Low Sensitivity of the Anion Gap as a Screen to Detect Hyperlactatemia in Critically Ill Patients

Iberti, Thomas J.; Leibowitz, Andrew B.; Papadakos, P. J.; Fischer, Ellen P.

doi:10.1097/00000542-198909001-00171

Cited by 42 publications

(60 citation statements)

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“…In all studies, an increased anion gap was denoted when it exceeded the upper range of normal, either 12 or 16 mEq/L. In the first study, 43% of 56 patients with a serum lactate between 2.5 and 4.9 mmol/L and 50% of them with serum lactate between 5 and 9.9 mmol/L had a normal serum anion gap (,12 mEq/L) (25). Similarly, in 272 consecutive patients seen in the emergency department in whom serum lactate and anion gaps were obtained simultaneously, only 58% of those with a serum lactate .2.5 mmol/L had an anion gap outside the normal range (26).…”

Section: Recognition Of An Increase In the Serum Anion Gapmentioning

confidence: 99%

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

Kraut

Nagami

2013

Clinical Journal of the American Society of Nephrology

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SummaryThe serum anion gap has been utilized to identify errors in the measurement of electrolytes, to detect paraproteins, and, most relevant to the nephrologist, to evaluate patients with suspected acid-base disorders. In regard to the latter purpose, traditionally an increased anion gap is identified when it exceeds the upper limit of normal for a particular clinical laboratory measurement. However, because there is a wide range of normal values (often 8-10 mEq/L), an increase in anion concentration can be present in the absence of an increased anion gap. In addition, the type of retained anion can affect the magnitude of the increase in anion gap relative to change in serum [HCO 3 2 ] being greater with lactic acidosis compared with ketoacidosis. This review examines the methods of calculation of the serum anion gap in textbooks and published literature, the effect of perturbations other than changes in acid-base balance, and its effectiveness in identifying mild and more severe disturbances in acidbase balance. Limitations of the present methods of determining the normal anion gap and change in the anion gap are highlighted. The possibility of identifying the baseline value for individuals to optimize the use of the calculation in the detection of metabolic acidosis is suggested.

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Section: Recognition Of An Increase In the Serum Anion Gapmentioning

confidence: 99%

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

Kraut

Nagami

2013

Clinical Journal of the American Society of Nephrology

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“…[7][8][9][10][11][12][13] Penilaian kadar laktat darah pasien sakit gawat dapat digunakan sebagai salah satu indikator untuk mendeteksi secara dini keparahan dan atau derajat berat penyakit. 12,[14][15][16][17][18][19] Pada kelompok asidosis metabolik laktat, terdapat gangguan sistem organ yaitu, 1). Infeksi 22,5% terbanyak pasien dirawat dengan Sindrom dengue syok dan syok septik, 2).…”

Section: Pembahasanunclassified

“…Kadar laktat darah seringkali digunakan untuk mendeteksi hipoperfusi dan hipoksia atau sebagai parameter untuk monitor keberhasilan terapi serta prognostik pada berbagai keadaan sakit gawat. 11,12,16,17,19,20 Beberapa data laboratorium diprediksi berpengaruh pada prognosis dan mortalitas selain kadar laktat 2 , base exces, elektrolit darah dan albumin. Asidosis sangat dipengaruhi oleh konsentrasi ion hidrogen (pH), peningkatan risiko mortalitas terjadi jika pH darah <7,1 (asidosis berat) dan pH <6,8 bersifat letal.…”

Section: Pembahasanunclassified

Mortalitas Asidosis Metabolik Laktat dan Non-laktat di Unit Perawatan Intensif Pediatrik RSUP Sanglah

Windiyanto¹,

Gd²,

Igl³

et al. 2016

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H iperlaktasemia apabila konsentrasi laktat serum 2-5 mmol/L, 1 terjadi pada pasien sakit berat oleh karena peningkatan produksi dan hambatan pengeluaran laktat. Hiperlaktasemia merupakan tanda kardinal sepsis dan syok septik. Mekanisme hiperlaktasemia sepsis apabila terjadi peningkatan kadar laktat darah karena peningkatan Kata kunci: mortalitas, asidosis metabolik laktat, unit perawatan intensif pediatrik

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“…1 Insensitivity: it has been found that the anion gap is relatively poor at identifying small changes in ion concentrations, especially lactate [103], even when they would be considered clinically significant.…”

Section: Limitations Of the Anion Gapmentioning

confidence: 99%

Anions and the anaesthetist

2002

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SummaryAnions are the negative components of most chemical structures and play many important physiological and pharmacological roles that are of interest to the anaesthetist. Their relevance is reviewed with a particular emphasis on the inorganic anions (halides, bicarbonate, phosphate and sulphate) and the significance and limitations of the anion gap. Organic anions (albumin, lactate) are also discussed, albeit briefly. The suitability of anions for their role in neurotransmission and acid2base balance is outlined.

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Low Sensitivity of the Anion Gap as a Screen to Detect Hyperlactatemia in Critically Ill Patients

Cited by 42 publications

References 0 publications

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

Mortalitas Asidosis Metabolik Laktat dan Non-laktat di Unit Perawatan Intensif Pediatrik RSUP Sanglah

Anions and the anaesthetist

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