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Anion gap can be classified as either high, normal or, in rare cases, low. Laboratory errors need to be ruled out whenever anion gap calculations lead to results that do not fit the clinical picture. Methods used to determine the concentrations of some of the ions used to calculate the anion gap may be susceptible to very specific errors.
Result 1: if there is a normal anion gap acidosis, the (AG – 12) part of the equation will be close to zero, the delta ratio will be close to zero and there is no mixed acid–base disorder. Your calculations can stop here. A normal anion gap acidosis (NAGMA) has more to do with a change in [Cl −] or [HCO − 3] concentrations.
The serum anion gap is useful for determining whether a base deficit is caused by addition of acid or loss of bicarbonate. Base deficit with elevated anion gap indicates addition of acid (e.g., ketoacidosis). Base deficit with normal anion gap indicates loss of bicarbonate (e.g., diarrhea).
pcr = 1.0 arterial blood gas: hco 3 − = 24 p a co 2 = 40 p a o 2 = 95 ph = 7.40 alveolar gas: p a co 2 = 36 p a o 2 = 105 a-a g = 10 other: ca = 9.5 mg 2+ = 2.0 po 4 = 1 ck = 55 be = −0.36 ag = 16 serum osmolarity/renal: pmo = 300 pco = 295 pog = 5 bun:cr = 20 urinalysis: una + = 80 ucl − = 100 uag = 5 fena = 0.95 uk + = 25 usg = 1.01 ucr ...
As calculated by the Henderson–Hasselbalch equation, in order to maintain a normal pH of 7.4 in the blood (whereby the pK a of carbonic acid is 6.1 at physiological temperature), a 20:1 ratio of bicarbonate to carbonic acid must constantly be maintained; this homeostasis is mainly mediated by pH sensors in the medulla oblongata of the brain ...
Elevated protein (albumin, globulins) may theoretically increase the anion gap but high levels are not usually encountered clinically. Hypoalbuminaemia, which is frequently encountered clinically, will mask an anion gap. As a rule of thumb, a decrease in serum albumin by 1 G/L will decrease the anion gap by 0.25 mmol/L [citation needed]
The bicarbonate ion (hydrogencarbonate ion) is an anion with the empirical formula HCO − 3 and a molecular mass of 61.01 daltons; it consists of one central carbon atom surrounded by three oxygen atoms in a trigonal planar arrangement, with a hydrogen atom attached to one of the oxygens.
Winters's formula, [1] named after R. W. Winters, [2] is a formula used to evaluate respiratory compensation when analyzing acid-base disorders in the presence of metabolic acidosis. [ 3 ] [ 4 ] It can be given as: