Anion gap: Difference between revisions
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===DDx=== | ===DDx=== | ||
MUDPILES | MUDPILES | ||
*M - Methanol | *M - [[Methanol]] | ||
*U - Uremia | *U - [[Uremia]] | ||
*D - DKA | *D - [[Diabetic Ketoacidosis (DKA)|DKA]] | ||
*P - Paraldehyde | *P - Paraldehyde | ||
*I - Iron, INH | *I - [[Iron Toxicity|Iron]], INH | ||
*L - Lactic acidosis | *L - [[Lactic acidosis]] | ||
*E - Ethylene glycol | *E - [[Ethylene glycol]] | ||
*S - Salicylates | *S - [[Aspirin (Salicylate) Toxicity|Salicylates]] | ||
Also: | Also: | ||
*Starvation/ETOH ketoacidosis | *Starvation/[[Alcoholic ketoacidosis|ETOH ketoacidosis]] | ||
*CO, CN poisoning (incr. lactate) | *[[Carbon monoxide toxicity| Carbon Monoxide (CO)]], [[Cyanide|CN poisoning]] (incr. lactate) | ||
*toluene | *toluene | ||
Revision as of 03:35, 27 February 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
DDx
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 (incr. lactate)
- toluene
Low Anion Gap
DDX
- 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)
- Bromide intoxication (e.g. for myasthenia gravis and some herbal medications)
- Machine mistakenly reads Br as Cl
- 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)