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Excess Anion Gap

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1. 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

2. Excess Anion Gap

Excess Anion Gap Excess Anion Gap Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Excess Anion Gap Excess Anion Gap Aka: Excess Anion (...) Gap II. Calculation EAG = - 12 meq/L + serum bicarbonate III. Interpretation EAG > 30 mEq/L: present EAG < 23 mEq/L: Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Excess Anion Gap." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Pathology and Laboratory Medicine About FPnotebook.com is a rapid access, point-of-care medical

2018 FP Notebook

3. Comparing biomarkers of traumatic shock: the utility of anion gap, base excess, and serum lactate in the ED. (PubMed)

Comparing biomarkers of traumatic shock: the utility of anion gap, base excess, and serum lactate in the ED. Biomarkers such as serum lactate, anion gap (AG), and base excess (BE) have been shown to be of use in determining shock in patients with seemingly normal vital signs. We seek to determine if these biomarkers can be used interchangeably in patients with trauma in the emergency setting based on their test characteristics and correlation to each other.A prospective observational cohort

2015 American Journal of Emergency Medicine

4. Excess Anion Gap

Excess Anion Gap Excess Anion Gap Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Excess Anion Gap Excess Anion Gap Aka: Excess Anion (...) Gap II. Calculation EAG = - 12 meq/L + serum bicarbonate III. Interpretation EAG > 30 mEq/L: present EAG < 23 mEq/L: Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Excess Anion Gap." Click on the image (or right click) to open the source website in a new browser window. Related Studies (from Trip Database) Related Topics in Pathology and Laboratory Medicine About FPnotebook.com is a rapid access, point-of-care medical

2015 FP Notebook

5. Difference Between Critical Care Initiation Anion Gap and Prehospital Admission Anion Gap is Predictive of Mortality in critical illness. (PubMed)

similarly moderate discriminative ability for 30-day mortality in comparison to standard base excess and strong ion gap.An increase in standard anion gap at critical care initiation relative to prehospital admission standard anion gap is a predictor of the risk of all cause patient mortality in the critically ill. (...) Difference Between Critical Care Initiation Anion Gap and Prehospital Admission Anion Gap is Predictive of Mortality in critical illness. We hypothesized that the delta anion gap defined as difference between critical care initiation standard anion gap and prehospital admission standard anion gap is associated with all cause mortality in the critically ill.Observational cohort study.Two hundred nine medical and surgical intensive care beds in two hospitals in Boston, MA.Eighteen thousand nine

2012 Critical Care Medicine

6. Anion gap corrected for albumin, phosphate and lactate is a good predictor of strong ion gap in critically ill patients: a nested cohort study (PubMed)

in patients with base-excess <-2 mEq/L (low BE group - lBE) and the other in patients with base-excess >-2 mEq/L (high BE group - hBE). A logistic regression was performed to evaluate the association between admission strong ion gap levels and hospital mortality.There was a very strong correlation and a good agreement between anion gap corrected for albumin, phosphate and lactate and strong ion gap in the general population (r2=0.94; bias 1.40; limits of agreement -0.75 to 3.57). Correlation was also high (...) in the lBE group (r2=0.94) and in the hBE group (r2=0.92). High levels of strong ion gap were present in 66% of the whole population and 42% of the cases in the hBE group. Strong ion gap was not associated with hospital mortality by logistic regression.Anion gap corrected for albumin, phosphate and lactate and strong ion gap have an excellent correlation. Unmeasured anions are frequently elevated in critically ill patients with normal base-excess. However, there was no association between unmeasured

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2013 Revista brasileira de terapia intensiva

