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Anion Gap

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2. Tiny Tips: “KULT IMPACT” as a mnemonic for Anion Gap Metabolic Acidosis

Tiny Tips: “KULT IMPACT” as a mnemonic for Anion Gap Metabolic Acidosis Tiny Tips: “KULT IMPACT” as a mnemonic for Anion Gap Metabolic Acidosis - CanadiEM Tiny Tips: “KULT IMPACT” as a mnemonic for Anion Gap Metabolic Acidosis In , by Rakesh Gupta March 30, 2018 Every medical student learns the differential diagnosis for an anion gap metabolic acidosis. The list is particularly crucial for emergency physicians, who often see this finding in sick, undifferentiated patients. Many people use (...) as your tox screen bloodwork) C yanide, C arbon monoxide (remember these together as CN, CO) T oluene Next time you’re faced with an anion gap metabolic acidosis, first think “KULT”, and if the story fits, move on to “IMPACT”! (Visited 2,059 times, 2 visits today) Rakesh Gupta Rakesh is an EM resident at McMaster University. His medical interests include quality improvement, medical education, simulation, and technology in medicine. Outside the hospital, Rakesh enjoys eating delicious food, traveling

2018 CandiEM

3. Elevated Serum Anion Gap in Adults with Moderate Chronic Kidney Disease Increases Risk for Progression to End Stage Renal Disease. (PubMed)

Elevated Serum Anion Gap in Adults with Moderate Chronic Kidney Disease Increases Risk for Progression to End Stage Renal Disease. Acid retention associated with reduced GFR exacerbates nephropathy progression in partial nephrectomy models of CKD and might be reflected in CKD patients with reduced eGFR by increased anion gap (AG).We explored the presence of AG and its association with CKD in 14,924 adults, aged ≥20 years and eGFR≥15ml/min/1.73m2, enrolled in the National Health and Nutrition

2019 American Journal of Physiology. Renal physiology

4. Lactate, bicarbonate and anion gap for evaluation of patients presenting with sepsis to the emergency department: A prospective cohort study. (PubMed)

Lactate, bicarbonate and anion gap for evaluation of patients presenting with sepsis to the emergency department: A prospective cohort study. A serum lactate level >2 mmol/L has been chosen as the preferred cut-off value for screening of patients with suspected sepsis. In patients with suspected sepsis presenting to the ED, we aimed to determine the outcomes of patients with initial lactate levels ≤2 mmoL/L, but abnormal bicarbonate or anion gaps (AGs).This prospective cohort study enrolled

2019 Emergency medicine Australasia

5. Serum anion gap on admission predicts intensive care unit mortality in patients with aortic aneurysm (PubMed)

Serum anion gap on admission predicts intensive care unit mortality in patients with aortic aneurysm It has been widely reported that the serum anion gap is significantly associated with mortality in intensive care unit (ICU); however, it remains unknown whether the association is present in aortic aneurysm (AA) patients. The present study aimed to investigate the association between the admission serum anion gap and ICU mortality in AA patients. Data extracted from a publicly accessible (...) clinical database using a modifiable data mining technique were analyzed retrospectively, mainly by employing multivariable logistic regression analysis. The primary study outcome was ICU mortality. A total of 273 patient records were analyzed. The ICU mortality was 8.79% (24/273). The median serum anion gap was significantly higher in non-survivors [17.50 mEq/l, interquartile range (IQR) 15.75-22.50 mEq/l] compared with survivors [13.00 mEq/l, IQR 11.00-15.00 mEq/l, P<0.001]. Multivariate analysis

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2018 Experimental and therapeutic medicine

6. db’s anion gap pearls

db’s anion gap pearls db's Medical Rants » Blog Archive » db’s anion gap pearls Internal medicine, American health care, and especially medical education 1 Posted by rcentor | Posted on 27-08-2018 Category : Almost every resident has an anion gap talk. Many students learn MUDPILES – I prefer (An anion gap puzzle that explains KILU). But many learners do not know these particular pearls. A gap of 25 or greater generally has a discoverable cause, 30 or greater almost certain – | NEJM , i.e. check (...) lactic acid levels if you suspect lactic acidosis do not rely on the anion gap Most patients with mildly elevated anion gaps (15-19) do not need immediate evaluation. You should use clinical judgment prior to evaluating such gaps. This article describes the precise formula. We use albumin times 3 as a reasonable estimate. Share this: Like this: Like Loading... Comments (1) said on 11-09-2018 […] några korta bra tips om anjongap. KILU ~ KULT (keton, uremi, laktat, […] Post a comment Name (required

