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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.
High anion gap metabolic acidosis is typically caused by acid produced by the body. More rarely, it may be caused by ingesting methanol or overdosing on aspirin . [ 1 ] [ 2 ] The delta ratio is a formula that can be used to assess elevated anion gap metabolic acidosis and to evaluate whether mixed acid base disorder (metabolic acidosis) is present.
The anion gap (AG) without potassium is calculated first and if a metabolic acidosis is present, results in either a high anion gap metabolic acidosis (HAGMA) or a normal anion gap acidosis (NAGMA). A low anion gap is usually an oddity of measurement, rather than a clinical concern.
As with any buffer system, the pH is balanced by the presence of both a weak acid (for example, H 2 CO 3) and its conjugate base (for example, HCO − 3) so that any excess acid or base introduced to the system is neutralized.
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).
One difficulty in evaluation acid-base derangements is the presence of multiple pathologies. A patient may present with a metabolic acidosis process alone, but they may also have a concomitant respiratory acidosis.
Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and an increase in plasma chloride concentration [1] (see anion gap for a fuller explanation).
An air purifier or air cleaner is a device which removes contaminants from the air in a room to improve indoor air quality. These devices are commonly marketed as being beneficial to allergy sufferers and asthmatics , and at reducing or eliminating second-hand tobacco smoke .
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