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Decreased serum anion gap

MedGen UID:
1670952
•Concept ID:
C4732779
•
Finding
HPO: HP:0031963

Definition

An abnormally low value of the serum anion gap (the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration). [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVDecreased serum anion gap

Professional guidelines

PubMed

Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999
Toxic alcohol ingestions: clinical features, diagnosis, and management.
Kraut JA, Kurtz I
Clin J Am Soc Nephrol 2008 Jan;3(1):208-25. Epub 2007 Nov 28 doi: 10.2215/CJN.03220807. PMID: 18045860
Diagnosis and management of metabolic alkalosis.
Pahari DK, Kazmi W, Raman G, Biswas S
J Indian Med Assoc 2006 Nov;104(11):630-4, 636. PMID: 17444063

Recent clinical studies

Etiology

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Potassium Metabolism and Management in Patients with CKD.
Yamada S, Inaba M
Nutrients 2021 May 21;13(6) doi: 10.3390/nu13061751. PMID: 34063969Free PMC Article
Anion gap reference intervals show instrument dependence and weak correlation with albumin levels.
Pratumvinit B, Lam L, Kongruttanachok N, Hemthong C, Kost GJ, Kamkang P, Reesukumal K
Clin Chim Acta 2020 Jan;500:172-179. Epub 2019 Oct 26 doi: 10.1016/j.cca.2019.10.012. PMID: 31669932
The anion gap and routine serum protein measurements in monoclonal gammopathies.
van Hoeven KH, Joseph RE, Gaughan WJ, McBride L, Bilotti E, McNeill A, Schmidt L, Schillen D, Siegel DS
Clin J Am Soc Nephrol 2011 Dec;6(12):2814-21. doi: 10.2215/CJN.07380711. PMID: 22157711Free PMC Article
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999

Diagnosis

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Acid-Base Disorders in the Critically Ill Patient.
Achanti A, Szerlip HM
Clin J Am Soc Nephrol 2023 Jan 1;18(1):102-112. Epub 2022 Aug 23 doi: 10.2215/CJN.04500422. PMID: 35998977Free PMC Article
Metabolic Acidosis of CKD: An Update.
Kraut JA, Madias NE
Am J Kidney Dis 2016 Feb;67(2):307-17. Epub 2015 Oct 23 doi: 10.1053/j.ajkd.2015.08.028. PMID: 26477665
Drug-induced acid-base disorders.
Kitterer D, Schwab M, Alscher MD, Braun N, Latus J
Pediatr Nephrol 2015 Sep;30(9):1407-23. Epub 2014 Nov 5 doi: 10.1007/s00467-014-2958-5. PMID: 25370778
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999

Therapy

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Acid-Base Disorders in the Critically Ill Patient.
Achanti A, Szerlip HM
Clin J Am Soc Nephrol 2023 Jan 1;18(1):102-112. Epub 2022 Aug 23 doi: 10.2215/CJN.04500422. PMID: 35998977Free PMC Article
0.9% saline is neither normal nor physiological.
Li H, Sun SR, Yap JQ, Chen JH, Qian Q
J Zhejiang Univ Sci B 2016 Mar;17(3):181-7. doi: 10.1631/jzus.B1500201. PMID: 26984838Free PMC Article
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999
Treatment of ethylene glycol poisoning.
Scalley RD, Ferguson DR, Piccaro JC, Smart ML, Archie TE
Am Fam Physician 2002 Sep 1;66(5):807-12. PMID: 12322772

Prognosis

Acute Kidney Injury in Pediatric Diabetic Ketoacidosis.
Yang EM, Lee HG, Oh KY, Kim CJ
Indian J Pediatr 2021 Jun;88(6):568-573. Epub 2020 Nov 19 doi: 10.1007/s12098-020-03549-9. PMID: 33210207
Renal aspects of metabolic acid-base disorders in neonates.
Iacobelli S, Guignard JP
Pediatr Nephrol 2020 Feb;35(2):221-228. Epub 2018 Nov 19 doi: 10.1007/s00467-018-4142-9. PMID: 30456666
The ischemic/nephrotoxic acute kidney injury and the use of renal biomarkers in clinical practice.
Andreucci M, Faga T, Pisani A, Perticone M, Michael A
Eur J Intern Med 2017 Apr;39:1-8. Epub 2016 Dec 21 doi: 10.1016/j.ejim.2016.12.001. PMID: 28011057
Metabolic Acidosis of CKD: An Update.
Kraut JA, Madias NE
Am J Kidney Dis 2016 Feb;67(2):307-17. Epub 2015 Oct 23 doi: 10.1053/j.ajkd.2015.08.028. PMID: 26477665
Serum anion gap is predictive of mortality in an elderly population.
Ahn SY, Ryu J, Baek SH, Han JW, Lee JH, Ahn S, Kim KI, Chin HJ, Na KY, Chae DW, Kim KW, Kim S
Exp Gerontol 2014 Feb;50:122-7. Epub 2013 Dec 11 doi: 10.1016/j.exger.2013.12.002. PMID: 24333141

Clinical prediction guides

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Veverimer: An Emerging Potential Treatment Option for Managing the Metabolic Acidosis of CKD.
Adrogué HJ, Madias NE
Am J Kidney Dis 2020 Dec;76(6):861-867. Epub 2020 Sep 10 doi: 10.1053/j.ajkd.2020.07.019. PMID: 32920151
Renal aspects of metabolic acid-base disorders in neonates.
Iacobelli S, Guignard JP
Pediatr Nephrol 2020 Feb;35(2):221-228. Epub 2018 Nov 19 doi: 10.1007/s00467-018-4142-9. PMID: 30456666
Metabolic Acidosis of CKD: An Update.
Kraut JA, Madias NE
Am J Kidney Dis 2016 Feb;67(2):307-17. Epub 2015 Oct 23 doi: 10.1053/j.ajkd.2015.08.028. PMID: 26477665
Anion gap and hypoalbuminemia.
Figge J, Jabor A, Kazda A, Fencl V
Crit Care Med 1998 Nov;26(11):1807-10. doi: 10.1097/00003246-199811000-00019. PMID: 9824071

Recent systematic reviews

Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article.
Belaunzaran M, Raslan S, Ali A, Newsome K, McKenney M, Elkbuli A
Am Surg 2022 Jan;88(1):10-19. Epub 2021 Nov 11 doi: 10.1177/00031348211060424. PMID: 34761698
Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review.
Fujii T, Udy A, Licari E, Romero L, Bellomo R
J Crit Care 2019 Jun;51:184-191. Epub 2019 Feb 26 doi: 10.1016/j.jcrc.2019.02.027. PMID: 30852347

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