1265:
unmeasured anions. In the largest study published to date, featuring over 12,000 data sets, Figge, Bellomo and Egi demonstrated that the anion gap, when used to detect critical levels of lactate (greater than 4 mEq/L), exhibited a sensitivity of only 70.4%. In contrast, the albumin-corrected anion gap demonstrated a sensitivity of 93.0%. Therefore, it is important to correct the calculated value of the anion gap for the concentration of albumin, particularly in critically ill patients. Corrections can be made for the albumin concentration using the Figge-Jabor-Kazda-Fencl equation to give an accurate anion gap calculation as exemplified below.
2108:
2014:
1956:
27:
850:
concentration, and result in a corresponding mild reduction in the anion gap. In many situations, alterations in renal function (even if mild, e.g., as that caused by dehydration in a patient with diarrhea) may modify the anion gap that may be expected to arise in a particular pathological condition.
794:
In normal health there are more measurable cations than measurable anions in the serum; therefore, the anion gap is usually positive. Because we know that plasma is electro-neutral (uncharged), we can conclude that the anion gap calculation represents the concentration of unmeasured anions. The anion
916:
resulting in metabolic acidosis. In these conditions, bicarbonate concentrations decrease by acting as a buffer against the increased presence of acids (as a result of the underlying condition). The bicarbonate is consumed by the unmeasured cation(H+) (via its action as a buffer) resulting in a high
832:
Anion gap can be classified as either high, normal or, in rare cases, low. Laboratory errors need to be ruled out whenever anion gap calculations lead to results that do not fit the clinical picture. Methods used to determine the concentrations of some of the ions used to calculate the anion gap may
803:
Different labs use different formulas and procedures to calculate the anion gap, so the reference range (or "normal" range) from one lab isn't directly interchangeable with the range from another. The reference range provided by the particular lab that performed the testing should always be used to
1264:
The anion gap is often employed as a simple scanning tool by clinicians at the bedside to detect the presence of anions such as lactate, which can accumulate in critically ill patients. Hypoalbuminemia can mask a mild elevation of the anion gap, resulting in failure to detect an accumulation of
1189:
Note: a useful mnemonic to remember this is FUSEDCARS – fistula (pancreatic), uretero-enterostomy, saline administration, endocrine (hyperparathyroidism), diarrhea, carbonic anhydrase inhibitors (acetazolamide), ammonium chloride, renal tubular acidosis, spironolactone.
742:
The total number of cations (positive ions) should be equal to the total number of anions (negative ions), so that the overall electrical charge is neutral. However, routine tests do not measure all types of ions. The anion gap is representative of how many ions are
823:
for and as well as flame photometry for and . Thus normal reference values ranged from 8 to 16 mEq/L plasma when not including and from 10 to 20 mEq/L plasma when including . Some specific sources use 15 and 8–16 mEq/L.
885:
due to bicarbonate's activity as a buffer (without a concurrent increase in Cl). Thus, finding a high anion gap should result in a search for conditions that lead to excesses of the unmeasured anions listed above.
762:
The cations calcium (Ca) and magnesium (Mg) are also commonly measured, but they aren't used to calculate the anion gap. Anions that are generally considered "unmeasured" include a few normally occurring serum
811:
which give a normal anion gap as <11 mEq/L. Therefore, according to the new classification system, a high anion gap is anything above 11 mEq/L. A normal anion gap is often defined as being within the
694:
Because potassium concentrations are very low, they usually have little effect on the calculated gap. Therefore, omission of potassium has become widely accepted. This leaves the following equation:
1971:"Anion gap, anion gap corrected for albumin, base deficit and unmeasured anions in critically ill patients: implications on the assessment of metabolic acidosis and the diagnosis of hyperlactatemia"
638:
The anion gap is a calculated measure. It is computed with a formula that uses the results of several individual lab tests, each of which measures the concentration of a specific anion or cation.
1273:
Given the following data from a patient with severe hypoalbuminemia suffering from postoperative multiple organ failure, calculate the anion gap and the albumin-corrected anion gap.
1058:
is the primary pathology. Since there is only one other major buffering anion, it must be compensated for almost completely by an increase in Cl. This is therefore also known as
1035:
Note: a useful mnemonic to remember this is MUDPILES – Methanol, Uremia, Diabetic
Ketoacidosis, Paraldehyde, Infection, Lactic Acidosis, Ethylene Glycol and Salicylates
833:
be susceptible to very specific errors. For example, if the blood sample is not processed immediately after it is collected, continued cellular metabolism by
747:
accounted for by the lab measurements used in the calculation. These "unmeasured" ions are mostly anions, which is why the value is called the "anion gap."
2124:
1245:
the calculated value of the anion gap should be increased by 2.3 to 2.5 mEq/L per each 1 g/dL decrease in serum albumin concentration (refer to
1483:
1178:
Alcohols (such as ethanol) can cause a high anion gap acidosis in some patients, but a mixed picture in others due to concurrent metabolic alkalosis.
1688:
45:
1645:
2605:
795:
gap varies in response to changes in the concentrations of the above-mentioned serum components that contribute to the acid-base balance.
