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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.
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 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 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).
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.
Serum glucose levels are measured to document the degree of hypoglycemia. Serum electrolytes calculate the anion gap to determine presence of metabolic acidosis; typically, patients with glycogen-storage disease type 0 (GSD-0) have an anion gap in the reference range and no acidosis. See the Anion Gap calculator. [citation needed]
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Stool osmotic gap is a measurement of the difference in solute types between serum and feces, used to distinguish among different causes of diarrhea. Feces is normally in osmotic equilibrium with blood serum, which the human body maintains between 290–300 mOsm/kg. [ 1 ]