low anion gap

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negative anion gap

other anions

Cl

HCO3

other cations

Na

Anions Cations=

Gamblegram

THE ANION GAP

other anions

Cl

HCO3

other cations

Na

Anions Cations=

Cl + HCO3 + other anions Na + other cations=

Cl + HCO3 + other anions – other cations Na=

other anions – other cations Na – (Cl + HCO3)=THE ANION GAP

the anion gap

THE ANION GAPother anions

Cl

HCO3

other cations

Na

Anions Cations=

other anions – other cations Na – (Cl + HCO3)=

Occurs with metabolic acidosis

Addition of exogenous or endogenous acids

G glycols O oxoproline L l-lactic acid D d-lactic acid M methanol A aspirin R renal failure K ketones

Increased “other anions” Could theoretically occur with decreased “other cations”

THE ANION GAP

increased anion gap

THE ANION GAPother anions

Cl

HCO3

other cations

Na

Anions Cations=

other anions – other cations Na – (Cl + HCO3)=

Occurs due to decreased anions

Albumin Proteins Phosphorus Sulfates IgA

THE ANION GAP

Due to increased cations

Potassium Calcium Magnesium Lithium IgG Bromide

decreased anion gap

Sodium 128 Potassium 4.7 Chloride 97 Carbon dioxide 32 Glucose 103 Osmolality 303

anion gap -1

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