1913:"Quantitative relationships among plasma lactate, inorganic phosphorus, albumin, unmeasured anions and the anion gap in lactic acidosis"
2166:
1380:
Gabow PA, Kaehny WD, Fennessey PV, Goodman SI, Gross PA, Schrier RW (1980). "Diagnostic importance of an increased serum anion gap".
854:
A high anion gap indicates increased concentrations of unmeasured anions by proxy. Elevated concentrations of unmeasured anions like
177:
2069:
Fencl V, Kazda A, Jabor A, Figge J (December 2000). "Diagnosis of metabolic acid-base disturbances in critically ill patients".
759:) are used to calculate the anion gap. (As discussed above, potassium may or may not be used, depending on the specific lab.)
1731:
739:
Calculating the anion gap is clinically useful because it helps in the differential diagnosis of a number of disease states.
580:) is a value calculated from the results of multiple individual medical lab tests. It may be reported with the results of an
192:
2772:
2746:
1119:
Renal hypoaldosterone (i.e., renal tubular acidosis also known as type IV RTA) characterized by elevated serum potassium.
1311:
In this example, the albumin-corrected anion gap reveals the presence of a significant quantity of unmeasured anions.
2777:
2639:
2598:
982:(no longer on market in U.S. since 1978 due to severe lactic acidosis, but still a problem globally. "Old metformin")
895:
616:
63:
804:
interpret the results. Also, some healthy people may have values outside of the "normal" range provided by any lab.
339:
80:
333:
2259:
1786:
Berend K, de Vries A, Gans R (9 October 2014). "Physiological approach to assessment of acid-base disturbances".
1307:
Albumin-Corrected Anion Gap = Anion Gap + 2.5 x ( - ) = 11 + 2.5 x (4.4 - 0.6) = 20.5 mEq/L.
2552:
2159:
913:
750:
By definition, only the cations sodium (Na) and potassium (K) and the anions chloride (Cl) and bicarbonate (HCO
515:
257:
1487:
2484:
2471:
1136:
585:
1509:
2591:
2213:
1565:
Winter SD, Pearson JR, Gabow PA, Schultz AL, Lepoff RB (February 1990). "The fall of the serum anion gap".
1476:
1530:
Kirschbaum B, Sica D, Anderson FP (June 1999). "Urine electrolytes and the urine anion and osmolar gaps".
1214:. As bicarbonate and chloride anions are used to calculate the anion gap, there is a subsequent decrease.
2530:
2244:
1832:
1422:
783:) specifically, but it isn't used to calculate that "gap," even if it is measured. Commonly 'unmeasured'
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is an anionic protein and its loss results in the retention of other negatively charged ions such as
1044:
369:
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2013:
1955:
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808:
150:
135:
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216:
88:
1715:
1237:
The calculated value of the anion gap should always be adjusted for variations in the serum
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1182:
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477:
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430:
278:
8:
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2395:
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813:
532:
471:
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113:
611:. The magnitude of this difference (i.e., "gap") in the serum is calculated to identify
2631:
2456:
2385:
1997:
1970:
1811:
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1254:
612:
284:
159:
1543:
2514:
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2002:
1944:
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1886:
1873:
Figge J, Jabor A, Kazda A, Fencl V (November 1998). "Anion gap and hypoalbuminemia".
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1803:
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1397:
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1159:
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523:
345:
2134:
1502:
723:
Anion Gap = (the most prevalent cation) minus (the sum of the most prevalent anions)
2535:
2282:
2208:
2175:
2139:
2088:
2040:
1992:
1982:
1934:
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1816:
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1457:
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1354:
1226:
1222:
1218:
1078:
959:
838:
413:
324:
41:
2029:"Defining metabolic acidosis in patients with septic shock using Stewart approach"
1249:, below). Common conditions that reduce serum albumin in the clinical setting are
2659:
2218:
2092:
1939:
1242:
1199:
1116:
Kidney dysfunction (i.e., distal renal tubular acidosis also known as type 1 RTA)
954:
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501:
483:
457:
381:
297:
77:
1764:
1393:
1358:
2344:
2044:
1929:
1912:
1578:
1003:
912:. Raised levels of acid bind to bicarbonate to form carbon dioxide through the
183:
107:
1848:
1484:"Urine Anion Gap: Acid Base Tutorial, University of Connecticut Health Center"
1129:
1. Low renin may be due to diabetic nephropathy or NSAIDS (and other causes).
1006:, causes high anion gap acidosis by decreased acid excretion and decreased HCO
2766:
2526:
2364:
2354:
2129:
1153:
495:
1074:
lost is replaced by a chloride anion, and thus there is a normal anion gap.