2018 db's Medical Rants blog

7. Anion Gap as a Determinant of Ionized Fraction of Divalent Cations in Hemodialysis Patients. (PubMed)

Anion Gap as a Determinant of Ionized Fraction of Divalent Cations in Hemodialysis Patients. Circulating levels of anions that bind to magnesium and calcium are often altered in patients with CKD. However, it is unknown how these alterations affect the ionized fraction of magnesium and calcium.This cross-sectional study involved patients on maintenance hemodialysis and patients not on dialysis who visited the outpatient department of nephrology. We collected whole-blood samples to measure (...) ionized magnesium and calcium concentrations. Adjusted anion gap was calculated as an integrative index of unmeasured anions.A total of 118 patients on hemodialysis and 112 patients not on dialysis were included. Although the prevalence of hypermagnesemia defined by total magnesium was much higher in patients on hemodialysis than in patients not on dialysis (69% versus 12%; P<0.001), the prevalence of hypermagnesemia defined by ionized magnesium did not differ significantly (13% versus 18%; P=0.28

2017 Clinical Journal of the American Society of Nephrology

8. A systematic review and diagnostic test accuracy meta-analysis of the validity of anion gap as a screening tool for hyperlactatemia. (PubMed)

A systematic review and diagnostic test accuracy meta-analysis of the validity of anion gap as a screening tool for hyperlactatemia. This systematic review and meta-analysis seeks to determine the validity of the anion gap to screen for hyperlactatemia in critically ill patients. We have previously shown that the anion gap does not predict 31-day and in-hospital mortality in critically ill patients. The present review aims to add confirmatory evidence to identify whether the anion gap (...) is a suitable tool for risk stratification in low-resource countries.Nine studies reporting on 4504 samples from 2111 patients were included. The anion gap failed to detect hyperlactatemia defined as lactate above 2.5 mmol/l but showed good discriminatory ability for the detection of severe hyperlactatemia defined as lactate over 4 mmol/l. At the 2.5 mmol/l threshold, the anion gap had high specificity but low sensitivity for the detection of hyperlactatemia. A meta-analysis of correlation coefficients

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2017 BMC research notes

9. Urine Anion Gap to Predict Urine Ammonium and Related Outcomes in Kidney Disease. (PubMed)

Urine Anion Gap to Predict Urine Ammonium and Related Outcomes in Kidney Disease. Low urine ammonium excretion is associated with ESRD in CKD. Few laboratories measure urine ammonium, limiting clinical application. We determined correlations between urine ammonium, the standard urine anion gap, and a modified urine anion gap that includes sulfate and phosphate and compared risks of ESRD or death between these ammonium estimates and directly measured ammonium.We measured ammonium, sodium (...) , potassium, chloride, phosphate, and sulfate from baseline 24-hour urine collections in 1044 African-American Study of Kidney Disease and Hypertension participants. We evaluated the cross-sectional correlations between urine ammonium, the standard urine anion gap (sodium + potassium - chloride), and a modified urine anion gap that includes urine phosphate and sulfate in the calculation. Multivariable-adjusted Cox models determined the associations of the standard urine anion gap and the modified urine

2017 Clinical Journal of the American Society of Nephrology

10. Metabolic Acidosis or Respiratory Alkalosis? Evaluation of a Low Plasma Bicarbonate Using the Urine Anion Gap. (PubMed)

