ANIONIC GAP

Defination and types of anionic gap

 Metabolic Acidosis -- Anion Gap
 If you determine that your patient has
a primary metabolic acidosis (low pH
with low HCO3), the next step is
to calculate the anion gap because
the anion gap helps you determine the
etiology of the metabolic acidosis.
 The anion gap is the difference between the
measured serum cations (positively charged
particles) and the measured serum anions
(negatively charged particles). The commonly
measured cation is sodium and the measured
anions include chloride and bicarbonate.

 Anion gap = [Na+] - ([Cl-] + [HCO3-])

 The normal anion gap is 8-12. An anion
gap of greater than 12 is "increased".

The differential diagnosis for an

elevated anion gap metabolic acidosis
(simply called "anion gap acidosis")
differs from the differential diagnosis for
an non-elevated anion gap metabolic
acidosis (simply called "non-anion gap
acidosis").
Anion gap metabolic acidosis
 "MUDPILES"
Methanol intoxication
Uremia
Diabetic or alcoholic ketoacidosis
Paraldehyde
Isoniazid or Iron overdose
Lactic acid
Ethylene glycol intoxication
Salicylate intoxication
Non-anion gap metabolic
acidosis
 Renal tubular acidosis
 Diarrhea
 Gastrointestinal fistula
 Post-hyperventilation
 Post-anion gap acidosis