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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.
By itself, low albumin levels are associated with increased mortality rate in the general population. [8] In disease states specifically, hypoalbuminemia has been used a predictive factor for poor outcomes in a number of conditions, [3] including periprosthetic joint infection treatment failure, [13] and cirrhosis. [8]
The reference range for total protein is typically 60-80g/L. (It is also sometimes reported as "6.0-8.0g/dl"), [2] but this may vary depending on the method of analysis. Concentrations below the reference range usually reflect low albumin concentration, for instance in liver disease or acute infection.
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.
Serum glucose levels are measured to document the degree of hypoglycemia. Serum electrolytes calculate the anion gap to determine the 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]
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).
Malabsorption, often caused by celiac disease or inflammatory bowel disease; Liver disease can also cause hypoproteinemia by decreasing synthesis of plasma proteins like albumin. Renal disease like nephrotic syndrome can also result in hypoproteinemia because plasma proteins are lost in the urine.
Other causes [citation needed] Ingestion of ammonium chloride, hydrochloric acid, or other acidifying salts; The treatment and recovery phases of diabetic ketoacidosis; Volume resuscitation with 0.9% normal saline provides a chloride load, so that infusing more than 3–4L can cause acidosis; Hyperalimentation (i.e., total parenteral nutrition)