Metabolic Acidosis or Respiratory Alkalosis? Evaluation of a Low Plasma Bicarbonate Using the Urine Anion Gap. Hypobicarbonatemia, or a reduced bicarbonate concentration in plasma, is a finding seen in 3 acid-base disorders: metabolic acidosis, chronic respiratory alkalosis and mixed metabolic acidosis and chronic respiratory alkalosis. Hypobicarbonatemia due to chronic respiratory alkalosis is often misdiagnosed as a metabolic acidosis and mistreated with the administration of alkali therapy (...) . Proper diagnosis of the cause of hypobicarbonatemia requires integration of the laboratory values, arterial blood gas, and clinical history. The information derived from the urinary response to the prevailing acid-base disorder is useful to arrive at the correct diagnosis. We discuss the use of urine anion gap, as a surrogate marker of urine ammonium excretion, in the evaluation of a patient with low plasma bicarbonate concentration to differentiate between metabolic acidosis and chronic respiratory

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2017 American Journal of Kidney Diseases

11. Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. (PubMed)

Anion gap can differentiate between psychogenic and epileptic seizures in the emergency setting. Differentiation between psychogenic nonepileptic seizures (PNES) and generalized convulsive epileptic seizures (ES) is important for appropriate triaging in the emergency department (ED). This can be difficult in the ED, as the event is often not witnessed by a medical professional. In the current study, we investigated whether anion gap (AG), bicarbonate, and the Denver Seizure Score (DSS) could

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2017 Epilepsia

12. Ileal Neobladder: An Important Cause of Non-Anion Gap Metabolic Acidosis. (PubMed)

Ileal Neobladder: An Important Cause of Non-Anion Gap Metabolic Acidosis. The differential diagnosis for a non-anion gap metabolic acidosis is probably less well known than the differential diagnosis for an anion gap metabolic acidosis. One etiology of a non-anion gap acidosis is the consequence of ileal neobladder urinary diversion for the treatment of bladder cancer.We present a case of a patient with an ileal neobladder with a severe non-anion gap metabolic acidosis caused by a urinary tract (...) infection and ureteroenterostomy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Part of the ileal neobladder surgery includes ureteroenterostomy and predisposes patients to several clinically significant metabolic derangements, including a non-anion gap metabolic acidosis. These patients have an increased chronic acid load, bicarbonate deficit, and hypokalemia, which should be appreciated when resuscitating these patients.Copyright © 2017 Elsevier Inc. All rights reserved.

2017 Journal of Emergency Medicine

13. Can base excess and anion gap predict lactate level in diagnosis of septic shock? (PubMed)

Can base excess and anion gap predict lactate level in diagnosis of septic shock? Lactate measurement is the key component in septic shock identification and resuscitation. However, point-of-care lactate testing is not widely used due to the lack of access to nearby test equipment. Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) are used in determining shock in patients with seemingly normal vital signs.We aimed to determine if these biomarkers can be used interchangeably

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2017 Open access emergency medicine : OAEM

14. Serum anion gap at admission as a predictor of mortality in the pediatric intensive care unit (PubMed)

Serum anion gap at admission as a predictor of mortality in the pediatric intensive care unit An accurate method to predict the mortality in the intensive care unit (ICU) patients has been required, especially in children. The aim of this study is to evaluate the value of serum anion gap (AG) for predicting mortality in pediatric ICU (PICU). We reviewed a data of 461 pediatric patients were collected on PICU admission. Corrected anion gap (cAG), the AG compensated for abnormal albumin levels

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2017 Scientific reports

15. Hyperphosphatemia, a Cause of High Anion Gap Metabolic Acidosis: Report of a Case and Review of the Literature (PubMed)

Hyperphosphatemia, a Cause of High Anion Gap Metabolic Acidosis: Report of a Case and Review of the Literature BACKGROUND Hyperphosphatemia is a common problem in patients with kidney failure. It is usually mild and rarely severe enough to cause metabolic acidosis on its own. Besides kidney failure, use of phosphate containing enemas, rhabdomyolysis, and tumor lysis syndrome are common causes of severe hyperphosphatemia. CASE REPORT A 74-year-old man with a history of diabetes mellitus type II (...) , arterial hypertension, and end stage renal disease, who was on hemodialysis and who had undergone hemicolectomy for ischemic bowel disease, and had not eaten for several days, developed severe metabolic acidosis, with an anion gap (AG) of 31 meq/L, -uncorrected for serum albumin. At that time he had a high level of beta-hydroxybutyrate and severe hyperphosphatemia (16.5 mg/dL). Metabolic acidosis and hyperphosphatemia were corrected with hemodialysis, confirming the role of hyperphosphatemia

