Electrolytes

Anion Gap

Optimal Result: 8 - 16 mEq/L.

Our body chemistry consists of a never-ending cascade of molecules reacting with one another to make more complex molecules. A few are commonly familiar: sodium, potassium, and chloride. These can be further classified by their electrical charge. Sodium and potassium are positively charged and are referred to as cations; chloride is negatively charged and is referred to as an anion. An anion gap refers to the measured difference between cations and anions in serum, plasma, or urine.  An usual anion gap measurement may indicate a number of conditions depending on whether the reading is high or low, the most common being a high anion gap reading as an indication of acidosis. Symptoms of acidosis include:

- Fatigue

- Confusion

- Shortness of breath

- Headache

There are a number of cations and anions in the body; therefore, it is most useful to narrow an anion gap blood test to a few specific molecules or a single source of fluid to make the readings more concise. 

Anion gap (AG) is a calculated value commonly used in clinical practice. It approximates the difference between the concentration of unmeasured anions (UA) and unmeasured cations (UC) in serum. At present, the reference range of anion gap has been lowered from 8-16 to 3-11 mmol/l because of the changes in technique for measuring electrolyte. However, clinicians and textbooks still refer and use the old reference value of 8-16 mmol/l. This may lead to misinterpretation of the value of anion gap. [R]

What does it mean if your Anion Gap result is too low?

A low anion gap level is rare and indicates an abnormally high level of positively charged molecules. The most common cause of which, is multiple myeloma. Multiple myeloma is a cancer of a class of white blood cells called plasma cells. Typically, plasma cells help our bodies fight infection. In multiple myeloma, cancerous plasma cells accumulate in the bone marrow and crowd out health blood cells. The cancerous cells then produce abnormal proteins that cause kidney problems. This can result in an unusually high level of positively charged molecules.

What does it mean if your Anion Gap result is too high?

An anion gap level of 20 or above signals a problem. The most likely issue is acidosis—too much acid in the blood. Acidosis can start in the kidneys or the lungs.

Metabolic Acidosis occurs when the kidneys can’t eliminate enough acid, or they are eliminating too much base. Poorly controlled diabetes can result in metabolic acidosis, as well as a lack of sodium in the body and an excess of lactic acid. A lack of sodium typically indicates diarrhea and / or vomiting. However, lactic acid buildup can be caused by chronic alcohol use, heart failure, cancer, seizures, liver failure, and prolonged exercise. Symptoms of metabolic acidosis:

- Rapid, shallow breathing

- Lack of appetite

- Jaundice (yellowing of skin and eyes)

- Increased heart rate

- Breath that smells fruity

Respiratory acidosis happens when there is too much CO2 in the body, because the lungs aren’t working properly.  Respiratory acidosis almost always results from a problem with the chest cavities of our bodies. These can include: injury to the chest, difficulty breathing caused by obesity, chronic airway conditions like asthma, muscle weakness in the chest, deformed chest structure, or overuse of alcohol. 

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