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Anion gap acidosis

K Ishihara1, H M Szerlip

  • 1Department of Medicine, Tulane University School of Medicine, New Orleans, LA 70131, USA.

Seminars in Nephrology
|February 12, 1998
PubMed
Summary
This summary is machine-generated.

Elevated anion gap indicates acidosis, often from lactate, ketoacids, toxins, or uremia. Treatment varies, with some acidoses like lactic acidosis having controversial or high-mortality outcomes.

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Area of Science:

  • Clinical Chemistry
  • Internal Medicine
  • Nephrology

Background:

  • Anion gap elevations typically signify identifiable acidoses.
  • Low anion gap values have limited clinical significance.

Purpose of the Study:

  • To review the causes and clinical utility of anion gap elevations and decreases.
  • To discuss the management of various anion gap acidoses.

Main Methods:

  • Review of literature on anion gap.
  • Classification of anion gap acidoses into categories: lactate, ketoacid, toxin, and uremia.
  • Discussion of treatment strategies for each category.

Main Results:

  • Lactic acidosis, ketoacidosis, toxin-induced acidosis (methanol, ethylene glycol, salicylates), and uremia are primary causes of elevated anion gap.

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  • Lactic acidosis carries high mortality; bicarbonate treatment is often ineffective.
  • Methanol and ethylene glycol poisoning require alcohol infusion and dialysis.
  • Salicylate toxicity typically presents with mild metabolic acidosis and respiratory alkalosis.
  • Uremic acidosis results from decreased ammonia secretion and retained anions.

    • Conclusions:

    • Significant anion gap elevations are clinically important indicators of specific acidotic states.
    • Understanding the etiology of anion gap acidosis guides appropriate and timely management.
    • Decreased anion gap has minimal diagnostic value.