2644:
2390:
2234:
2100:
2052:
2006:
1987:
1948:
1856:
1807:
1630:
1551:
1172:
929:
768:
604:
101:
2130:
Anion Gap
Calculator (includes a correction for the albumin concentration)
1894:
1799:
1772:
1586:
1401:
1135:
3. Low response to aldosterone maybe due to potassium-sparing diuretics,
2567:
2432:
2418:
2329:
2324:
1833:"Influence of hypoalbuminemia or hyperalbuminemia on the serum anion gap"
1621:
1469:
1366:
1325:
1232:
1211:
964:
900:
The anion gap is affected by changes in unmeasured ions. In uncontrolled
855:
662:
623:
600:
581:
547:
541:
303:
168:
92:
1749:"Value of the anion gap in clinical diagnosis and laboratory evaluation"
1689:"Anion Gap: Acid Base Tutorial, University of Connecticut Health Center"
1175:, particularly during rehydration with sodium-containing solutions (IV).
2370:
2349:
2274:
1250:
1020:
979:
819:
In the past, methods for the measurement of the anion gap consisted of
657:
The anion gap is calculated by subtracting the serum concentrations of
360:
320:
2583:
2174:
1132:
2. Low aldosterone may be due to adrenal disorders or ACE inhibitors.
207:
2710:
1320:
1258:
1028:
990:
834:
674:
1969:
Chawla L, Shih S, Davison D, Junker C, Seneff M (16 December 2008).
2622:
2027:
Mallat J, Michel D, Salaun P, Thevenin D, Tronchon L (March 2012).
1207:
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1016:
949:
905:
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658:
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1904:
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1203:
995:
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909:
764:
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592:
422:
272:
123:
1605:"Serum Anion Gap: Its Uses and Limitations in Clinical Medicine"
1448:
Emmett M.; Narins R.G. (1977). "Clinical use of the anion gap".
16:
Difference in quantities of cations and anions in blood or urine
1429:. American Association for Clinical Chemistry. 24 February 2015
1097:
969:
784:
670:
666:
596:
248:
198:
1901:
2572:
2339:
2188:
1304:
Anion Gap = - ( + ) = 137 - (102 + 24) = 11 mEq/L.
1024:
646:
608:
1558:
876:, which rise with disease or intoxication, cause loss of HCO
2504:
2140:
More information about the Figge-Jabor-Kazda-Fencl equation
1379:
985:
2125:
Clinical
Physiology of Acid-Base and Electrolyte Disorders
2071:
American
Journal of Respiratory and Critical Care Medicine
2026:
1564:
1261:. Hypoalbuminemia is common in critically ill patients.
774:
Similarly, tests do often measure the anion phosphate (PO
1968:
1609:
Clinical
Journal of the American Society of Nephrology
1529:
1233:
Correcting the anion gap for the albumin concentration
920:
Causes of high anion gap metabolic acidosis (HAGMA):
816:
of 3–11 mEq/L, with an average estimated at 6 mEq/L.
2068:
1872:
1510:"Urine anion and osmolal gaps in metabolic acidosis"
1447:
1423:"Electrolytes: Common Questions: What is anion gap?"
1049:
In patients with a normal anion gap the drop in HCO
36:
may be too technical for most readers to understand
1830:
1785:
1094:) (note: vomiting causes hypochloraemic alkalosis)
727:(Bicarbonate may also be referred to as "total CO
591:The anion gap is the quantity difference between
2764:
1910:
1837:The Journal of Laboratory and Clinical Medicine
1532:The Journal of Laboratory and Clinical Medicine
1831:Feldman M, Soni N, Dickson B (December 2005).
1746:
2599:
2160:
2064:
2062:
1911:Figge J, Bellomo R, Egi M (13 October 2017).
709:Anion Gap = sodium - (chloride + bicarbonate)
641:The concentrations are expressed in units of
584:panel, which is often performed as part of a
1868:
1866:
827:
1602:
1598:
1596:
1523:
1345:Oh MS, Carroll HJ (1977). "The anion gap".
2606:
2592:
2167:
2153:
2059:
998:, coupled with elevated venous oxygenation
615:. If the gap is greater than normal, then
2082:
1996:
1986:
1938:
1928:
1863:
1815:
1747:Lolekha PH, Lolekha S (1 February 1983).
1620:
1344:
649:(mEq/L) or in millimoles/litre (mmol/L).
64:Learn how and when to remove this message
48:, without removing the technical details.
1713:
1593:
1246:
1241:concentration. For example, in cases of
858:, beta-hydroxybutyrate, acetoacetate, PO
767:, and some pathological proteins (e.g.,
530:
420:
358:
318:
264:
214:
157:
86:
2613:
1722:. Lippincott Williams Wilkens. p.
1221:, where there is an increase in plasma
2765:
2033:American Journal of Emergency Medicine
1417:
1415:
1413:
1411:
1338:
1268:
1217:The anion gap is sometimes reduced in
841:) may result in an increase in the HCO
798:
622:The term "anion gap" usually implies "
309:
2587:
2148:
1441:
705:Expressed in words, the equation is:
630:is also a clinically useful measure.
46:make it understandable to non-experts
1373:
689:
20:
2747:Mixed disorder of acid-base balance
1788:The New England Journal of Medicine
1408:
1257:, intestinal obstruction and liver
1038:
13:
14:
2794:
2118:
1643:
1139:, or diabetes (and other causes).
