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Abstract
The relation between the serum anion gap and the serum total carbon dioxide concentration
was studied in 100 admissions of patients with diabetic ketoacidosis and 43 normal
control subjects. In 20 admissions of patients with diabetic ketoacidosis (Group 1),
the patients had no other conditions or medications known to after acid-base or electrolyte
homeostasis, whereas in 80 admissions of patients with diabetic ketoacidosis (Group
2), the patients had at least one of these factors. Analysis of the change in total
carbon dioxide compared with the change in anion gap in Group 1 and control subjects
revealed the following relation: change in total carbon dioxide = 0.74 + 1.00 × change
in anion gap, in meq/liter (r = 0.886, p <10−7). The 95 percent prediction interval for detecting mixed acid-base disorders with
this equation was ± 8 meq/liter. Analysis of all admissions of patients with diabetic
ketoacidosis and control subjects combined showed that the anion gap increased 0.24
meq/liter per mg/dl increase in blood urea nitrogen (with total carbon dioxide constant).
Because the highest blood urea nitrogen level in Group 1 and control subjects was
22 mg/dl, the change in total carbon dioxide-change in anion gap regression is generally
not valid for blood urea nitrogen levels higher than 22 mg/dl. Thus, both the wide
prediction interval and volume depletion (as reflected by blood urea nitrogen level)
impair the usefulness of the anion gap as a screen for mixed acid-base disorders in
patients with diabetic ketoacidosis.
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References
- Clinical use of the anion gap.Medicine (Baltimore). 1977; 56: 38-54
- The anion gap.N Engl J Med. 1977; 297: 814-817
- Anion gap and serum bicarbonate (letter).N Engl J Med. 1980; 303: 161
- Diabetic comas.in: Arieff AI Defronzo RA Fluid, electrolyte, and acid-base disorders. Churchill Livingstone, New York1985: 933-967
- Diabetic ketoacidosis: role of the kidney in the acid-base homeostasis re-evaluated.Kidney Int. 1984; 25: 591-598
- The role of the anion gap in detecting and managing mixed metabolic acid-base disorders.Clin Endocrinol Metab. 1984; 13: 333-349
- Simple and mixed acid-base disorders: a practical approach.Medicine. 1980; 59: 161-187
- Spurious hyperchloremia and decreased anion gap in hyperlipidemia.Ann Intern Med. 1983; 98: 607-609
- Misleading hyponatremia due to hyperlipidemia: a method dependent error.Ann Intern Med. 1981; 95: 707-708
- Applied regression analysis and other multivariable methods.Duxbury Press, Boston1978
- Statistical methods in medical research.in: Blackwell Scientific Publications, Boston1971: 147-166
- Plasma acid-base patterns in diabetic ketoacidosis.N Engl J Med. 1982; 307: 1603-1610
- Disorders associated with an altered anion gap.Kidney Int. 1985; 27: 472-483
- Changes in the plasma anion gap during chronic metabolic acid-base disorders.Am J Physiol. 1978; 235: F291-F297
- Multiple myeloma and the anion gap.N Engl J Med. 1975; 292: 574-575
- The anion gap: its use in quality control.Clin Chem. 1976; 22: 643-646
- Decreased anion gap associated with monoclonal and pseudomonoclonal gammopathy.Can Med Assoc J. 1976; 114: 231-232
- The anion gap in asymptomatic plasma cell dyscrasias.Ann Intern Med. 1977; 86: 304-305
- Value of anion-gap determination in multiple myeloma.N Engl J Med. 1977; 296: 858-860
- Relationship between anion gap and immunoglobulins in patients without myeloma.Acta Clin Belg. 1980; 35: 222-226
- Effect of chemotherapy on the anion gap in multiple myeloma.Acta Haematol. 1981; 66: 31-34
- Factors influencing normal reference intervals for creatinine, urea, and electrolytes in plasma, as measured with a Beckman Astra 8 analyzer.Clin Chem. 1985; 31: 292-295
Article Info
Publication History
Accepted:
January 7,
1986
Received:
June 27,
1985
Footnotes
☆The opinions or assertions contained herein are the private views of the author, and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
Identification
Copyright
© 1986 Published by Elsevier Inc.
