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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.
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).
Hyperparathyroidism – can cause hyperchloremia and increase renal bicarbonate loss, which may result in a normal anion gap metabolic acidosis. Patients with hyperparathyroidism may have a lower than normal pH, slightly decreased PaCO2 due to respiratory compensation, a decreased bicarbonate level, and a normal anion gap. [3]
Urine NH 4 + is difficult to measure directly, but its excretion is usually accompanied by the anion chloride. A negative urine anion gap can be used as evidence of increased NH 4 + excretion. In a metabolic acidosis without a serum anion gap: A positive urine anion gap suggests a low urinary NH 4 + (e.g. renal tubular acidosis).
The mnemonic "MUDPILES" is used to remember the causes of a high anion gap. [ 1 ] M - methanol / metformin U - uremia D - diabetic ketoacidosis P - paraldehyde / propylene glycol I - Infection / ischemia / isoniazid L - lactate E - ethylene glycol / ethanol S - salicylates / starvation
The Vietnamese Wikipedia initially went online in November 2002, with a front page and an article about the Internet Society.The project received little attention and did not begin to receive significant contributions until it was "restarted" in October 2003 [3] and the newer, Unicode-capable MediaWiki software was installed soon after.
Chữ Nôm (𡨸喃, IPA: [t͡ɕɨ˦ˀ˥ nom˧˧]) [5] is a logographic writing system formerly used to write the Vietnamese language.It uses Chinese characters to represent Sino-Vietnamese vocabulary and some native Vietnamese words, with other words represented by new characters created using a variety of methods, including phono-semantic compounds. [6]