896:High anion gap metabolic acidosis
889:
716:which is logically equivalent to:
652:
617:high anion gap metabolic acidosis
2106:
2012:
1954:
1887:10.1097/00003246-199811000-00019
1462:10.1097/00005792-197701000-00002
1198:A low anion gap is often due to
1193:
1031:accounts for the high anion gap.
791:and a number of serum proteins.
25:
2020:
1962:
1824:
1779:
1740:
1707:
1681:
1660:
1637:
1113:(RTA) also known as type 2 RTA)
2553:Fractional excretion of sodium
1650:Essentials of Human Physiology
1181:Mineralocorticoid deficiency (
1015:reabsorption. Accumulation of
914:Henderson-Hasselbalch equation
633:
595:(positively charged ions) and
1:
1567:Archives of Internal Medicine
1544:10.1016/S0022-2143(99)90190-7
1331:
1137:trimethoprim/sulfamethoxazole
669:) from the concentrations of
599:(negatively charged ions) in
586:comprehensive metabolic panel
2093:10.1164/ajrccm.162.6.9904099
1603:Kraut JA, Madias NE (2006).
771:found in multiple myeloma).
7:
2531:Effective renal plasma flow
2375:Intracellular fluid/Cytosol
2135:Metabolic acidosis by Merck
1394:10.1056/NEJM198010093031505
1359:10.1056/NEJM197710132971507
1314:
10:
2799:
2480:Glomerular filtration rate
2472:Assessment and measurement
2335:Atrial natriuretic peptide
2045:10.1016/j.ajem.2010.11.039
1930:10.1016/j.jcrc.2017.10.007
1646:"Section 7/7ch12/7ch12p51"
1579:10.1001/archinte.150.2.311
1164:total parenteral nutrition
1042:
904:, there is an increase in
893:
685:= ( + ) − ( + ) = 20 mEq/L
2739:
2709:
2687:
2630:
2621:
2563:Tubuloglomerular feedback
2545:
2490:Augmented renal clearance
2470:
2447:Bicarbonate buffer system
2405:
2363:
2317:
2310:
2273:
2227:
2196:
2186:
2176:Physiology of the kidneys
1849:10.1016/j.lab.2005.07.008
1765:10.1093/clinchem/29.2.279
1045:Normal anion gap acidosis
828:Interpretation and causes
118:
2778:Electrolyte disturbances
2452:Respiratory compensation
2214:Clearance of medications
1917:Journal of Critical Care
809:ion-selective electrodes
731:" or "carbon dioxide".)
2558:BUN-to-creatinine ratio
2293:Countercurrent exchange
1714:Sabatine, Mark (2011).
1060:hyperchloremic acidosis
734:
702:Normal AG = 8-16 mEq/L
2773:Acid–base disturbances
2655:Alcoholic ketoacidosis
1988:10.1186/1471-227X-8-18
1975:BMC Emergency Medicine
1875:Critical Care Medicine
1126:There are three types.
1111:renal tubular acidosis
2752:Acid–base homeostasis
2724:Contraction alkalosis
2650:Diabetic ketoacidosis
2495:Renal clearance ratio
2414:Darrow Yannet diagram
1940:20.500.14094/90004761
1800:10.1056/NEJMra1003327
940:Hazardous alcohol use
935:Diabetic ketoacidosis
908:due to metabolism of
807:Modern analyzers use
2520:Hemodialysis product
2500:Urea reduction ratio
2485:Creatinine clearance
2325:Antidiuretic hormone
2180:acid–base physiology
1622:10.2215/CJN.03020906
626:anion gap", but the
431:LIVER FUNCTION TESTS
2615:Acid–base disorders
2396:Transcellular fluid
2380:Extracellular fluid
2298:Filtration fraction
1695:on 21 November 2008
1490:on 21 November 2008
1269:Sample calculations
1247:Sample calculations
814:prediction interval
799:Normal value ranges
83:
2457:Renal compensation
2386:Interstitial fluid
1753:Clinical Chemistry
1255:nephrotic syndrome
613:metabolic acidosis
160:ARTERIAL BLOOD GAS
76:
2783:Medical mnemonics
2760:
2759:
2705:
2704:
2581:
2580:
2515:Dialysis adequacy
2510:Standardized Kt/V
2466:
2465:
2439:Winters's formula
2424:Davenport diagram
2407:Acid–base balance
2306:
2305:
1733:978-1-60831-905-3
1644:Nosek, Thomas M.