7. Effectiveness of Subcutaneous Glargine On The Time To Closure of The Anion Gap in Patients Presenting to the Emergency Department With Diabetic Keto-acidosis

resulting in ketone formation. Anion Gap is a surrogate measure for the level of ketones resulting in the excess acid production. Results reported are adjusted for initial anion gap, etiology of diabetic ketoacidosis, and comorbidities. Secondary Outcome Measures : Number of Participants Admitted to the ICU [ Time Frame: Participants followed for the duration of the Emergency Department stay, an expected average of 12 hours ] The goal was to determine if the amount of patients admitted to the ICU could (...) Effectiveness of Subcutaneous Glargine On The Time To Closure of The Anion Gap in Patients Presenting to the Emergency Department With Diabetic Keto-acidosis Effectiveness of Subcutaneous Glargine On The Time To Closure of The Anion Gap in Patients Presenting to the Emergency Department With Diabetic Keto-acidosis - Full Text View - ClinicalTrials.gov Hide glossary Glossary Study record managers: refer to the if submitting registration or results information. Search for terms x × Study Record

2013 Clinical Trials

8. Observed and corrected anion gap as a prognostic tool in patients admitted to an acute care setting to predict clinical outcomes reflecting patient deterioration and death: protocol of a systematic review

Observed and corrected anion gap as a prognostic tool in patients admitted to an acute care setting to predict clinical outcomes reflecting patient deterioration and death: protocol of a systematic review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files (...) , which generally include various species, strains and treatment regimes, for which different true effects are likely to exist. The random-effects model takes into account both the within-study (sampling error) and between-study (differences in the true effect size) variance. Should the excessive between-study variance be very low or zero, the random-effects model will yield the same results as the fixed-effect model. For further details, see the and to pre-clinical meta-analysis. Example: Because

2016 PROSPERO

9. Anion gap as a diagnostic tool to screen for elevated lactate levels in patients admitted to an acute care setting: protocol of a diagnostic test accuracy review

Anion gap as a diagnostic tool to screen for elevated lactate levels in patients admitted to an acute care setting: protocol of a diagnostic test accuracy review Print | PDF PROSPERO This information has been provided by the named contact for this review. CRD has accepted this information in good faith and registered the review in PROSPERO. CRD bears no responsibility or liability for the content of this registration record, any associated files or external websites. Email salutation (e.g. "Dr (...) various species, strains and treatment regimes, for which different true effects are likely to exist. The random-effects model takes into account both the within-study (sampling error) and between-study (differences in the true effect size) variance. Should the excessive between-study variance be very low or zero, the random-effects model will yield the same results as the fixed-effect model. For further details, see the and to pre-clinical meta-analysis. Example: Because of the exploratory nature

2016 PROSPERO

10. A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study (PubMed)

A comparison of prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill: a cohort study This cohort study compared the prognostic significance of strong ion gap (SIG) with other acid-base markers in the critically ill.The relationships between SIG, lactate, anion gap (AG), anion gap albumin-corrected (AG-corrected), base excess or strong ion difference-effective (SIDe), all obtained within the first hour of intensive care unit (ICU) admission (...) should always be considered regardless whether physiological, base excess or physical-chemical approach is used to interpret acid-base disturbances in critically ill patients.

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2016 Journal of intensive care

11. Base excess, strong ion difference, and expected compensations: as simple as it is. (PubMed)

important publications in the field, the authors attempt to show that each diagnostic strategy is acceptable, although the one based on base-excess calculation perhaps seems too 'rough' to understand the mixed disorders, whereas the Stewart approach is attractive from a chemical point of view, but unsuitable for the emergency physician because of the cumbersome calculations needed. Finally, the anion gap and 'expected compensation' approach seems to be more comprehensive and feasible at the bedside. (...) Base excess, strong ion difference, and expected compensations: as simple as it is. The main purpose of this article is to provide some practical insights into acid-base disorders interpretation, comparing the three most widespread diagnostic approaches. After a brief summary of the history of blood gas analysis and the shift from a purely chemical approach to more clinically useful applications, the pros and cons of the different methodologies are compared and discussed. Reviewing the most

2014 European Journal of Emergency Medicine

12. Comparison of three methods of diagnosis of plasma unmeasured anions in critically ill patients. (PubMed)

Comparison of three methods of diagnosis of plasma unmeasured anions in critically ill patients. The measurement of plasma unmeasured anions (PUA) is paramount in assessing metabolic acid base disorders. The aim of this study was to compare the accuracy of three methods in diagnosing abnormal PUA values: standard base excess (SBE), the albumin corrected anion gap (AGc), and the Stewart-Figge approach, based on unidentified anions (XAc-).Acid-base variables were prospectively collected in ICU (...) on unidentified anions, is the most efficient in diagnosing high PUA values not associated with hyperlactatemia.

