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Decreased serum anion gap

MedGen UID:
1670952
•Concept ID:
C4732779
•
Finding
HPO: HP:0031963

Definition

An abnormally low value of the serum anion gap (the sum of serum chloride and bicarbonate concentrations subtracted from the serum sodium concentration). [from HPO]

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVDecreased serum anion gap

Professional guidelines

PubMed

Management of Acute Kidney Injury and Acid-Base Balance in the Septic Patient.
Weyker PD, Pérez XL, Liu KD
Clin Chest Med 2016 Jun;37(2):277-88. Epub 2016 Mar 8 doi: 10.1016/j.ccm.2016.01.012. PMID: 27229644
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999
Toxic alcohol ingestions: clinical features, diagnosis, and management.
Kraut JA, Kurtz I
Clin J Am Soc Nephrol 2008 Jan;3(1):208-25. Epub 2007 Nov 28 doi: 10.2215/CJN.03220807. PMID: 18045860

Recent clinical studies

Etiology

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article.
Belaunzaran M, Raslan S, Ali A, Newsome K, McKenney M, Elkbuli A
Am Surg 2022 Jan;88(1):10-19. Epub 2021 Nov 11 doi: 10.1177/00031348211060424. PMID: 34761698
Potassium Metabolism and Management in Patients with CKD.
Yamada S, Inaba M
Nutrients 2021 May 21;13(6) doi: 10.3390/nu13061751. PMID: 34063969Free PMC Article
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999
Sympathetic-adrenergic activity and acid-base regulation under acute physical stress in type I (insulin-dependent) diabetic children.
Yasar SA, Tulassay T, Madácsy L, Körner A, Szücs L, Nagy I, Szabó A, Miltényi M
Horm Res 1994;42(3):110-5. doi: 10.1159/000184158. PMID: 7995614

Diagnosis

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Acid-Base Disorders in the Critically Ill Patient.
Achanti A, Szerlip HM
Clin J Am Soc Nephrol 2023 Jan 1;18(1):102-112. Epub 2022 Aug 23 doi: 10.2215/CJN.04500422. PMID: 35998977Free PMC Article
Drug-induced acid-base disorders.
Kitterer D, Schwab M, Alscher MD, Braun N, Latus J
Pediatr Nephrol 2015 Sep;30(9):1407-23. Epub 2014 Nov 5 doi: 10.1007/s00467-014-2958-5. PMID: 25370778
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999
Sodium bromide encephalopathy with decreased serum Cl- level and increased anion gap: report of one case.
Robe PA, Sadzot B, Frank G
Eur Neurol 2004;51(4):246-7. Epub 2004 May 18 doi: 10.1159/000078554. PMID: 15159612

Therapy

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Acid-Base Disorders in the Critically Ill Patient.
Achanti A, Szerlip HM
Clin J Am Soc Nephrol 2023 Jan 1;18(1):102-112. Epub 2022 Aug 23 doi: 10.2215/CJN.04500422. PMID: 35998977Free PMC Article
Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article.
Belaunzaran M, Raslan S, Ali A, Newsome K, McKenney M, Elkbuli A
Am Surg 2022 Jan;88(1):10-19. Epub 2021 Nov 11 doi: 10.1177/00031348211060424. PMID: 34761698
0.9% saline is neither normal nor physiological.
Li H, Sun SR, Yap JQ, Chen JH, Qian Q
J Zhejiang Univ Sci B 2016 Mar;17(3):181-7. doi: 10.1631/jzus.B1500201. PMID: 26984838Free PMC Article
Metabolic acidosis: pathophysiology, diagnosis and management.
Kraut JA, Madias NE
Nat Rev Nephrol 2010 May;6(5):274-85. Epub 2010 Mar 23 doi: 10.1038/nrneph.2010.33. PMID: 20308999

Prognosis

Acute Kidney Injury in Pediatric Diabetic Ketoacidosis.
Yang EM, Lee HG, Oh KY, Kim CJ
Indian J Pediatr 2021 Jun;88(6):568-573. Epub 2020 Nov 19 doi: 10.1007/s12098-020-03549-9. PMID: 33210207
Renal aspects of metabolic acid-base disorders in neonates.
Iacobelli S, Guignard JP
Pediatr Nephrol 2020 Feb;35(2):221-228. Epub 2018 Nov 19 doi: 10.1007/s00467-018-4142-9. PMID: 30456666
The ischemic/nephrotoxic acute kidney injury and the use of renal biomarkers in clinical practice.
Andreucci M, Faga T, Pisani A, Perticone M, Michael A
Eur J Intern Med 2017 Apr;39:1-8. Epub 2016 Dec 21 doi: 10.1016/j.ejim.2016.12.001. PMID: 28011057
Metabolic Acidosis of CKD: An Update.
Kraut JA, Madias NE
Am J Kidney Dis 2016 Feb;67(2):307-17. Epub 2015 Oct 23 doi: 10.1053/j.ajkd.2015.08.028. PMID: 26477665
Serum anion gap is predictive of mortality in an elderly population.
Ahn SY, Ryu J, Baek SH, Han JW, Lee JH, Ahn S, Kim KI, Chin HJ, Na KY, Chae DW, Kim KW, Kim S
Exp Gerontol 2014 Feb;50:122-7. Epub 2013 Dec 11 doi: 10.1016/j.exger.2013.12.002. PMID: 24333141

Clinical prediction guides

Dose-dependent relationship between SGLT2 inhibitor hold time and risk for postoperative anion gap acidosis: a single-centre retrospective analysis.
Steinhorn B, Wiener-Kronish J
Br J Anaesth 2023 Oct;131(4):682-686. Epub 2023 Aug 2 doi: 10.1016/j.bja.2023.06.063. PMID: 37541949
Renal aspects of metabolic acid-base disorders in neonates.
Iacobelli S, Guignard JP
Pediatr Nephrol 2020 Feb;35(2):221-228. Epub 2018 Nov 19 doi: 10.1007/s00467-018-4142-9. PMID: 30456666
Metabolic Acidosis of CKD: An Update.
Kraut JA, Madias NE
Am J Kidney Dis 2016 Feb;67(2):307-17. Epub 2015 Oct 23 doi: 10.1053/j.ajkd.2015.08.028. PMID: 26477665
Acidosis and nutrition.
Louden JD, Roberts RR, Goodship TH
Kidney Int Suppl 1999 Dec;73:S85-8. doi: 10.1046/j.1523-1755.1999.07319.x. PMID: 10633471
Anion gap and hypoalbuminemia.
Figge J, Jabor A, Kazda A, Fencl V
Crit Care Med 1998 Nov;26(11):1807-10. doi: 10.1097/00003246-199811000-00019. PMID: 9824071

Recent systematic reviews

Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article.
Belaunzaran M, Raslan S, Ali A, Newsome K, McKenney M, Elkbuli A
Am Surg 2022 Jan;88(1):10-19. Epub 2021 Nov 11 doi: 10.1177/00031348211060424. PMID: 34761698
Sodium bicarbonate therapy for critically ill patients with metabolic acidosis: A scoping and a systematic review.
Fujii T, Udy A, Licari E, Romero L, Bellomo R
J Crit Care 2019 Jun;51:184-191. Epub 2019 Feb 26 doi: 10.1016/j.jcrc.2019.02.027. PMID: 30852347

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