1285:= 102 mEq/L;
1282:= 137 mEq/L;
1183:Addison's disease
1160:Hyperalimentation
1150:Ammonium chloride
839:white blood cells
690:Without potassium
566:
565:
74:
73:
66:
2790:
2667:Normal anion gap
2628:
2627:
2608:
2601:
2594:
2585:
2584:
2536:Extraction ratio
2315:
2314:
2283:Renal blood flow
2209:Pharmacokinetics
2194:
2193:
2169:
2162:
2155:
2146:
2145:
2112:
2111:
2110:
2104:
2086:
2066:
2057:
2056:
2024:
2018:
2017:
2016:
2010:
2000:
1990:
1966:
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1959:
1958:
1952:
1942:
1932:
1908:
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1898:
1870:
1861:
1860:
1828:
1822:
1821:
1819:
1783:
1777:
1776:
1744:
1738:
1737:
1721:
1711:
1705:
1704:
1702:
1700:
1691:. Archived from
1685:
1679:
1678:
1676:
1674:
1664:
1658:
1657:
1652:. Archived from
1641:
1635:
1634:
1624:
1600:
1591:
1590:
1562:
1556:
1555:
1527:
1521:
1520:
1518:
1516:
1506:
1500:
1499:
1497:
1495:
1486:. Archived from
1480:
1474:
1473:
1445:
1439:
1438:
1436:
1434:
1427:Lab Tests Online
1419:
1406:
1405:
1377:
1371:
1370:
1342:
1294:= 0.6 g/dL.
1291:= 4.4 g/dL;
1288:= 24 mEq/L;
1227:paraproteinaemia
1219:multiple myeloma
1109:(i.e., proximal
1108:
1107:
1089:
1088:
1079:Gastrointestinal
1073:
1072:
1057:
1056:
1039:Normal anion gap
1014:
1013:
960:Propylene glycol
884:
883:
875:
874:
866:
865:
849:
848:
782:
781:
758:
757:
643:milliequivalents
321:SERUM OSMOLARITY
130:
121:
84:
75:
69:
62:
58:
55:
49:
29:
28:
21:
2798:
2797:
2793:
2792:
2791:
2789:
2788:
2787:
2763:
2762:
2761:
2756:
2735:
2701:
2683:
2617:
2612:
2582:
2577:
2541:
2462:
2401:
2359:
2311:Other functions
2302:
2288:Ultrafiltration
2269:
2223:
2219:Urine flow rate
2182:
2173:
2121:
2116:
2115:
2105:
2084:10.1.1.322.2433
2067:
2060:
2025:
2021:
2011:
1967:
1963:
1953:
1909:
1902:
1881:(11): 1807–10.
1871:
1864:
1829:
1825:
1794:(15): 1434–45.
1784:
1780:
1745:
1741:
1734:
1718:Pocket Medicine
1712:
1708:
1698:
1696:
1687:
1686:
1682:
1672:
1670:
1668:"The Anion Gap"
1666:
1665:
1661:
1656:on 23 May 2016.
1642:
1638:
1601:
1594:
1563:
1559:
1528:
1524:
1514:
1512:
1508:
1507:
1503:
1493:
1491:
1482:
1481:
1477:
1446:
1442:
1432:
1430:
1421:
1420:
1409:
1382:N. Engl. J. Med
1378:
1374:
1347:N. Engl. J. Med
1343:
1339:
1334:
1317:
1271:
1243:hypoalbuminemia
1235:
1200:hypoalbuminemia
1196:
1106:
1103:
1102:
1101:
1087:
1084:
1083:
1082:
1071:
1068:
1067:
1066:
1055:
1052:
1051:
1050:
1047:
1041:
1012:
1009:
1008:
1007:
955:Ethylene glycol
925:Lactic acidosis
898:
892:
882:
879:
878:
877:
873:
870:
869:
868:
864:
861:
860:
859:
847:
844:
843:
842:
837:(also known as
830:
801:
780:
777:
776:
775:
756:
753:
752:
751:
737:
730:
692:
655:
636:
628:urine anion gap
288:
252:
247:
237:
232:
202:
197:
187:
182:
172:
145:
128:
127:
122:
119:
78:Pathophysiology
70:
59:
53:
50:
42:help improve it
39:
30:
26:
17:
12:
11:
5:
2796:
2786:
2785:
2780:
2775:
2758:
2757:
2755:
2754:
2749:
2743:
2741:
2737:
2736:
2734:
2733:
2728:
2727:
2726:
2715:
2713:
2707:
2706:
2703:
2702:
2700:
2699:
2693:
2691:
2685:
2684:
2682:
2681:
2680:
2679:
2674:
2672:Hyperchloremic
2664:
2663:
2662:
2657:
2652:
2647:
2640:High anion gap
2636:
2634:
2625:
2619:
2618:
2611:
2610:
2603:
2596:
2588:
2579:
2578:
2576:
2575:
2570:
2565:
2560:
2555:
2549:
2547:
2543:
2542:
2540:
2539:
2533:
2524:
2523:
2522:
2512:
2507:
2502:
2497:
2492:
2487:
2482:
2476:
2474:
2468:
2467:
2464:
2463:
2461:
2460:
2459:
2454:
2449:
2441:
2436:
2426:
2421:
2416:
2411:
2409:
2403:
2402:
2400:
2399:
2393:
2388:
2382:
2369:
2367:
2361:
2360:
2358:
2357:
2355:Prostaglandins
2352:
2347:
2345:Erythropoietin
2342:
2337:
2332:
2327:
2321:
2319:
2312:
2308:
2307:
2304:
2303:
2301:
2300:
2295:
2290:
2285:
2279:
2277:
2271:
2270:
2268:
2267:
2262:
2257:
2252:
2247:
2242:
2237:
2231:
2229:
2225:
2224:
2222:
2221:
2216:
2211:
2206:
2200:
2198:
2191:
2184:
2183:
2172:
2171:
2164:
2157:
2149:
2143:
2142:
2137:
2132:
2127:
2120:
2119:External links
2117:
2114:
2113:
2077:(6): 2246–51.
