Anion gap: Difference between revisions
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*Toluene | *Toluene | ||
*Chronic [[acetaminophen]] use | *Chronic [[acetaminophen]] use | ||
KILR | |||
*K – Ketoacidosis - ([[Diabetic ketoacidosis (DKA)|diabetic]], [[Alcoholic ketoacidosis|Alcohol]], Starvation) | |||
*I – Ingestion - ([[Aspirin (Salicylate) Toxicity|Salicylates]], [[Acetaminophen]], [[Methanol]], [[Ethylene glycol]], [[Carbon monoxide toxicity|CO]], [[Cyanide|CN]], [[Iron toxicity|Iron]], [[INH toxicity|INH]]) | |||
*L – [[Lactic acidosis]] - (infection, hemorrhage, hypoperfusion, [[Alcohol]], [[Metformin]]) | |||
*R – Renal - ([[Uremia]]) | |||
==Low Anion Gap== | ==Low Anion Gap== | ||
Revision as of 02:34, 18 August 2015
Background
AG = Na - (Cl + HCO3)
Normal Anion Gap = 12+/-4 (8-16)
Cutoffs for "normal" Anion Gap are laboratory and equipment specific. Newer technology and equipment have been shown to measure "low" AG in otherwise normal, healthy people.[1][2]
Elevated Anion Gap
Differential Diagnosis
MUDPILES
- M - Methanol
- U - Uremia
- D - DKA
- P - Paraldehyde
- I - Iron, INH
- L - Lactic acidosis
- E - Ethylene glycol
- S - Salicylates
Also:
- Starvation/ETOH ketoacidosis
- Carbon Monoxide (CO), CN poisoning (increased lactate)
- Toluene
- Chronic acetaminophen use
KILR
- K – Ketoacidosis - (diabetic, Alcohol, Starvation)
- I – Ingestion - (Salicylates, Acetaminophen, Methanol, Ethylene glycol, CO, CN, Iron, INH)
- L – Lactic acidosis - (infection, hemorrhage, hypoperfusion, Alcohol, Metformin)
- R – Renal - (Uremia)
Low Anion Gap
Differential Diagnosis
- Lab error
- Decreased "unmeasured" anions
- Hypoalbuminemia
- Increased "unmeasured" cations
- Increased cationic paraprotein
- Multiple myeloma
- Polyclonal IgG gammopathy
- Pseudo
- Severe Hypernatremia (>170 meq/L)
- True conc of Na is underestimated
- Marked hyperlipidemia
- Leads to overestimation of plasma Cl conc)
- Elevated serum bromide (e.g. for myasthenia gravis and some herbal medications)
- Assay mistakenly reads Br as Cl
- Elevated serum iodide
- Severe Hypernatremia (>170 meq/L)
- AG falls by 2.5 meq/L for every 1 g/dL reduction in albumin concentration
See Also
Anion Gap and Osmolar Gap (High)