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2017 The American journal of case reports

16. The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease (PubMed)

The serum anion gap is associated with disease severity and all-cause mortality in coronary artery disease To evaluate the associations between the serum anion gap (AG) with the severity and prognosis of coronary artery disease (CAD).We measured serum electrolytes in 18,115 CAD patients indicated by coronary angiography. The serum AG was calculated according to the equation: AG = Na+[(mmol/L) + K+ (mmol/L)] - [Cl- (mmol/L) + HCO3- (mmol/L)].A total of 4510 (24.9%) participants had their AG

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2017 Journal of geriatric cardiology : JGC

17. Common, yet elusive: a case of severe anion gap acidosis (PubMed)

Common, yet elusive: a case of severe anion gap acidosis Acid-base disturbances are common occurrence in hospitalized patients with life threatening complications. 5-oxoproline has been increasingly recognized as cause of high anion gap metabolic acidosis (AGMA) in association with chronic acetaminophen use. However, laboratory workup for it are not widely available. We report case of 56-year-old female with severe AGMA not attributable to ketoacidosis, lactic acidosis or toxic ingestion

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2017 Oxford Medical Case Reports

18. Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis (PubMed)

Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis Normal anion gap metabolic acidosis is a common but often misdiagnosed clinical condition associated with diarrhea and renal tubular acidosis (RTA). Early identification of RTA remains challenging for inexperienced physicians, and diagnosis and treatment are often delayed.The presence of RTA should be considered in any patient with a high chloride level when the CL-/Na+ ratio is above 0.79, if the patient does not have (...) diarrhea. In patients with significant hyperkalemia one should evaluate for RTA type 4, especially in diabetic patients, with a relatively conserved renal function. A still growing list of medications can produce RTA.This review highlights practical aspects concerning normal anion gap metabolic acidosis.

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2017 Kidney Diseases

19. Astrocyte calcium waves propagate proximally by gap junction and distally by extracellular diffusion of ATP released from volume-regulated anion channels (PubMed)

Astrocyte calcium waves propagate proximally by gap junction and distally by extracellular diffusion of ATP released from volume-regulated anion channels Wave-like propagation of [Ca2+]i increases is a remarkable intercellular communication characteristic in astrocyte networks, intercalating neural circuits and vasculature. Mechanically-induced [Ca2+]i increases and their subsequent propagation to neighboring astrocytes in culture is a classical model of astrocyte calcium wave and is known (...) via extracellular ATP in the distal region. Simultaneous imaging of astrocyte [Ca2+]i and extracellular ATP, the latter of which was measured by an ATP sniffing cell, revealed that ATP was released within the proximal region by volume-regulated anion channel in a [Ca2+]i independent manner. This detailed analysis of a classical model is the first to address the different contributions of two major pathways of calcium waves, gap junctions and extracellular ATP.

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2017 Scientific reports

20. The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication (PubMed)

The Anion Gap is a Predictive Clinical Marker for Death in Patients with Acute Pesticide Intoxication Pesticide formulation includes solvents (methanol and xylene) and antifreeze (ethylene glycol) whose metabolites are anions such as formic acid, hippuric acid, and oxalate. However, the effect of the anion gap on clinical outcome in acute pesticide intoxication requires clarification. In this prospective study, we compared the anion gap and other parameters between surviving versus deceased (...) , and seriousness of toxic symptoms), and the calculated anion gap. Among the 481 patients with a high anion gap, 52.2% had a blood pH in the physiologic range, 35.8% had metabolic acidosis, and 12.1% had acidemia. Age, anion gap, pesticide field of use, pesticide class, seriousness of symptoms (all P < 0.001), and time lag after ingestion (P = 0.048) were significant risk factors for death in univariate analyses. Among these, age, anion gap, and pesticide class were significant risk factors for death

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2016 Journal of Korean medical science

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