2058:
2019:
1961:
1900:
1862:
1823:
1778:
1739:
1732:
1706:
1680:
1659:
1636:
1615:(1): 162–174.
1592:
1557:
1538:(6): 597–604.
1522:
1501:
1475:
1440:
1407:
1372:
1336:
1335:
1333:
1330:
1329:
1328:
1323:
1316:
1313:
1309:
1308:
1305:
1296:
1295:
1292:
1289:
1286:
1283:
1270:
1267:
1234:
1231:
1195:
1192:
1187:
1186:
1179:
1176:
1171:Some cases of
1169:
1168:
1167:
1162:fluids (i.e.,
1157:
1143:
1142:
1141:
1140:
1133:
1130:
1127:
1121:
1120:
1117:
1114:
1104:
1095:
1085:
1069:
1053:
1043:Main article:
1040:
1037:
1033:
1032:
1010:
1004:Kidney failure
1001:
1000:
999:
993:
988:
983:
977:
972:
967:
962:
957:
952:
944:
943:
942:
937:
927:
894:Main article:
891:
890:High anion gap
888:
880:
871:
862:
845:
829:
826:
800:
797:
778:
754:
736:
733:
728:
725:
724:
720:
719:
718:
717:
711:
710:
700:
699:
691:
688:
687:
686:
654:
653:With potassium
651:
635:
632:
619:is diagnosed.
564:
563:
557:
551:
545:
538:
537:
528:
527:
521:
519:
513:
506:
505:
499:
493:
491:
488:
487:
481:
475:
469:
462:
461:
455:
449:
443:
436:
435:
418:
417:
411:
405:
399:
392:
391:
385:
379:
373:
366:
365:
356:
355:
349:
343:
337:
330:
329:
316:
315:
313:
307:
301:
294:
293:
291:
286:
282:
276:
269:
268:
262:
261:
255:
250:
245:
240:
235:
230:
225:
222:
221:
212:
211:
205:
200:
195:
190:
185:
180:
175:
170:
165:
164:
155:
154:
148:
143:
139:
132:
131:
117:
111:
105:
98:
97:
72:
71:
33:
31:
24:
15:
9:
6:
4:
3:
2:
2795:
2784:
2781:
2779:
2776:
2774:
2771:
2770:
2768:
2753:
2750:
2748:
2745:
2744:
2742:
2738:
2732:
2729:
2725:
2722:
2721:
2720:
2717:
2716:
2714:
2712:
2708:
2698:
2695:
2694:
2692:
2690:
2686:
2678:
2677:Renal tubular
2675:
2673:
2670:
2669:
2668:
2665:
2661:
2658:
2656:
2653:
2651:
2648:
2646:
2643:
2642:
2641:
2638:
2637:
2635:
2633:
2629:
2626:
2624:
2620:
2616:
2609:
2604:
2602:
2597:
2595:
2590:
2589:
2586:
2574:
2571:
2569:
2566:
2564:
2561:
2559:
2556:
2554:
2551:
2550:
2548:
2544:
2537:
2534:
2532:
2528:
2527:PAH clearance
2525:
2521:
2518:
2517:
2516:
2513:
2511:
2508:
2506:
2503:
2501:
2498:
2496:
2493:
2491:
2488:
2486:
2483:
2481:
2478:
2477:
2475:
2473:
2469:
2458:
2455:
2453:
2450:
2448:
2445:
2444:
2442:
2440:
2437:
2434:
2430:
2427:
2425:
2422:
2420:
2417:
2415:
2412:
2410:
2408:
2404:
2397:
2394:
2392:
2389:
2387:
2383:
2381:
2378:
2377:
2376:
2372:
2368:
2366:
2365:Fluid balance
2362:
2356:
2353:
2351:
2348:
2346:
2343:
2341:
2338:
2336:
2333:
2331:
2328:
2326:
2323:
2322:
2320:
2316:
2313:
2309:
2299:
2296:
2294:
2291:
2289:
2286:
2284:
2281:
2280:
2278:
2276:
2272:
2266:
2263:
2261:
2260:Oligopeptides
2258:
2256:
2253:
2251:
2248:
2246:
2243:
2241:
2238:
2236:
2233:
2232:
2230:
2226:
2220:
2217:
2215:
2212:
2210:
2207:
2205:
2202:
2201:
2199:
2195:
2192:
2190:
2185:
2181:
2177:
2170:
2165:
2163:
2158:
2156:
2151:
2150:
2147:
2141:
2138:
2136:
2133:
2131:
2128:
2126:
2123:
2122:
2109:
2102:
2098:
2094:
2090:
2085:
2080:
2076:
2072:
2065:
2063:
2054:
2050:
2046:
2042:
2038:
2034:
2030:
2023:
2015:
2008:
2004:
1999:
1994:
1989:
1984:
1980:
1976:
1972:
1965:
1957:
1950:
1946:
1941:
1936:
1931:
1926:
1922:
1918:
1914:
1907:
1905:
1896:
1892:
1888:
1884:
1880:
1876:
1869:
1867:
1858:
1854:
1850:
1846:
1843:(6): 317–20.
