Anion Gap and Osmolar Gap (High): Difference between revisions
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==DDx==
==Calculations==
===Anion Gap===
AG = Na - (Cl  +  HCO3)
===Calculated Osm===
Calculated Osm = 2 x Na + (glu/18) + (BUN/2.8) + (ethanol/4.6) + (methanol/2.6) + (ethylene glycol/5) + (acetone/5.5) + (isopropanol/5.9)
*Normal = 275-295
===Osmolal Gap===
Osmolal Gap = measured osm - calculated osm
*Normal = (-)14-10 mOsm/L
 
==Differential Diagnosis==
===Toxicological===
===Toxicological===
#Methanol
*[[Methanol Poisoning|Methanol]]
#Ethanol glycol
*[[Ethylene Glycol Poisoning|Ethanol glycol]]
#Salicylates
*[[Aspirin (Salicylate) Toxicity]]
#Iron
*[[Iron Toxicity|Iron]]
#Inh
*[[INH]]
#Paraldehyde
*Paraldehyde
#Alcoholic ketoacidosis
*[[Alcoholic Ketoacidosis]]
#Inhalants - CN, CO, H2S
*Inhalants - [[CN]], [[CO]], [[Hydrogen Sulfide]]
#Toluene
*Toluene


===Non-Toxicological===
===Non-Toxicological===
#Lactic acidosis
*[[Lactic Acidosis]]
#DKA
*[[DKA]]
#Uremia
*[[Uremia]]


===MUDPILES===
{{CAT MUDPILERS}}
*M-Methanol
 
*U-Uremia
==Evaluation==
*D-DKA
{{Toxic Alcohols Anion/Osmolar Gaps}}
*P-Paraldehyde
*I-Iron, INH
*L-Lactic acidosis
*E-Ethylene glycol, ethanol
*S-Salicylates


==See Also==
==See Also==
*[[Osmolal or Osmolar Gap]]
*[[Osmolal or Osmolar Gap]]
*[[Anion Gap (High)]]
*[[Anion Gap (High)]]
*[[Toxidromes]]
==External Links==
*[http://www.mdcalc.com/serum-osmolality-osmolarity/ MDCalc - Serum Osmolality/Osmolarity]
*[http://www.mdcalc.com/anion-gap/ MDCalc - Anion Gap]


==Source==
==References==
MISTRY 6/06
<references/>


[[Category:FEN]]
[[Category:FEN]]
[[Category:Tox]]
[[Category:Toxicology]]

Latest revision as of 11:56, 23 July 2016

Calculations

Anion Gap

AG = Na - (Cl + HCO3)

Calculated Osm

Calculated Osm = 2 x Na + (glu/18) + (BUN/2.8) + (ethanol/4.6) + (methanol/2.6) + (ethylene glycol/5) + (acetone/5.5) + (isopropanol/5.9)

  • Normal = 275-295

Osmolal Gap

Osmolal Gap = measured osm - calculated osm

  • Normal = (-)14-10 mOsm/L

Differential Diagnosis

Toxicological

Non-Toxicological

CAT MUDPILERS

Evaluation

Toxic Alcohols Anion/Osmolar Gaps

Osmolar gap Metabolic acidosis Osmolar gap Anion gap Ketones Ca Oxolate stones Reduced vision Management
Ethanol + + + (if ketoacidosis) + - Mainly supportive
Ethylene glycol + + + - + - Fomepizole, Thiamine, Pyridoxine, +/- Dialysis
Methanol + + (early on, then disappears) + - - + Fomepizole or ethanol, Folinic acid, +/- Dialysis
Isopropyl alcohol - + - + - + Mainly supportive
Propylene gylcol + + (initially) + (converted to lactate) - - -

See Also

External Links

References

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