Increased anion gap after liver transplantation

Massive fibrinolysis after a liver transplant resulted in oliguric renal failure and necessitated the continuous infusion of large quantities of fresh frozen plasma. With the increase in plasma protein concentration, there was a simultaneous increase in the anion gap. These two parameters, the anion gap and total protein or albumin level in the blood, demonstrated a high degree of correlation. Weaker but significant correlations were found in a retrospective analysis of patients with a variety of renal diseases and a population of long-term peritoneal but not hemodialysis patients. This entity of hyperproteinemic acidosis should be added to the list of high anion gap acidoses.