Sunday, January 2, 2011
TOPIC DISCUSSION: Low or negative Anion gap!
In certain clinical settings,one can also see a low, zero or negative anion gap.
What are the causes that one has to consider in a low anion gap?
If one considers Na, K, Mg, Ca and immunoglobulins (IgG) as + cations and Cl, Bicarb, Phos, IgA and Phos as negative anions then the anion gap is the balance of these substances. Usually normal is 10-12.
So if one increases the + cations or decreases the - anions, you can have a negative or low anion gap.
Hence the causes are obvious
1. Hyperkalemia, Mg and Calcemia
2. elevated paraproteins( igG usually)-- one of the classic causes and whenever you see a low or negative anion gap, think paraproteinemias
3. decreased albumin or phosphorus
4. Lithium( increases the Cationic side)
5. Unmeasured cations like bromide or iodine or triglycerides can also do it
6. Lab error( most common cause)
7. Severe hypernatremia
8. Spurious elevation of HCo3 if cells are not separated from the sera
9. Over estimation of Cl ion
Out of these the ones to cause a negative anion gap more than low anion gap are lab errors, paraproteins, bromide and iodine intoxication.
Something to keep in mind while we walk the wards!
A nice review is here
- ► 2020 (20)
- ► 2019 (42)
- ► 2018 (57)
- ► 2017 (52)
- ► 2016 (45)
- ► 2015 (63)
- ► 2014 (95)
- ► 2013 (133)
- ► 2012 (201)
- Pregnancy in Chronic Kidney Disease
- CONSULT ROUNDS: Cetuximab therapy and wasting synd...
- TOPIC DISCUSSION: LEAD and the KIDNEY
- Vitamin D- NEJM Review 2011
- IN THE NEWS- TPA vs Heparin- NEJM Study
- Kidney Disease: Racial Disparities from the Inside...
- Dabigatran, and what about its use in Nephrology a...
- The Transplant Web
- TOPIC DISCUSSION: Blood Urea Nitrogen ( BUN)
- Diabetic Nephropathy Video on You tube
- 2011 Guest Lecture Series (Part 1 of 2): Gerald A...
- TOPIC DISCUSSION: Thiazides and Hyponatremia
- IN THE NEWS--> Storytelling and Hypertension
- Fibrosis with Inflammation at One Year Predicts Tr...
- NSLIJ - Innate B Cell in Humans that Protects Agai...
- IN THE NEWS-->AngII and Metabolic Syndrome
- TOPIC DISCUSSION: Magnesium for pre eclampsia?
- IN THE NEWS:- THE BOLDE Study
- TOPIC DISCUSSION: Paraneoplastic Glomerulopathy
- Informing the Debate: Rates of Kidney Transplantat...
- History of Nephrology: The Korean War 1950-3
- TOPIC DISCUSSION: Cryoglobulin Classification Made...
- CLINICAL CASE 31, ANSWER and SUMMARY
- Quiz 9 Answers
- HISTORY LESSON- Scribner Shunt
- IN THE NEWS --> Cytoresistance and the kidney
- PD University = HD university
- Medicine for residents: urinary calcium and renal ...
- Life After Renal Fellowship Survey Results
- Bisphosphonate Therapy in CKD and ESRD patients
- CONSULT ROUNDS: Amyloidosis vs Light Chain Deposit...
- The Study of Heart and Renal Protection — SHARP Trial
- Can Alcohol Consumption be protective post transpl...
- DID YOU KNOW? Extra renal Podocyte like systems?
- TOPIC DISCUSSION: Low or negative Anion gap!
- ▼ January (35)
- ► 2010 (461)