore, the accumulation of an acid species, such as ketoacids or lactic acid.
This is balanced by accumulation of chloride to maintain electroneutrality and as both bicarbonate and chloride are measured, the anion gap is not altered.
www.learndoctor.com /chapterpages/chapter26.htm   (176 words)

 A New Range for the Anion Gap -- Sadjadi 123 (10): 807 -- Annals of Internal Medicine
The anion gap, the difference between routinely measured anions
typical anion gap range as a reference value.
Low sensitivity of the anion gap as a screen to detect hyperlactatemia in critically ill patients.
www.annals.org /cgi/content/full/123/10/807   (594 words)

 American Family Physician: Metabolic acidosis with an elevated anion gap
Metabolic Acidosis with an Elevated Anion Gap Determining the cause of metabolic acidosis with a high anion gap may present a diagnostic challenge.
The history and physical examination may not suggest a cause of the acidosis, or important information may be unavailable, as in the case of an unconscious patient or a nonverbal child.
Since many of the causes of metabolic acidosis with a high anion gap are lethal if not properly treated, an awareness of the differential diagnosis and an organized approach to rapid diagnosis are essential.
www.findarticles.com /p/articles/mi_m3225/is_n4_v39/ai_7609829   (445 words)

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