Anion Gap and Osmolar Gap (High): Difference between revisions

Latest revision as of 11:56, 23 July 2016

AG = Na - (Cl + HCO3)

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)

Osmolal Gap = measured osm - calculated osm

C-Cyanide
A-ASA, Alcohol
T-Toluene
M-Methanol, Metformin
U-Uremia
D-DKA
P-Paraldehyde, Post-ictal lactic acidosis (transient, 60-90 min), Phenformin (withdrawn in 1970s)
I-Iron, INH, Inhalants, Inborn Errors
L-Lactic Acidosis
E-Ethylene glycol, Ethanol
R-Rhabdomyolysis
S-Salicylates, Solvents, Starvation

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)	-	-	-

Authors:

@@ Line 1: / Line 1: @@
-==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===
+*[[Methanol Poisoning|Methanol]]
+*[[Ethylene Glycol Poisoning|Ethanol glycol]]
+*[[Aspirin (Salicylate) Toxicity]]
+*[[Iron Toxicity|Iron]]
+*[[INH]]
+*Paraldehyde
+*[[Alcoholic Ketoacidosis]]
+*Inhalants - [[CN]], [[CO]], [[Hydrogen Sulfide]]
+*Toluene
-TOXICOLOGICAL
+===Non-Toxicological===
+*[[Lactic Acidosis]]
+*[[DKA]]
+*[[Uremia]]
-methanol
+{{CAT MUDPILERS}}
-ethanol glycol
+==Evaluation==
+{{Toxic Alcohols Anion/Osmolar Gaps}}
-salicylates
+==See Also==
+*[[Osmolal or Osmolar Gap]]
+*[[Anion Gap (High)]]
+*[[Toxidromes]]
-iron
+==External Links==
+*[http://www.mdcalc.com/serum-osmolality-osmolarity/ MDCalc - Serum Osmolality/Osmolarity]
+*[http://www.mdcalc.com/anion-gap/ MDCalc - Anion Gap]
-inh
+==References==
+<references/>
-paraldehyde
+[[Category:FEN]]
+[[Category:Toxicology]]
-alcoholic ketoacidosis
-inhalants- CN, CO, H2S
-toluene
-NONTOX
-lactic acidosis
-dm ketoacidosis
-uremia
-MUDPILES
-M- methanol
-U- uremia
-D- dka
-P- paraldehyde
-I- iron. inh
-L- lactic acidosis
-E- ethylene glycol
-S- salicylates
-==Source==
-MISTRY 6/06
-[[Category:Tox]]