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Related Experiment Videos

Anion gap and hypoalbuminemia

J Figge1, A Jabor, A Kazda

  • 1Department of Medicine, St. Peter's Hospital, State University of New York, Albany, USA.

Critical Care Medicine
|November 21, 1998
PubMed
Summary

Hypoalbuminemia can falsely lower the anion gap, masking acidosis. A simple correction factor adjusts the anion gap for low serum albumin levels, improving diagnostic accuracy.

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Area of Science:

  • Clinical Chemistry
  • Critical Care Medicine
  • Acid-Base Balance

Background:

  • Hypoalbuminemia is prevalent in critically ill patients.
  • Low serum albumin can significantly decrease the measured anion gap.
  • This reduction may obscure the presence of a high anion gap metabolic acidosis.

Purpose of the Study:

  • To demonstrate how hypoalbuminemia lowers the anion gap.
  • To derive a correction factor for the anion gap in hypoalbuminemia.
  • To improve the diagnostic utility of the anion gap in clinical practice.

Main Methods:

  • Observational study design.
  • Analysis of arterial blood samples from critically ill patients and normal subjects.
  • Measurement of electrolytes, proteins, pH, and PCO2.

Main Results:

  • Hypoalbuminemia was observed in 49% of critically ill patients.
  • Each 1 g/L decrease in serum albumin led to a 0.25 mEq/L underestimation of the anion gap.
  • A strong correlation (r2 = .94) was found between albumin levels and anion gap deviation.

Conclusions:

  • A formula was derived to adjust the anion gap for serum albumin concentration.
  • Adjusted anion gap = observed anion gap + 0.25 x ([normal albumin] - [observed albumin]) (in g/L).
  • This adjustment standardizes the anion gap, aiding in the diagnosis of metabolic acidosis.

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