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Acid-Base, Electrolyte And Renal Emergencies
Published in Anthony FT Brown, Michael D Cadogan, Emergency Medicine, 2020
Anthony FT Brown, Michael D Cadogan
Metabolic acidosis may be associated with a high, normal, or low anion gap. The anion gap is calculated from the equation [Na+] – ([Cl−] + [HCO3–]) with all units in mmol/L.A normal anion gap is 8–16.
Renal Pathophysiology
Published in Manit Arya, Taimur T. Shah, Jas S. Kalsi, Herman S. Fernando, Iqbal S. Shergill, Asif Muneer, Hashim U. Ahmed, MCQs for the FRCS(Urol) and Postgraduate Urology Examinations, 2020
Herman S. Fernando, Mohamed Yehia Abdallah, Iqbal S. Shergill
The anion gap is defined as the difference between the levels of routinely measured cations (Na+) and anions (Cl− and CO2) in blood. It is calculated using the formula: Anion gap = Na+−(Cl− + HCO3−) = 140 – (105 + 24) = 11. The normal range is 9 – 14 mEq/L. The predominant unmeasured anions include albumin, and phosphate. The major unmeasured cations include calcium, magnesium and gamma globulins. If the anion gap is elevated in a patient with metabolic acidosis, the condition occurs because acids that do not contain chloride are present in the blood.
Section 8
Published in Padmanabhan Ramnarayan, MCQs in Paediatrics for the MRCPCH, Part 1, 2017
Anion gap is calculated by the equation: Na + K - HC03 - Cl. This represents the unmeasured anions. In the presence of acidic products in the circulation, this value is raised, as in diabetic ketoacidosis (ketones) and shock (lactate). Thus, the causes of an increased anion gap include dehydration and lactic acidosis, DKA (diabetic ketoacidosis), alcoholic ketoacidosis and uraemia due to raised inorganic acids. Renal tubular causes usually cause normal anion gap acidosis due to a compensatory hyperchloraemia.
Diethylene glycol produces nephrotoxic and neurotoxic effects in female rats
Published in Clinical Toxicology, 2022
Courtney N. Jamison, Robert D. Dayton, Brian Latimer, Mary P. McKinney, Hannah G. Mitchell, Kenneth E. McMartin
For blood, CSF and tissue collection, animals were anesthetized at 168 h, or sooner using criteria described above, using isoflurane induction, followed by sodium pentobarbital (50 mg/kg, i.p.). Plasma from the collected blood was analyzed for concentrations of blood urea nitrogen (BUN), creatinine, glucose, sodium [Na+], potassium [K+] and chloride [Cl-] by the Ochsner LSU Health – Shreveport Clinical Laboratory. Anion gap was calculated as [(Na+ + K+) – (Cl- + HCO3-)]. Statistically increased values of plasma BUN and creatinine over values in concurrently treated control rats and over historical ranges at the endpoint were used to substantiate that the animal had AKI. Such animals were categorized as the “kidney injury” group for data analysis. Other animals that were treated with DEG for 7 days, without evidence of kidney injury, were then categorized as the “no kidney injury” group.
Electrolyte and acid-base disorders in cancer patients and its impact on clinical outcomes: evidence from a real-world study in China
Published in Renal Failure, 2020
Yang Li, Xiaohong Chen, Ziyan Shen, Yimei Wang, Jiachang Hu, Jiarui Xu, Bo Shen, Xiaoqiang Ding
Electrolytes for analysis include serum sodium, potassium, chloride, calcium, magnesium, and phosphorus. The reference value range is 137–147 mmol/L in sodium, 3.5–5.3 mmol/L in potassium, 99–110 mmol/L in chloride, 2.15–2.55 mmol/L in calcium, 0.67–1.04 mmol/L in magnesium and 0.90–1.34 mmol/L in phosphorus respectively. A value less than the lower range of each electrolyte is considered as hypo-electrolytemia, and a value greater than the upper range is considered as hyper-electrolytemia. Arterial blood gas values were measured by Medica Easy Electrolytes (Medica Corporation, Bedford, MA, USA). Acidemia is regarded as arterial blood gas with a pH value less than 7.35, while alkalemia refers to that with a pH value higher than 7.45. The anion gap (AG) was calculated by the formula [14]: AG = [Na+] − [Cl−] − [HCO3−], with an elevated AG of greater than 16 mmol/L. Simple, dual, and triple acid-base disorders were diagnosed based on the level of pH, HCO3−, anion gap (AG), and pCO2 through the flow diagrams developed by Fulop M [15].
High anion gap metabolic acidosis induced by cumulation of ketones, L- and D-lactate, 5-oxoproline and acute renal failure
Published in Acta Clinica Belgica, 2018
Laura Heireman, Boris Mahieu, Mark Helbert, Wim Uyttenbroeck, Jan Stroobants, Marian Piqueur
Laboratory results for biochemical (Vitros® 5600, Ortho Clinical Diagnostics, Rochester, USA), blood gas (RAPIDPoint® 500, Siemens Healthcare, Erlangen, Germany) and haematological analysis (Sysmex XE 2100™, Sysmex Corporation, Kobe, Japan and STAR®, Diagnostica Stago, Asnières-sur-Seine, France) are shown in Table 1. Blood gas analysis revealed the presence of acidosis and a strong negative base excess along with an increased partial oxygen pressure (pO2) and decreased partial carbon dioxide pressure (pCO2) due to oxygen therapy. Laboratory analysis showed a very low serum bicarbonate concentration, an increased potassium concentration and slightly elevated levels of sodium and chloride. We calculated a high anion gap (range 37.4–42.4 mmol/L), indicating a HAGMA. In addition, an osmolar gap of 35 mOsm/kg was present. Serum L-lactate levels were elevated, urine screening for ketones was strongly positive and serum glycated haemoglobin and glucose levels were increased. Renal function was severely compromised (estimated glomerular filtration rate measured 18.8 mL/min/1.73 m2 using the CKD-EPI formula), leading to high serum creatinine, urea, uric acid and phosphate levels.