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Related Experiment Videos

Strong ion gap: a methodology for exploring unexplained anions

J A Kellum1, D J Kramer, M R Pinsky

  • 1Department of Anesthesiology/CCM, University of Pittsburgh Medical Center, PA 15213-2582, USA.

Journal of Critical Care
|June 1, 1995
PubMed
Summary
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The strong ion gap (SIG) effectively identifies unknown anions in patients with sepsis or liver disease, unlike the standard anion gap (AG). This method proves sensitive and specific for metabolic acidosis.

Area of Science:

  • Biochemistry
  • Clinical Chemistry
  • Critical Care Medicine

Background:

  • The anion gap (AG) is a common clinical tool to assess the anion-cation balance.
  • However, the AG may not accurately reflect the presence of unmeasured anions in certain clinical conditions.
  • A novel physical chemical methodology, the strong ion gap (SIG), was developed to address this limitation.

Purpose of the Study:

  • To calculate and evaluate the strong ion gap (SIG) as a measure of anion/cation balance.
  • To compare the SIG methodology with the traditional anion gap (AG) in diverse patient groups.
  • To determine the sensitivity and specificity of SIG in detecting unexplained anions.

Main Methods:

  • Calculation of SIG, AG, and corrected AG (AGc) for three groups: healthy volunteers with exercise-induced hyperlactatemia, ICU patients with sepsis, and ICU patients with severe liver disease.

Related Experiment Videos

  • Data were sourced from original reports and retrospective chart reviews.
  • Correlation analysis was performed between SIG and AG/AGc.

    • Main Results:

    • SIG showed poor correlation with AG in sepsis and healthy groups but correlated with AGc across all groups.
    • SIG levels differed significantly between groups, with near-zero SIG in healthy volunteers and elevated SIG in sepsis and liver disease patients.
    • The composition of the anion gap varied markedly among the studied subject types.

    Conclusions:

    • The strong ion gap (SIG) correlates with the corrected anion gap (AGc), indicating its ability to account for all known anions.
    • SIG accurately detects unknown anions in patient populations with sepsis or liver disease.
    • SIG is a sensitive and specific diagnostic tool for characterizing metabolic acidosis, distinguishing between healthy individuals and those with critical illnesses.