A Simple Estimate of the Effect of the Serum Albumin Level on the Anion Gap

Carvounis, Christos P.; Feinfeld, Donald A.

doi:10.1159/000013618

Cited by 36 publications

(16 citation statements)

References 5 publications

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“…Surprisingly, it is only within the last 13 years that a correction factor has been developed that can be introduced into clinical practice. These studies revealed that the anion gap is reduced by 2.3-2.5 mEq/L per gram of fall in serum albumin concentration, whereas it is increased to a similar degree with a rise in serum albumin concentration (21,22).…”

Section: Definition and Characterization Of The Normal Serum Anion Gapmentioning

confidence: 97%

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

Kraut

Nagami

2013

Clinical Journal of the American Society of Nephrology

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SummaryThe serum anion gap has been utilized to identify errors in the measurement of electrolytes, to detect paraproteins, and, most relevant to the nephrologist, to evaluate patients with suspected acid-base disorders. In regard to the latter purpose, traditionally an increased anion gap is identified when it exceeds the upper limit of normal for a particular clinical laboratory measurement. However, because there is a wide range of normal values (often 8-10 mEq/L), an increase in anion concentration can be present in the absence of an increased anion gap. In addition, the type of retained anion can affect the magnitude of the increase in anion gap relative to change in serum [HCO 3 2 ] being greater with lactic acidosis compared with ketoacidosis. This review examines the methods of calculation of the serum anion gap in textbooks and published literature, the effect of perturbations other than changes in acid-base balance, and its effectiveness in identifying mild and more severe disturbances in acidbase balance. Limitations of the present methods of determining the normal anion gap and change in the anion gap are highlighted. The possibility of identifying the baseline value for individuals to optimize the use of the calculation in the detection of metabolic acidosis is suggested.

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Section: Definition and Characterization Of The Normal Serum Anion Gapmentioning

confidence: 97%

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

Kraut

Nagami

2013

Clinical Journal of the American Society of Nephrology

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“…For every increase of 1 g per deciliter in the plasma albumin level, one should subtract 2.5 mmol per liter from the calculated value of the plasma anion gap. 4,5 Even with this adjustment, it appears that the net negative valence on albumin is increased when there is an appreciable decrease in the effective arterial blood volume, and hence there is a higher value for the plasma anion gap. 6 The relation between the increase (Δ) in the plasma anion gap and the decrease (Δ) in the plasma bicarbonate concentration -which is commonly referred to as delta-delta (Δ-Δ) -is used to provide an estimate of the magnitude of the acid load and to detect the presence of coexisting metabolic acid-base disorders.…”

Section: Pl a Sm A Bic A R Bonate A Nd The Pl A Sm A A Nion Ga Pmentioning

confidence: 99%

Acid–Base Problems in Diabetic Ketoacidosis

Kamel

Halperin

2015

N Engl J Med

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T h e ne w e ngl a nd jou r na l o f m e dicine n engl j med 372;6 nejm.org February 5, 2015 546 Review Article T his review focuses on three issues facing clinicians who care for patients with diabetic ketoacidosis; all of the issues are related to acid-base disorders. The first issue is the use of the plasma anion gap and the calculation of the ratio of the change in this gap to the change in the concentration of plasma bicarbonate in these patients; the second concerns the administration of sodium bicarbonate; and the third is the possible contribution of intracellular acidosis to the development of cerebral edema, particularly in children with diabetic ketoacidosis. In this article, we examine the available data and attempt to integrate the data with principles of physiology and metabolic regulation and provide clinical guidance. Pl a sm a Bic a r bonate a nd the Pl a sm a A nion Ga pThe accumulation of ketoacids in the extracellular fluid leads to a loss of bicarbonate anions and a gain of ketoacid anions. Because of hyperglycemia-induced osmotic diuresis and natriuresis, patients with diabetic ketoacidosis usually present with a marked contraction of the extracellular fluid volume. This factor affects the assessment of their acid-base status and in some cases their therapy.Determination of the severity of metabolic acidemia is usually based on the extent of the decrease in the plasma bicarbonate concentration. Nevertheless, as shown in the equation below, the plasma bicarbonate concentration may be only moderately reduced when there is both a large deficit of bicarbonate in the extracellular fluid and a severe contraction of the volume of extracellular fluid. The bicarbonate deficit becomes evident during reexpansion of the volume of extracellular fluid when saline is administered:Extracellular fluid bicarbonate concentration [HCO 3 − ] = extracellular fluid HCO 3 − content ÷ extracellular fluid volume.The addition of new anions is reflected in an increase in the plasma anion gap, 1,2 which is the difference between the concentration of the major cation in plasma (sodium) and the major anions in plasma (chloride and bicarbonate). This difference is due largely to the net anionic valence on plasma proteins, principally albumin. A pitfall in using the plasma anion gap is the failure to correct for the net negative valence attributable to plasma albumin. 3 This correction must be made not only when the plasma albumin concentration decreases but also when it increases; the latter may occur in patients with diabetic ketoacidosis because of the marked contraction in the volume of extracellular fluid. For every decrease of 1 g per deciliter in the plasma albumin concentration from its normal value of 4 g per deciliter, one should add 2.5 mmol per liter to the calculated value of the plasma anion gap. For every increase of 1 g per deciliter in the plasma albumin level, one should subtract 2.5 mmol per liter from the calculated value of the plasma anion gap. 4,5 Even with this adjustment, it appears that the net neg...

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“…Kritik hasta grubunda hipoalbüminemi ile azalmış anyon gap birlikteliği literatürde önemli bir yer tutmaktadır (6)(7)(8). Fedman ve arkadaşları 1ay-102 yaş aralığında albumin çalışılan 5328 hastayı incelemiş ve hiperalbuminemi saptanan hastalarda hiperalbumineminin artmış anyon gap ile birlikteliğine dikkat çekmiştir (2).…”

Section: Discussionunclassified

How Does the Clinician Lay Out Hyperalbuminemia and Associated Hypercalcemia? Case Report and Review

Coskun¹,

Yüzbaşıoğlu²,

Kavakli³

et al. 2014

JAEMCR

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Introduction: Hyperalbuminemia and associated hypercalcemia is an extremely rare clinical condition. Although it is most commonly encountered as a laboratory error, in the literature, it has been reported to be due to dehydration, depending on relative hyperproteinemia with unchanged albumin/globulin ratio.Case Report: In this manuscript, we reported a 20-year-old male who was admitted to the emergency department with the complaints of progressive fatigue and nausea for 1 week due to hyperalbuminemia and hypercalcemia and reviewed the literature. Conclusion:In the patients who are admitted to emergency departments with nonspecific complaints, like fatigue and nausea, if the cause of the complaints cannot be shown, hyperalbuminemia and hypercalcemia should be investigated.

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A Simple Estimate of the Effect of the Serum Albumin Level on the Anion Gap

Cited by 36 publications

References 5 publications

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

The Serum Anion Gap in the Evaluation of Acid-Base Disorders

Acid–Base Problems in Diabetic Ketoacidosis

How Does the Clinician Lay Out Hyperalbuminemia and Associated Hypercalcemia? Case Report and Review

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