Low Anion Gap

Jurado, Rafael; Río, Carmen del; Nassar, G.; Navarette, J.; Pimentel, J.L.

doi:10.1097/00007611-199807000-00004

Cited by 25 publications

(19 citation statements)

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“…In the presence of marked hypertriglyceridemia, light-scattering effects can produce marked overestimation of serum chloride and therefore a spuriously low serum anion gap (21). If serum chloride is determined by direct ion selective electrodes, however, then the measured value will be very close to the actual value, despite hypertriglyceridemia.…”

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

“…This error is avoided by use of ion selective electrodes. If an indirect method that requires predilution is used to measure sodium, then errors in calculation of the serum anion gap will arise with severe hypertriglyceridemia or dysproteinemia as a result of underestimation of serum sodium concentration that is caused by dilution artifacts even with ion selective electrodes (21,22). With severe macroglobulinemia, the measured serum sodium concentration can be as much as 23 mEq/L lower than the actual value (22).…”

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

“…Errors in measurement of serum chloride, which are more common when it is determined by the colorimetric method, also will cause an erroneous value for the serum anion gap (21). In the presence of marked hypertriglyceridemia, light-scattering effects can produce marked overestimation of serum chloride and therefore a spuriously low serum anion gap (21).…”

Section: Low or Negative Serum Anion Gapmentioning

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: Low or Negative Serum Anion Gapmentioning

confidence: 99%

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

Section: Low or Negative Serum Anion Gapmentioning

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 use of sodium-selective electrodes with a larger dynamic range negates this artifact from instrument non-linearity. Large non-aqueous volumes in the plasma such as hypertriglyceridemia or dysproteinemia (12)(13)(14)(15)(16) can lead to an underestimation of serum sodium especially with flame photometric instruments. However, sodium-selective electrodes are not spared even though the sodium activity registered by the sodium electrode is oblivious to the non-aqueous volume.…”

Section: Approach To a Low Anion Gapmentioning

confidence: 99%

“…Hypertriglyceridemia can interfere with the colorimetric assays of serum chloride measurements due to light-scattering effects and result in marked overestimation of serum chloride. Overestimation of serum chloride by lipid interference does not occur with ion selective electrode measurements (14). Chloride is normally the only halide present in the extracellular fluid in significant concentrations.…”

Section: Approach To a Low Anion Gapmentioning

confidence: 99%

Clinical acid–base pathophysiology: disorders of plasma anion gap

Moe

Fuster

2003

Best Practice & Research Clinical Endocrinology & Metab

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The plasma anion gap is a frequently used parameter in the clinical diagnosis of a variety of conditions. The commonest application of the anion gap is to classify metabolic acidosis into those that do or do not leave unmeasured anions in the plasma. While this algorithm is useful in streamlining the diagnostic process, it should not be used solely in this fashion. The anion gap measures the difference between the unmeasured anions and unmeasured cations and thus conveys much more information to the clinician than just quantifying anions of strong acids. In this review, the significance of the anion gap is emphasized and several examples are given to illustrate a more analytic approach to using the clinical anion gap. These include disorders of low anion gap, respiratory alkalosis and pyroglutamic acidosis.2 Practice Points •The anion gap measures the difference between all unmeasured anions other than HCO 3 -and Cl -, and all unmeasured cations other than Na + .• The clinical utility of the anion gap extends far beyond the differential diagnosis of metabolic acidosis.• It is advisable that the clinician knows the normal range of the anion gap and the assays used in measuring Na + and Cl -in the laboratories supporting their practice.• The ability to suspect and recognize that the anion gap is higher or lower than expected in a given clinical scenario allows the clinician to have much wider, sharper and more sophisticated diagnostic capabilities with information that is presented in routine chemistry reports.3 Research Agenda• The role of strong (fully dissociated at plasma pH) ions and weak (titratable with H + at plasma pH) cations and anions in determining in acid-base physiology is often unrecognized. This area deserves further data collection in whole organism physiologic and pathophysiologic settings.• There are vast unexplored territories in how physiologic and pathophysiologic conditions alter unmeasured cation and anion concentrations in terms of their generation, metabolism, and renal handling. Work in these areas is likely to be fruitful in generating novel knowledge in acid-base-electrolyte physiology and clinical medicine.• Pyroglutamic acidosis, particularly in milder forms, are more common than realized. The

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Acid-Base and Electrolyte Disorders in Emergency Critical Care

Whitmore¹,

Gunnerson

2020

Emergency Department Critical Care

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Low Anion Gap

Cited by 25 publications

References 0 publications

Serum Anion Gap

Serum Anion Gap

Clinical acid–base pathophysiology: disorders of plasma anion gap

Acid-Base and Electrolyte Disorders in Emergency Critical Care

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