Reduced or Absent Serum Anion Gap as a Marker of Severe Lithium Carbonate Intoxication

Kelleher, Stephen P.; Raciti, Alfred; Arbeit, Leonard A.

doi:10.1001/archinte.1986.00360210237038

Cited by 27 publications

(11 citation statements)

References 8 publications

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“…Lithium is commonly prescribed for the treatment of bipolar disorder (6). Because lithium is a cation, it can lower the serum anion gap when present in sufficient concentration (6,36).…”

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

“…Lithium is commonly prescribed for the treatment of bipolar disorder (6). Because lithium is a cation, it can lower the serum anion gap when present in sufficient concentration (6,36). Although a slightly reduced serum anion gap can be observed with a serum concentration of lithium as low as 0.5 to 1 mEq/L, values within the therapeutic range, a substantial decrease in the serum anion gap is observed more commonly when lithium concentration is Ͼ4 mEq/L (6).…”

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

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Serum Anion Gap

Kraut

Madias

2007

Clinical Journal of the American Society of Nephrology

333

257

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The serum anion gap, calculated from the electrolytes measured in the chemical laboratory, is defined as the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration. This entity is used in the detection and analysis of acid-base disorders, assessment of quality control in the chemical laboratory, and detection of such disorders as multiple myeloma, bromide intoxication, and lithium intoxication. The normal value can vary widely, reflecting both differences in the methods that are used to measure its constituents and substantial interindividual variability. Low values most commonly indicate laboratory error or hypoalbuminemia but can denote the presence of a paraproteinemia or intoxication with lithium, bromide, or iodide. Elevated values most commonly indicate metabolic acidosis but can reflect laboratory error, metabolic alkalosis, hyperphosphatemia, or paraproteinemia. Metabolic acidosis can be divided into high anion and normal anion gap varieties, which can be present alone or concurrently. A presumed 1:1 stoichiometry between change in the serum anion gap (⌬AG) and change in the serum bicarbonate concentration (⌬HCO 3 ؊ ) has been used to uncover the concurrence of mixed metabolic acid-base disorders in patients with high anion gap acidosis. However, recent studies indicate variability in the ⌬AG/⌬HCO 3 ؊ in this disorder. This observation undercuts the ability to use this ratio alone to detect complex acid-base disorders, thus emphasizing the need to consider additional information to obtain the appropriate diagnosis. Despite these caveats, calculation of the serum anion gap remains an inexpensive and effective tool that aids detection of various acid-base disorders, hematologic malignancies, and intoxications.

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“…Lithium is commonly prescribed for the treatment of bipolar disorder (6). Because lithium is a cation, it can lower the serum anion gap when present in sufficient concentration (6,36).…”

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

Section: Low or Negative Serum Anion Gapmentioning

confidence: 99%

Serum Anion Gap

Kraut

Madias

2007

Clinical Journal of the American Society of Nephrology

333

257

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“…Persistently low AG is seen when there is a decrease in unmeasured anions (primarily albumin) or by an increase in unmeasured cations (e.g. K + , Ca 2+ , Mg 2+ , myeloma IgG cationic proteins and lithium intoxication) (43–45).…”

Section: Low Serum Anion Gapmentioning

confidence: 99%

Clinical utility of anion gap in deciphering acid-base disorders

Reddy

Mooradian

2009

International Journal of Clinical Practice

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The anion gap (AG) measurement is a very useful tool in the evaluation of patients with acid-base disorders. Once metabolic acidosis is identified, AG will provide the important first step in the differential diagnosis of disorders that either increase the AG and those that leave the AG unchanged. Delta gap is the comparison between change (delta) in the AG and the change (delta) in bicarbonate (HCO(3)(-)). Delta ratio, defined as delta AG:delta HCO(3)(-) is usually 1:1 in patients with an uncomplicated high AG acidosis. A value below 1:1 suggests a combined high and normal AG acidosis. A value above 2:1 suggests a combined metabolic alkalosis and a high AG acidosis. Urine AG (unmeasured anions-unmeasured cations) is an indirect estimate of the urine NH(4)(+) excretion. It is typically negative in patients with normal AG metabolic acidosis secondary to diarrhoea. Utilisation of AG calculations helps clinicians in identifying and treating acid-base disorders.

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“…Neben Messfehlern (bzw. Ungenauigkeiten) sollte in derartigen Fällen kationische Paraproteine und kationische Medikamente in toxischer Dosierung in Betracht gezogen werden [21][22][23]. Darüber hinaus besteht die weitgehend unerforschte Möglichkeit des Auftretens von endogenen ungemessenen Kationen im Rahmen von Organdysfunktionen.…”

Section: Metabolische Azidose Infolge Von Ungemessenen Anionenunclassified

Das Säure-Basen-Modell nach Stewart

Funk

2007

Wien Klin Wochenschr

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In addition to paCO(2), Stewart's acid base model takes into account the influence of albumin, inorganic phosphate, electrolytes and lactate on acid-base equilibrium. It allows a comprehensive and quantitative analysis of acid-base disorders. Particularly simultaneous and mixed metabolic acid-base disorders, which are common in critically ill patients, can be assessed. Stewart's approach is therefore a valuable tool in addition to the customary acid-base approach based on bicarbonate or base excess. However, some chemical aspects of Stewart's approach remain controversial.

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Reduced or Absent Serum Anion Gap as a Marker of Severe Lithium Carbonate Intoxication

Cited by 27 publications

References 8 publications

Serum Anion Gap

Serum Anion Gap

Clinical utility of anion gap in deciphering acid-base disorders

Das Säure-Basen-Modell nach Stewart

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