1842:
1838:
1834:
1827:
1818:
1813:
1809:
1805:
1801:
1797:
1793:
1789:
1782:
1774:
1770:
1766:
1762:
1759:(2): 279–83.
1758:
1754:
1750:
1743:
1735:
1729:
1725:
1720:
1719:
1710:
1694:
1690:
1684:
1669:
1663:
1655:
1651:
1647:
1640:
1632:
1628:
1623:
1618:
1614:
1610:
1606:
1599:
1597:
1588:
1584:
1580:
1576:
1572:
1568:
1561:
1553:
1549:
1545:
1541:
1537:
1533:
1526:
1511:
1505:
1489:
1485:
1479:
1471:
1467:
1463:
1459:
1455:
1451:
1444:
1428:
1424:
1418:
1416:
1414:
1412:
1403:
1399:
1395:
1391:
1388:(15): 854–8.
1387:
1383:
1376:
1368:
1364:
1360:
1356:
1353:(15): 814–7.
1352:
1348:
1341:
1337:
1327:
1324:
1322:
1319:
1318:
1312:
1306:
1303:
1302:
1301:
1300:
1299:Calculations:
1293:
1290:
1287:
1284:
1281:
1280:
1279:
1278:
1274:
1266:
1262:
1260:
1256:
1252:
1248:
1244:
1240:
1230:
1228:
1224:
1220:
1215:
1213:
1209:
1205:
1201:
1194:Low anion gap
1191:
1184:
1180:
1177:
1174:
1170:
1165:
1161:
1158:
1156:, ifosfamide.
1155:
1154:acetazolamide
1151:
1148:
1147:
1145:
1144:
1138:
1134:
1131:
1128:
1125:
1124:
1123:
1122:
1118:
1115:
1112:
1099:
1096:
1093:
1080:
1077:
1076:
1075:
1063:
1061:
1046:
1036:
1030:
1026:
1022:
1018:
1005:
1002:
997:
994:
992:
989:
987:
984:
981:
978:
976:
973:
971:
968:
966:
963:
961:
958:
956:
953:
951:
948:
947:
945:
941:
938:
936:
933:
932:
931:
928:
926:
923:
922:
921:
918:
915:
911:
907:
903:
897:
887:
857:
852:
840:
836:
825:
822:
817:
815:
810:
805:
796:
792:
790:
786:
772:
770:
766:
760:
748:
746:
740:
732:
722:
721:
715:
714:
713:
712:
708:
707:
706:
703:
697:
696:
695:
684:
683:
682:
680:
676:
672:
668:
664:
660:
650:
648:
644:
639:
631:
629:
625:
620:
618:
614:
610:
606:
602:
598:
594:
589:
587:
583:
579:
575:
571:
561:
558:
555:
552:
549:
546:
543:
540:
539:
536:
534:
529:
525:
522:
520:
517:
514:
511:
508:
507:
503:
500:
497:
494:
492:
490:
489:
485:
482:
479:
476:
473:
470:
467:
464:
463:
459:
456:
453:
450:
447:
444:
441:
438:
437:
434:
432:
428:
424:
419:
415:
412:
409:
406:
403:
400:
397:
394:
393:
389:
386:
383:
380:
377:
374:
371:
368:
367:
364:
362:
357:
353:
350:
347:
344:
341:
338:
335:
332:
331:
328:
326:
322:
317:
314:
311:
308:
305:
302:
299:
296:
295:
292:
289:
283:
280:
277:
274:
271:
270:
267:
263:
259:
256:
253:
244:
241:
238:
229:
226:
224:
223:
220:
218:
213:
209:
206:
203:
194:
191:
188:
179:
176:
173:
167:
166:
163:
161:
156:
152:
149:
146:
140:
137:
134:
133:
125:
115:
112:
109:
106:
103:
100:
99:
96:
94:
90:
85:
82:
81:sample values
79:
68:
65:
57:
47:
43:
37:
34:This article
32:
23:
22:
19:
2645:Ketoacidosis
2428:
2235:Solvent drag
2228:Reabsorption
2074:
2070:
2039:(3): 391–8.
2036:
2032:
2022:
1978:
1974:
1964:
1920:
1916:
1878:
1874:
1840:
1836:
1826:
1791:
1787:
1781:
1756:
1752:
1742:
1717:
1709:
1697:. Retrieved
1693:the original
1683:
1671:. Retrieved
1662:
1654:the original
1649:
1639:
1612:
1608:
1573:(2): 311–3.
1570:
1566:
1560:
1535:
1531:
1525:
1513:. Retrieved
1504:
1492:. Retrieved
1488:the original
1478:
1456:(1): 38–54.
