Gaps in the Anion Gap

Salem, Mahmoud; Mujais, Salim

doi:10.1001/archinte.1992.00400200063011

Cited by 108 publications

(42 citation statements)

References 49 publications

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“…The ⌬AG also has been used to assess changes in organic acid concentration: An increase has been taken to indicate a rise in organic acid concentration presumably reflecting a rise in its production. However, as indicated by Table 3, a closer examination of the events that unfold during the evolution of high anion gap metabolic acidosis indicates that this 1:1 stoichiometry might be transient in nature and/or depend largely on the type of metabolic acidosis present (23,45,52,54,56,61,69).…”

Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 99%

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Serum Anion Gap

Kraut

Madias

2007

Clinical Journal of the American Society of Nephrology

325

257

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The serum anion gap, calculated from the electrolytes measured in the chemical laboratory, is defined as the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration. This entity is used in the detection and analysis of acid-base disorders, assessment of quality control in the chemical laboratory, and detection of such disorders as multiple myeloma, bromide intoxication, and lithium intoxication. The normal value can vary widely, reflecting both differences in the methods that are used to measure its constituents and substantial interindividual variability. Low values most commonly indicate laboratory error or hypoalbuminemia but can denote the presence of a paraproteinemia or intoxication with lithium, bromide, or iodide. Elevated values most commonly indicate metabolic acidosis but can reflect laboratory error, metabolic alkalosis, hyperphosphatemia, or paraproteinemia. Metabolic acidosis can be divided into high anion and normal anion gap varieties, which can be present alone or concurrently. A presumed 1:1 stoichiometry between change in the serum anion gap (⌬AG) and change in the serum bicarbonate concentration (⌬HCO 3 ؊ ) has been used to uncover the concurrence of mixed metabolic acid-base disorders in patients with high anion gap acidosis. However, recent studies indicate variability in the ⌬AG/⌬HCO 3 ؊ in this disorder. This observation undercuts the ability to use this ratio alone to detect complex acid-base disorders, thus emphasizing the need to consider additional information to obtain the appropriate diagnosis. Despite these caveats, calculation of the serum anion gap remains an inexpensive and effective tool that aids detection of various acid-base disorders, hematologic malignancies, and intoxications.

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Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 99%

“…First, a portion of the protons are buffered within compartments outside the extracellular fluid (23,70,71). Therefore, the generated anions also must disappear from the extracellular fluid at a similar rate to preserve the 1:1 stoichiometry (66).…”

Section: Ratio Of Change In Unmeasured Anion Concentration and Changementioning

confidence: 99%

Serum Anion Gap

Kraut

Madias

2007

Clinical Journal of the American Society of Nephrology

325

257

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“…Its value is usually positive and re¯ects anions which are not accounted for in the above expression, such as proteins (the most quantitatively important in healthy subjects), phosphate, sulphate [17], as well as other unidenti®ed anions [18]. More ................................................................................................................................................................................................................... recent reviews of the Ôanion gapÕ have cited many potential confounding factors that may limit its usefulness [19]. Particularly relevant to critically ill patients is the concentration of plasma protein, as reduced plasma albumin concentrations result in a reduction in the expected or ÔnormalÕ anion gap.…”

Section: The Anion Gapmentioning

confidence: 99%

Acid−base physiology: the ‘traditional’ and the ‘modern’ approaches

et al. 2002

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The interpretation and understanding of acid±base dysfunction has recently been revisited. The ÔtraditionalÕ approach developed from the pioneering work of Henderson and Hasselbalch and is still the most widely used in clinical practice. There are a number of problems identi®ed with this approach, however. The ÔmodernÕ approach derives from Stewart's work in physical chemistry. In this review we describe the origins of the traditional approach and discusses related concepts. We then describe Stewart's approach, including how it is derived and how it may be used to classify acid±base derangements. The applications of Stewart's approach to clinical scenarios in intensive care is then discussed brie¯y before we examine some published clinical studies based on his work.

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“…7 Anion gap in plasma is a time-honored diagnostic tool used in the evaluation of metabolic acidosis. However, the observed AG is often unreliable in detecting increased concentrations of these gap anions, 8 and Rocktaeschel et al 9 insisted that the AG alone has limitations in critical illness. In particular, hypoalbuminemia, a common disturbance in hospitalized patients, can mask an increased concentration of gap anions by lowering the value of AG.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, hypoalbuminemia, a common disturbance in hospitalized patients, can mask an increased concentration of gap anions by lowering the value of AG. 8,10 Hatherill and colleagues 5 insisted that ACAG was a more appropriate screening tool for the diagnosis of metabolic acidosis in the intensive care unit and ACAG should be calculated to screen for occult tissue anions in children with shock. Morris et al 11 proposed ACAG-based techniques for bedside use in critically ill patients.…”

Section: Discussionmentioning

confidence: 99%