2013 Minerva anestesiologica

13. Overview of acid-base and electrolyte disorders

bicarbonate retention and loss, respectively; metabolic acidosis and alkalosis are accompanied by compensatory hyperventilation and hypoventilation, respectively. Mixed metabolic disorders can occur (e.g., diabetic ketoacidosis complicated by vomiting), and evaluation depends on clinical history and examination, assessment of anion gap, serum electrolytes, and arterial blood gases. These disorders can be effectively evaluated by a stepwise pathophysiological approach. Berend K, de Vries AP, Gans RO (...) than 7.35, a decrease in the plasma bicarbonate level, and/or a marked increase in the serum anion gap (SAG; calculated by subtracting the sum of major measured anions, chloride and bicarbonate, from the major measured cation, sodium). Where SAG is normal (6-12 mmol/L [6-12 mEq/L]), gastrointestinal or renal causes are common. Batlle DC, Hizon M, Cohen E, et al. The use of urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis. N Engl J Med. 1988 Mar 10;318(10):594-9. http

2018 BMJ Best Practice

14. Overview of acid-base and electrolyte disorders

bicarbonate retention and loss, respectively; metabolic acidosis and alkalosis are accompanied by compensatory hyperventilation and hypoventilation, respectively. Mixed metabolic disorders can occur (e.g., diabetic ketoacidosis complicated by vomiting), and evaluation depends on clinical history and examination, assessment of anion gap, serum electrolytes, and arterial blood gases. These disorders can be effectively evaluated by a stepwise pathophysiological approach. Berend K, de Vries AP, Gans RO (...) than 7.35, a decrease in the plasma bicarbonate level, and/or a marked increase in the serum anion gap (SAG; calculated by subtracting the sum of major measured anions, chloride and bicarbonate, from the major measured cation, sodium). Where SAG is normal (6-12 mmol/L [6-12 mEq/L]), gastrointestinal or renal causes are common. Batlle DC, Hizon M, Cohen E, et al. The use of urinary anion gap in the diagnosis of hyperchloremic metabolic acidosis. N Engl J Med. 1988 Mar 10;318(10):594-9. http

2018 BMJ Best Practice

16. Statin Safety and Associated Adverse Events: A Scientific Statement From the American Heart Association

were analyzed. Observational studies with a control group, including cohort studies, case-control studies, registry studies, and cross-sectional surveys, are less reliable than RCTs for assessment of causality because of potential biases inherent in these studies , , but can be useful in situations where there is a high excess risk (a hazard ratio [HR] too high to be attributed to unmeasured confounding) in the population exposed to the medication. This usually implies a low risk in the population (...) are typically bilateral and symmetrical and always confined to skeletal muscle. , Cardiomyopathy has never been associated with any statin, and in the 2 major trials of statin therapy in participants with heart failure, statins did not lead to symptomatic worsening of the condition or any increase in hospitalization. , The excess risk of myopathy relative to placebo is <0.1% in large long-term RCTs with all currently marketed statins at up to maximum recommended doses. The risk is greatest in the first year

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2019 American Gastroenterological Association Institute

