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Urinary Anion Gap

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1. Urinary Anion Gap

Urinary Anion Gap Urinary 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 Urinary Anion Gap Urinary Anion Gap Aka: Urinary (...) "Urinary 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 reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews

2018 FP Notebook

2. 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 (...) Examination Survey III, 1988-1994 using multivariable regression analysis. The model was adjusted for socio-demographic characteristics, diabetes, and hypertension. We further examined the association between AG and incident end-stage renal disease using frailty models, adjusting for demographics, clinical factors, BMI, serum albumin, bicarbonate, eGFR, and urinary albumin-to-creatinine ratio, by following 558 adults with moderate CKD for 12 years via the United States Renal Data System. Laboratory

2019 American Journal of Physiology. Renal physiology

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

. 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 (...) 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

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2017 American Journal of Kidney Diseases

4. 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

5. Urinary Anion Gap

Urinary Anion Gap Urinary 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 Urinary Anion Gap Urinary Anion Gap Aka: Urinary (...) "Urinary 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 reference for primary care and emergency clinicians. Started in 1995, this collection now contains 6656 interlinked topic pages divided into a tree of 31 specialty books and 728 chapters. Content is with systematic literature reviews

2015 FP Notebook

6. Low Anion Gap

Low Anion Gap Renal Fellow Network: Low Anion Gap | | | | | Sunday, March 25, 2012 Low Anion Gap Classically, we are taught to look out for an elevated anion gap in patients with a metabolic acidosis. Although much less common, a low anion gap can also be a useful sign and there are a variety of causes. The commonest cause is lab error, particularly in the measurement of the serum sodium. As previously , high serum lipids or high serum proteins can lead to spuriously low serum sodium (...) are not associated with changes in the AG. It is uncertain why this is the case. Hypermagnesemia usually does not affect the AG because it is normally accompanied by sulphates and as these are unmeasured anions, they balance each other out. Several drugs are associated with reductions in the AG. As mentioned by Nate , bromide intoxication is a rare cause of a negative anion gap. At first, this does not appear to make sense; bromide is an anion, similar to chloride. As a result, elevated bromide levels should

2012 Renal Fellow Network

7. Renal Grand Rounds - What Lurks in the Gap

for ED residents) Posted by Gearoid McMahon at Labels: , , , 2 comments: Anonymous said... Interesting case. Can you please show us the urine electrolytes? Urine osmolar gap would be more helpful when you suspect high execration of negative anion in the urine. said... We did not have a urinary osmolar gap. I do not have the numbers to hand but the urinary anion gap was strongly positive. Along with the low urine pH, this suggested the presence of an unmeasured anion in the urine. Agree that osmolar (...) that progressed to encephalopathy with dysarthria. His baseline labs from a month prior to presentation were notable for a chronically low serum bicarbonate of 15-17 with no anion gap. When he presented he was hypokalemic to 2.5 and his bicarbonate had dropped to 11 with a new elevated anion gap of 25 and normal L-lactate. Metabolic acidosis was confirmed on VBG. Interestingly, his urine electrolytes demonstrated a positive urine anion gap of 26. He was ultimately diagnosed with D-lactic acidosis based on his

2017 Renal Fellow Network

8. Chronic Insulin Infusion Down-Regulates Circulating and Urinary Nitric Oxide (NO) Levels Despite Molecular Changes in the Kidney Predicting Greater Endothelial NO Synthase Activity in Mice (PubMed)

) by osmotic minipump for 14 days. One group of insulin-infused mice was switched to 4% NaCl diet (high-sodium diet, HSD) in the second week. Blood chemistry revealed a significantly higher anion gap and blood sodium concentrations with insulin infusion, i.e., relative metabolic acidosis. Systolic BP and heart rate were slightly (~5 mm Hg) higher in insulin-infused versus control mice. HSD resulted in a modest and transient rise in mean arterial blood pressure (BP), relative to control or insulin-infused (...) Chronic Insulin Infusion Down-Regulates Circulating and Urinary Nitric Oxide (NO) Levels Despite Molecular Changes in the Kidney Predicting Greater Endothelial NO Synthase Activity in Mice Insulin therapy is often needed to overcome insulin receptor resistance in type 2 diabetes; however, the impact of providing additional insulin to already hyperinsulinemic subjects is not clear. We infused male TALLYHO/Jng (TH) mice (insulin resistant) with insulin (50 U/kg·bw/d) or vehicle (control

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2018 International journal of molecular sciences

9. Real-time urinary electrolyte monitoring after furosemide administration in surgical ICU patients with normal renal function (PubMed)

[Cl(-)] and ammonium [NH4 (+)] concentrations were measured every 10 min for three to 8 h. Urinary anion gap (AG), electrolyte excretion rate, fractional excretion (Fe) and time constant of urinary [Na(+)] variation (τNa(+)) were calculated.Ten minutes after furosemide administration (12 ± 5 mg), urinary [Na(+)] and [Cl(-)], and their excretion rates, increased to similar levels (P < 0.001). After the first hour, urinary [Cl(-)] decreased less rapidly than [Na(+)], leading to a reduction (...) Real-time urinary electrolyte monitoring after furosemide administration in surgical ICU patients with normal renal function Although the loop-diuretic furosemide is widely employed in critically ill patients with known long-term effects on plasma electrolytes, accurate data describing its acute effects on renal electrolyte handling and the generation of plasma electrolyte alterations are lacking. We hypothesized that the long-term effects of furosemide on plasma electrolytes and acid-base

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2016 Annals of intensive care

