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The cations calcium (Ca 2+) and magnesium (Mg 2+) are also commonly measured, but they aren't used to calculate the anion gap. Anions that are generally considered "unmeasured" include a few normally occurring serum proteins , and some pathological proteins (e.g., paraproteins found in multiple myeloma).
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.
The anion gap can be increased due to relatively low levels of cations other than sodium and potassium (e.g. calcium or magnesium). An anion gap is usually considered to be high if it is over 12 mEq/L. High anion gap metabolic acidosis is typically caused by acid produced by the body. More rarely, it may be caused by ingesting methanol or ...
Base excess is defined as the amount of strong acid that must be added to each liter of fully oxygenated blood to return the pH to 7.40 at a temperature of 37°C and a pCO 2 of 40 mmHg (5.3 kPa). [2] A base deficit (i.e., a negative base excess) can be correspondingly defined by the amount of strong base that must be added.
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. Winters's formula gives an expected value for the patient's P CO 2; the patient's actual (measured) P CO 2 is then compared to this ...
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).
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A basic metabolic panel including calcium is sometimes colloquially referred to as a "CHEM-8". Calcium, as an alkaline earth metal , is also an electrolyte, but abnormalities are more commonly associated with malnutrition, osteoporosis , or malignancy , especially of the thyroid .