Question

Which of the following would scenerios would most likely significantly reduce an anion gap?

-hypoalbuminemia

-hypoglycemia

-thrombocytopemia

-low lactate dehydrogenase

Answer 1

hypoalbuminemia

-hypoglycemia

-thrombocytopemia

-low lactate dehydrogenase These all reduce anion gap

Significant reduce in anion gap is seen in hypoalbuminemia

Normally, anion gap results range from 3 to 10 milliequivalents per liter (mEq/L).

Several underlying conditions can result in a pH imbalance and cause an abnormal anion gap.

A low anion gap is very rare. If an electrolyte test shows a low anion gap, a doctor will usually order a second test, as the results may be due to a laboratory error.

Other than a laboratory error, a less common cause of a low anion gap is hypoalbuminemia.

Hypoalbuminemia

Hypoalbuminemia is when a person has too little albumin in their blood. Albumin is an essential protein.

Hypoalbuminemia usually occurs because of inflammation throughout the body.

Causes of hypoalbuminemia include:

• sepsis
• recent surgery
• malnutrition
• severe burns
• liver or kidney disease

Hypoalbuminemia is also considereda contributing factor to having a low anion gap in people with multiple myeloma. It is not known, however, if testing a person’s anion gap is a useful tool for monitoring the progression of the disease.

A low anion gap has several utilities. First, it can be an early and sometimes only sign of an underlying disease process such as paraproteinemia. In addition to displacement of sodium-containing water from serum by large amounts of non-sodium-containing paraproteins, some paraproteins (eg, IgG in multiple myeloma) can have a net positive charge at physiological pH. This leads to an increase in unmeasured cations and a low anion gap7, 8). Concomitant severe hypercalcemia and hypoalbuminemia are often contributing factors to a low anion gap in multiple myeloma9). Since the only cation included in the anion gap calculation is sodium, severe hyperkalemia, hypercalcemia, hypermagnesemia or lithium intoxication theoretically can also lead to a significantly decreased anion gap. Second, at normal serum pH of 7.4, the majority of plasma proteins are anionic. Albumin with an average negative charge of 18 per mole at physiological pH has been shown to be responsible for approximately 75% of the unmeasured anions of the normal anion gap. A drop in albumin by 10 g/L therefore will cause the anion gap to fall by approximately 2.5 mEq/L at constant pH10, 11). Hypoalbuminemia is probably the commonest cause of a clinically relevant lowered anion gap. Third, a low anion gap can mask an underlying high anion gap acidosis and potentially delay intervention. While an increase in the anion gap is almost always caused by retained unmeasured anions, a decrease in the anion gap can be generated by multiple mechanisms.

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