17. Primary postpartum haemorrhage

, ALP, GGT, LD, calcium, phosphate, magnesium, anion gap, osmolality, urea/creatinine ratio, globulin, albumin- corrected calcium, eGFR (patients over 18 years). Critical bleeding Major haemorrhage that is life threatening and likely to result in the need for massive transfusion. 1 Massive transfusion In adults, massive transfusion may be defined as a transfusion of half of one blood volume in four hours, or more than one blood volume in 24 hours (adult blood volume is approximately 70 mL/kg). 1 (...) · Fibrinogen concentrate or cryoprecipitae to maintain fibrinogen > 2.5 g/L · FFP 2 units MHP PACK 2 · RBC 4 units · Fibrinogen concentrate or cryoprecipitate to maintain fibrogen > 2.5 g/L · FFP 2 units · Platelets 1 adult dose · If ionised calcium 35° C · pH > 7.2 · Base excess minus 6 to positive 6 · Lactate 1.1 mmol/L · Platelets > 50 x 10 9 /L · PT/aPPT 2.5 g/L Optimise · Oxygenation · Cardiac output · Tissue perfusion · Temperature (actively warm woman and fluid) · Metabolic state Monitor (30?60

2019 Queensland Health

18. Diagnosis and Management of Glycogen Stored Diseases type VI and IX a practice resource of ACMG

for this disease is not well known or understood, some cases could be lost to follow up while they are doing well, and subsequently develop liver cirrhosis. This is especially true in patients with GSD IX. Liver ultrasound is recommended every 12–24 months for children 3mM. 73,74 If blood level is =3mmol/L, ketones will be detected in urine, and there is a risk of ketoacidosis. Anion gap acidosis due to hyperketonemia can occur in patients with ketotic forms of hepatic GSD during periods of metabolic (...) providers recognize patients with GSDs VI and IX, expedite diagnosis, and minimize adverse sequelae from delayed diagnosis and inappropriate management. It will also help identify gaps in scientific knowledge that exist today and suggest future studies. GeneticsinMedicine (2019)https://doi.org/10.1038/s41436-018-0364-2 Keywords: glycogen storage diseases; glycogen storage disease type VI; glycogen storage disease type IX; diagnostic guidelines; management guidelines PURPOSE This guideline is intended

2019 American College of Medical Genetics and Genomics

19. Metformin Use in Patients with Historical Contraindications or Precautions

, observational studies will also be useful in comparing metformin to newer diabetes agents in these populations. Additional studies focusing specifically on cohorts with eGFR 30-45 mL/min/1.73m 2 or even 45mg/dl (5.0mEq/L), decreased blood pH, and electrolyte disturbances with an increased anion gap. It may result from lactate overproduction because of inadequate tissue oxygen delivery or without overt tissue hypoperfusion. The LA type classifications are explained in Table 1. Table 1. Lactic Acidosis Type (...) discouraged use of metformin in many individuals with relatively normal kidney function. Therefore, the kidney function cutoff was revised to an eGFR of 45 mL/min/1.73m 2 if renal function is monitored every 3 months to 6 months, but still contraindicated if eGFR is 45mg/dl or 5.0mEq/L, decreased blood pH, and electrolyte disturbances with an increased anion gap. Metformin-associated LA is defined as meeting the definition for LA plus either (a) elevated metformin level or (b) investigator judgment

2017 Veterans Affairs Evidence-based Synthesis Program Reports

20. Physiologic Predictors of Severe Injury: Systematic Review

Highway Traffic Safety Administration requested this report from the EPC Program at AHRQ to support revision of the Field Triage Guidelines. AHRQ assigned this report to the Pacific Northwest Evidence-based Practice Center (Contract No. 290-2015-00009-I). The reports and assessments provide organizations with comprehensive, evidence-based information on common medical conditions and new health care technologies and strategies. They also identify research gaps in the selected scientific area, identify (...) was for the Glasgow Coma Scale, age, and arterial pressure (GAP) combination measure (AUROC, 0.96; estimate based on emergency department data). All of the measures had low sensitivities and comparatively high specificities (e.g., sensitivities ranging from 13% to 74% and specificities ranging from 62% to 96% for out- of-hospital pooled estimates). Conclusions. Physiologic measures usable in triaging trauma patients have been evaluated in multiple studies; however, their predictive utilities are moderate and far

2018 Effective Health Care Program (AHRQ)

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