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Metabolic alkalosis, if from vomiting or diuretic use can be associated with a small increment of anion gap ( around 4-6meq/L) and this is ofcouse if no other disorder has been identified. Why? Largely due to increase in albumin and some due to other increase in anionic proteins.
Serum anion gap does not change notably in acute respiratory alkalosis, but small increases up to 3meq/L have been observed in chronic respiratory alkalosis.
Alkalemia also causes glycolysis in the liver and a mild lactic acidosis (seen in our patient). In addition, in a volume contracted patient, the change in anion gap can be due to the change in valence of circulating proteins to preserve extracellular volume.
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