10. Mind the Gap

Mind the Gap Renal Fellow Network: Mind the Gap | | | | | Thursday, August 11, 2011 Mind the Gap As Nate mentioned in a previous , the urinary anion gap is helpful in differentiating whether a non-gap acidosis is of renal or extra-renal origin. Urinary Anion Gap = Na + K – Cl Because the major cation in the urine is NH4, this gives you a rough estimate of the NH4 level. In the setting of a distal RTA, the urine NH4 should be low and therefore there should be a positive anion gap. The problem (...) with this test is that if there is some other unmeasured anion (e.g. ketoacids or hippurate following glue-sniffing) or even if the patient’s diet leads to significant changes in PO4 or SO4 excretion, it can be very inaccurate. One alternative suggested by Mitch Halperin is to measure the urinary osmolar gap. This is more useful because it detects the NH4 excretion regardless of the anion that is excreted along with it. Urine Osmolar Gap = measured Uosm – calculated Uosm Calculated Uosm = 2(Na + K) + Urea

2011 Renal Fellow Network

11. Overview of acid-base and electrolyte disorders

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 (...) 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

2018 BMJ Best Practice

12. Hyperosmolar hyperglycaemic state

investigations plasma glucose level serum or urinary ketone level serum urea level serum creatinine level serum sodium level serum potassium level serum chloride level serum magnesium level serum calcium level serum phosphate level serum osmolality anion gap calculation serum lactate level blood gas urinalysis liver function tests FBC CXR ECG cardiac biomarkers blood, urine, or sputum cultures Treatment algorithm ACUTE ONGOING Contributors Authors Endocrinologist Joslin Diabetes Clinic Boston MA Disclosures

2018 BMJ Best Practice

13. Overview of acid-base and electrolyte disorders

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 (...) 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

2018 BMJ Best Practice

14. Hyperosmolar hyperglycaemic state

investigations plasma glucose level serum or urinary ketone level serum urea level serum creatinine level serum sodium level serum potassium level serum chloride level serum magnesium level serum calcium level serum phosphate level serum osmolality anion gap calculation serum lactate level blood gas urinalysis liver function tests FBC CXR ECG cardiac biomarkers blood, urine, or sputum cultures Treatment algorithm ACUTE ONGOING Contributors Authors Endocrinologist Joslin Diabetes Clinic Boston MA Disclosures

2018 BMJ Best Practice

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

statin doses result in higher plasma levels of statins and their active metabolites, which increases the risk of myopathy or rhabdomyolysis. Pasanen et al reported that blood levels of simvastatin acid (a primary active metabolite of simvastatin) were ≈3 times higher in participants with the c.521CC genotype than in those with the c.521TT reference genotype in SLCO1B1 on chromosome 12, which encodes OATP1B1 (organic anion transporting polypeptide 1B1), a transporter that facilitates hepatic uptake (...) the size of an effect , , (exceptions are noted in 1. Assessment of Adverse Events). In USAGE (Understanding Statin Use in America and Gaps in Patient Education Survey), an internet survey of 10 138 US patients prescribed statins, muscle symptoms that were new or worse after starting a statin were reported by 25% of the 8918 who were current statin users and by 60% of the 1220 who had discontinued statin use. Muscle symptoms were the most common reason cited by patients for statin discontinuation (60

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2019 American Gastroenterological Association Institute

16. 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 (...) , colour, cerebral perfusion) o Hypovolemic shock disproportionate to the revealed blood loss o Feelings of pelvic or rectal pressure o Urinary retention · Act promptly to: o Resuscitate as required [refer to 3.3 Resuscitation] o Perform vaginal/rectal examination to determine site and extent o Consider transfer to operating theatre (OT) for clot evacuation, primary repair and/or tamponade of blood vessels · Refer to Queensland Clinical Guideline: Perineal care 38 Refer to online version, destroy

2019 Queensland Health

17. Renal tubular acidosis

by hypobicarbonataemia and depressed arterial blood pH. In the absence of other acid-base disorders the serum anion gap is normal. Either hypokalaemia or hyperkalaemia may be present, depending on the nature of the acidification defect. Fanconi's syndrome is characterised by a generalised dysfunction of the renal proximal tubule that results in the urinary loss of substances normally reabsorbed by the kidney at this site. The substrates lost include bicarbonate, glucose, amino acids, phosphate, small proteins (...) to respiratory compensation. Patients with RTA have a low arterial pH and serum bicarbonate with hyperchloraemia and a normal serum anion gap. The urine pH exceeds 5.5 in classic distal RTA, but is lower than 5.0 in patients with untreated proximal RTA and is low also in hyperkalaemic distal RTA. Alkali therapy is the mainstay of treatment. Potassium supplementation may be required for hypokalaemia, and low-potassium diets are used if hyperkalaemia is present. If hyperkalaemic distal RTA is due

2017 BMJ Best Practice

18. CRACKCast Episode 149 – Aspirin and Nonsteroidal Agents

dysfunction Coma, pulmonary/cerebral edema, seizures Renal failure Cardiovascular collapse Acid base disturbances: any disturbance can occur! Respiratory alkalosis (unfortunately leads to bicarbonate losses) Metabolic acidosis (eventually high ASA levels depress the respiratory centre) With an anion gap Refer to Box 144.1 in Rosen’s 9 th edition for a handy table that describes the acid base disturbance and progression of toxicity in acute salicylate overdose. Early (0-4 hours; level 20-60 mg/dL (...) salicylates more time to pass through the blood brain barrier. 5) Describe mild, moderate and severe ASA toxicity Mild/moderate: Salicylate toxicity initially generates GI distress followed by tachypnea, tinnitus, and hearing disturbance due to concentration-dependent reversible ototoxicity, diaphoresis, and an evolving anion gap acidosis. Severe: as the toxicity progresses, hyperthermia, coagulopathy, cerebral and pulmonary edema, cardiovascular collapse, and ultimately, death, occur. Chronic poisoning

2018 CandiEM

19. 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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