1453:
1449:
1443:
1431:. Retrieved
1426:
1385:
1381:
1375:
1350:
1346:
1340:
1310:
1298:
1297:
1276:
1275:
1272:
1263:
1236:
1216:
1197:
1188:
1173:ketoacidosis
1064:
1048:
1034:
930:Ketoacidosis
919:
899:
853:
831:
818:
806:
802:
793:
773:
769:paraproteins
761:
749:
744:
741:
738:
726:
704:
701:
693:
656:
640:
637:
621:
590:
577:
573:
569:
567:
531:
421:
359:
319:
265:
217:ALVEOLAR GAS
215:
158:
93:ELECTROLYTES
87:
60:
51:
35:
18:
2731:Respiratory
2697:Respiratory
2689:Respiratory
2568:Natriuresis
2433:Delta ratio
2419:Base excess
2330:Aldosterone
1923:: 101–10 .
1515:14 November
1494:14 November
1433:10 November
1326:Delta ratio
1212:bicarbonate
1146:Ingestions
1100:loss of HCO
1081:loss of HCO
965:Lactic acid
917:anion gap.
821:colorimetry
663:bicarbonate
634:Calculation
582:electrolyte
2767:Categories
2443:Buffering
2371:Body water
2350:Calcitriol
2275:Filtration
1981:(18): 18.
1332:References
1251:hemorrhage
1021:phosphates
980:Phenformin
835:leukocytes
698:= - ( + )
361:URINALYSIS
54:April 2010
2719:Metabolic
2711:Alkalosis
2632:Metabolic
2429:Anion gap
2204:Clearance
2197:Secretion
2187:Creating
2079:CiteSeerX
1699:4 October
1673:4 October
1321:Osmol gap
1259:cirrhosis
1029:hippurate
991:Isoniazid
906:ketoacids
675:potassium
570:anion gap
560:CSF/S glu
554:CSF/S alb
2623:Acidosis
2318:Hormones
2245:Chloride
2101:11112147
2053:21277142
2007:19087326
1949:29080515
1857:16310513
1808:25295502
1631:17699401
1552:10360635
1450:Medicine
1315:See also
1208:chloride
1092:diarrhea
1017:sulfates
950:Methanol
946:Toxins:
902:diabetes
867:, and SO
789:sulfates
787:include
765:proteins
659:chloride
306:= −0.36
2265:Protein
2255:Glucose
1998:2644323
1895:9824071
1817:1675324
1773:6821931
1587:2302006
1402:6774247
1239:albumin
1204:Albumin
1090:(i.e.,
1065:The HCO
996:Cyanide
975:Aspirin
910:ketones
856:lactate
679:cations
593:cations
548:CSF glu
542:CSF alb
496:AST/ALT
423:PROTEIN
404:= 1.01
390:= 0.95
336:= 300
210:= 7.40
40:Please
2660:Lactic
2391:Plasma
2240:Sodium
2099:
2081:
2051:
2005:
1995:
1947:
1893:
1855:
1814:
1806:
1771:
1730:
1629:
1585:
1550:
1470:401925
1468:
1400:
1367:895822
1365:
1098:Kidney
1027:, and
970:Uremia
785:anions
671:sodium
667:anions
605:plasma
597:anions
562:= 0.6
556:= 7.5
518:= 1.0
512:= 3.0
510:AF alb
504:= 0.2
498:= 0.6
486:= 0.5
474:= 4.0
460:= 0.7
448:= 7.6
442:= 100
416:= 800
378:= 100
352:BUN:Cr
342:= 295
281:= 2.0
275:= 9.5
266:OTHER:
254:= 105
153:= 1.0
110:= 100
104:= 140
2740:Other
2573:Urine
2546:Other
2340:Renin
2189:urine
1812:S2CID
1277:Data:
1025:urate
647:liter
624:serum
609:urine
607:, or
601:serum
550:= 60
544:= 30
526:= 60
480:= 40
468:= 71
454:= 25
410:= 60
398:= 25
372:= 80
354:= 20
325:RENAL
312:= 16
300:= 55
260:= 10
258:A-a g
239:= 36
204:= 95
189:= 40
174:= 24
147:= 22
126:= 150
116:= 20
2505:Kt/V
2250:Urea
2178:and
2097:PMID
2049:PMID
2003:PMID
1945:PMID
1891:PMID
1853:PMID
1804:PMID
1769:PMID
1728:ISBN
1726:–3.
1701:2008
1675:2008
1627:PMID
1583:PMID
1548:PMID
1517:2008
1496:2008
1466:PMID
1435:2015
1398:PMID
1363:PMID
1210:and
1152:and
986:Iron
735:Uses
673:and
661:and
578:AGAP
568:The
516:SAAG
458:TBIL
388:FENa
384:= 5
348:= 5
290:= 1
138:= 4
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2075:162
2041:doi
1993:PMC
1983:doi
1935:hdl
1925:doi
1883:doi
1845:doi
1841:146
1796:doi
1792:371
1761:doi
1617:doi
1575:doi
1571:150
1540:doi
1536:133
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1390:doi
1386:303
1355:doi
1351:297
1229:).
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745:not
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478:ALT
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346:POG
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